The Microbiom - it makes a difference...

My dear patients !

The last article focused on how stress can affect the course of your inflammatory bowel disease, your Crohn`s disease or your ulcerative colitis.

To be quite honest, at first I didn`t want to write about the microbiome. Because even though we hear or read something about the microbiome almost every day someway and it sounds like everything was pretty easy – just a few bacteria, right ? And a stool analysis (about 250€) is easily performed, And then you take “something for the microbiome“, performing a “colon rehabilitation” (that term – in german”Darmsanierung” – makes me actually laugh every once in a while) and everything will be allright … Well, it is not that easy, not at all.  

When it comes to the microbiome one really has to recognize, that we  do know quite something about it today. But how things in the gut between the different bacteria – not to mention the viruses and funghi – work out and how they influence eachother, we acutally do not understand completely by far.

When you think about stress and how it affects the intestine the microbiome is always mentioned. And it is mentioned everywhere that stress actually does affect the microbiome

And that the microbiome itself does influence our behaviour and with that our resistance to stress.

So, there is actually no way around…

... Microbiome ?

To say it right away: not everybody has the same microbiome – of course. It is determined  by geopgraphics, meaning where you are from or better where you live, genetics are important as well and nutrition plays a crucial role (that one ! favorite issue, see below) 

Microbiome” is another term for “intestinal flora” and describes the whole of bacteria in the intestine. There a lot o bacteria, countless to be more precisely and they are important. And they are not just “there”, they have a given function.

Their job is “digestion” as many of you probably know. And that means digestion of complex carbohydrates, which means they split up sugar molecules. Doing that the bacteria produce certain metabolic products, for example (maybe the most prominent example) short chain fatty acids. And these metabolic products aren`t just there but rather have an effect on the intestine. In the example of short chain fatty acids they have an effect on the mucosal barrier. The microbiome is also involved in the synthesis of special vitamins. A healthy micobiome is also important for the regulation of so called “pathogenic bacteria”, which means potentially harmfull bacteria. These do exist in a very small number in the intestine and we don`t even recognize them. But with increasing numbers – and according to that a growing influence to their enviroment (by producing “unfavorable” metabolic products) – they really can cause problems. 

Except … you can`t actually speak of good  or bad bacteria anyway (as these categorization in “good” and “bad”, “good” and “evil” are difficult anyhow, but that is another issue…). It is more about the balance of bacteria, the balance of the microbiome is key.

And this  issue of balance or imbalance of the microbiome has quite a lot to do with IBD.

Because there is a so called “dysbiosis” in the microbiome of patients with inflammatory bowel disease, Crohn`s disease or ulcerative colitis. Probably some of you have heard about that already. “Dysbiosis” means “imbalance“. In the intestine of IBD patients compared to people without IBD we finde less of the so called “goodbacteria and we find more of the so called “not so goodbacteria. That`s the imbalance (dysbiosis)

Wether the microbiome of IBD patients changes simply by the presence of the inflammatory bowel disease, or wether IBD develops because of the changes and the dysbalance of the microbiome is not yet fully understood.

Communication ...

The microbiome is in contact and even is communicating with the immune system. And not just since it is a mass of bacteria, which triggers the immune systems. It is rather able to stabilize the immune system (or to destablilize it…)

The microbiome also is in a way connected to the nervous system (or different nervous systems as we know…). And there is also communication in both directions. The nerve fibres in the gut recognize the microbiome, recognize it`s shape and composition. This  happens via the metabolic products which are synthesized by the microbiome and these change the nerve signals. Similar to the interaction whith the immune system the interaction with the nervous system in case of a leaky gut syndrome…

(… that was again: when in case of inflammation the intestinal mucosal barrier isn`t tight anymore and therefore the microbiome is even closer to the cells inside the mucosa than it is normally.)

… a special situation. Wich leads too more reaction from the nerve fibres or the cells of the immunsystem.

But also without “leaky gut” the microbiome communicates with the nerveous system via their metabolic products, These can initiate the release of certain signal transmitters, which have an effect on the nerve fibres.

And the other way round the  nerv signals affect the microbiome. For example the microbiome changes – you might have guessed it ! – in case of stress and especially in case of psychosocial stress

And this interaction between the microbiome and the nervous system even goes further:  it is assumed that by affecting the microbiome  behaviour can be influenced. (“pretty weird, isn`t it ?“) Research on that has been performed with animals mostly and the focus was offen on “anxiety” but with that there where some results on  stress and stress resistence.

This was also studied in humans and the effects and correlations were similar. It even gors so far, that there is the approach of “psychobiotics“.  Relating to the findings that certain bacteria or a certain composition of the microbiome can affect mood and emotional processing.

This is all in a rather early stage. You won`t be able to walk into a pharmacy telling the pharnacust you´d like to get something for your microbiome. , Something that makes you more resiliant to stress. I just wanted to make clear how much influence the microbiome is supposed to have. And also that emotions, emotional behavior or capabilities aren`t as “diffuse” as one might think.

What`s the point ?

Ok, very nice – but what does that have to do with you ? And especially with you and your inflammatory bowel disease, Crohn`s disease or ulcerative colitis ?

I hope as always here on I.M. INFORMATION MATTERS: less blank spots on the map of the intestine, the issue of IBD, Crohn`s disease or ulcerative colitis. One more idea of what are relevant factors for IBD .

And despite all limitations (I wrote it above: your microbiome is different than the microbiome of people without IBD) you have the chance to make a difference here.

To finally connect this topic of microbiome with the topic of stress in a very practical way (since this was the origin for this article): stress does affect everything. Also the microbiome. And even if, even though or exactly because of the fact that your microbiome is different than that of people without IBD  and there is a so called dysbiosis (that was the imbalance of the gut bacteria): the microbiome  can trigger and enhance the negative effects of stress on the gut or it can contribute to stabilze the intestine and have a protective effect.

And because of that I want to motivate you, to make an active contribution to stabilize the microbiome. By – and you might guess it  – nutrition ! Because nutrition can stabilize the microbiome and therefore the intestine or destabilize it.

Because what happens when you are stressed  out (when we all are stressed out, myself included, this is not IBD-specific) ?

We all have a tendency to make not the best decisions for our health, even though one should  even pay more attention to self-care in case of stressful situations. When it comes to nutrition you sometimes start to just grab something to eat, the easy and fast solution.

That always has an affect and consequences. Especially when the intestine isn`t “stable” anyway, when a lot is going on for days, weeks and months. Then dishes or food whith too much artifical flavourings, preserving agents, emulsifying agents or sweeteners, same as too much fat and sugar …

(with emphasis on “too much” ! Fat and sugar are important energy suppliers and the body needs them. The right ones, in moderation …!)

… are just not the right thing for you. Because they have a proinflammatory effect on the intestine, which means they enhance inflammation. And they do that amongst others by affecting the microbiome

So what can you do ?

You can read it here in my blog in the article on “nutrition in IBD” or in the one about “dairy products in IBD” or the one on “alkohol in IBD”  (another thing that is very often correlated to stress – totally wrong thing for the gut !) 

(You can actually read or hear about it in any other place, it really and fortunately is not a secret anymore.)

So just very short here: eat naturally. Avoid artifcial  preserving angents, colouring agents, emulsifying agents, flavoring substances. Do eat fibres, your intestine and your microbiome love fibres ! (they stabilize the mucosal barriere in the intestine, they stabilize the microbiome. The more stable the microbiome the more “good” metabolic products it produces, that again are benefitial for the intestine and the mucosal barrier)

You may consume dairy products in moderation, choose the probiotic ones (like yoghurt or kefir). That also is great for your intestine, it stabilizes the microbiome, stabelizes the mucosal barrier and by that the immune system.

Keep in mind that your nutrition alwyas does affect your intestine and by that your microbiome.

And with that once again: take care ! 

Best regards,

Dr. med. Susanne Weyrauch

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