Tag Archives: human microbiome

It’s Alimentary (Part 3)

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A recent ‘clinical quality forum’ sponsored by The Children’s Care Network (TCCN) and Nutrition4Kids featured several good lectures. The symposium was titled “It’s Alimentary.” What follows are my notes –the full lectures from these talks will be available in the coming weeks on the Nutrition4Kids website. My notes may include some errors in transcription and errors of omission.

“The Importance of Intestinal Microbiota in Pediatric Health and Disease” by W Allan Walker (Harvard Medical School, Director of Division of Nutrition) reviewed data showing how changes in the microbiome, likely related to a ‘Western lifestyle’ has resulted in numerous health consequences.

Key points:

  • The hygiene hypothesis has correlated a greatly reduced risk of infections inversely to an increase in immune-mediated diseases including Crohn’s disease, multiple sclerosis, type 1 diabetes mellitus, and metabolic syndrome/obesity.
  • The consequences of improved hygiene are likely mediated by alterations in gut microbiome
  • To counter alterations in a ‘healthy’ microbiome, perhaps most important is normal neonatal colonization.  This, in turn, is related to healthy pregnancy/full term gestation, vaginal delivery, absence of antibiotics in the first year of life (if feasible), and exclusive breastfeeding.
  • A healthy first-year-of-life microbiome leads to improved tolerance (less allergies) and absence of chronic diseases.
  • In those at risk for altered microbiome, probiotics may be beneficial.
  • By 12-18 months, the microbiome has an ‘adult’ pattern of colonization with a bacterial signature that is present for the rest of someone’s life

Related blog posts:

A subsequent segment addressed “Weight Bias in Healthcare Professionals and What We Can Do About It” by Sheethal Reddy (Strong4Life Clinical Psychologist).

Key points:

  • Physicians have been shown to exhibit decreased empathy with obese patients (KA Gudzune et al. Obesity 2013; 21: 2146-52)
  • Bias can not be eliminated but can be better understood. The Implicit Attitude Test can help ascertain one’s level of bias. https://implicit.harvard.edu/implicit
  • Ways to address obesity as a topic: “Is it OK to talk about…”, use of health report cards to review BMI
  • “The most important thing you can be is kind”

Related blog posts:

In another talk was related to obesity: “ERAS Nutrition in Bariatric Surgery” by Mark Wulkan (Emory University Professor of Surgery). ERAS is an acronym for Enhanced Recovery After Surgery –pioneered in colorectal surgery (Previous post on ERAS: ERAS-Enhanced Recovery after surgery)

Key points:

  • Using ERAS protocol, hospital length of stay has been shortened from 2 days to 1 day
  • ERAS protocol has been associated with minimal use of narcotics –occasionally for breakthrough pain.
  • Current bariatric surgery favored by Strong4Life team –Laparoscopic Sleeve Gastrectomy

Related blog entries:

Bariatric Surgery Candidates

Nutrition Symposium Georgia AAP (Part 2)

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Last week I summarized an excellent talk by Ronald Kleinman.  For me, I had never heard such a concise and definitive rebuttal of the claims of those fearful of food biotechnology.  There were three other lectures at the symposium.  These three lectures covered areas that are well-known to pediatric gastroenterologists but less familiar to general pediatricians.  The full set of slides are available at the Georgia AAP Symposium Website.

Jeff Lewis had an excellent lecture that tied together gluten and our microbiome: Gluten – Eat not, suffer not and Microbiome 101: Waste Not, Want Not

After reviewing celiac disease and other wheat-related disorders (eg. wheat intolerance syndrome, and wheat allergy), he summarized a great deal of information regarding the human microbiome and which factors influence this. In addition, he had the opportunity to briefly present data from his research on fecal microbiota transplantation (for C diff) and its influence on the microbiome over time. Here are a couple of slides from his talk:

 

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Key points:

  • “It is hard to communicate science to families. It is a huge challenge for us.”
  • Dermatitis herpetiformis (rare in kids), a rash associated with celiac disease, can be treated with Dapsone. This rash has caused such severe itching that there are cases of suicide that have been reported.
  • For celiac disease, Dr. Lewis recommends testing of 1st degree relatives but this needs to be after gluten exposure and before gluten-free diet.
  • Wheat allergy reviewed. Skin test positivity does not prove that you are allergic to food. IgG based testing is worthless –it means you have been exposed to a food, but is not an indication of food allergy.
  • Nonceliac gluten sensitivity (aka. wheat intolerance syndrome): need to test for celiac first. No tests/biomarker that can confirm this diagnostic. This appears to be a true disease; there is a small subset of patients who develop symptoms with a double-blind challenge.
  • Microbiome –more bacterial DNA in us than human DNA. New organisms –archaea kingdom.  Now a specimen of a person’s microbiome can be run for <$50.
  • Microbiome terms: Richness, Diversity, and Dysbiosis. Many diseases are associated with dysbiosis (obesity, IBD), but there is a ‘chicken and the egg’ problem. Is dysbiosis a causal factor or a secondary factor?
  • Xyloglucans (in lettuce) –not broken down by humans and affected by gut bacteria.
  • Mice given stool from fat mice or fat person become heavy.