Questions and answers edited for length and clarity.
These AMAs are quickly becoming one of our favorite ways to interact with the gut health community! Check out some of the most popular questions we received and responded to below. To all the Redditors who sent in questions, thank you!
Table of Contents
1. Are probiotics in pill form beneficial, or just a waste of money?
2. What's the research like for the connection between gut microbiome health and mental health?
3. Should I eat as many varieties of foods as possible to increase my gut microbiome?
4. Could you give examples of how integral the gut microbiome is to overall health, and how we can improve and ensure our gut microbiome is optimal?
5. Are we even close to finding a cause or cure for ulcerative colitis?
6. How far are we from widespread poop transplants?
7. Do artificial sweeteners have any effect on the gut microbiome?
Q1: Are probiotics in pill form beneficial, or just a waste of money? What would you suggest is the best strategy for achieving "optimal" gut health? (u/sdnw88)
A1: To start with, at this point no probiotics have been approved for the treatment of any disease. But this doesn’t mean they do not have the potential to help in the future. Several clinical trials have been completed to determine if probiotics have an effect on a variety of different health measures. One exciting probiotic in development is VSL no. 3 which consists of 8 different probiotic bacteria. Some small clinical trials have suggested this probiotic helps prevent pouchitis in adult patients, although further and larger studies are needed to better assess the probiotic’s efficacy (https://pubmed.ncbi.nlm.nih.gov/17033538/).
One aspect that makes developing a probiotic difficult is the personalized nature of the microbiome. The gut microbiomes of two individuals can vary drastically depending on a variety of lifestyle factors, with these differences affecting whether the probiotic bacteria will be able to thrive in their gut. In future studies, it will be important to identify the bacteria in the patient’s gut before and after probiotic treatment to better understand the dynamic changes occurring and hopefully identify you will be responsive to the probiotic.
One of the best ways to maintain a healthy gut is through the food you consume. Your diet not only provides the nutrients you require but also those that your gut bacteria need to survive. One dietary pattern that provides a rich source of nutrients for you and your gut is the Mediterranean diet, which is rich in fruits, vegetables, nuts, legumes, olive oil, and meats such as fish and poultry and limits consumption of red meats and refined grains.
Q2: What's the research looking like for the connection between gut microbiome health and prevalence of psychological conditions like depression? (u/VS-Banana) Have you found any correlation between gut health and worsened anxiety (as opposed to anxiety causing gut problems)? (u/LordFluffy)
A2: The research on microbiome and mental health is ongoing and never fails to fascinate me. The brain-gut axis is a two-way relationship and these two organ systems basically communicate with each other through signals, the microbiome, and the vagus nerve. Here's an example of this research. The brain-gut axis is linked to both microbiome and mood disorders.
For example, mood-related disorders like anxiety and depression have been linked to abnormal gut microbiome activity, such as stress responses and inflammation occurring due to compounds produced by gut microbiota (for example, short-chain fatty acids and serotonin). The risk of such mood disorders is also increased in people with gut issues, such as inflammatory bowel disease and irritable bowel syndrome, due to changes in healthy gut bacteria and the stress of coping with chronic, stigmatized gut health issues, among numerous other factors. In fact, this study suggests that people with IBS are three times more likely to have anxiety or depression. The brain-gut connection likely has something to do with this.
So gut microbiota trigger stress responses that affect mood, while being stressed or anxious can also trigger gastrointestinal symptoms. It makes sense why many people with gut issues are encouraged to try meditation; healing and centering the mind and body can help relieve symptoms (including anxiety, abdominal pain, etc)! This helps to explain why we consider the relationship between the brain and the gut bidirectional. You can read more on the science here!
Q3: I'm of the belief that I should eat as many varieties of foods as possible to increase my gut biome. Am I right in this line of thinking? Also, does alcohol and spicy food kill gut bacteria? (u/Niko******d)
A3: Great question, you are definitely correct. Diet diversity is closely linked to microbiome diversity which is linked to overall health. However, it is important to mention that dietary diversity alone will not improve your microbiome diversity unless the dietary quality is also high. For example eating 10 different kinds of junk food will not improve your diversity, while eating 10 different kinds of vegetables will.
Alcohol in general has a tendency to kill beneficial bacteria, especially in the oral microbiome. This then predisposes the microbiome to colonization by pathogenic bacteria and further problems.
Spicy food on the other hand also has an impact on the microbiome, as shown in a few studies, but whether this is directly beneficial to our health still requires more research.
Q4: I've heard that the gut microbiome can have a great effect on a person's overall health. Could you give examples of that, and how can we improve and ensure our gut biome is optimal? (u/DungeonMaster24)
A4: There are several links between your gut microbiome and different diseases and your overall health. For example, the gut microbiome of patients with inflammatory bowel disease is drastically altered from healthy individuals. Two consequences of the altered gut microbiome are: Individuals with IBD have a different collection of bacteria in their gut which can promote inflammation and the bacteria produce different compounds which are absorbed by the gut and can have adverse effects on the individual.
In addition to links with diseases, the microbiome has also been associated with a person’s quality of sleep and exercise levels. For example, the bacteria Blautia was associated with a negative effect on sleep quality and the bacteria Veillonella was associated with endurance athletic performance.
One of the most important ways to maintain a healthy gut microbiome is through the food you consume. Your diet not only provides you energy and nutrients, but also feeds the bacteria living throughout your gastrointestinal tract. One dietary pattern that provides a rich source of nutrients for you and your gut is the Mediterranean diet, which is rich in fruits, vegetables, nuts, legumes, olive oil, and meats such as fish and poultry and limits consumption of red meats and refined grains.
Q5: Are we even close to finding a cause or cure for UC? Biologics have helped me a bit but I still have symptoms. It would be easier to accept if I knew why I ended up like this and if there's any hope for the future. (u/Grateful_Undead_69)
A5: IBD-type illnesses such as Crohn's disease or Ulcerative colitis (UC) are complicated to treat as they are highly personalized and multifactorial. Indeed, like other immune-mediated disorders, they are a result of a fundamental shift in how our entire body operates and an actual cure is still distant until we understand how to fully revert such a shift. In the meantime, there are already treatments such as the biologics you mentioned that can mostly eliminate disease symptoms, as well as new drugs being researched and developed.
In general, there are 3 components to an illness like UC. The immune system, the microbiome and the external environment (lifestyle, stress, diet, etc.). Most but not all medications given by a GI doctor will impact the immune system, and I am happy to hear that biologics have helped you even if only somewhat. Aside from biologics, you can try to address the other contributors to the illness. Diet and lifestyle can play a large component in UC. Indeed, many patients find relief from symptoms by applying dietary changes. Unfortunately, yet again, this is highly personalized. One diet may work for someone else with UC but it might not necessarily work for you. Similarly, other patients find that their largest trigger may be stress and find the most relief by using antidepressants or other ways to address their mental health.
To help discover what could be a potential trigger for the UC, many patients benefit from keeping a log of their diet and lifestyle to determine which factors actually contribute to their symptoms so that they can exclude them. I am actually working with a team of doctors, data scientists and IBD patients on an app that allows patients to track their symptoms and lifestyle in order to quickly discover triggers and help them manage their illness.
Q6: How far are we from widespread poop transplants?
A6: Fecal microbiota transplantation (FMT) has a lot of potential as a treatment for microbiota-mediated diseases, but the research is still in its infancy. The only approved indication for FMT is currently relapsing C. difficile infection. Use of this treatment for other illnesses has only been in clinical trials.
There's lots of unanswered questions about FMT, like what dosages work best, what makes the ideal donor, what kind of diet works best after a transplant, should FMT be done once or at a higher frequency, etc. This takes years of research, not to mention investigations of the long-term efficacy of this treatment, how regulatory measures can be determined, and what to do to standardize research protocols so that scientists, doctors, and other health professionals can assess the research on FMT for different purposes on an even playing field.
So although FMT is gradually emerging as a possible option for Crohn's, colitis, cancer treatment protocols, and more, we are still a while away from having all the answers we need in order to make this option more widespread and accessible to different people and communities. I assure you there are plenty of people working on this though!
Q7: Do artificial sweeteners have any effect on the gut microbiome? (u/T****ofSekhmet)
A7: This is a very interesting topic. In general, sweeteners do have an impact on the gut microbiome, and specifically artificial sweeteners have been shown to change the composition of the gut bacteria and impact glucose intolerance. Further research in humans demonstrates that the glucose intolerance seen during extended use of artificial sweeteners such as saccharin could cause a gut microbiome shift, causing glucose intolerance.
Extended use of certain artificial sweeteners does indeed have an impact on the microbiome and it is thought that extended use of them could lead to pre-diabetic/glucose intolerant states.
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