State of the Art Review

The role of the gut microbiome in systemic inflammatory disease

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5145 (Published 08 January 2018)

Cite this as: BMJ 2018;360:j5145

The statement by Hippocrates might be correct. Just we have to attention to the point that in thousand years ago he did not know about genetic disorders. Also, he was talking about a healthy person. As far as I read in the papers, I can not mention to a non hereditary disease that the gut microbiota had no role in its causation.

About the inflammation ; when we talk about Microbiota, the balance between the bacterial population is important and any dysbiosis could disturb the tissue environment resulting in unbalanced cytokine production and induce inflammation.

Thank you Diana for the good and helpful reference.

Thanks Arfa for your comments. The concept of genetic disorders does not seem to fit with the gut being the place where they begin. While some genetic disorders may have a link to the microbiome, it seems unlikely that a disease such as sickle cell where the underlying genetic disorder is well understood has any causation from the gut.

.... I can not mention to a non hereditary disease that the gut microbiota had no role in its causation. ...

but in some hereditary disease the dysbiosis of the gut microbiota is associated with the severity of the pathology (see Hirschsprung disease, Prader Willi and others).

Dear Roberto Biassoni IN OUR PRACTICE ON PREVENTION IN PREGNANCY, THE HYPOTHESIS THAT THE MICROBIAL PHENOTYPE CAN BE CHANGED IN THAT PERIOD IS YET BE DEMOSTRATE BY A MANY AND MANY 'RESEARCHES. Have a Nice Day https://www.researchgate.net/project/The-Importance-of-Gut-Microbiota-in-Pregnancy-Prevention-Care-and-Support

📷A microbiome is born: Changes to the microbiome during pregnancy and infancyArticle

• Sep 2018
• Reproductive Toxicology
• 📷Omry Koren

https://www.researchgate.net/scientific-contributions/2146821671_Omry_Koren

Zonulin, regulation of tight junctions, and autoimmune diseases

Alessio Fasano

Additional article information

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384703/

I would like to propose and separate different questions according to the comments here.

1- Does all disease begin in the gut ?

2- Does gut microbiota dysbiosis cause a hereditary disorder or affect the severity of pathology?

3- Do hereditary disorders cause gut bacteria dysbiosis?

4- Does all acquired disease begin in the gut?

5- Is there any simultaneity of disease occurrence and gut dysbiosis? or one is on the top of another?

https://www.nytimes.com/2012/06/19/science/studies-of-human-microbiome-yield-new-insights.html

I will add my question with why researchers and scientist just working that how dysbiosis may effect health.. there are few which work that how to stop dysbios through probiotics, prebiotics, change in eating habits while using all this as a therapuetic. There are working alot in the area but compared to those who work on the consequences of dysbios is much more, studies( i mean reserach articles and research not reviws) are mostly of low quality and not reliable which untill now i have gone through.. Can't find more article in Nature, Science, Cell and other High Impact factor Journals. I guess to find the consquence of dysbiosis is easy compared to taking back the microbiome to the normal; but someone will point out that how i can define the Normal GUt.. its a big question which also need an answer that how we can define Normal Gut.. ...

The normale gut? How many people we are in the world? Healthy gut Healthy different people. In our practice We use different gut test to find causes of disbiosis zonuline cortisol ormone imbalance testosterone etc.etc the conposition of the gut and after the results of trsts we make personal diet, personal presciption of pre pro bio or simbiotic and other natural prod to clean the gut. Have a nice evening

Ahmad - while your question is valuable regarding the need to understand both probiotic and prebiotic (and overall food intake) and we do need to understand the microbiome of people that both appear normal (health and/or microbiome) and those with diseases that are affected by the dysbiosis.

There are several parts of the reason for the focus on dysbiosis, I will mention two.

First, there is usually more financial support to study a disease than to study the use of something to improve health.

The second is critical for research, and that is that we need to understand the bacterial shifts/changes that cause dysbiosis. We still do not understand fully whether it is particular organisms alone overgrowing, the loss of diversity and then the overgrowth of some bacteria, or whether some other combination of species and interactions of the microbiome are the cause of the dysbiosis/diseases.

Not all diseases start in the intestines.

I heard about wisdom say "Stomach is a house of sickness and fasting is a medicine"

The makeup of bacteria within our gut determines whether we are likely to have GI conditions like colitis or irritable bowel; psychological states like depression or anxiety, skin disorders like eczema or psoriasis, neurological disorders like multiple sclerosis, Parkinson’s or Alzheimer’s Disease; inflammatory conditions like rheumatoid arthritis, systemic sclerosis and ankylosing spondylitis; even susceptibility to being overweight can be mediated by the microbiome’s impact on thyroid autoimmunity and insulin resistance.

Reference ->

Dr. Ronald Hoffman

https://drhoffman.com/article/all-disease-begins-in-the-gut/

An interesting paper is about the loss of intestinal microbial diversity before and after immigration to the U.S. See this article for a nice discussion of the topic:

https://phys.org/news/2018-11-immigration-person-microbiome.html

It is a useful scientific discussion.

Thank you Prof. Robert

You are welcome Laura! I hope you and the others joining will add to the discussion. I would appreciate it if we could start to address each of the questions posed by Dr. Moshiri.

A great start to these questions of Dr. Moshiri is number 3 - Do hereditary disorders cause gut bacteria dysbiosis? And a great preprint on this topic, that also addresses the concern of Ahmad, is from a follower of this question: Preprint Dysbiosis of microbiome and probiotic treatment in a genetic...

This is an interesting article to read, it covers both the impact of genetics on the dysbiosis of the intestine and the impact on a neurodevelopmental condition (autism) and in addition it looks at the positive impact at reducing unsocial behavior following the addition of Lactobacillus reuteri as a therapy. I hope we see more research like this moving forward.

The most common diseases start from the intestines but not all diseases, some skin or respiratory, which is not the method of infection from the stomach or bowel.

1. https://www.gutmicrobiotaforhealth.com/en/home/probiotics/page/2/

2. https://isappscience.org/

3. https://isappscience.org/clinical-evidence-not-microbiota-outcomes-drive-value-probiotics/

First two are Websites which mainly focus and have discussion about Gut microbiota, Probiotics as well as conferences while the 3rd is a recent discussion; worth seeing for those who are engaged in related field.

Very interesting..

I am not human Dr.but I am docrete in fisheries some diseases start from intestine but not all.

RESEARCH ARTICLE

The Evolution of Stomach Acidity and Its Relevance to the Human Microbiome

DeAnna E. Beasley, Amanda M. Koltz, Joanna E. Lambert, Noah Fierer, Rob R. Dunn

Dear Sir, I do not agree with your opinion. Some diseases can be caused by intestines, but not all.

Yes! Please take a look at this link.

https://www.omicsonline.org/conference-proceedings/2161-069X-C1-051-004.pdf

Not all diseases begin in the stomach, but most are liver disorders

Please also see the following RG links.

Article Leaky Gut As a Danger Signal for Autoimmune Diseases

Article Does disease start in the mouth, the gut or both?

Article Impacts of Gut Bacteria on Human Health and Diseases

Article Human Microbiome and Its Association With Health and Diseases

Article [Gut microbiota in health and disease.]

Article Alterations in intestinal permeability

Article Intestinal Barrier Function: Molecular Regulation and Diseas...

Certainly not. Not even all infections not to talk of all diseases. For instance what does a respiratory pathogen want with the gut. Its business is with the airways and associated tissues or organs or systems. I do not believe cirrhosis begins in the gut and very many others too.

No

At the present state of knowledge the answer is simple and it is 'NO'.

ليست جميع الامراض تبدا من الامعاء قسم منها فقط اعتقد ذالك

not necessarily

All of your contributions are appreciated.

Our current state of pandemic COVID-19 is a good example where the infections beginning in the nasal passage do not need the digestive system to cause disease. That being said, the status of the microbiome in the intestines may influence how virulent the infection becomes. Also, it appears the virus can infect the intestines somewhat and the virus can be spread in the feces. This could increase the time needed for a person to not be infective to others.

There are diseases that start from the lung and there are other diseases that start from the heart.

Not all but the greatest number of them

Not necessarily because there are, for example, respiratory diseases

Thanks for the continuing responses. While this type of statement is made by many people in the "alternative" health fields (especially those who sell 'colon cleanses', to most of us the idea is somewhat silly as we are familiar with infectious diseases elsewhere and inflammatory responses due to injuries. The problem is that while the microbiome (intestinal mostly) does have affects on the immune system and all other systems, it often is not the 'cause' of the disease.

Dear Prof Robert John Wolff ,

Although not all diseases begin in the gut (intestines) , only the gut (microbiome) can cure all diseases. This is because, only the microbiome have all the essential nutrients needed by our body:

Article Commentary: Reconciling Hygiene and Cleanliness: A New Persp...

So a diverse gut microorganisms is pivotal for our health, and dysbiosis is the main factor for a disease to become chronic, communicable or non-communicable.

Yet, when a diverse variety of microorganism species is introduced in our body, restrictive eating is mandatory. This is because as potential pathogens, these microorganisms are competitors of our body cells, and they also need nutrition to grow. Only xenophagy (autophagy, which is maintained by serum starvation) can control their possible growth in other places (like in the respiratory tract, and cause infection there), and restrict them in our gastrointestinal tract. So only restrictive eating can stop the adverse effect of the microorganisms, and make full use of them as the nutrition source for our body, as what Luigi Cornaro stated in in his Discourses 500 years ago:

"... men should live up to the simplicity dictated by nature, which teaches us to be content with little, and accustom ourselves to eat no more than is absolutely necessary to support life, remembering that all excess causes disease and leads to death. How many friends of mine, men of the finest understanding and most amiable disposition, have I seen carried off in the flower of their manhood by reason of excess and overfeeding, who, had they been temperate,would now be living, and ornaments to society, and whose company I should enjoy with as much pleasure as I am now deprived of it with concern."

https://soilandhealth.org/wp-content/uploads/02/0201hyglibcat/020105cornaro.html

Ligen Yu -- I am not sure if I am correctly understanding you. A cure is the complete end to a particular disease or pathologic condition. While a healthy microbiome may help prevent cancer, there is no evidence that it will cure the cancer (though a good microbiome can help make chemotherapy more effective).

To say ONLY the microbiome contains all the nutrients the body needs is just not correct. While it makes some useful meatabolites that can be healthy, and some that are definitely not, we constantly need energy 'food', fats, amino acids, carbs, vitamins and minerals. While the microbiome can make some vitamins (K) it needs us to eat or we would die.

Dear Prof Robert John Wolff , you have got my points correctly, and obviously you don’t agree with me.

By saying that microbiome can cure all diseases, I have simplified the self-healing process of our body. The real process is much more complicated, and none of us may know how it really works. In short, as the microbiome has 100 times more genes than human being, it contains all the essential nutrition we need. With such nutrition source and the nutrition transformed from non-bioactive food to bioactive ingredients by the microbiome, coupled with restrictive eating, our body will reconstruct its cells according to our initial genes, and all the illness, including most of cancer can be cured in this way. Of cause, in terminal cancer, our body’s self-healing capacity, like autophagy, will be hijacked by cancer cell, and used to duplicate cancer cell instead of repairing damaged cell with our initial genes, then there is no way to cure it.

By stating the good effect of the microbiome, I don’t mean microorganisms are good. On the contrary, I think all microorganisms are bad if we don’t have our immune system. Our body is an ecosystem, and the microorganisms and our body cells are neighbours and “Good fences make good neighbours”. Also these “good” neighbours are helping us in building our good fences. Our body is much more cleaver than our mind in letting only the good metabolites to get into our body, and stop the unwanted ingredients, or degrade them if they accidentally entered our body.

Its a useful discussion.. keep updating 👍

Most, but not all, diseases

One question that has crossed my mind - if a person does not get all of the nutrients they require (do to poverty, poor food choices...) does the resulting disease 'begin' in the intestines or did it begin in improper input (ingestion) of the needed nutrients?

Dear Prof Robert John Wolff ,

This is a good question. Yet, disease due to lack of nutrients only happens in severe famine. Most of the people have developed diseases due to nutrition imbalance, especially over-nutrition of some of the nutrients.

Actually slight under-nutrition is favored for our health, as anorexia nervosa patients are free from most of the viral infections:

Article The adaptive response of the immune system to the particular...

This is because, our immune system is also served as a nutrition acquisition system. The phagocytosis equipped in each cell of our body is able to engulf and degrade the microorganisms around it and use them as source of nutrition. Only when the virulence of the microorganism is strong enough to escape this phagocytosis, then the special immune phagocytes will be recruited to attack these microorganisms, and our immune system turn itself from nutrition acquisition into defense of invasion.