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Gut bacteria balance may affect your appetite

Over the last half decade, it has become increasingly clear that the normal gastrointestinal (GI) bacteria play a variety of very important roles in the biology of human and animals. Now Vic Norris of the University of Rouen, France, and coauthors propose yet another role for GI bacteria: that they exert some control over their hosts’ appetites. Their review was published online ahead of print in the Journal of Bacteriology.

This hypothesis is based in large part on observations of the number of roles bacteria are already known to play in host biology, as well as their relationship to the host system. “Bacteria both recognize and synthesize neuroendocrine hormones,” Norris et al. write. “This has led to the hypothesis that microbes within the gut comprise a community that forms a microbial organ interfacing with the mammalian nervous system that innervates the gastrointestinal tract.” (That nervous system innervating the GI tract is called the “enteric nervous system.” It contains roughly half a billion neurons, compared with 85 billion neurons in the central nervous system.)

“The gut microbiota respond both to both the nutrients consumed by their hosts and to the state of their hosts as signaled by various hormones,” write Norris et al. That communication presumably goes both ways: they also generate compounds that are used for signaling within the human system, “including neurotransmitters such as GABA, amino acids such as tyrosine and tryptophan-which can be converted into the mood-determining molecules, dopamine and serotonin”-and much else, says Norris.

Furthermore, it is becoming increasingly clear that gut bacteria may play a role in diseases such as cancer, metabolic syndrome, and thyroid disease, through their influence on host signaling pathways. They may even influence mood disorders, according to recent, pioneering studies, via actions on dopamine and peptides involved in appetite. The gut bacterium, Campilobacter jejuni, has been implicated in the induction of anxiety in mice, says Norris.

But do the gut flora in fact use their abilities to influence choice of food? The investigators propose a variety of experiments that could help answer this question, including epidemiological studies, and “experiments correlating the presence of particular bacterial metabolites with images of the activity of regions of the brainassociated with appetite and pleasure.”

Source: American Society for Microbiology

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England Rugby Captain discusses his Ulcerative Colitis

The former England rugby captain Lewis Moody was used to some tough battles on the pitch but none were to prove harder than coping with a bowel disease.

Ulcerative Colitis is a long-term inflammatory disorder that causes ulceration of the rectum and the colon.

When symptoms of the condition – which can mean bloody diarrhoea, abdominal pain, a frequent need to go to the toilet and weight loss – first appeared, the rugby star put off going to the doctor for four weeks.

“It was very debilitating and humiliating as a young man because you expect it to be an old person’s disease”
Lewis Moody

Then once he was diagnosed he feared it would wreck his rugby career.

So he hid it from his teammates – but the frequent need to visit the toilet was not always an easy thing to conceal.

“That was really tough to be fair. I don’t know anyone that openly talks about their toilet habits.

“So for a young man – I was 25 at the time – all of a sudden you are going to the loo 20 or 30 times a day.

“You are losing a relentless amount of blood and being a classic bloke I left it a month before I went to see the doctor even though this was a daily routine,” he told the BBC’s HARDtalk programme.

Charity support
Moody, known affectionately by teammates and fans as “Mad Dog” retired from rugby in March following a shoulder injury.

CAREER HIGHLIGHTS

1996: Makes his senior debut at Leicester Tigers at 18 while still at school
2001: Makes his debut for England against Canada
2003: Part of England’s Grand Slam-winning Six Nations squad
2005: Wins three caps for the British & Irish Lions on their tour of New Zealand
2010: Captains England for the first time in a Six Nations clash with France. Leaves Leicester after 14 seasons to join Bath
2012: Announces retirement from rugby after a shoulder injury
He is now supporting the work of the charity Crohn’s and Colitis UK and urging other sufferers to get treatment quickly and to try to lift the taboo surrounding the subject.
He said: “It was very debilitating and humiliating as a young man because you expect it to be an old person’s disease but it is the complete opposite I have learnt since – most people are diagnosed under the age of 30.”
Doctors say the most vulnerable age groups for the disease are those aged between 15 and 30.
“For me not having any information was the hardest thing and trying to hide it from my teammates.
“I had such an array of injuries I didn’t want there to be another reason for the guys to say ‘well we are not going to be able to pick Lewis because he will never make it to the start of the game because he might have to run off the loo’.”

Special diet
Covering the short distance from his home to training ground could be a battle in itself.
He recalled: “I was struggling to leave the house sometimes. I only lived four minutes away from the training ground and sometimes I would have to plan my route so that I could stop three or four times en route just to go to the loo.

“Some of the poor people in the establishments on the way probably wondered what on earth was going on as I pulled in every morning.”

Moody wrote in his autobiography that he believed his rugby career could have played a part in him developing the condition.

He was plagued by injuries throughout his 15 years at the top and this led to an over-exposure to anti-inflammatories, antibiotics and painkillers.

To keep the disease under control he now takes tablets daily and has to stick to a special diet.

Being more open about his condition eventually made it easier to cope with.
“I have to admit it was probably a couple of years until I told my good mates and they probably knew anyway because it was obvious. I had lost weight. I was gaunt.
“But it became much easier when I did tell the guys…

“That was one of the learning curves for me with the disease. The more I spoke about it, the easier it became.”

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Timebomb of ‘impossible to treat’ diseases in UK as experts see a rise in antibiotic-resistant infections

A rise in antibiotic-resistant blood poisoning – caused by the E.coli bacteria – is posing such a huge risk that experts fear the country could be facing a timebomb of diseases that are impossible to treat.

The growth of antibiotic-resistance has become so serious that experts now say it is as much of a threat to global health as the emergence of new diseases such as Aids and pandemic flu.

It is now such a cause for concern that health professionals believe the issue has become the medicine world’s equivalent to climate change, it has been reported.

According to the Independent, Professor Peter Hawkey said common infections are threatening to turn into untreatable diseases by the ‘slow but insidious growth’ of resistant organisms.

The clinical microbiologist, and chair of the Government’s antibiotic-resistance working group, told the Independent: ‘It is a worldwide issue – there are no boundaries.

‘We have very good policies on the use of antibiotics in man and in animals in the UK. But we are not alone. We have to think globally.’

It is estimated that 25,000 people die every year in Europe from bacterial infections resistant to antibiotics.

Those resistant to antibiotics have risen from 1 per cent at the beginning of the century to 10 per cent, according to the Independent.

The incidence of E.coli ‘bacteraemias’ – which is the presence of bacteria in the blood – rose by 30 per cent, from 18,000 to over 25,000 cases, between 2005 and 2009.
Professor Hawkey’s group has produced a report commissioned by the Department of Health and the Department for Environment, Food and Rural Affairs into the issue.

‘Drug companies are not as interested in developing new and more effective types of antiobiotics as they are, for instance, heart medication, because the former is a short-term course while the latter is a lifelong medication – and more commercially viable.

In it, says: ‘Only one in 20 of infections with [resistant] E.coli is a bacteraemia, so the above data are only the tip of an iceberg of infected individuals.’

The Government’s chief medical officer, Dame Sally Davies, has now pledged £500,000 to fund research into the threat.

The steep increase in E.coli blood poisoning is thought to be linked with the ageing of the population.

The bacteria is also a common cause of urinary-tract infections but may also cause wound infections following surgery or injury.

Last year it emerged how a ‘super’ resistant strain of E.coli was behind many cases of cystitis, which doctors were having trouble treating with antibiotics.

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‘Doctors were certain I was Anorexic – in fact I had Crohn’s’

Looking back at teenage photos, Fiona Argo can barely recognise herself as the young woman with jutting collarbones and stick-thin legs. But she can see why concerned friends and family thought she was in the grip of an eating disorder.

Between the ages of 16 and 19, Fiona’s weight plummeted from 9½ stone to just 5st, extremely underweight for her 5ft 5in frame. Her periods stopped and her weight was so dangerously low she was told she was at risk of heart failure and even death.
She was diagnosed with anorexia and hospitalised. But while the diagnosis seemed obvious to doctors, friends and family, Fiona remained adamant she was not anorexic.

‘I always knew I was experiencing a physical reaction to eating, not a mental one,’ she says. ‘Every time I ate I’d suffer crippling stomach cramps and end up being sick after most meals. I’d never suffered from negative body image and didn’t want to lose weight, so I knew I didn’t have an eating disorder.’

But despite Fiona’s protestations, her doctor did not run tests to establish whether she had an undiagnosed medical condition, instead interpreting her constant denials as secrecy, a trait often exhibited by anorexia sufferers.

It was only when Fiona collapsed in agony in January 2004, aged 19, and was rushed to hospital that doctors discovered she was suffering from Crohn’s disease, a chronic bowel disorder that affects the gastrointestinal tract.

‘Every day is an uphill struggle, and I’ll never forgive the doctors for getting it so terribly wrong,’ says Fiona, now 27, who lives with her partner Simon, 30, in St Peter Port on Guernsey.

‘Sadly, Crohn’s is an illness with no cure, but I probably wouldn’t be this ill today if it had been detected earlier. Though I’m a normal weight, I’m often in pain and still struggle to keep food down. These are symptoms I’d suffer anyway, but are worse because the Crohn’s was allowed to progress.

‘I have to eat several small meals a day because large amounts of food leave me in agony, and I also need to take daily medication.

‘It makes me angry that doctors could have given me a simple stool test or blood test, yet they chose to ignore my symptoms and told me I had a psychiatric illness.’
Fiona’s nightmare started in 2001 when she suddenly started losing weight, dropping from 9½ stone to just 7st in a less than a year.

‘My mum and dad realised something was wrong when I started eating smaller portions at dinner, and they thought I was making excuses. But I couldn’t eat a full meal without pain and vomiting afterwards,’ she says.

In March 2002, when she weighed just under 8st, Fiona’s worried mother Jacqui took her to a local GP, who immediately diagnosed anorexia.

‘I told the doctors that I found eating extremely painful, and that I didn’t want to be this way, but they clearly didn’t believe me,’ says Fiona.

Other GPs at the practice and a bone specialist confirmed this diagnosis.
‘One doctor told my mum I was in denial, and that it was a classic symptom of anorexia. They even told my mum the tricks to watch out for, such as hiding food under the table or slipping off to the bathroom to make myself sick after meals. I wasn’t anorexic, but I don’t blame my parents for thinking I was. I looked really ill.’

Over the next two years, Fiona’s weight dropped further, and by the age of 18 she weighed just 6st. That was when the GP referred her to a bone specialist, thinking the pain may be due to a bad back, but again she hit a brick wall.

‘The specialist wrote a letter to my parents insisting there was “nothing physically wrong” with me and it was all in my head. I felt trapped in a nightmare in which no one was listening to me.

‘My relationship with my parents became strained, too. In the end we went to family therapy, but as the cause wasn’t emotional it wasn’t that helpful.’

By January 2004, Fiona’s weight had dropped to just 5st, dangerously low for her height, and she was admitted to a psychiatric hospital, where doctors force-fed her small meals, but her stay was cut short on the third day when she collapsed in agony.
It was only then that hospital doctors discovered Fiona had suffered a perforated ulcer on her small intestine. Further blood tests revealed she was suffering from advanced Crohn’s disease.

Septicaemia had started to set in and Fiona underwent emergency surgery that same day.
‘For a while it was touch and go, and my dad still can’t speak about my time in hospital without getting upset.’ Thankfully, Fiona made a good recovery and was discharged from hospital two weeks later.

‘My intestines had been blocked because a symptom of Crohn’s is a narrowing of the intestinal tract, but the doctors removed the damaged section of my bowel.
‘Suddenly I could eat properly again — it was a revelation. My parents kept apologising for not believing me. In less than a month, I gained more than a stone.’
There is a simple, non-invasive test that can help diagnose Crohn’s disease even in the early stages of the illness, which could have prevented Fiona’s ordeal.
‘If a doctor suspects Crohn’s, they can carry out a faecal calprotectin test early on, which will show any inflammation in the bowel,’ says Dr Shaw.

‘Crohn’s is a long-term chronic disease that needs to be controlled and half of patients will need an operation at some point. But there is evidence that early diagnosis can avoid complications and the risk of surgery is likely to be reduced.’
Earlier this month, Fiona underwent a fourth operation to remove part of her bowel, and is now in recovery.

‘I don’t know how many more operations I’ll need or if I’ll end up with a colostomy bag, but I try not to think about it,’ she says. ‘I’m moving on with my life, but I hope no one else has to experience what I went through.’

For more information, visit the National Association for Colitis and Crohn’s Disease (NACC), crohnsandcolitis.org.uk

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Patrick Strudwick talks about SIBO

Those of you who have had telephone consultations with the Helpline Team here at Immunecare may have heard us talking about SIBO – Small Intestinal Bacterial Overgrowth as an alternative diagnosis for some cases of IBS. We have recognised this for years, and it is now becoming more to the forefront. This is the story of a SIBO sufferer:

“For ten years I looked pregnant. Between 1997 and 2007 my bloated belly peered over my waistband as I tried to hold it in. I wasn’t overweight or malnourished. Instead, doctor after doctor gave me the same diagnosis: irritable bowel syndrome.
About one in ten people have – or think they have – this horrible condition. Its chief symptoms, apart from bloating, are constipation and diarrhoea, with pain, fatigue and sometimes depression joining in.

It is hardly taboo – several celebrities have revealed they suffer from IBS: actress Kirsten Dunst and model Tyra Banks to name a few. But are we being told the truth? Do we all really have IBS?

Four years ago, I began to suspect not. All my symptoms had intensified, in particular, the pain. I tried cutting out some of the known triggers: wheat, alcohol and cheese. I tried yoga and meditation – stress is thought to worsen the condition. But still I looked pregnant, and I grew suspicious something else was wrong. Desperate and fed up, I went to my GP and begged to be referred to a gastroenterologist.
He prodded at my protruding belly in search of cysts or tumours. He asked about my symptoms and how long I had suffered from them. He ran blood and urine tests to check for diabetes or signs of various cancers. Crucially, he took me seriously.

Having eliminated the most serious possible causes, he referred me for two tests at London’s St. Thomas’ Hospital: one for lactose intolerance and one for something called Small Intestinal Bacterial Overgrowth (SIBO).
The first test involved drinking a sugar solution and every 15 minutes for three hours breathing into a tube to measure the hydrogen levels in my breath. The second was the same except I drank a lactulose solution – a type of glucose also used as a laxative.
The first test – which was looking for a lactose (milk sugar) intolerance – came back negative, but the other, for SIBO, was positive. I had never heard of it. So back at home, I plundered Google in search of answers. The same symptoms kept coming up as for IBS: constipation, diarrhoea, bloating, pain and fatigue. Why had none of the doctors I had seen ever mentioned this condition?

‘Most GPs have never heard of it,’ explains Dr Ian Penman, a consultant gastroenterologist at Edinburgh’s Western General Hospital.

So what is it? And how many other IBS sufferers could in fact have SIBO? ‘SIBO is a condition whereby the small intestine, which normally has very few bacteria in it, becomes colonised with too many bacteria. In healthy people, stomach acid and the waves of muscular contraction in the small intestine flush most bacteria into the bowel. But with SIBO that doesn’t happen.’
Why? Mostly, Dr Penman says, it is because of four different types of underlying conditions. The first is when stomach acid is not produced because of gastric surgery, such as a bypass, or old age.
Another vulnerable group is people who’ve had multiple operations on their intestines with parts cut out or joined together, such as those with Crohn’s disease. Thirdly there are people who have other gut disorders. And, finally, people who have had multiple courses of antibiotics.

‘People with recurrent chest or urinary infections may have had lots of antibiotics,’ says Dr Penman. ‘This can upset the delicate ecosystem in the bowel – the balance of different types of bacteria – which then allows certain bacteria groups to proliferate.’

In my early 20s I had a succession of antibiotics for tonsillitis – eventually they were removed – which may explain my diagnosis. But, says Dr Penman, there are also those who do not fall into any of these categories who think they have IBS but test positive for SIBO, with none of the underlying factors.
‘We get into the area of could SIBO be the cause of IBS?’ he says. ‘The answer is that it is unclear. It’s difficult to tease out – the causes of IBS are multi-factorial: stress, food intolerances, and in some cases, bacterial overgrowth.’

A 2005 study published in the journal of Alimentary Pharmacology and Therapeutics found a staggering link between the condition: 98 IBS sufferers were given the hydrogen breath test for SIBO and 64 tested positive. This suggests a huge proportion of those who think they have IBS actually suffer from SIBO.
However, Dr Penman points out: ‘A more recent study found that some people with IBS give false positive results for the SIBO breath test. The reason is that what they really have wrong with them is the time it takes for stuff to go from the stomach to the bowel is too fast. So when we give them lactulose for the breath test, it reaches the bowel too quickly, which causes them to excrete hydrogen in their breath, so we get a positive result. My estimate would be that in fact no more than 10 per cent of IBS sufferers actually have SIBO.’

But if ten percent of Britons have IBS and even five percent of those in fact have SIBO, that would mean 300,000 people with a chronic undiagnosed intestinal disorder.
There is no cure. Instead, the condition is managed. If it is not it can lead to vitamins such as B12 and folic acid not being absorbed by the body. This can cause infertility, depression, and chronic fatigue. What then is the treatment?

‘Firstly, we look for any underlying case – are they making no acid, do they have Crohn’s or have they had surgery?’ Says Dr Penman. ‘If we can treat those factors we will. But otherwise the treatment is cyclical courses of antibiotics to reduce the number of bacteria in the small intestine.
‘We rotate several different antibiotics one after the other to try and prevent resistance or side effects. Another strategy would be four weeks on antibiotics and then four weeks off.’
A change in diet is also essential. ‘I recommend small, frequent meals, making sure you get a good intake of vitamins, and a reduction in intake of carbohydrates.’
Dr Penman advises SIBO patients to take a multi-vitamin supplement and peppermint capsules to help with bloating. ‘I’m also a fan of pro-biotics,’ he says. ‘Not so much the yoghurt-y drinks from the supermarket but a dried formulation of acidophilus from a pharmacy.’

The treatment works. After a few courses of antibiotics my symptoms all but vanished. Concerned about taking them long-term, however, I started taking probiotics instead every day, and only taking antibiotics every year or so.

Sticking to the dietary guidelines are not easy when – as I do – you have a problematic cupcake obsession. But, annoyingly, limiting carbohydrates has proved to be the most effective way of managing the condition. Although I give in now and again, cutting out cake, I can report with some sadness, is the only way to avoid looking like I’m in my second trimester.