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Dietary Patterns and Interventions to Alleviate Chronic Pain.
Dragan, S, Șerban, MC, Damian, G, Buleu, F, Valcovici, M, Christodorescu, R
Nutrients. 2020;12(9)
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A common symptom of many conditions is pain, with chronic pain being a significant cause of emotional distress and disability. Chronic pain is associated with a pro-inflammatory state. Diet interventions can be a helpful tool for the management of chronic pain and its associated inflammation. The increase of nutrient-dense, antioxidant-rich foods and the reduction of pro-inflammatory foods, as well as correcting nutrient deficiencies, all appear to have a positive effect on pain. Whilst previous research on the impact of diet therapy in chronic pain yielded varied results, the authors of this article sought to analyse the most important literature to gain more clarity and direction for future research. After a detailed introduction on the different types of pain, the article summarises the outcome of a range of dietary interventions for chronic pain management. These include calorie restriction and fasting, polyunsaturated fatty acids, low-fat plant-based diets, high protein diet, elimination diet, antioxidants and vitamins including vitamin D, fruits and fibres, prebiotics and probiotics. In the discussion, a helpful table presents the key results organised by type of pain (chronic musculoskeletal pain, chronic headache, neuropathic pain, chronic abdominal pain) and the clinical interventions that showed positive outcomes. In conclusion, diet interventions could be part of a multidisciplinary approach in the management of chronic pain. This article yields an oversight of the possible interventions to consider when supporting people with different types of chronic pain.
Abstract
Pain is one of the main problems for modern society and medicine, being the most common symptom described by almost all patients. When pain becomes chronic, the life of the patients is dramatically affected, being associated with significant emotional distress and/or functional disability. A complex biopsychosocial evaluation is necessary to better understand chronic pain, where good results can be obtained through interconnected biological, psychological, and social factors. The aim of this study was to find the most relevant articles existent in the PubMed database, one of the most comprehensive databases for medical literature, comprising dietary patterns to alleviate chronic pain. Through a combined search using the keywords "chronic pain" and "diet" limited to the last 10 years we obtained 272 results containing the types of diets used for chronic pain published in the PubMed database. Besides classical and alternative methods of treatment described in literature, it was observed that different diets are also a valid solution, due to many components with antioxidant and anti-inflammatory qualities capable to influence chronic pain and to improve the quality of life. Thirty-eight clinical studies and randomized controlled trials are analyzed, in an attempt to characterize present-day dietary patterns and interventions to alleviate chronic pain.
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The role of diet and probiotics in prevention and treatment of bacterial vaginosis and vulvovaginal candidiasis in adolescent girls and non-pregnant women.
Mizgier, M, Jarzabek-Bielecka, G, Mruczyk, K, Kedzia, W
Ginekologia polska. 2020;91(7):412-416
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In adolescent girls and non-pregnant women, vaginitis, including fungal infections, is a common problem. Vaginitis clinically manifests as abnormal vaginal discharge, irritation, itching, burning and discomfort, and is especially prevalent with a decrease in immunity. The normal bacterial flora of the vagina and cervix protect against the development of pathogenic strains, while abnormal flora tend to be the most common starting point for the development of infections. The aim of this study was to determine the role of proper diet and probiotics and prebiotics use in relation to therapy and prophylaxis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in non-pregnant women and girls. This review shows that: - An unbalanced diet can be a risk factor for BV. Women tend to be more exposed to BV if they have poor micronutrient status, including vitamins A, E, D, C and beta carotene — indicating a lower fruit and vegetable intake. - Many studies proved that regulated use of probiotics, administered both orally and vaginally, are effective in the prevention and treatment of vaginal infections such as BV and VVC. - To create a positive environment for probiotics, it is important to provide prebiotics that support the development of probiotic strains. Authors conclude that gynaecologists, obstetricians, general practitioners and dieticians should share their findings, and raise awareness among the general population as to the importance of optimal nutrition. Probiotics and prebiotics could be considered to prevent infections of the genital tract, reduce associated disease, and maintain reproductive health.
Abstract
The article raises important issues regarding the use of diet and probiotics in prevention and treatment of vaginitis. Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge. The most common causes of vaginitis are vulvovaginal candidiasis (VVC), trichomoniasis and bacterial vaginosis (BV). Vaginitis has been linked to itching, burning, pain, discharge, irritation and also adverse reproductive and obstetric health outcomes. Moreover, microorganisms that build vaginal flora in the state of bacterial vaginosis are a source of cervicitis and endometritis (often in subclinical forms) and pelvic inflammatory disease (PID) The proper diet and probiotics consumption may influence the composition of the gut microbiota, improve gut integrity, and have an impact on maintaining and recovering the normal vaginal microbiota. Future studies and reviews investigating the role of diet and probiotics in changes to gut and vaginal microbiome need to focus on deciphering the mechanismus of host bacteria interaction in vulvovaginal health.
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Pain regulation by gut microbiota: molecular mechanisms and therapeutic potential.
Guo, R, Chen, LH, Xing, C, Liu, T
British journal of anaesthesia. 2019;123(5):637-654
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Acute pain serves to protect us from further tissue damage. Chronic pain is debilitating and significantly reduces the quality of life for affected individuals and their loved ones. The relationship between gut bacteria and various diseases, including chronic pain, is receiving increasing attention. This review article discusses the current understanding of the role of the gut microbiota in pain regulation and what the science says in relation to gut bacteria manipulation and chronic pain. The authors of the review discuss the role of various compounds and metabolites of gut bacteria in relation to inflammation, neuropathic pain, visceral pain and headache. Whilst a lot of the current findings are based on results of rodent studies, the emerging evidence suggests that gut dysbiosis participates in various chronic pain conditions in a number of ways. Therefore, modulation of the gut microbiome through diet and pro- and pre-biotics is warranted for use by Nutrition Practitioners.
Abstract
The relationship between gut microbiota and neurological diseases, including chronic pain, has received increasing attention. The gut microbiome is a crucial modulator of visceral pain, whereas recent evidence suggests that gut microbiota may also play a critical role in many other types of chronic pain, including inflammatory pain, headache, neuropathic pain, and opioid tolerance. We present a narrative review of the current understanding on the role of gut microbiota in pain regulation and discuss the possibility of targeting gut microbiota for the management of chronic pain. Numerous signalling molecules derived from gut microbiota, such as by-products of microbiota, metabolites, neurotransmitters, and neuromodulators, act on their receptors and remarkably regulate the peripheral and central sensitisation, which in turn mediate the development of chronic pain. Gut microbiota-derived mediators serve as critical modulators for the induction of peripheral sensitisation, directly or indirectly regulating the excitability of primary nociceptive neurones. In the central nervous system, gut microbiota-derived mediators may regulate neuroinflammation, which involves the activation of cells in the blood-brain barrier, microglia, and infiltrating immune cells, to modulate induction and maintenance of central sensitisation. Thus, we propose that gut microbiota regulates pain in the peripheral and central nervous system, and targeting gut microbiota by diet and pharmabiotic intervention may represent a new therapeutic strategy for the management of chronic pain.
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Beta Glucan: Supplement or Drug? From Laboratory to Clinical Trials.
Vetvicka, V, Vannucci, L, Sima, P, Richter, J
Molecules (Basel, Switzerland). 2019;24(7)
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Beta glucans, β-1,3-glucans (glucans) are chains of sugars (polysaccharides) naturally occurring in the cell walls of plants such as cereals, bacteria and fungi. They are gaining attention not only as an important food supplement but also as an immunostimulant and potential drug. It has been known since prehistoric times that mushrooms have medicinal properties. Glucans effect various branches of the immune system and there are numerous animal and human studies showing remarkable activity against a wide variety of tumours. This paper represents an up-to-date review of glucans and their role in various immune reactions and the treatment of cancer. It also cites studies showing their potential use for wound healing and skin health, chronic respiratory problems in children, alleviation of allergic problems and reducing cholesterol levels. Additional lesser-known effects of glucan include improvements in colitis, obesity, or Lyme disease The authors conclude that glucans are an important immunomodulator. They believe that glucans will soon move from food supplement to widely accepted drug.
Abstract
Glucans are part of a group of biologically active natural molecules and are steadily gaining strong attention not only as an important food supplement, but also as an immunostimulant and potential drug. This paper represents an up-to-date review of glucans (β-1,3-glucans) and their role in various immune reactions and the treatment of cancer. With more than 80 clinical trials evaluating their biological effects, the question is not if glucans will move from food supplement to widely accepted drug, but how soon.
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Psoriasis and Microbiota: A Systematic Review.
Benhadou, F, Mintoff, D, Schnebert, B, Thio, HB
Diseases (Basel, Switzerland). 2018;6(2)
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Psoriasis is an autoimmune inflammatory skin disease that causes red, itchy, flaky and scaly skin. Skin integrity and function are critically dependent on the microbial population on it. Based on this systematic review, the immune system's interaction with microbes on the skin was examined and its relationship to psoriasis. T-cell mediated inflammation is characteristic of psoriasis where interaction between type IV collagen and α1β1 integrin, a collagen receptor, occurs. In psoriatic skin lesions, Firmicutes were predominant, while Actinobacteria were less prevalent. Psoriasis exacerbations are also associated with an exacerbated number of fungi, Malassezia species, in skin lesions. As therapeutic strategies for psoriasis, this systematic review suggests adhering to a gluten-free diet and incorporating prebiotics and probiotics such as Lactobacillus. However, further research is needed to develop specific therapeutic and skin modulation strategies. Health care professionals can benefit from this systematic review by understanding the pathophysiology behind psoriasis and possible therapeutic strategies to consider.
Abstract
BACKGROUND Recent advances have highlighted the crucial role of microbiota in the pathophysiology of chronic inflammatory diseases as well as its impact on the efficacy of therapeutic agents. Psoriasis is a chronic, multifactorial inflammatory skin disorder, which has a microbiota distinct from healthy, unaffected skin. AIM: Through an extensive review of the literature, we aim to discuss the skin and gut microbiota and redefine their role in the pathogenesis of psoriasis. CONCLUSIONS Unfortunately, the direct link between the skin microbiota and the pathogenesis of psoriasis remains to be clearly established. Apart from improving the course of psoriasis, selective modulation of the microbiota may increase the efficacy of medical treatments as well as attenuate their side effects.
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Crosstalk between the microbiome and epigenome: messages from bugs.
Qin, Y, Wade, PA
Journal of biochemistry. 2018;163(2):105-112
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Trillions of microbes live symbiotically in and on an individual human being, most of them inside the digestive tract and communally known as the gut microbiome. The gut microbiome plays a vital role in the individual host’s health, not only by helping digest food and harvest energy, but also by regulating immune development and influencing gene expression. Diet and factors, such as infections and the use of antibiotics, can alter the balance of the microbiome and lead to various outcomes. This paper reviewed the current understanding of the ways in which the gut microbiome is capable of altering the host’s gene expression through microbial signals, including metabolites, bile acids, inflammation and altered composition. The studies highlighted in the paper show that gut microbes communicate both with local cells in the intestines and with more distant organs, such as the liver and the cardiovascular system. Through this communication, they can regulate the expression of immune cells, cancer cells, enzymes and inflammation-related molecules. The authors concluded that these interactions, or the crosstalk between the microbes and the host, demonstrate a crucial role of the gut microbiome in the host’s response to environmental signals. However, many of the mechanisms are still unclear, so further studies are needed to explain specific microbe-derived signals, affecting host gene expression, and to deepen our understanding of how lifestyle, health status and environmental exposures, such as antibiotics, regulate the microbiome and its influence.
Abstract
Mammals exist in a complicated symbiotic relationship with their gut microbiome, which is postulated to have broad impacts on host health and disease. As omics-based technologies have matured, the potential mechanisms by which the microbiome affects host physiology are being addressed. The gut microbiome, which provides environmental cues, can modify host cell responses to stimuli through alterations in the host epigenome and, ultimately, gene expression. Increasing evidence highlights microbial generation of bioactive compounds that impact the transcriptional machinery in host cells. Here, we review current understanding of the crosstalk between gut microbiota and the host epigenome, including DNA methylation, histone modification and non-coding RNAs. These studies are providing insights into how the host responds to microbial signalling and are predicted to provide information for the application of precision medicine.
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A Review of Microbiota and Irritable Bowel Syndrome: Future in Therapies.
Rodiño-Janeiro, BK, Vicario, M, Alonso-Cotoner, C, Pascua-García, R, Santos, J
Advances in therapy. 2018;35(3):289-310
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Irritable bowel syndrome (IBS) is a common functional gut disorder characterised by abdominal pain and associated changes in bowel habits. Increasing evidence points to altered gut microbiota, dysbiosis, as a predominant factor in IBS development and has therefore become a primary target for therapeutic options in patients with IBS. This review evaluates existing literature on IBS interventions targeting the gut microbiota and suggests future approaches useful for diagnosis, prevention and treatment of IBS. Based on the current literature, this review suggests there is a strong role of dysbiosis in the pathophysiology of IBS. The authors conclude that there are promising therapeutic options available but further evidence is needed from larger controlled studies.
Abstract
Irritable bowel syndrome (IBS), one of the most frequent digestive disorders, is characterized by chronic and recurrent abdominal pain and altered bowel habit. The origin seems to be multifactorial and is still not well defined for the different subtypes. Genetic, epigenetic and sex-related modifications of the functioning of the nervous and immune-endocrine supersystems and regulation of brain-gut physiology and bile acid production and absorption are certainly involved. Acquired predisposition may act in conjunction with infectious, toxic, dietary and life event-related factors to enhance epithelial permeability and elicit mucosal microinflammation, immune activation and dysbiosis. Notably, strong evidence supports the role of bacterial, viral and parasitic infections in triggering IBS, and targeting microbiota seems promising in view of the positive response to microbiota-related therapies in some patients. However, the lack of highly predictive diagnostic biomarkers and the complexity and heterogeneity of IBS patients make management difficult and unsatisfactory in many cases, reducing patient health-related quality of life and increasing the sanitary burden. This article reviews specific alterations and interventions targeting the gut microbiota in IBS, including prebiotics, probiotics, synbiotics, non-absorbable antibiotics, diets, fecal transplantation and other potential future approaches useful for the diagnosis, prevention and treatment of IBS.
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Human Gut Microbiota and Gastrointestinal Cancer.
Meng, C, Bai, C, Brown, TD, Hood, LE, Tian, Q
Genomics, proteomics & bioinformatics. 2018;16(1):33-49
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In this article the authors review research on the influence of the human gut microbiota on the development and progression of gastrointestinal cancers, and go into significant detail about the molecular mechanisms involved. Helicobacter pylori is a known risk factor for gastric cancer (GC) but other dysbiotic changes in the gut microbiota are also observed in GC. On the other hand, H. pylori is associated with a decreased risk for oesophageal cancer (OC). An increase in gram-negative bacteria is associated with OC, whilst gram-positive bacteria are dominant in a healthy oesophagus. Dietary factors are associated with the risk for colorectal cancer (CRC) and may be due to their effect on the bacterial composition of the bowel. The authors explore possible mechanisms for these links. Although the liver is considered sterile, carcinogenesis can be influenced by the gut microbiota through pathogens and bacterial metabolites which can disturb metabolic pathways and immune responses in the liver. In pancreatic cancer (PC), the gut microbiota may influence carcinogenesis by promoting inflammation. In addition to various lifestyle factors, H. pylori is a risk factor for PC. The authors also review the use of prebiotics, probiotics, synbiotics (a combination of pre- and pro-biotics) and Traditional Chinese Medicine as an adjunct to conventional cancer treatment to reduce side effects, as well as their potential preventive mechanisms.
Abstract
Human gut microbiota play an essential role in both healthy and diseased states of humans. In the past decade, the interactions between microorganisms and tumors have attracted much attention in the efforts to understand various features of the complex microbial communities, as well as the possible mechanisms through which the microbiota are involved in cancer prevention, carcinogenesis, and anti-cancer therapy. A large number of studies have indicated that microbial dysbiosis contributes to cancer susceptibility via multiple pathways. Further studies have suggested that the microbiota and their associated metabolites are not only closely related to carcinogenesis by inducing inflammation and immune dysregulation, which lead to genetic instability, but also interfere with the pharmacodynamics of anticancer agents. In this article, we mainly reviewed the influence of gut microbiota on cancers in the gastrointestinal (GI) tract (including esophageal, gastric, colorectal, liver, and pancreatic cancers) and the regulation of microbiota by diet, prebiotics, probiotics, synbiotics, antibiotics, or the Traditional Chinese Medicine. We also proposed some new strategies in the prevention and treatment of GI cancers that could be explored in the future. We hope that this review could provide a comprehensive overview of the studies on the interactions between the gut microbiota and GI cancers, which are likely to yield translational opportunities to reduce cancer morbidity and mortality by improving prevention, diagnosis, and treatment.
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The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials.
Yeh, TL, Shih, PC, Liu, SJ, Lin, CH, Liu, JM, Lei, WT, Lin, CY
Drug design, development and therapy. 2018;12:217-230
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Influenza vaccination is widely used although concerns regarding its efficacy exist. Both prebiotics and probiotics have been shown to produce protective effects against influenza infection and may enhance the immune response to the vaccination, especially in the elderly. The aim of this systematic review and meta-analysis was to determine the effect of pre- and probiotics on immune response to the influenza vaccination. According to the existing literature, participants who took prebiotics or probiotics were found to have higher hemagglutination inhibition (HI) antibodies, meaning a reduced likelihood of the virus attaching to the host’s red blood cells. Based on these results, the authors conclude both pre- or probiotic supplementation may enhance immune response in three influenza strains. While these results are promising, larger controlled trials are warranted to confirm the effectiveness and establish best clinical practice for supplementation.
Abstract
BACKGROUND Influenza infection is a common disease with a huge disease burden. Influenza vaccination has been widely used, but concerns regarding vaccine efficacy exist, especially in the elderly. Probiotics are live microorganisms with immunomodulatory effects and may enhance the immune responses to influenza vaccination. METHODS We conducted a systematic review and meta-analysis to determine the influence of prebiotics/probiotics/synbiotics supplementation on vaccine responses to influenza vaccination. Studies were systematically identified from electronic databases up to July 2017. Information regarding study population, influenza vaccination, components of supplements, and immune responses were extracted and analyzed. Twelve studies, investigating a total of 688 participants, were included in this review. RESULTS Patients with prebiotics/probiotics supplements were found to have higher influenza hemagglutination inhibition antibody titers after vaccination (for A/H1N1, 42.89 vs 35.76, mean difference =7.14, 95% CI =2.73, 11.55, P=0.002; for A/H3N2, 105.4 vs 88.25, mean difference =17.19, 95% CI =3.39, 30.99, P=0.01; for B strain, 34.87 vs 30.73, mean difference =4.17, 95% CI =0.37, 7.96, P=0.03). CONCLUSION Supplementation with prebiotics or probiotics may enhance the influenza hemagglutination inhibition antibody titers in all A/H1N1, A/H3N2, and B strains (20%, 19.5%, and 13.6% increases, respectively). Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.
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Heat-stabilised rice bran consumption by colorectal cancer survivors modulates stool metabolite profiles and metabolic networks: a randomised controlled trial.
Brown, DG, Borresen, EC, Brown, RJ, Ryan, EP
The British journal of nutrition. 2017;117(9):1244-1256
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Colorectal cancer (CRC) is the third most common cancer in the world. Rice bran is high in phytochemicals, fibre and other bioactive compounds that may have potential to reduce cancer formation. Rice bran consumption has been shown to reduce CRC growth in mice, as well as alter the stool microbiome in humans. This alteration of the gut microbiome and the metabolic end products produced by it is thought to provide positive health benefits in terms of CRC development. This randomised controlled trial with CRC survivors included daily consumption of 30g/day of rice bran for 28 days in the intervention group, consisting of 9 participants. No rice bran was consumed in the control group of 10 participants. The aim of the study was to identify changes in metabolites that may have potential to reduce the risk of CRC, in the stool samples given by the participants after consuming rice bran, as well as to understand the differences in stool metabolites in the intervention and control groups. The authors found that rice bran consumption led to changes in 93 metabolites, 33 of which increased, while 60 metabolites decreased after 4 weeks of consumption. Metabolic pathways affected included advanced glycation end products, steroid metabolism, primary bile acid metabolism, leucine, isoleucine and valine metabolism, methionine, cysteine, S-adenosyl methionine and taurine metabolism, inositol metabolism, vitamin B6 metabolism and benzoate metabolism. The authors hypothesise that these metabolic changes may have potential for the prevention of cancer and they should be further explored in larger studies.
Abstract
Rice bran (RB) consumption has been shown to reduce colorectal cancer (CRC) growth in mice and modify the human stool microbiome. Changes in host and microbial metabolism induced by RB consumption was hypothesised to modulate the stool metabolite profile in favour of promoting gut health and inhibiting CRC growth. The objective was to integrate gut microbial metabolite profiles and identify metabolic pathway networks for CRC chemoprevention using non-targeted metabolomics. In all, nineteen CRC survivors participated in a parallel randomised controlled dietary intervention trial that included daily consumption of study-provided foods with heat-stabilised RB (30 g/d) or no additional ingredient (control). Stool samples were collected at baseline and 4 weeks and analysed using GC-MS and ultra-performance liquid chromatography-MS. Stool metabolomics revealed 93 significantly different metabolites in individuals consuming RB. A 264-fold increase in β-hydroxyisovaleroylcarnitine and 18-fold increase in β-hydroxyisovalerate exemplified changes in leucine, isoleucine and valine metabolism in the RB group. A total of thirty-nine stool metabolites were significantly different between RB and control groups, including increased hesperidin (28-fold) and narirutin (14-fold). Metabolic pathways impacted in the RB group over time included advanced glycation end products, steroids and bile acids. Fatty acid, leucine/valine and vitamin B6 metabolic pathways were increased in RB compared with control. There were 453 metabolites identified in the RB food metabolome, thirty-nine of which were identified in stool from RB consumers. RB consumption favourably modulated the stool metabolome of CRC survivors and these findings suggest the need for continued dietary CRC chemoprevention efforts.