Good health begins in the gut

UAlberta scientists and clinicians explore how gut bacteria may be key to a healthy life.

For the germaphobes among us, the mere thought of bacteria can be gut-wrenching. But as it turns out, the bacteria in our guts is a key factor to good health.

Scientists at the University of Alberta’s Faculty of Medicine & Dentistry are among Canada’s leading experts on the microbiome—the bacteria residing in our digestive tract. Together they are broadening the understanding of how these micro-organisms in our gut influence our health throughout life, impacting our likelihood of developing allergies, obesity and other serious conditions.

A groundbreaking U of A study shows that babies from families with pets had higher levels of two types of microbes associated with lower risks of allergic disease and obesity.

“There’s definitely a critical window of time when gut immunity and microbes co-develop, and when disruptions to the process result in changes to gut immunity,” said Anita Kozyrskyj, a U of A pediatric epidemiologist and one of the world’s leading researchers on gut microbes.

The study expands on two decades of research that show children who grow up with dogs have lower rates of asthma. According to Kozyrskyj, the findings may one day lead to the pharmaceutical industry creating a “dog in a pill” as a preventative tool for allergies and obesity.

While Kozyrskyj focuses on the early influences affecting gut bacteria in life, other U of A experts like gastroenterologist Dina Kao are making their own mark on the quickly expanding field of microbiome research. Kao’s work focuses on correcting unhealthy gut bacteria.

Could poop be the new scoop?

Kao is one of just a few clinicians across Canada performing fecal transplants to remedy the effects of a compromised microbiome. She has discovered that altered gut bacteria—often caused by the unnecessary use of antibiotics—can lead to serious conditions such as recurrent Clostridium difficile infection. Her research has proven that a fecal transplant from a healthy donor can replenish the microbiome of C. difficile patients with healthy bacteria, and is far more effective than conventional treatments.

“Currently no effective conventional therapy exists for recurrent Clostridium difficile infection,” says Kao. “But fecal transplant can provide a permanent cure for over 90 per cent of patients. You can see the changes in them right before your eyes. It is amazing.”

While the study of gut bacteria is still in its infancy, giant strides are being made at the U of A and beyond. And Kao firmly believes the best is yet to come.

“It’s an open book. And it has tremendous potential.”

Learn more about this topic at the Festival of Health

Register here for your free ticket

ECHA 2-490 1:00-5:00 p.m.
Edmonton Clinic Health Academy,
North Campus, University of Alberta

Today’s most critical health topics
delivered in rapid doses
by U of A’s leading health experts
1-2 p.m.

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Interactive displays
2 - 3 p.m. & 3:45 - 4:45 p.m.

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3 - 3:45 p.m.

More information available at  uab.ca/healthfest.

This article originally appeared on ualberta.ca and was written by Ross Neitz.

More than half your body is not human

More than half of your body is not human, say scientists.

Human cells make up only 43% of the body's total cell count. The rest are microscopic colonists.

Understanding this hidden half of ourselves - our microbiome - is rapidly transforming understanding of diseases from allergy to Parkinson's.

The field is even asking questions of what it means to be "human" and is leading to new innovative treatments as a result.

"They are essential to your health," says Prof Ruth Ley, the director of the department of microbiome science at the Max Planck Institute, "your body isn't just you".

No matter how well you wash, nearly every nook and cranny of your body is covered in microscopic creatures.

This includes bacteria, viruses, fungi and archaea (organisms originally misclassified as bacteria). The greatest concentration of this microscopic life is in the dark murky depths of our oxygen-deprived bowels.

Prof Rob Knight, from University of California San Diego, told the BBC: "You're more microbe than you are human."

Originally it was thought our cells were outnumbered 10 to one.

"That's been refined much closer to one-to-one, so the current estimate is you're about 43% human if you're counting up all the cells," he says.

But genetically we're even more outgunned.

The human genome - the full set of genetic instructions for a human being - is made up of 20,000 instructions called genes.

But add all the genes in our microbiome together and the figure comes out between two and 20 million microbial genes.

Prof Sarkis Mazmanian, a microbiologist from Caltech, argues: "We don't have just one genome, the genes of our microbiome present essentially a second genome which augment the activity of our own.

"What makes us human is, in my opinion, the combination of our own DNA, plus the DNA of our gut microbes."

Listen to The Second Genome on BBC Radio 4.

Airs 11:00 BST Tuesday April 10, repeated 21:00 BST Monday April 16 and on the BBC iPlayer

It would be naive to think we carry around so much microbial material without it interacting or having any effect on our bodies at all.

Science is rapidly uncovering the role the microbiome plays in digestion, regulating the immune system, protecting against disease and manufacturing vital vitamins.

Prof Knight said: "We're finding ways that these tiny creatures totally transform our health in ways we never imagined until recently."

It is a new way of thinking about the microbial world. To date, our relationship with microbes has largely been one of warfare.

Microbial battleground

Antibiotics and vaccines have been the weapons unleashed against the likes of smallpox, Mycobacterium tuberculosis or MRSA.

That's been a good thing and has saved large numbers of lives.

But some researchers are concerned that our assault on the bad guys has done untold damage to our "good bacteria".

Prof Ley told me: "We have over the past 50 years done a terrific job of eliminating infectious disease.

"But we have seen an enormous and terrifying increase in autoimmune disease and in allergy.

"Where work on the microbiome comes in is seeing how changes in the microbiome, that happened as a result of the success we've had fighting pathogens, have now contributed to a whole new set of diseases that we have to deal with."

The microbiome is also being linked to diseases including inflammatory bowel disease, Parkinson's, whether cancer drugs work and even depression and autism.

Obesity is another example. Family history and lifestyle choices clearly play a role, but what about your gut microbes?

This is where it might get confusing.

A diet of burgers and chocolate will affect both your risk of obesity and the type of microbes that grow in your digestive tract.

So how do you know if it is a bad mix of bacteria metabolising your food in such a way, that contributes to obesity?

Prof Knight has performed experiments on mice that were born in the most sanitised world imaginable.

Their entire existence is completely free of microbes.

He says: "We were able to show that if you take lean and obese humans and take their faeces and transplant the bacteria into mice you can make the mouse thinner or fatter depending on whose microbiome it got."

Topping up obese with lean bacteria also helped the mice lose weight.

"This is pretty amazing right, but the question now is will this be translatable to humans"

This is the big hope for the field, that microbes could be a new form of medicine. It is known as using "bugs as drugs".

Goldmine of information

I met Dr Trevor Lawley at the Wellcome Trust Sanger Institute, where he is trying to grow the whole microbiome from healthy patients and those who are ill.

"In a diseased state there could be bugs missing, for example, the concept is to reintroduce those."

Dr Lawley says there's growing evidence that repairing someone's microbiome "can actually lead to remission" in diseases such as ulcerative colitis, a type of inflammatory bowel disease.

And he added: "I think for a lot of diseases we study it's going to be defined mixtures of bugs, maybe 10 or 15 that are going into a patient."

Microbial medicine is in its early stages, but some researchers think that monitoring our microbiome will soon become a daily event that provides a brown goldmine of information about our health.

Prof Knight said: "It's incredible to think each teaspoon of your stool contains more data in the DNA of those microbes than it would take literally a tonne of DVDs to store.

"At the moment every time you're taking one of those data dumps as it were, you're just flushing that information away.

"Part of our vision is, in the not too distant future, where as soon as you flush it'll do some kind of instant read-out and tells you are you going in a good direction or a bad direction.

"That I think is going to be really transformative."

This article originally appeared on bbc.com and was written by James Gallagher

Illustrations: Katie Horwich

A Broken Body isn't a Broken Person

Cross-country skier Janine Shepherd hoped for an Olympic medal -- until she was hit by a truck during a training bike ride. She shares a powerful story about the human potential for recovery. Her message: you are not your body, and giving up old dreams can allow new ones to soar.

Outer Elbow Pain? You may have Tennis Elbow.

Could you be suffering from tennis elbow and not realise it?

The most common kind of elbow pain is a condition known as lateral epicondylalgia – or tennis elbow. Ironically, you also don’t need to be a tennis player to get tennis elbow. Many who have suffered from tennis elbow, actually do not play tennis. It’s also important to point out that recovery from tennis elbow requires a proactive approach involving diagnosis, treatment and strengthening. Through rest alone, your recovery will be very slow.

The causes of tennis elbow

This type of problem can occur at any age, but is most common between the ages of 35 and 50. Predictably, it is more common in your dominant arm but can affect both. The biggest misconception about this type of elbow pain is you don’t have to be a tennis player to get this condition. In fact it is just as common in people who repetitively overuse their forearm muscles such as office workers or tradespeople.

Referred Pain
A huge contributing factor to this condition which can be easily forgotten is referred pain from the neck or shoulder. This can either mimic symptoms of tennis elbow, or most commonly there is a combination of elbow and neck, shoulder or thoracic spine issues. You will need to have a thorough examination by a physiotherapist to determine if you have any referred pain from your neck and shoulder or if your elbow pain is isolated. This will assist in a more direct approach to your problem and a speedier recovery.

Tennis elbow and it’s symptoms

Typically, this condition presents as pain at or just below the lateral epicondyle- that is, the pointy part on the outside of your elbow. Generally people experience pain with gripping, lifting or wringing activities which cause tension over the tendon (see above picture). Clinically, we as physiotherapists often find people suffering this condition have weak and/or tight forearm muscles and stiff elbow and wrist joints.

There is a wide variation in the severity of this condition and how long the symptoms may last for. As with any injury, it is best that we see you as soon as possible to start you on an injury management plan. On assessment, your physiotherapist will be able to give you a guide as to how long your injury may last.

6 Steps to treating tennis elbow pain

Initial management of this condition is through pain relieving techniques such as soft tissue massage, joint mobilisations, stretching tight nerves and muscles, dry needling, heat and/or cold therapy and taping. We also sell tennis elbow braces to our clients that are effective in relieving pain in some people. I’ll cover these methods in more detail;:

1. Soft Tissue Massage: A massage therapist can use a range of techniques to release soft tissue, break down tension and realign the fibres. These techniques include myofacial release and transverse friction techniques.

2. Joint mobilisation: this management may include massage around the problem area or gently mobilising the joints of your neck and elbow.

3. Stretching: As soon as your pain allows, start stretching the area. Extension exercises of the wrist will be the most important stretches you can do to improve your range of motion and to increase the amount of load on the tendon.

4. Dry Needling: Dry needling is a technique that is fast gaining appreciation within the physiotherapy world, with many practitioners throughout Australia now trained in the use of acupuncture needles to assist with their client’s pain and rehabilitation. The insertion of needles at varying lengths and points are thought to alter the way pain signals are transmitted by nerve pathways.

5. Hot/Cold therapy: Apply ice to the elbow regularly to reduce the pain and inflammation will be a good start, particularly at the early onset of pain.

6. Kinesio Taping: Kinesio taping may help decrease the pain and can reduce the likelihood of injury aggravation.

Another exercise option is the ‘The Tyler Twist”, where clients are asked to perform an exercise using a FlexBar®. The experiment consisted of a group of 22 subjects who suffered from tennis elbow. These subjects were then split into 2 groups. The first group were asked to perform the FlexBar® exercise as well as receive standard physiotherapy. The control group received physiotherapy alone. It was found after 7 weeks of therapy that the first group had significantly more improvement than the group receiving only standard physio; in particular, the eccentric exercise group improved their pain level 81% vs. 22% in the standard group.

Ongoing management and prevention of tennis elbow.

Of utmost importance in managing this condition is a progressive strengthening program. Tendons require gradual load in order to heal correctly, so it is very important to continue to strengthen your muscles even if your pain is gone. At this phase of your rehabilitation, it is also important to look at contributing factors such as workstation setup and your posture. If you have some referred pain, assessing your pillow may also be necessary to ensure that your whole body is always in optimal alignment.

Sometimes patients are recommended by their GP to consider a cortisone injection into the elbow. The most recent research regarding this shows that it actually makes you worse in the longer term. Cortisone assists in settling inflammation, which may help in the short term, but generally this condition is not an inflammatory condition.

Recovery from tennis elbow pain

Typically, tendon overload injuries such as this can take anywhere between 2 and 24 months to be back to normal. No, this doesn’t mean you will be in pain for that long or that you will necessarily need one on one treatment for that long. It means that the healing process of tendons is longer than any other tissue in the body so you may need to continue with an exercise regime in the longer term- even after you stop seeing your physiotherapist. This will ensure that your pain stays away.

Remember, tennis elbow is not the same as Golfers elbow which we’ll be covering in a later post. If you are experiencing elbow pain, even if you’re not sure if it’s tennis elbow, it is important to seek treatment as soon as possible to reduce your recovery time. 

This article originally appeared on sportandspinalphysio.com.au and was written by Craig Honeybrook

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