Review – 2/18/19

1. Those who use antidepressants are significantly more likely to experience severe gastrointestinal bleeding, and the risk is increased in those who take over-the-counter pain relievers (such as Advil, Motrin, Aleve, Coumadin, aspirin, and Plavix). The 2019 review study looked at selective serotonin reuptake inhibitors (SSRIs), prescribed to 13% of Americans 12 years and older and the most commonly prescribed medication in the United States. After a complete review of the literature, scientists found that those on SSRIs are 40% more likely to experience severe gastrointestinal bleeding and are at a higher risk of life threatening intracranial bleeding. Journal of the American Osteopathic Association

→Takeaway: If you’re taking antidepressants and are wondering if you’re experiencing gastrointestinal bleeding, bright red blood in the stool or tarry stools are signs you can look for. If you experience either of these symptoms, contact you’re healthcare provider immediately.

No matter how safe or harmless a medication seems, all medicines come with risk – especially when taken in combination. If you are currently on a medication or multiple medications, talk to your health care provider and do your research to understand the risks involved so that you’re able to assess whether the benefits outweigh the risks. Lastly, antidepressants are often subject to legacy prescribing. If you’ve been on an antidepressant for some time and feel you may be ready to taper off, talk to your doctor. For more on how the gut microbiome may influence the brain and behavior, including its role in dementia, autism, and other brain-related disorders, check out the January 2019 New York Times article, Germs in Your Gut Are Talking to Your Brain. Scientists Want to Know What They’re Saying.

2. A reduction in specific gut bacteria is linked to lower quality of life and incidents of depression. The study – one of the most compelling in illustrating the influence the gut microbiota has on mental health – included 1,063 participants enrolled in Belgium’s Flemish Gut Flora Project. Using DNA sequencing to analyze fecal microbiota, researchers compared gut bacteria with participants’ incidence of depression and quality of life (self- and physician reported) and found that two families of bacteria; Coprococcus and Dialister, were significantly reduced in those with depression. There was also a direct relationship between quality of life and the gut microbiome’s ability to breakdown and synthesize the dopamine (a neurotransmitter) byproduct, 3,4-dihydroxyphenylacetic acid. Nature

→Takeaway: While this study shows a strong link between the gut microbiome and mental health, it demonstrates only correlation, not cause. Next steps are for researchers to find out whether – and if so how – neurotransmitters and neuroactive compounds (serotonin, GABA, and dopamine, for example) interact with the central nervous system, and whether this interaction alters behavior and mental health disease risk.

3. Super-donors could be the key to fecal microbiota transplantation (FMT) success. While FMT is an approved treatment for C. diff infection, it has shown very little promise in treating other dysbiosis (gut bacteria imbalance) –related chronic diseases. A recent review article looked at the evidence supporting the idea of FMT “super donors”; donors who possess specific microbial composition and diversity in their stool, “keystone” bacterial species by condition, and how the concept of super-donors could be the foundation of dysbiosis-matched FMT. Frontiers in Cellular and Infectious Microbiology

→Takeaway: While dysbiosis is an overall term to describe gut bacteria imbalance, each disease and condition has its own dysbiosis road map with large variations in bacteria species. This article hypothesizes that there is no “one stool fits all” approach. For FMT to be successful, stool composition and diversity, as well as the microbial footprint of the disease the stool is aiming to treat, must be taken into consideration. Honing in on the FMT super-donor concept and conducting studies that specifically address which bacterial species are critical for treating which conditions will hopefully bring us closer to more FMT remedies for chronic illness.

4. In the absence of fiber, gut bacteria eat the protective mucus layer in the colon, the gut’s primary defense mechanism against intestinal pathogens. In a mouse model, the study found that without dietary fiber, both in chronic and intermittent situations, gut bacteria begin consuming secreted mucus glycoproteins as a nutrient source, leading to the destruction of the mucus barrier. In the study, an eroding mucus barrier along with dietary fiber deprivation, gave Citrobacter rodentium, a mucosal pathogen, increased access to the epithelial layer and caused severe colitis (or inflammation of the colon). Cell

→Takeaway: While we are aware of the incredible benefits of fiber on gut and overall health, this study sheds light on why fiber is so important on a microbial level and how its absence negatively and directly affects the gut and its ability to fight pathogens. The recommended fiber intake is 14 grams per 1,000 calories, or 25 grams for women and 38 grams for men per day. Get your fiber from plant-based whole foods that come from the ground. Your colonic mucus layer will thank you! Image credit

5. The same meal results in vastly different blood glucose levels across individuals. For one week a recent study monitored blood glucose levels and measured glucose responses to 46, 898 meals across 800 participants. After finding extreme variations in blood glucose levels in the participants after consuming identical meals, researchers successfully created an algorithm – taking into account blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota analysis – that accurately predicted personalized post-meal glycemic response to specific meals. The success of the algorithm was tested in 100 participants. Researchers then conducted a dietary intervention based on the algorithm, which resulted in significantly lower post-meal blood glucose levels and consistent positive changes in the gut microbiome. Based on their algorithm’s success, the scientists who conducted the study concluded that personalized diets might be a viable way to treat high blood glucose and the detrimental effects it has on metabolism. Cell

→Takeaway: This study adds to the compelling evidence that the glycemic index has little bearing on real life, post-meal blood glucose response, and that responses are instead based on the individual. Yet, does eating for good health have to be as complicated as a computer algorithm? At Gutbliss, we say no. A February 2018 study showed that a whole food, vegan diet drastically and rapidly improves type II diabetes markers in overweight adults over a 16-week period. A 2017 study reviewed the evidence of a plant-based diet as a viable treatment for type II diabetes and found that “cohort studies strongly support the role of plant-based diets… in reducing the risk of type 2 diabetes. Evidence from observational and interventional studies demonstrates the benefits of plant-based diets in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications.” Before undergoing extensive medical analysis and complicated algorithms to come up with what to eat, we recommend trying a whole food, plant-based diet first. Image credit

By: Leslie Ann Berg, MSPH