Probiotic Resistance; Everything Should Be Taken In Moderation

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Exams, tests and anything that describes the same thing can be a bit annoying (or fill in the blank) especially when you are working for 16 -18 hour a day and have to power through, reading, memorising and jotting down some notes for it before you can hit the sack. To be honest, I'm at the weakest after work as I spent most of my time standing, running, climbing the stairs instead of taking the elevator and eat only biscuits (can be considered a luxurious treat for people who have no time to eat) and still be scolded by my supervisor either for no reason (they were annoyed with something and need to release it to someone else) or a very good reason (most frequently the first one). I lose almost 12 kg for the past 14 months trying to adapt to my new daily routine and frankly speaking, I never did. I miss eating good foods, travel and stuff and I will after I've concluded my housemanship program sometimes around next year. I can feel it, 2019 will be my year. Now enough of that jibber jabber, I'm sure all of you miss me already (lol), it's been almost 3 weeks since the last time I read articles and wrote one so today we are going to start our discussion regarding certain bacteria specifically the good one. Probiotics have been promoted by various organisations across the globe as a good thing to be taken frequently so that our digestive system will be healthy.

People (laymen) were often paranoid when I explained to them that probiotics are essentially good bacteria mostly because bacteria were usually associated with diseases. Have you ever heard someone who encouraged people to eat something which contains good bacteria to stay healthy? No, they replaced the word with probiotics; you know, to avoid stigma. Is it a form of stigma? Yeah, I consider something which usually been associated with bad things, a stigma as it is not fair for the bacteria. A large portion of them, aid us, to maximise our health benefits and some are presumed to be a great factor in longevity. Even the definition which is given by the World Health Organisation (WHO) regarding probiotics is indicative of its benefits to enrich our life:

Probiotics are live organisms which when administered in adequate amounts confer a health benefit on the host

Probiotic is actually a subgroup of living microorganism which exerts a certain beneficial effect on the body if they were given in an adequate amount. We have another subgroup which consists of some element that could stimulate bacterial activities called the prebiotics and if both of them are combined, they were called the synbiotics. I would guess that the majority of you (if not all) are quite familiar with antibiotics? They opposed the action of either a huge population of bacteria or only to a selected few. Antibiotic is a group of drug which needs to be taken when we were having bacterial infections as they work in a few ways to disable bacterial activity hence eliminate them. They were discovered by Alexander Flemming (accidentally if I must say) and it has revolutionised the field of medicine ever since.

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The benefits conferred by probiotics towards longevity and preventing certain diseases are noted first among people of Eastern European who live longer than the average population by simply consuming fermented milk on a daily basis; credit goes to the Lactic Acid Bacteria (LAB) for that. In a normal condition, when we were eating some foods, some part of the digestive processes were aided by a cocktail of bacteria which usually produced byproducts which can be considered toxic to the human's colon. This situation contributes to ageing and by consuming related probiotics (like the LAB) can produce a protective coating of the colon which would suppress the toxic effect brought by the proteolytic bacteria. This hypothesis was pointed out by Ilya Metchnikoff which received a Nobel prize for his contribution to the field of immunology.

As research protocol is not quite standardized back in the 1890s, Metchnikoff conducted self-experimentation with a few other subjects while jotting down some of the benefits contributed by a bacterium called Bulgaria bacillus. It was also worth noting that, enterocolitis was quite common among soldiers during the World War 1. Among the other, they were a few soldiers who seem protected from enterocolitis so to satisfy scientific curiosity, Alfred Nissle obtained a few stool samples and analysed them. He realised that there were a few E. coli (different strain) which could have protected them from enterocolitis hence the discovery of the probiotic E. coli Nissle which is still being used today.

If you want me to describe the microbiome in numbers, I would estimate them to be somewhat closer to or probably an exact trillion of bacteria which colonise our gut. Among them, only a handful can be cultured in the laboratory which makes it difficult for us to understand all kind of benefits that they might have potentially provided us with. It's reasonable to assume that there were hundreds of mechanism at play which could have contributed beneficial effects to various systems that would have led to its ultimate effect, longevity. According to a few research papers written by different authors, the mechanism of probiotics can be divided into 6 (for now):

• Modulation of GI immunity by altering inflammatory cytokine profiles and downregulating proinflammatory cascades or inducing regulatory mechanisms in a strain-specific manner;

• Displacement of gas-producing, bile salt-deconjugating bacterial species and thus possibly inhibiting pathogenic bacterial adherence;

• Alteration of bacterial flora by acidification of the colon by nutrient fermentation;

• Enhancement of epithelial barrier function;

• Induction of µ-opioid and cannabinoid receptors in intestinal epithelial cells;

• Reduction of visceral hypersensitivity, spinal afferent traffic, and stress response

Source

Probiotics, Antibiotic Resistance And Probiotic Resistance

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Antibiotic resistance has been an important medical complication for a very long time. Bacteria seem to know a trick or two in dealing with their worst enemy; they somehow mutated, probably due to the "survival of the fittest" thing. Talk about a superbug that might only respond to one kind of antibiotic which can be costly. There are a lot of things that we might have been in contact with on a daily basis which might have increased our chances of being infected by a resistant species of bacterium. Being in the hospital is one thing and eating the meat of a farm animal which has been overtreated with antibiotics is another. In between them, there are others like antibiotic overprescription, complications from certain surgery etc. Nevertheless, if we look at it in context of food items, even though the Food and Drug Administration (FDA) has a set of rules regarding treating animals with antibiotics, farmers seem smart enough to find a loophole, somewhere in the system for them to exploit the benefit of antibiotics towards dairy farm animals growth.

Farmers are struggling to raise a big fat dairy farm animal for a big chunk of cash. Back in the 1940s, they have been feeding those animals with any kind of foods which are rich in vitamin B12 that were speculated to be the main ingredient of making your animals bigger and healthier. It is however found later that feeding them with a specific kind of antibiotics can make them grow bigger in a shorter period of time. We are talking about making money in the most efficient way by investing in a product that can give you a more satisfying income. As a result, most of the dairy farm animals have been overtreated with antibiotics thus the era of the resistant species of bacteria start to unveil. When we are talking about the solution to this ongoing overprescribed antibiotics (in animals), probiotics have the potential to be one of the most efficient ways. I'm not talking about the potential of probiotics to replace antibiotics as they can never do like what antibiotics can but to prevent diseases from happening, that it does.

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Treatment failures due to being infected by resistant species of bacteria can be frustrating for both the clinician and the patient. Trial and error can take much patient's energy and wits and sometimes those frustrations can be channelled through either violation or unethical drugs/procedures "trial and error"; neither the doctor nor the patient knows what is the outcome of said, treatment. Although using probiotics to optimise the health of dairy farm animals can be somewhat relevant, without being properly monitored, antibiotic resistant can develop through an overused of probiotics though it is pretty rare. It would be great if eventually, probiotics become immune to a certain antibiotic which usually will provide them with some evolutionary advantage over the pathogenic species in surviving antibiotic treatment thus making it more efficient but the problem is, the same species of probiotics which turn pathogenic can use this to do more harm than good. One thing I've learned about probiotics is although they were resilient, sometimes, they are prone to run amok.

Whether or not probiotics would cause beneficial effects as intended by the user will depend on a multitude of factors. The most important one is whether the probiotic that we've been taking in would be able to colonise our gut as what we aim for. The only reference that we can use to analyse whether or not probiotics are potentially colonising our gut is by analysing stool sample. However, it is rather inaccurate as we can't be sure that all of the strain of probiotics we were eating could be shed in the stool. If they were, is it because they are shed as part of the gut physiological processes or whether they were unable to colonise the gut which subsequently causes them to be expelled in the stool. The latest study on the probiotics that examine 30 people, 15 people were taking probiotics while the other 15 were taking placebo has found that the probiotics were only effective in 40% of the subjects in the probiotics group. It's rather low and I would say quite unnecessary for the other 60% people but it worth the try. A few reasons have been proposed and would be included as variables in the future studies to be investigated.

On 6th September 2018, a paper was published in the Cellpress regarding a study which investigated the effect of probiotics on patients who underwent antibiotic treatment for a specified amount of duration. In theory, probiotics would have the capacity to repopulate the gut's microbiome after they were obliterated by broad-spectrum antibiotics or any kind which could have targetted the gut's bacteria population. It's pretty simple and not at all complicated. Well, unfortunately, life doesn't operate on that kind of principle. In the study which involved 21 healthy participants, it was found that instead of helping repopulate the gut's microbiome, probiotics have the potential of delaying it by a significant number of duration making the host susceptible to various kind of infection involving the guts. However, the author regretfully stated that they didn't consider the type of clinical outcome that the patient was going through. We should really look into all kind of possibility before we can start to expand the concept of probiotics could have actually caused more harm than good.

Baby Poops As Probiotics, Anyone?

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Although it kinda infamous, poop transplant also known as the faecal microbiota transplant (FMT) is a thing. It can alleviate quite a number of gastrointestinal symptoms and sure, provided some bacteria to the disease-ridden bowel of a patient by stimulating the production of a chemical fuel used by most of the fibre-digesting bacteria called the short-chain fatty acids (SCFA) that can optimise bowel health. Sure, it's kinda gross to think about how people would buy some products which are made up of baby poops and all but if they can be extracted and materialise into supplements that could actually work, then why not? Since baby's poop are relatively free from any problems related to ages, they can be considered safe and much efficient to be used. One of the most dangerous kind of pathogenic bacteria that you can catch while staying in the hospital is Clostridium difficile. This particular bacterium can cause severe diarrhoea if they started to colonise the gut as a consequence of antibiotics overtreatment.

Although the theory seems quite sound, I would say that more studies should be conducted before we can start to harvest baby's poop for probiotics extraction; I suddenly imagine how's the world would go by seeing people selling their own children's poops. For now, most of the tests were conducted among mice but the effect of this FMT is quite potent. Even in its most dilute concentration, we can expect to see a significant rise in gut microbiome of the recipient. It's elegant and dirty at the same time.

Sources

• Why Probiotics May Not Always Help, And Could Actually Do Harm
• Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045285/
• Addressing the Antibiotic Resistance Problem with Probiotics: Reducing the Risk of Its Double-Edged Sword Effect
• Will Baby Poop Bacteria Become the New Probiotic?

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