The Brain in the Gut: The Microbiota

The microbiota is the internal ecosystem of our body. Assoc. Dr. We talked to Emel Uzunoğlu about how the microbiota determines the quality of vital processes such as chronic diseases, metabolism, psychology and the immune system.

Can we call one cause and another an effect in the relationship between microbiota disorder and diabetes?

Our microbiota plays a very important role in maintaining our energy balance. We call dysbiosis the deterioration of the microbiota composition and the dominance of putrefactive bacteria. Dysbiosis plays a role in the development and aggravation of some chronic diseases. Studies to date have not yet conclusively shown that these changes in our microbiota lead to diabetes. Classical medical textbooks still refer to diabetes as a multifactorial disease in which genetic and environmental factors play a role, especially high-fat and high-energy diets. Of course, the importance of our genetic heritage is undeniable, but in many clinical situations, our genes do not have the last word. Today, we know very clearly that intestinal dysbiosis begins long before the development of insulin deficiency seen in Type 1 diabetes, and with weight gain for Type 2 diabetes, before Type 2 diabetes develops. The results of all the studies carried out are in this direction. However, it is still not clear whether our genetic potential causes dysbiosis or whether dysbiosis causes our genes to be activated.

Does a less diverse microbiota mean a higher risk of diabetes?

Speaking of diversity, the types of microorganisms that make up that diversity are also very important, but overall less diverse microbiota means we are prone to many diseases, including diabetes. Microbial diversity is an indicator of health.

Can balancing the health of the gut microbiota prevent someone with hidden sugar from becoming diabetic?

The father of medicine, Hippocrates, said centuries ago, “All diseases begin in the gut”. Unfortunately, we are only just beginning to understand the value of this word. Microbiota in our body; It is found in many localizations such as the skin, eyes, vagina, mouth, but the organ that contains the most microorganisms is our intestines. When our intestines are healthy, especially the development of Type 2 diabetes is prevented. Because when we talk about gut health, we don't really talk about guts alone. Intestinal health; It is possible with a healthy functioning digestive system, nervous system, liver and hormonal balance. The treatment of all these systems begins with the modulation of the intestinal microbiota. Because the gut microbiota; It is effective in many points from energy balance to appetite control, from our ability to cope with stress to our sleep pattern.

What is the connection between the vagus nerve and diabetes?

The vagus nerve is the longest cranial nerve in our body.  BIt starts from the blood and branches to vital organs such as the pancreas, stomach, liver and intestines. It is the communication pathway between the central nervous system and the intestines. This communication is bidirectional and is called the gut-brain axis. All kinds of chronic stress or mood disorders can affect the intestines through the vagus nerve, and dysbiosis in the microbiota affects the central nervous system and leads to clinical conditions such as anxiety, depression and diabetes. 

Enteroendocrine cells in the intestines communicate with microorganisms and secrete 500 times more melatonin than the brain, more than 90% of the serotonin we need. Sleep disorders and the weakness in our ability to cope with stress unfortunately bring along eating problems. In addition, hormones released from enteroendocrine cells in the intestines through short-chain fatty acids synthesized by microbiota elements; It also protects against the development of obesity and diabetes by controlling appetite, insulin and glucagon release, regulation of blood sugar, satiety directly or indirectly via the vagus nerve.

vagus nerve parasympathetic border is the most important member of the system. A healthy parasympathetic system is necessary for a healthy digestive system. The sympathetic system in the body exists and is necessary for self-protection in times of threat. However, a body that constantly perceives threat is constantly under the influence of an active sympathetic system and high cortisol levels. This situation both causes digestive problems and complicates the regulation of blood sugar. I think that breathing exercises and meditation practices that allow us to stay in the parasympathetic system, and the use of psychobiotics, a subgroup of probiotics to be selected individually, in diabetes are very important in balancing our nervous system, lowering cortisol and providing our insulin balance, and intestinal restoration. 

What can we say about the gluten-free diet in the context of diabetes and gut health?

The coexistence of Type 1 diabetes and Celiac is very common. HLA DR4-DQ8, a biomarker for Celiac, can be detected in almost half of the cases. Celiac cases have to be fed gluten-free and unfortunately the only treatment with proven effectiveness is gluten-free, which will be applied for life.  diet. However, in these cases where Celiac and Diabetes are seen together, or when the microbiota is examined in cases with Celiac disease only, the results obtained are not bright at all. Because when you have to eat gluten-poor diet, you remove very important carbohydrate sources from your diet. There is a high use of carbohydrates and fats in gluten-free packaged foods consumed as a substitute. This negatively affects health. If what we mean by gluten-free diet is to replace gluten-containing foods with alternative cereals and to preserve fiber intake, the results are very pleasing; diversity increases, the ongoing inflammation in the body is suppressed.

Can prebiotics and probiotics lower high blood sugar, what should diabetic patients pay attention to when using them?

Probiotics are defined as live microorganisms that have positive effects on human health when taken in sufficient quantities. With the intake of probiotics in diabetics, a significant improvement can be achieved in fasting blood sugar, HbA1C levels, and insulin resistance. However, it is not appropriate to do this treatment on one's own. The most ideal is to select the appropriate probiotic according to the result of the microbiota test to be performed and to use it under the control of a health professional. Because each type of probiotic bacteria is used for different treatments. For example, some bacteria help leptin hormone and suppress appetite, some bacteria cause an increase in appetite. In addition, people with diabetes are people whose immune systems are partially suppressed. Probiotics should be carefully observed for unexpected side effects. 

Prebiotics, on the other hand, with a very simple definition, are the foods consumed by the bacteria in our gut.  There are also publications in the literature that have achieved successful results in diabetes using only prebiotics without using any probiotics, but the results are more successful when probiotics and prebiotics are used together.

How is the gut microbiota affected in obesity or underweight? 

First of all, in both cases, the diversity decreases and the bacteria that make up the microbiota composition change.

When faecal microbiota was transplanted from obese individuals to normal-weight germ-free mice without microorganisms, it was observed that obesity also developed in normal mice. It has been determined that the gut microbiota in obese individuals obtains 150 kcal of additional energy per day from dietary fiber alone. 

If the cause of obesity is an excessive fat and calorie diet, the bacteria of the Firmicutes branch, which are microorganisms that help fat digestion, become dominant in number, while the cause of thinness is "'" which accelerates our metabolism when very low calorie diets. Akkermansia muciniphilaThe number of microorganisms such as '' is decreasing and sometimes even completely lost.

How can people with high blood sugar guide their diets by getting a microbiome test?

Microbiome tests are an important indicator of what foods you eat in your diet, the variety of microorganisms in your gut, and which types of microorganisms that will affect your health.  indicator. In fact, for some diseases, they are very important and special tests that can be done for control purposes in order to detect biomarkers before the disease begins. Bacterial balance in the gut in diabetes is very different when compared to healthy individuals. This brings along many complaints such as gas, diarrhea, bloating, and difficulty in controlling appetite. If an individual evaluation is made, very valuable information is obtained and a long way is covered. In the follow-ups, you can easily monitor the increase in your microbiota, intestinal permeability and beneficial battery composition. In addition, we observe positive changes in appetite control, fasting blood sugar levels, HbA1c levels and mood of the person with the probiotics selected according to the test results.

What foods do you have to include in your diet for your microbiota health?

I also have relatives with diabetes in my family. Thirty four  on my right leg  I am struggling with existing lymphedema.  For this reason, for many years, I had to take care of my microbiota health and change my diet, not only scientifically, but also individually. All studies show that the Mediterranean Type Diet is the most ideal for our microbiota health. I also make sure that three-quarters of my plate consists of colorful vegetables and fruits, and one-fourth of it consists of protein. Fiber-rich foods increase microbial diversity. Microorganisms produce short-chain fatty acids, which are very important for our health, from carbohydrates that are resistant to digestion, so I especially take care to consume legumes as a carbohydrate source in small portions. I especially include prebiotic-containing foods such as dandelion, banana, onion, garlic, red beet, leek, broccoli, artichoke, radish, because without prebiotics, many beneficial microorganisms, including probiotics, cannot settle and multiply in our gut. Fermented foods are not probiotic because the bacteria they contain are unstable to stomach and bile acids, but they have numerous health benefits. They contain many beneficial molecules produced by body-friendly bacteria.  I prepare and consume these myself at home. I try to stay away from packaged foods, refined sugar, sweeteners and bakery products. These are some of the things I do in my daily life, but nutrition is actually a form of treatment for the individual, the foods that should be consumed and prohibited vary from person to person. Because the genetic heritage of all of us, the microbiota we brought from our ancestors, are as different from each other as our fingerprints.

How does our microbiota interact with antidiabetic drugs?

Unfortunately, a perception has begun to develop in society that the drugs used by classical medicine until today are harmful. This is not the right perspective. Scientific studies already support this.  Studies with some of the drugs used in diabetes Akkermansia muciniphila, Faecalibacterium praustnitzii It gives results that increase the bacteria that are beneficial in the intestinal microbiota, such as  Moreover, these bacteria do not have a form produced as a probiotic. So you can't outsource it. For this reason, it should be kept in mind that in the treatment of diabetes, the best results are obtained when medical treatments, nutritional strategies that will restore the health of the gut microbiota, probiotics and other nutritional supplements are carried out in synergy by the experts of the subject.

Assoc. Dr. Emel Uzunoglu - Medical Microbiology Specialist

Giresun University Faculty of Medicine, Department of Medical Microbiology.

Assoc. Dr. Emel Uzunoğlu completed her Medical Faculty at Karadeniz Technical University Faculty of Medicine and her Medical Microbiology Specialization Training at Ankara University Faculty of Medicine. He worked on the biofilm formed by yeast fungi and bacteria at Hacettepe University Biomedical Engineering and Stevens Institute of Technology in the USA. He taught Medical Microbiology and Immunology at the undergraduate and postgraduate level at Cyprus Eastern Mediterranean University, Faculty of Pharmacy, Stevens Institute of Technology. Currently; He continues his education at the Molecular Medicine Doctorate Program at Samsun Ondokuz Mayıs University and at the American Institute of Functional Medicine Functional Medicine Platform and works as a lecturer at Giresun University Faculty of Medicine, where he was appointed for compulsory service. Nurigenomics, Microbiota, Outbreak analysis, Rare microorganisms and Antibiotic Resistance are among his research topics. He has scientific articles published in domestic and foreign journals on these subjects.

He is a member of the European Society of Clinical Microbiology and Infectious Disease, Turkish Microbiology Society, Clinical Microbiology Specialization Association, Turkish Medical Microbiology Competence Board, National Board Examination Committee.





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