Monday, January 22, 2007

Probiotics, stress and the war on terrorism in the gut

Though it is a rat study I hated during my gastroenterology training, I love a new article by Zareie et al from Toronto published in Gut. Though the link of stress to gut inflammation and bowel diseases is still debated or ignored by many doctors these researchers found probiotics prevented intestinal abnormalities from stress in rats. Their introduction is refreshing as they write “the influence of chronic stress on intestinal dysfunction and clinical outcome of chronic intestinal disorders is recognised…stress is an important risk factor for both development and the reactivation of intestinal inflammation in chronic inflammatory bowel diseases (IBD).”

There are “genetically susceptible rodent models” in whom “chronic psychological stress induces mucosal dysfunction via increased epithelial ion secretion and permeability, enhancing binding of luminal antigens…and initiation of mucosal inflammation.” In other words, rats that are water stressed develop a leaky gut that allows bacteria through the bowel wall (bacterial translocation) that results in intestinal inflammation. This is an accepted inflammatory bowel disease model. However, rats given probiotics consisting of two strains of Lactobacilli bacteria did not experience bacterial translocation effects or bacteria reaching the surrounding lymph nodes.

Though they did not demonstrate elimination of intestinal permeability with the pre-treatment with probiotics, markers of gut barrier dysfunction were improved. Since only two strains of Lactobacilli were used there may have been less of a protective effect of the probiotics because different strains of bacteria (and yeast) produce different beneficial effects on the gut.

Most doctors are skeptical that stress, altered gut flora and food proteins are central to development of gut injury. They rely instead on medications to treat the symptoms and gut inflammation that is already well established. Most of the time this is not particularly effective but instead is often too late to prevent one or more secondary autoimmune diseases. It is possible if not probable that much of this is preventable by dietary changes and probiotics. Does anyone else find the lack of awareness or acceptance of the war on terrorism in our gut frustrating. Is it because someone is waiting for a political solution? It is time to start employng the weapons we have in this battle rather than allow altered gut microorganisms and genetically altered food proteins win.

Reference: Probiotics prevent bacterial translocation and improve barrier function in rats following chronic psychological stress. Zariee, M. et al Gut 206;55:1553-1560.

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