Berks County Medical Society Medical Record Fall 2018 - 35

M e d i c a l R e c o R d F e at u R e

The World
Inside Us
by Aparna Mele, M.D.

I

ntestinal health is the optimal digestion, absorption and
assimilation of food. Gut health is critical to overall health,
and the crucial element in our digestive and global health
is in the microorganisms living in our gut. The true diversity of
these microorganisms that inhabit the gastrointestinal tract of
humans (collectively referred to as the human gut microbiota) is
being discovered, and there has been increased appreciation of its
contributions to both homeostasis in health and pathogenesis of
disease. Consequently, the study of gut ecology has emerged as one
of the most active and exciting fields in biology and medicine.
Gut flora are microorganisms that live in our digestive tracts
and are the largest reservoir of human flora. They ferment
undigested unused carbohydrates, which produces short chain
fatty acids, energy substrates absorbed into the bloodstream.
Intestinal bacteria also synthesize essential vitamins and metabolize
bile acids and sterols. The bacteria that colonize our digestive
tract are essential for life. We are dependent on these bacteria
to help digest our food, produce certain vitamins, regulate our
immune system, and keep us healthy by protecting us against
disease-causing bacteria. There are 100 trillion microorganisms
in the digestive tract. The metabolic activities performed by these
bacteria resemble those of an organ, leading some to call our gut
bacteria a "forgotten" organ. Like a fingerprint, each person's
microbiota is unique: The mix of bacteria in your body is different
from everyone else's mix. It's determined partly by your mother's
microbiota-the environment that you're exposed to at birth-
and partly from your diet and lifestyle.
Research suggests that the relationship between intestinal
microbiota and humans is symbiotic, as these microorganisms
perform many important roles in promoting normal
gastrointestinal function, regulating metabolism, and
comprising 75% of our immune systems. Because
of the immense diversity of the microbiota,
interpersonal variation and temporal
fluctuations in composition, especially during

disease and early development, there has been enormous interest
in studying factors related to their dysregulation. In fact, it
is their dysregulation that can contribute to many diseases,
including allergies, colon cancer, inflammatory bowel disease, and
infection. There are many causes of dysregulation of these enteric
bacteria, including nonsteroidal anti-inflammatories, antibiotics,
chronic stress, prolonged illness, diets that are high in refined
carbohydrates, sugars and processed foods, and low in fermentable
fibers.
At birth, the intestinal tract is sterile. The infant's gut is
then colonized by maternal and environmental bacteria during
birth and continues to be populated through feeding and other
exposures and contacts. Factors known to influence colonization
include gestational age, mode of delivery, diet, level of sanitation,
and exposure to antibiotics. Without this microbial exposure,
adaptive immunity would not exist. This is a vital defensive
mechanism that learns how to respond to microbes after
encountering them. This allows for a quicker and more effective
response to disease-causing organisms. This period of maturation
of the intestinal flora may be critical, as there is accumulating
evidence that disruption of the microbiota in early infancy may be
a critical determinant of disease expression later in life. Rodents
that are completely clean of microorganisms show a range of
pathological effects, and an underdeveloped immune system
is among them. The microbiota also relates to autoimmune
conditions and allergies, which can be more likely to develop when
exposure to microbes is disturbed early on.
Microbial populations in the gastrointestinal system have
provided insights into disease conditions. Differences in fecal
microbial community diversity, composition and function has
been linked to everything from acne and asthma to
inflammatory bowel disease and type 2 diabetes.
In recent studies, scientists have found that
they are also linked with obesity. Animal
studies found that transplanting feces from
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FALL 2018

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Berks County Medical Society Medical Record Fall 2018

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