Intestinal bacteria/ intestinal health
= microscopically small organisms
Microorganisms are the smallest living beings comprising of either single cells or an aggregation (cluster) of cells. These include bacteria, archaea, many fungi including yeast (yeast fungus), algae and single-cell organisms (protozoa). Viruses aren't made up of cells but are usually included in the definition of microorganisms because of their size. .
According to current science, life is divided into 3 fundamental taxa - bacteria, archaea and eukaryotes. As neither archaea nor bacteria have a cell nucleus, they are summarised under the term prokaryote.
Bacteria were first discovered in water and human saliva back in 1676 by Antoni van Leeuwenhoek with the help of a self-made microscope. These bacteria are single-cell microbes (0,1 – 700µm diameter) that multiply through cell division and have no cell nucleus - the genetic material lies freely within the cell's interior (cytoplasm). Bacteria are categorised by their shape (rod-shaped = bacilli; spherical, round = cocci), their affinity towards oxygen (aerobic = bacteria that use oxygen;
anaerobic = bacteria that can live without oxygen), their mechanism of movement, and their taxonomy (branches/fractions). They can be found everywhere but only a small percentage of all bacteria can cause diseases in humans (= pathogenic bacteria). Good (=commensal) bacteria inhabit the entire human body, including the intestines, where they boost digestion. .
Eukaryotes are living organisms with a cell nucleus - these include protozoa, algae, plants, animals and even humans. Eukaryotic cells usually have a diameter of 10 to 30µm and are much bigger than prokaryotes. So that all cellular processes run smoothly a higher level of organisation, a separation of the cellular space into compartments (separated areas), and an adequate transport between said compartments are needed. This is why eukaryotic cells are structured into cell organelles that each have their own function like the organs in the human body.
Medically speaking, a virus is an infectious particle that consists of a strain of genetic material and a protein shell. Viruses are tiny with a diameter of 20-300 nm, which is why they can only be seen with an electron microscope. Unlike bacteria, viruses aren't cells and don't have their own metabolism or energy production - technically speaking, viruses aren't even living organisms.
Bacteria that don't need molecular oxygen to survive are called anaerobic. These can be divided further into:
- obligate anaerobes: Bacteria that can only grow in oxygen-free environments. Oxygen is harmful to them.
- aerotolerant anaerobes: Bacteria that don't need oxygen to survive. However, they do tolerate it and can survive in the presence of oxygen.
- facultative anaerobes: Bacteria that can completely survive without oxygen but use it when available.
= The entirety of all microorganisms that inhabit the intestines of humans and animals.
An eubiosis describes the balance between the living microorganisms in the human intestines.
The intestinal lumen is the interior of the intestines and usually filled with food pulp or stool. The intestinal lumen can be larger or smaller depending on the peristaltic movements of the bowels.
Epithelial cells form the single-cell layer of our intestinal barrier. The apical side, i.e. the side facing the interior of the intestine, has a brush border of microvilli. These microscopically small bristle-like structures are responsible for the enormous surface of the intestines (400-500 m2).
The intestinal barrier is the protective shield of our intestines and prevents harmful substances, such as pathogens or poisons, from entering our bodies.
The intestinal barrier is made up of 3 layers:
- Intestinal flora - this is the layer that faces the interior of the intestines. The "good" bacteria are responsible for creating a balanced environment and prevent "bad" (pathogenic) germs from settling down.
- Intestinal epithelium - is a single layer of epithelial cells. The intestinal epithelium is intact if every epithelial cell is tightly connected to its neighbouring cell via protein molecules (Tigh Junction Proteins).
- Intestinal immune system - this layer contains the defence cells of the immune system.
Tight Junctions are cell connections between neighbouring intestinal epithelial cells and form a barrier that prevents the diffusion of substances between cells. If these Tight Junctions break apart, pathogens, poisons, etc., can enter the bloodstream.
The mucous produced by the intestinal mucosa lies above the epithelial cell layer. This mucous forms a protective shield against harmful hazards within the intestinal lumen, increases the lubricity and hydrates the mucosal surface.
These are fatty acids with a maximum capacity of 6 carbon atoms. Commensal bacteria produce SCFA's such as butyrate, acetate and propionate out of, for example, fibres in the colon.
Microorganisms are very adaptable and can multiply quickly. Under certain circumstances, they can spontaneously change or adapt their genetic material and pass it on to the next generation. This is how bacteria can become resistant to antibiotics. In other words, bacteria aren't killed, and their growth isn't thwarted by the antibiotic - the antibiotic has lost its efficacy.
Common causes for the development of antibiotic resistances are the sloppy and untargeted use as well as an excessive and incorrect (e.g. if the antibiotic isn't taken for the full duration of treatment) intake of antibiotics.
The term "Leaky Gut" refers to nothing else, other than a "permeable intestine". If the intestinal barrier is intact, the individual epithelial cells in the intestines are tightly linked through cellular connections (Tight Junctions) and therefore create an unbroken barrier against pathogens and toxins.
In the case of a "Leaky Gut" syndrome, these cellular connections break apart. As a result, the barrier function disappears and harmful substances can enter the bloodstream unhindered. The immune system reacts with inflammatory and allergic processes. The causes of a "Leaky Gut" include factors such as stress, an unhealthy diet, infections and the frequent intake of antibiotics.
Zonulin is a marker protein for the detection of increased intestinal permeability = Leaky Gut. It can be detected in the blood as well as the stool. Elevated zonulin values point towards an increased intestinal permeability.
Calprotectin is a marker for inflammation in the intestinal mucosa. The calprotectin concentration is measured in the stool and correlates with the number of granulocytes (belong to the group of the white blood cells) in the interior of the intestines. Elevated calprotectin levels point towards an inflammatory process in the intestines.
Alpha-1 antitrypsin measured in the stool is a marker for an ongoing inflammation. It is a protein that forms a reversible complex with active inflammatory cells and prevents neighbouring healthy tissue from being attacked over the course of the inflammation. Alpha-1 antitrypsin values are especially high in cases of ulcerative colitis or Crohn's disease.
Faecalibacterium prausnitzii is a gram-negative bacteria that makes about 5% of the total number of bacteria found in the human intestines and is one of the most common representatives of anaerobic (survive without oxygen) intestinal bacteria. Since F. prausnitzii produces the short-chain fatty acid butyrate, it is one of the most important energy providers for the cells in the intestinal mucosa. Furthermore, F. prausnitzii releases anti-inflammatory substances that directly have a positive impact on the human organism.
Akkermansia muciniphila is a gram-negative, strictly anaerobic bacteria. A. muciniphila is closely associated with the mucosa of the colon. This bacteria is responsible for the production of highly viscous mucous. This layer of mucous strengthens the intestinal barrier so that foreign germs and harmful substances can't pass through the intestinal mucosa and enter the bloodstream.
Enterotoxins are poisons produced by microorganisms. These toxins attack the intestines and often cause food poisoning with a subsequent inflammation in the stomach and intestinal mucosa. Enterotoxins are responsible for the symptoms in diseases such as cholera, traveller's diarrhoea and dysentery.
Lipopolysaccharides, short LPS, are made of polysaccharides connected to lipids. Lipopolysaccharides can be found on the cell walls of gram-negative bacteria and are released when the bacteria die. The immune system reacts as though they are antigens, and can cause inflammation, among others. If the intestinal barrier is damaged, i.e. porous, lipopolysaccharides can enter the bloodstream and cause damage in various parts of the body.
CFU/g = colony forming units per gram
This abbreviation can be found in stool results as well as in connection with medically relevant probiotics. It is the measurement unit for the number of bacteria.
For example, 5 x 10^9 CFU/g re probiotics = One sachet of probiotics contains 5 billion bacteria per gram.
To create a favourable environment for commensal (=good) bacteria to live in. This environment optimisation can be supported and promoted through the intake of probiotic bacteria.
A probiotic contains living bacteria that can improve the health of humans if the right amount reaches the intestines.
As such, probiotics are defined by the following requirements:
- A proven health-promoting effect
- Can survive the passage through the stomach and multiply in the intestines
- Proven genetic stability to avoid pathogenic mutations
- Production of lactic acid and other protective substances
The addition of living, probiotic intestinal bacteria strengthen the preexisting "good" intestinal bacteria and can support the balance of the intestinal flora together with a healthy diet, plenty of exercise and stress avoidance.
Synbiotics are a combination of probiotics and prebiotics. Because of the various positive interactions between prebiotics and probiotics with the intestinal flora and the intestinal immune system, this combination is highly recommended. They usually contain one or several bacteria strains, in combination with the ideal substrates, the prebiotics. Prebiotics act as a protection and growing medium for probiotic bacteria against the stomach and bile acids when they pass through the digestive tract and enable the optimal colonisation of the intestines.
A matrix is a combination of prebiotic substances, physiological salts and enzymes that can be found in a sachet with the bacteria. The matrix is supposed to support the activation time of the bacteria as best as possible and strengthen them on their journey through the stomach.
Toxins are substances that are produced by biological organisms (plants, fungi, animals, etc.) and harm other organisms, such as humans, by disturbing their physiological metabolic pathways.
Toxins can lead to acute and chronic poisonings and other diseases.
Fibres are indigestible carbohydrates that are mainly found in plants. They are the food and energy source for the intestinal bacteria and are indispensable in a healthy diet.
Important is the difference between soluble and insoluble fibres. Soluble fibres come from fruit and vegetables. They swell in the stomach and intestines, creating a feeling of satiety and positively influence the intestinal flora in the colon. Insoluble fibres, on the other hand, are found in grains and legumes. They stimulate the intestinal peristaltic (muscle activity) and counteract constipation.
Fructooligosaccharides (FOS) belong to the category of fructans and are naturally found in chicory roots, topinambur, several varieties of grains, as well as artichokes, onions and garlic. Since the human body does not have the enzymes to break down FOS, they are classified as indigestible food components and are only metabolised by the bacteria in the colon. FOS are a type of fibre.
Pectin is the main component in the cell walls of plants and fruits, and belong to the soluble, viscous fibres. Pectin is often associated with "weight-loss" because of its swelling and stabilising properties. By swelling in the stomach, it creates a feeling of fullness - leading to a possible reduced intake of food and weight-loss.
Since the 1950s, the seeds of the guar plant were used to make guar gum in India and Pakistan and is often used as a food additive. Nowadays, guar gum is one of the most promising fibres on the market. Due to its partially hydrolysed form, the white guar gum powder dissolved completely in water without changing its consistency. Furthermore, guar gum has no taste and is the perfect additive to water, yoghurts and soups. Once it reaches the intestines, it supports the production of short-chain fatty acids, which, in turn, stimulate the growth of lactobacilli and bifidobacteria. Ultimately, it improves the health of the host.
Glucomannan is extracted from the bulb of the so-called konjac root and has always been used in Traditional Chinese Medicine (TCM) because of its health-promoting effects. Konjac-glucomannan only contains small amounts of proteins and vitamins yet is rich in fibres (which is why it makes such an excellent prebiotic). In comparison to other prebiotic substances, glucomannan has an enormous water-binding capacity.
Progression is used to describe the progression of a disease or the deterioration of the patient's wellbeing.
The endoplasmic reticulum (ER) is a cell organelle found in the cytosol of eukaryotes and has a tubular, labyrinth-like structure.
Endo = inside; plasmatic = cell plasma/cytoplasm; reticulum = net
The ER is responsible for synthesis and storage within the cell.
Comorbidity is another word for accompanying diseases - in other words, a further medically diagnosed disease, that occurs at the same time as the primary disease.
A placebo is a control substance in clinical studies. The placebo has to have the exact same form of delivery as the tested drug, it just doesn't have any active ingredients.
Randomised refers to the type of study. Randomisation is the division of test subjects in different groups by using a random generator.
Double-blind/blinded refers to the type of study. In a double-blind study, neither the involved professionals nor the test subjects know who belongs to the experimental group and who to the control group.
An observational study is a non-interventional study within medical research. It enables scientists to gather new findings of a product that's already on the market.
The immune system is the biological defence system of the human body. It destroys microorganisms that enter our bodies, foreign substances and degenerate (damaged) cells.
An autoimmune disease is a dysfunction of the immune system in which healthy, endogenous structures - cells and organs -. are attacked. This leads to a plethora of diseases such as chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis), type-1 diabetes, multiple sclerosis and so on. In many cases, autoimmune diseases, which aren't infectious, are hereditary. The exact cause of these diseases is still unknown.
Dendritic cells belong to the defence cells of the immune system. They originate from monocytes (= a subtype of white blood cells) and can be found all over the body - especially in the gastrointestinal tract, the lungs and mucosa throughout the body.
Antigens are substances that the body recognises as foreign and triggers the formation of so-called antibodies after first contact. Typical antigens are proteins that are found on the surfaces of bacteria. Toxins, viruses and foreign blood cells can also act as antigens.
Antibodies (= immunoglobulins) are protein molecules from the family of globulins that are produced as a reaction towards foreign substances (= antigens). They are a part of the immune system and protect us against pathogens and other foreign substances. In modern medicine, antibodies are mainly used in vaccines to prevent certain diseases.
Macrophages are large, mononuclear cells of the immune system and belong to the white blood cells as so-called scavenger cells. As an important component of the immune system, they are responsible for the annihilation of invading pathogens such as bacteria, viruses and toxins.
The production of macrophages begins in the bone marrow, where the precursor cells, monocytes, are formed from stem cells. Once the monocytes reach the circulation, they differentiate into macrophages once they come into contact with cytokines - mature macrophages have a lifespan of 30-90 days.
Cytokines are messenger substances that are produced by the immune system. Cytokines trigger the differentiation and activation of the defence cells in the immune system, e.g. the differentiation of monocytes to active macrophages (= scavenger cells).
Phagocytosis is the absorption (= devouring) of small particles by certain cells - macrophages, granulocytes and dendritic cells are all capable of phagocytosis. As a part of the immune system, macrophages devour invading pathogens. Furthermore, phagocytes also eat endogenous cells that are irreversibly damaged as a part of apoptosis.
Apoptosis is the self-induced death of a cell by eukaryotic organisms. This controlled cell death is inevitable for the development and function of an organism. This allows degenerate and potentially harmful cells to be eliminated, and also controls the number of cells and, therefore, the size of tissue in the body.
Neopterin is a messenger substance that is produced by endogenous cells (macrophages). Neopterin acts as an indicator for the activation of cellular defences and provides evidence for ongoing pathogenic processes in the body.
Triglycerides are dietary fats and are among the most important energy stores in the body. Triglycerides in the blood originate from food as well as the fat metabolism and can be measured medically through blood analysis. Increased triglyceride levels could be caused by a fat metabolism dysfunction or diseases such as hypothyroidism. Especially in combination with increased cholesterol levels, elevated triglyceride levels are a cardiovascular risk factor.
Adiponectin is a tissue hormone that is released by the fat cells (adipocytes) and comes in many different forms. They all have a different effect on lipid and glucose metabolism. The defective regulation of this hormone appears to play an important role in the development of the metabolic syndrome.
Interleukin-6 (IL-6) belongs to the interleukins that regulate inflammatory processes within the body. IL-6 is an inflammatory marker that is released by white blood cells at the site of infection.
Interleukin-10 is a cytokine (regulatory protein) from the family of the interleukins. It has an immunomodulating effect and plays a decisive role in restricting and suspending inflammatory processes within the human body.
IL-10 is anti-inflammatory.
Immune cells are cells within the immune system. Generally speaking, they all derive from blood stem cells and can be roughly divided into two groups: the innate and adaptive immune response. Once the cells are produced in the bone marrow, they circulate in the blood and eventually wander into the tissue. Here, they act as a sentinel and transform into further subspecies.
Leucocytes, or white blood cells, belong to the family of blood cells that can have many different functions within the human immune system. These cells are roughly divided into 3 groups: the granulocytes, lymphocytes and monocytes.
Granulocytes make up the majority of the white blood cells and play a role in the cellular immune response.
Once activated, granulocytes attack pathogens and make them harmless. During infections, poisonings and allergies, the number of granulocytes increases rapidly.
Lymphocytes are a subgroup of white blood cells. Their main responsibility is the targeted defence against pathogens and altered endogenous cells, e.g. tumour cells.
Monocytes belong to the family of the leucocytes and circulate in the blood. Once they leave the blood and enter the tissue, they transform into macrophages, so-called scavenger cells.
The stomach acts as the first repository for consumed food. Here, the food is mixed, soaked in gastric juices and broken down by enzymes. The gastric juice is produced by glands in the gastric mucosa. The gastric mucosa is the part of the stomach that faces the food bolus and is covered by a protective layer of mucous. This thin lining protects the stomach from the aggressive gastric acid and, as a result, from digesting itself. Various factors (stress, drugs, alcohol, etc.) can attack this protective layer and lead to an overproduction of gastric acid.
One of the possible consequences of this is gastritis an inflammation of the gastric mucosa. This inflammation can either appear suddenly and disappear just as quickly or develop slowly and cause prolonged complaints.
One of the possible consequences of this is gastritis - an inflammation of the gastric mucosa. This inflammation can either appear suddenly and disappear just as quickly or develop slowly and cause prolonged complaints. Acute or sudden gastritis can be caused by many different factors - some of the most common being the excessive intake of nicotine and alcohol, the intake of painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), massive stress or shock. In such cases, acute gastritis presents itself with strong upper abdominal pain, loss of appetite, vomiting and bloatedness.
Type-A-Gastritis is also known as autoimmune, chronic gastritis and is responsible for 5% of all chronic gastric mucosa inflammations. Here, the parietal cells (cells that produce gastric acid) are attacked and consequently, less gastric acid is produced.
About 80% of all chronic types of gastritis belong to type B. Generally, they are caused by the bacterium Helicobacter pylori which can be passed on by saliva or faeces. This pathogenic germ can survive in the acidic environment of the stomach for a short amount of time and attach itself to the mucosal cells of the stomach where there is almost a neutral environment.
About 15% of all chronic gastric mucosa inflammations are type C and are caused by the chemical irritation (drugs, mainly painkillers) of the stomach.
The colon is a section of the large intestines that can be found between the appendix and the rectum. The colon forms a sort of frame around the small intestines and is divided into 3 segments:
- the ascending segment: Colon ascendens
- the horizontal segment: Colon transversum
- the descending segment Colon descendens
Diverticulitis is a disease of the large intestine in which small, sac-like protrusions form in the mucous membrane of the large intestine, known as diverticula. Diverticula are more common in older people and are usually harmless and do not cause any discomfort. However, if these diverticula become inflamed, this is called diverticulitis.
SIBO = small intestinal bacterial overgrowth
SIBO is the flawed colonisation if the small intestines. Usually, the small intestines are only home to a very small number of bacteria - the majority of our intestinal bacteria can be found in the large intestines. The ileocaecal valve separates both of these areas and only opens towards the large intestines. This prevents large intestinal bacteria from entering the small intestines. Nevertheless, SIBO is characterised by the ascension of bacteria. Some of the causes include chronic inflammatory bowel diseases, a defect of the ileocaecal valve, food intolerances, antibiotics, etc.
As a result, the bacteria in the small intestines feed off of food that is not absorbed, ferment carbohydrates and produce gases. Flatulence, burping, nausea, diarrhoea and constipation are the consequence.
Liver cirrhosis is the end-stage of liver damage where liver tissue is transformed into connective tissue. This prevents the liver from performing its functions, including metabolic tasks and detoxification with chronic liver failure being the final consequence. Typically, cirrhosis develops over a period of years or decades. In Europe, alcohol abuse, non-alcoholic fatty liver and chronic viral inflammations of the liver (hepatitis B and C) are the most common causes.
Through early recognition and treatment of the underlying disease (e.g. alcohol abuse), further damage of the liver can be prevented.
A fatty liver is characterised by increased deposits of fat in the liver cells. Fatty liver is one of the most common chronic liver diseases and is usually caused by a lack of exercises, too much food and alcohol abuse. Abstaining from alcohol and a healthy, low-fat diet can cause a fatty liver to disappear within a few months. However, if a fatty liver remains untreated, liver damage such as fatty liver inflammation, liver cirrhosis and liver insufficiency can arise.
Hepatocytes are liver cells that are roughly 20 - 30 µm in size and amount to 80% of the liver's volume. Hepatocytes are metabolically active cells that have a pronounced endoplasmic reticulum, a well-developed Golgi-apparatus and a high concentration of mitochondria to enable their huge metabolic activities.
Oxidative stress is the imbalance between oxidative and anti-oxidative processes in the body. Since our bodies are constantly exposed to so-called free radicals (= oxidants), a strong anti-oxidative protective system is necessary. "Radical catchers" are a part of this protective system and include vitamins C and E as well as trace elements such as zinc, selenium, manganese and copper.
= the harmful form of oxygen that plays a big role in oxidative stress. These special oxygen compounds are highly reactive and chemically aggressive.
Tryptophan is an essential amino acid that can't be produced by the human body and has to be ingested through food. Foods such as cashews, oats, milk and rice all contain this amino acid. Tryptophan is very important for the human body because it is the precursor molecule for the neurotransmitter serotonin and therefore has an effect on our mood and behaviour.
Antioxidants protect our bodies from negative, external factors. They catch oxidative substances (free radicals) before they can damage our cells. Free radicals develop through stress, excessive sports and even from the light of cellphones and computers. Vitamins C and E, selenium, as well as carotenoids, are all natural antioxidants.
L-glutamine belongs to the group of non-essential amino acids since our bodies are able to produce this amino acid on their own.
The body needs more glutamine in times of stress. Large amounts of glutamine can be found in organs affected by stress, such as the intestines and the brain. L-glutamine is mainly found in the mucosa, especially the intestinal mucosa, and is a central metabolite in the metabolism of all organisms.
Dysuria is difficult and painful urination. If left untreated or doesn't heal properly, dysuria can become chronic.
Polycystic-Ovarian-Syndrome is a common metabolic disease in young women. Women with PCO-syndrome usually suffer from menstrual disturbances, severe menstrual complaints, increased levels of male sex hormones (androgens), sleeping problems, weight problems, enlarged ovaries with many follicles, impaired fertility, etc.
The treatment of PCO-syndrome is largely symptom-oriented. The goal of the treatment is to alleviate the symptoms that affect the patient the most and to prevent secondary diseases such as type II diabetes, metabolic syndrome and cervical cancer.
Endometriosis is a chronic disease that leads to changes in the body of the woman. Normally the uterus forms and dismantles the mucosa (endometrium) over the course of the monthly cycle. In the case of endometriosis, the endometrium is formed outside of the uterine cavity - usually in the small pelvis - and causes adhesions, pain and infertility. This mucosa-like tissue behaves as though it were in the uterus by growing and bleeding under the influence of the female sex hormones.
Diabetes and metabolic syndrome
Triglycerides are food fats and one of the most important stores of energy in the human body. Triglycerides in the bloodstream originate from our food, as well as the fat metabolism, and can be measured medically through blood analysis. Elevated triglyceride levels can hint towards lipometabolic disorders or diseases such as hypothyroidism. In combination with increased cholesterol levels, increased triglyceride levels pose as a cardiovascular risk factor.
Adiponectin is a tissue hormone that is released by fat cells (adipocytes). This hormone comes in various forms and has different effects on lipid and glucose metabolisms. Most of all, adiponectin increases the sensitivity of the targeted tissue towards insulin. The faulty regulation of this hormone appears to play an important role in the development of metabolic syndrome.
Insulin is a peptide hormone that regulates the intake of glucose throughout the cells in the body. Once glucose levels in the blood rise, the pancreas produces more insulin and releases it into the bloodstream to lower the blood sugar levels.
Insulin resistance is characterised by the simultaneous increase of both insulin and blood glucose levels. Although there is plenty of insulin to initiate the transport of glucose from the blood into the cells, the efficacy of insulin isn't enough.
In summary, insulin resistance is the reduced effect of insulin on the target organ.
Metabolic syndrome is the umbrella term for the simultaneous occurrence of several symptoms and diseases:
- severe obesity with increased abdominal fat
- high blood pressure
- elevated blood sugar levels (impaired sugar metabolism in the form of insulin resistance)
Metabolic syndrome is a critical risk factor for blood vessel diseases, especially the coronary arteries, and the affected are considered as high-risk patients for cardiovascular diseases.
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