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    microbiome.jpg
    Lisa Bywaters
    13/May/2021
    Health InformationMSK articles

    Your gut microbiome

    You can’t pick up a magazine or scroll through socials without seeing a celebrity or influencer touting the latest probiotic, prebiotic, wonder food or tips to enhance your gut microbiome. When did the gut become big business? And what’s it all about?

    Let’s take a deep dive into the gut microbiome (sorry – that sounds a little gross ?) and find out.

    But first, some definitions:

    • microbes are tiny living things that exist all around us – in the air, soil, water, our food, and our bodies. They’re so small you can’t see them with the naked eye. They include bacteria, fungi, viruses and archaea.
    • microbiota refers to the entire community of microbes that inhabit a specific place. In this article we’re referring to the human microbiota – or the community of microbes that lives in and on your body, with a specific focus on the bacteria in the gut.
    • microbiome is what we call the genetic material of all of the cells in the microbiota. So this is not just the microbes themselves, but all of the genes in all the microbes.

    We’re all unique

    We’ve known for many years that there are trillions of microbes living inside and on our bodies. But did you know there are almost as many microbial cells as human cells that call our bodies home?! (1)

    The majority of these microbes are found along the digestive tract (or gut), especially in the large intestine.

    Microbes are extremely important for our health. We exist with them in a mutually beneficial, symbiotic relationship. That means that we both gain benefit from living in such close proximity with each other.

    We provide them with a cosy place to live and an abundant supply of food to feed on. They help us digest food, absorb nutrients and fight off harmful bacteria. They also have an effect on our metabolism, weight, mood, and most importantly, they help develop, modify and control our immune system.

    We’ve evolved with these microbes over thousands of years, passing them on from generation to generation. However your microbiome is completely unique to you.

    It started to develop when you were a newborn and was shaped by your mother’s health, how you were born (vaginally or via caesarean) and how you were fed as an infant (breastmilk, formula or combination). Then a multitude of other factors contributed to your microbiome, including where you live (e.g. rural/urban), your diet, the medications you use, if you’re a smoker, and your stress levels.

    The link between our microbiome and disease

    Even though we live in a symbiotic relationship with our gut microbiota, that doesn’t mean that all of the bacteria present in our gut are beneficial. It simply means that in a healthy person the gut microbiome is relatively stable, and the ‘good’ bacteria keep in check the numbers of ‘bad’ bacteria that could become harmful to us.

    For a healthy gut microbiome, we need sufficient levels and a diverse range of good bacteria. Poor diet, smoking, chronic stress and antibiotics can all affect the quantity and types of bacteria we have in our gut.

    Many studies have shown that it’s disturbances or imbalances with the gut microbiota that may contribute to the onset and/or severity of a long list of diseases. And that people who develop these conditions have too little or too much of certain types of bacteria, or lack some types of bacteria completely.

    For many autoimmune conditions, the cause is unknown. A genetic predisposition, coupled with an unknown trigger is often the closest we have to a cause.

    This has led some researchers investigating whether imbalances in the gut microbiome may be the a potential trigger that could result in some people developing:

    • inflammatory bowel disease (9) (Crohn’s disease and ulcerative colitis)
    • diabetes (8)
    • musculoskeletal conditions such as rheumatoid arthritis (2, 3), ankylosing spondylitis (4), and psoriatic arthritis (5).

    Scientists are researching whether improving the diversity and health of gut microbiota in people with these diseases will also decrease their symptoms.

    Probiotics and prebiotics

    Some of the treatments being researched include probiotics and prebiotics.

    Probiotics are live bacteria and yeast that are similar to those living in our digestive tract. They’re found in cultured and fermented foods including yoghurt, miso, sauerkraut, kimchi and kombucha tea.

    Probiotics help to maintain healthy levels of good bacteria in the gut and support our immune defences. They also help to break down foods we find difficult to digest, or foods that aren’t broken down by stomach acids.

    One meta-analysis investigated whether probiotic supplements provided any benefits for people with rheumatoid arthritis (RA). Researchers concluded that there’s a potential role for probiotics in relieving inflammation for people with RA; however more research is needed before we can know if probiotics can relieve the disease progression (6).

    Safety note – if you have a weakened immune system due to your condition and/or medications, you should talk with your doctor before taking a probiotic, as they contain live bacteria, and may not be safe for you to take.

    Prebiotics are a form of dietary fibre that we can’t digest. But our good bacteria love them, and they’re a great food source to help them grow and multiply in your gut. They’re found in foods such as beans, asparagus, garlic, brown rice, bananas and sweet potatoes.

    Scientists are investigating whether prebiotics can be used to treat or manage a range of health issues.

    Looking after your gut microbiome

    While there’s a lot of research being carried out investigating how our gut microbiome affects our health, we still have a long way to go before we have any definitive answers, especially when it comes to our musculoskeletal health. Our microbiomes are all so diverse and unique, which makes this research complex. And this research is also still quite new. So ‘watch this space’! We’ll bring you more information, especially as it relates to musculoskeletal conditions, as it emerges.

    In the meantime, there are things you can do to look after, and even improve your gut microbiome. And the good news is that these things are also good for managing your musculoskeletal condition/s and health in general.

    • Eat a well-balanced diet with a wide range of foods. The microbes in our gut are attracted to different nutrients. So providing a diverse range of healthy foods – fruit, vegetables, nuts, grains, seeds, fermented foods – means that you’ll be making a diverse group of microbes happy and healthy.
    • Eat a wide variety of fibre. The CSIRO says we can “feed our gut bacteria or microbiome by eating foods rich in resistant starch; for example, lentils, peas and beans, cooked and cooled potato, cold pasta salad, firm bananas, and certain wholegrain products” (7).
    • Avoid foods high in saturated fat and sugar as they have a negative impact on your microbiome.
    • Exercise – you didn’t think I’d get through an article without promoting exercise did you ?? Apart from all the amazing things regular exercise can do to help us manage our musculoskeletal conditions, our weight, mood, and sleep…studies have shown that exercise can improve the quantity and quality of the microbes in our gut. To find out more, check out this article from The Conversation.
    • Manage your stress. Studies have shown that stress – including psychological and emotional stress, lack of sleep, and stress caused by our environment such as noise, or extremes in temperature – can negatively affect the microbes in our gut. To manage stress, you can try to manage any environmental causes, get good, quality sleep, and use stress management techniques such as distraction, guided imagery, mindfulness meditation and deep breathing.
    • Avoid antibiotics when they’re not needed, They should only be used to treat bacterial infections. Antibiotics can’t kill viruses, so they shouldn’t be used for illnesses like the common cold. But they do kill bacteria – including the good ones we need in our gut. So discuss the risks and benefits of using antibiotics with your doctor. Read this information from the National Prescribing Service about antibiotics.
    • Get outdoors and interact with your environment. Whether it’s a walk in the park or digging in your garden, exposing yourself to external microbes is good for your microbiome.
    • Stop smoking – it affects your overall health, including the microbes that call you home. Quitting is hard, but there are people and organisations who can help you.
    • Talk with your doctor and/or dietitian about how you can improve your diet, for better gut health.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    1. Sender R, et al. 2016. Revised estimates for the number of human and bacteria cells in the body. PLoS Biology.
    2. Wells, P. M., et al. 2020. Associations between gut microbiota and genetic risk for rheumatoid arthritis in the absence of disease: a cross-sectional study. The Lancet. Rheumatology.
    3. Taneja, V. 2014, Arthritis susceptibility and the gut microbiome. FEBS Letters.
    4. Fletcher, J. 2021.Expert perspectives: Ankylosing spondylitis and the gut microbiome. Medical News Today.
    5. Fletcher, J. 2020. Psoriatic arthritis and the microbiome: Is there a link? Medical News Today.
    6. Mohammed, A.T, et al. 2017. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clinical Rheumatology.
    7. CSIRO, 2021, Resistant starch.
    8. Branca, M (2021). Plant-based diet may feed key gut microbes. The Harvard Gazette.
    9. Knights, D.et al (2014). Complex host genetics influence the microbiome in inflammatory bowel disease. Genome Med 6, 107 (2014).
    CONTINUE READING
    vitamin-D-cap.jpg
    Lisa Bywaters
    18/Jun/2020
    Health InformationMSK articles

    Vitamin D for healthy bones – and for COVID-19?

    Most of us know that vitamin D is important. It’s like the other things we ‘know’ – when to use the word literally, which fork goes with which course, and what Pi is. We sort of know vitamin D is good for us, but maybe not as much as we’d like. So let’s do a quick vitamin D refresher.

    It’s important for our health. Among its many benefits vitamin D:

    • regulates the amount of calcium and phosphate in our body, necessary for healthy bones, teeth and muscles
    • helps protect us against osteoporosis, a condition that causes bones to become weak and lose their strength, making them break more easily than normal bones
    • supports our immune system
    • can reduce the risk of falls, important for all of us, but especially those with fragile bones or another musculoskeletal condition.

    There are two types of vitamin D:

    • D3 (cholecalciferol) – formed in the skin by the action of ultraviolet (UV) light
    • D2 (ergocalciferol) – produced by UV light on plants and obtained through our diet.

    In Australia our main source of vitamin D is sunlight. It’s important to expose our hands, face and arms to the sun every day. The amount of time needed to do this depends on where you live, the time of the year and the complexion of your skin. Because we also need to be careful that our sun exposure is safe and we don’t risk skin cancer, Osteoporosis Australia and the Cancer Council have developed a useful chart to help you work this out.

    Vitamin D can also be found in small quantities in foods such as fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low fat milks and margarine. For most us though, it’s unlikely we’ll get enough vitamin D through diet alone.

    Vitamin D – whether it’s from sunlight, food or supplements – is stored in our fat cells until it’s needed.

    Why should we care about vitamin D?

    First, for the reasons we mentioned above. And second, in case you haven’t felt it, it’s getting cold. Winter is upon us and we’re not exposing as much of our skin to the sun in most parts of Australia as we did earlier in the year – at least not without risking frostbite.

    So we need to make sure we’re doing everything we can to get enough vitamin D during these colder months.

    Most people, through every day exposure to the sun in the warmer months, will have created enough vitamin D to make it through the winter without becoming deficient. Yay!

    For others however, it may take a more concerted effort to get enough vitamin D during winter. The best way to do this is to be active outdoors – e.g. going for a walk, working in the garden. You can also include foods that contain vitamin D in your diet. A dietitian can help you with this. They can also ensure your diet is healthy so that you get all the other nutrients you need.

    Finally there are some people who aren’t able to get enough vitamin D through sunlight or diet, which puts them at risk of vitamin D deficiency. This includes:

    • elderly people – especially those who are housebound or in residential care
    • people who wear concealing clothing for religious or cultural reasons
    • people with certain health or medical conditions who need to avoid the sun
    • people with dark skin as their skin contains higher amounts of melanin, which inhibits the creation of vitamin D
    • people in occupations where they have limited exposure to natural sunlight throughout the day – e.g. taxi drivers, factory workers, office workers and nightshift workers
    • people with diseases that make it difficult to absorb enough vitamin D – e.g. cystic fibrosis, coeliac disease and renal disease.

    If you‘re concerned that you may be deficient in vitamin D, it’s important to discuss this with your doctor. They can do a simple blood test to check your vitamin D levels. If you are deficient, it may be necessary to take vitamin D supplements for a period of time.

    It’s important to note that if you’re not vitamin D deficient, there’s no reason to take vitamin D supplements. It’s possible to have too much vitamin D, so only use these supplements as prescribed by your doctor.

    What does vitamin D have to do with COVID-19?

    There have been reports that vitamin D may be useful in our fight against COVID-19, however the results of these studies haven’t been conclusive.

    We know that vitamin D plays an important role in supporting our immune system. And in some recent studies people who’ve developed COVID-19 have been found to be vitamin D deficient. However these studies involved literature searches, analysis and observational studies – which are useful and provide valuable information – but can’t say with any certainty that vitamin D can help prevent people who are vitamin D deficient from catching COVID-19.

    That’s because they can’t eliminate other important risk factors such as age, obesity and socioeconomic status (e.g. level of income, education, access to healthcare, housing).

    However when researchers looked at the data of half a million people from the UK Biobank and adjusted for variables such as age, race, socioeconomic status and obesity, they found that ‘people with lower vitamin D have a higher risk of COVID infection, but it looks like this is explained by other risk factors and not by the vitamin D itself…our findings do not support a link between vitamin D concentration and the risk of COVID-19 infection.’ (1)

    Professor Mark Morgan, Chair of the Royal Australian College of General Practitioners Expert Committee – Quality Care (REC–QC), has also been quoted as saying ‘at the moment, I’ve not seen any evidence that using vitamin D could prevent or treat COVID-19…I know that there’s a number of controlled trials that are being commenced to look into that, but we’ll have to wait for the results of those trials before we have any information.’ (2)

    So at the moment, it’s a watch and wait situation when it comes to vitamin D and COVID-19. We need more information from randomised controlled trials that are able to tell us conclusively if vitamin D can protect at risk people from catching it.

    And remember if you’re concerned about your vitamin D levels, discuss this with your doctor. Don’t start taking a supplement without their expert advice.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    1. Exploring the links between coronavirus and vitamin D
      The New York Times, 10 June 2020
    2. Do vitamin D levels affect risk of infection and severity of COVID-19?
      newsGP 15 May 2020

    Photo by Michele Blackwell on Unsplash

    CONTINUE READING
    immunity.jpg
    Lisa Bywaters
    11/Jun/2020
    Health InformationMSK articles

    Our amazing immune system

    Every day we’re exposed to millions of microscopic germs – bacteria, viruses, fungi, parasites. Our immune system protects us from them so that we don’t get sick.

    But sometimes a germ (or pathogen) is able to get into our system – through a cut, from breathing in droplets from someone’s cough, or if our immune system has become weakened.

    When this happens, our body launches an attack.

    It starts with the white blood cells (or leukocytes). They’re our germ fighting cells. They patrol the body looking for foreign bodies like viruses. When they come across one, they immediately start to multiply. While they do this, they’re also sending signals to other immune cells to saddle up and get ready for battle.

    There are two types of white blood cells: phagocytes and lymphocytes.

    Phagocytes are hungry little buggers that eat pathogens for breakfast. They do this by surrounding the cell and absorbing it. When they do this they receive information from the proteins on the surface of the pathogen. These proteins are called antigens (or antibody generators). Phagocytes then send this info to the lymphocytes.

    There are several types of phagocytes including neutrophils, monocytes, macrophages and mast cells. They all play important roles in the immune system.

    Lymphocytes can be divided into B cells (they’re created in Bone marrow) and T cells (they’re created when they travel from the bone marrow to the Thymus).

    B cells create antibodies. Antibodies neutralise the antigen by binding to it and disabling it. The antigen and antibody fit together like a key in a lock. As with a specific key working for a specific lock, there’s only one antibody that can fit each type of antigen.

    T cells kill any of your infected cells. There are different types of T cells who have specific jobs in the immune response: Helper T cells and Killer T cells.

    Helper T cells help…they send instructions to the other immune cells to help them get coordinated. They tell the B cells to create antibodies. They tell the Killer T cells to do what they do best – kill or destroy the cells infected by the pathogen. And they tell the phagocytes (specifically the macrophages) to join the party for a tasty pathogen feast.

    When the battle is done and dusted, your body will keep copies of the antibody it created against this pathogen. That way if you encounter it again, you have a defence against it.

    That’s your immune system in the very briefest of nutshells. It’s a highly complex, involved system that includes a lot of other cells, organs and body parts. Check out the More to Explore section for more info about the immune system.

    Giving the immune system a head start – vaccines

    Vaccines work by introducing your immune system to a virus or bacteria. This allows it to learn how to protect you from the pathogen before you meet it out in the world. A vaccine is a weakened or inactivated version of the pathogen. It causes your body to create antibodies. We have many vaccines at our disposal for diseases that cause people to get seriously ill – including measles, flu, tetanus, typhoid and polio.

    There are currently more than 100 labs around the world researching and developing a vaccine for COVID-19. Read our blog to find out more.

    When things go wrong – autoimmunity

    Sometimes the immune system gets it wrong. Instead of attacking something foreign, like a virus or bacteria, it attacks healthy cells and tissues in the body. This is called autoimmunity. The attack causes inflammation and damage to the cells.

    We don’t know why the immune system attacks its own body, but it’s thought that it may be the result of genetic factors (or things you’ve inherited) and something from the environment (e.g. a bacteria, virus or some medications).

    There are many autoimmune conditions that are the result of a malfunctioning immune system. They include rheumatoid arthritis, lupus, ankylosing spondylitis, juvenile arthritis, Sjögren’s syndrome, coeliac disease and type 1 diabetes.

    Stopping the spread of disease – herd immunity

    There’s been a lot of talk recently about herd immunity – especially around COVID-19. But what does it mean?

    Simply put herd immunity means that a large proportion of the population (or the herd) is immune to the disease. This can happen if they’ve been vaccinated or they’ve had the disease and are now immune to it. When most of us are immune to a disease, the disease isn’t able to spread as easily from person to person. The people who are immune create a buffer between the disease and those who can’t be vaccinated.

    By building up this herd immunity, we not only look after ourselves (if we’re able to be vaccinated) but we help protect those who are vulnerable to infectious diseases – including babies, people with compromised or suppressed immune systems and older people.

    The number of people we need to be immune to a disease to achieve herd immunity – the herd immunity threshold – varies from disease to disease. It depends on how easily transmissible and how infectious a pathogen is. For example, in the case of measles we need 92-95% of the population to be vaccinated because it’s incredibly infectious and the virus can survive outside the body for up to two hours. So even if you’re not in the room with an infected person, if you touch a surface that they’ve coughed or sneezed on, you can become infected if you’re not immune to the measles virus.

    We don’t at this stage know what the herd immunity threshold will be for COVID-19. Estimates currently suggest around 60%. However we also don’t know if people remain immune to COVID-19 after they’ve recovered from an infection. So it may be that we only truly reach herd immunity if/when a vaccine is created and administered to the majority of us.

    As with so much to do with this virus, we’re still learning and gathering data.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING

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