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Gut Flora: A Digestible Account of Probiotics Man's best Friend

Every morning I eat porridge, and then, as the warm oats land in my belly and their complex carbohydrates burn slowly to energise my body for hours, I develop an internal glow, albeit less radiant and a lot more natural than the orange kids in the 1980 s advert for !eady "rek# $any may find the resemblance of my preferred breakfast to wallpaper paste a little repulsive, but close your eyes, if you must, tuck into a bowl, and experience the ama%ing &uracell battery'like powers of porridge# (ou won t be alone in en)oying your breakfast either *figure 1+, because the friendly bacteria in your gut thrive on it too# , substance in the oats, known as beta glucans, helps them to grow# -o persevere with that daily helping of wallpaper paste because it s good for you, and it s good for the bugs in your innards, which means it s doubly good for you . If your body s hospitality to bacteria comes as an unwelcome surprise, worry not# /he world is teeming with good bacteria that help to sustain life on Earth by carrying out crucial tasks# 0or example, cyanobacteria convert light energy into chemical energy using the process of photosynthesis, a by'product of which is oxygen# !hi%obacteria, on the other hand, convert, or fix, nitrogen in the air into a form which leguminous plants can use, enabling them to grow# ,nd the benefits don t stop there# -ome mammals, such as ruminants *figure 2+, use bacteria to boost the nutritional value of their diet# !uminants are strict vegetarians and have evolved a specialised intestinal compartment containing bacteria capable of breaking down otherwise indigestible plant materials such as cellulose# /his means that smaller, bite'si%ed, animals can relax, safe in the knowledge that their bigger counterparts are well fed# In short, microorganisms help humans to breathe easy whilst they en)oy vitamin'rich legumes, and eat meaty ruminants like cattle# In other words, miniscule microbes can achieve massive feats that utterly belie their si%e# "ut a lone bacterium is a powerless and vulnerable single cell# Its survival depends entirely on its external environment# Indeed, bugs like these rely on the bodies of more sophisticated, multicellular organisms to provide protection, organic nutrients and growth factors, and steady environmental conditions# 1iven the right environment, bacteria can double their numbers roughly every half hour, producing a formidable force from )ust a single cell within a short space of time# In fact, such is their productivity that whilst a 200kg cow can generate 1kg of protein per day, a cow'si%ed mass of bacteria can produce 10 000 times this amount#

HUMAN BOWE F O!A


3ot surprisingly the human body provides an appealing habitat for many bacteria as it maintains a constant temperature# Indeed, each of us plays host to trillions of bacteria, known as our normal flora , the vast bulk of which *824+ are harmless, if not beneficial# "ut bacterial residency is not always granted by default# Each of us employs a menacing array of anti'microbial defences to make sure our blood, lungs and brain remain bug'free %ones, although there are plenty of areas readily accessible to microbes and the respiratory, urogenital, and digestive tracts provide prefect tropical living conditions favoured by many types bacteria# /he skin also provides sites for colonisation with warm, damp areas, such as the groin and between the toes, proving particularly popular# "ut of all the places available to our normal flora, the gut is the most heavily occupied# 5hy6 "ecause the human digestive tract offers the microbe what 3ew 7ealand offers the tourist8 a massive variety of environments creating opportunities for a plethora of activities# It is a multicultural melting pot# 5ith something for almost everyone, it s no surprise that the human gut hosts 804 of the body s normal flora and includes more than 200 different bug species# /hough each microbe is tiny, the trillion or so that live in our guts and outnumber the human cells that make up the rest of the body, add at least a kilo in weight to each of us# "ut if, in the name of weight'loss, you re tempted to shed your body s bacterial load by soaking in a bath of /oilet &uck, or gulping down a bottle of &ettol, you might be wise to reconsider# 9ur normal flora produces essential nutrients and generates by'products that reduce the risks of developing certain cancers, digestive disorders, and heart disease# It serves our bodies from the cradle to the grave#

HOW BA"#E!$A "O ON$%E NEWBO!N BAB$E%


,ctually, bugs start making us their home before we even hit the crib# 5hen a germ'free baby is released from the sterile confines of its mother s womb, it swallows a mouthful of muck# -o, upon entering a world full of germs ever keen to enter a fresh new body, the bugless babe is at once no more# It has morphed into a vessel accommodating a mass of microbes, )ust like its fellow human beings# "eing born is invariably a messy business but the route taken will determine the nature of the mess ingested# :op out through the birth canal and you will gulp down your mother s vaginal and faecal flora including a wholesome mix of ;actobacillus, "ifidobacterium, E#coli and Enteroccoccus# "ut burst out through your mother s abdomen, along the path originally promoted by <ulius =aesar, gives you a mouthful of an entirely different assortment8 hospital'ac>uired bugs such as =lostridium and -treptococcus are often the main ingredients of a =aesarian baby s bacterial breakfast#

@ 5ith no pre'existing bacteria to demand competition, bugs ingested during the birth process colonise the infant gut within days# 9ver the first few days of life, additional types bacteria )oin the gut flora# -taphylococcus aureus, for example, is transferred from the mother s nipple during suckling, and through kisses and cuddles from doting relatives#

B!EA%# $% BE%#
-ome beneficial microbes, like bifidobacteria, receive a helping hand to become established from proteins in breast milk # ,s a result, after )ust a few weeks, this bug makes up over 904 of a breastfed baby s intestinal flora# "ifidobacteria make the baby s gut acidic which creates a barrier against infection with bugs which the child has yet to develop natural immunity, including many acid'intolerant disease'causing microbes# "ut bifidobacteria fail to thrive on the diet of proteins provided by the modified cow s milk used in formula feeds, meaning a formula'fed baby is more prone to infection with harmful gut germs# =olonisation of the gut by disease'causing microbes can also lead to a life'threatening condition known as necrotising enterocolitis which is common amongst pre'term *premature+ babies# 0or every 10 babies affected, approximately ? will die and @ will suffer long'term effects of their illness# $any premature births are the result of complications that necessitate caesarian delivery and breastfeeding is often delayed by several days whilst they are receiving intensive care# /ogether, these factors can lead to poor >uality gut flora and a higher susceptibility to necrotising enterocolitis# 0ortunately, recent research indicates that administration of certain probiotic ;actobacillus and "ifidobacterium strains to susceptible infants can decrease the risk of developing the disease# ,mongst older children, the introduction of solid foods into a baby s diet will change the gut flora again, as new substances selectively promote the growth of different bacteria# ,t the age of about two, once completely weaned off breast milk and onto more grown'up foods such as bangers and mash, mushy peas and macaroni cheese, the floral composition of a child s gut will resemble that of a normal adult ' "acteroides, "ifidobacterium, Eubacterium, and :eptostreptococcus predominate# Each of the different species residing in the digestive tract has a uni>ue set of adaptations making a particular environment suitable for colonisation# ,nd the large variety of species renders almost every part of the gut a cosy niche for some bug or another#

WH& AN#$B$O#$"% "AN UP%E# &OU! %#OMA"H


;ike settled s>uatters, these microbial populations are hard to shift, but ageing, and alterations in the gut environment caused by antibiotics can force changes# In general, young people have a healthier gut flora their grandparents, which is one of the reasons why older people are more susceptible to intestinal upsets than their younger counterparts# In the case of antibiotics, unfortunately they don t )ust kill the bad guys ' they also knock out members of the intestinal flora, allowing the numbers of disease'causing bacteria, previously held in check by the predominating friendly bacteria, to begin to multiply# If sufficient numbers of these disease'causing bugs emerge, they can cause a variety of symptoms, including diarrhoea# , common culprit responsible for this type of antibiotic'associated diarrhoea is a native colonic bug called =lostridium difficile# It produces a toxin which damages the bowel wall, triggering diarrhoea# Aowever, treatment with a yeast known as -acchromyces bombardii can relieve the symptoms, possibly because the yeast can destroy the toxin, thereby allowing the damaged bowel wall to heal#

%O HOW DO D$FFE!EN# BA"#E!$A "O ON$%E #HE $N#E%#$NE '


$icrobial access to the digestive tract is via the top# It is a piece of cake8 bugs can hitch a lift on food hand'delivered to the mouth# 9bviously, conditions must be conducive to growth for a species to set up home in a particular niche, but bugs searching for accommodation in the digestive tract must also be able to withstand the conditions of sites through which they must pass# <ust the thought of an imminent meal can make a hungry person dribble# /his is because the brain tells the mouth to prepare for the arrival of food by secreting saliva which makes a chemical and mechanical contribution to digestion# It contains amylase that begins the digestion of starchy foods, such as potatoes and rice, and it moistens and lubricates food to help swallowing# ,side from its roles in the digestive process, saliva also contains antimicrobial substances that inhibit the growth of bacteria# "ut -treptococcus mutans is a big fan of the mouth area and can easily side'step these defences# It also has a particular fondness for sweet'toothed mouths and, in the presence of cakes and biscuits, it forms films, or pla>ues , on the surfaces of teeth# "acteria thriving within these pla>ues turn sugar into acid that then burns holes in teeth# "ut, before you rush off in search of your toothbrush, it s worth noting that the benefits of this bug s activities are not exclusive to dentists, they extend to you too# /he sheer weight in numbers of -#mutans suppresses the growth of another bacterium found in the mouth, -treptococcus pneumoniae, which can cause pneumonia and meningitis# "y restricting the numbers of -#pneumoniae, -#mutans decreases the risk of these serious diseases developing, so maybe a few fillings might not be so bad after all . /he next part of the digestive tract, the oesophagus, is a difficult place for bacteria to gain a foothold# Aere, microbe'laden food and saliva are in rapid transit to the stomach8 there s little time to eye up, choose and settle down in an oesophageal site# /hose that manage to colonise this area, such as lactobacilli, can do so only transiently as the oesophageal contents are continuously propelled into the stomach when we swallow# Aeading south from the oesophagus, microbes approach the acid pit of the stomach# In here, food is processed for around three hours, giving microbes plenty of time to attach themselves to the stomach walls# /he gastric )uices secreted to li>uefy food into chime and start the breakdown of protein, are five times more acidic than lemon )uice# -o, splashed into your face, lemon )uice might cost you a few tears, but stomach acid could cost you your sight# (et for some, the stomach is a welcome sight for sore eyes ' Aelicobacter pylori, for example, is very at home here#

HE $"OBA"#E! P& O!$

? In 198@, a truly dedicated microbiologist called "arry $arshall drank some live A#pylori# /he experiment made "arry very ill, and his wife very angry, but it proved his theory that the bacterium causes gastric ulcers, and A#pylori is now also thought to play a role in the development of gastric and duodenal cancers# "ut Aelicobacter is found in the stomachs of 204 of people, yet only about one fifth of them become unwell, demonstrating that lifestyle factors must also play a role in the development of disease# Indeed, researchers now suspect that under some circumstances an A#pylori presence in the stomach might be >uite helpful since the bug seems to protect against infant diarrhoea, and oesophageal disease# ,side from A#pylori, the stomach houses lactic acid'producing bacteria that include strains of -treptococcus and ;actobacillus# /hese microbes convert sugar into acid# -ome research suggests that lactobacilli can inhibit the growth of A#pylori and decrease en%yme activity needed for its survival in the acid environment# ;actic acid'producing bacteria of the stomach do not re>uire oxygen to survive8 they are anaerobic# Aowever, unlike most anaerobic bacteria, certain strains can tolerate oxygenated environments# /he stomach is a well'oxygenated area because air swallowed with food arrives here within moments of ingestion# -o some lactic acid'producing bacteria grow well here alongside bacteria that need to use the available oxygen# $ost bugs do not relish the harsh conditions of the stomach, and alot will dissolve as they succumb to acid attack# /he tough ones drawn to the intestinal habitats beyond must have intrinsic resistance to acid, or a way to bypass the problem, for example under a protective blanket of alkaline milk# In the ma%e of the gastrointestinal tract, the small intestine follows the stomach# 0ood moves through here in about four hours# -ubstances released from the liver and pancreas help to breakdown food into its constituent molecules# &igestion and absorption of these molecules occur across an enormous surface provided by microvilli, hair'like pro)ections covering the surface of the small intestine# /he first part of the small intestine, called the duodenum, is only slightly less acidic than the neighbouring stomach# Aowever, the availability of oxygen is much reduced due to consumption by bacteria living higher up in the digestive tract# /herefore, this environment is ideal for bugs able to resist acid in the stomach and which are indifferent to the presence of oxygen# $icrobes encounter decreasingly acid conditions as they descend through the )e)unum and then the ileum of the small intestine# ,nd, from the end of this section of the small intestine, oxygen availability also decreases# /he last part of the gastrointestinal tract, the large intestine or colon, is virtually devoid of oxygen# /he main bacterial residents at the relatively acidic top end of the small intestine are ;actobacillus and Enterococcus faecalis# /owards the bottom of this section, where the living conditions are less arduous, less acidic, and more appealing to a wider section of the bacterial community, ;actobacillus and E#faecalis are )oined by other bugs such as E# coli, and "acteroides#

"O ON$" F O!A


"y the time food reaches the colon, the body s work is almost over8 the arsenal of digestion and nutrient'harnessing mechanisms has been spent# /he remaining task for the large intestine is to remove the excess water from what s left of the food, or faeces# /he transit time through the colon is normally a leisurely 1@ to @B hours# , longer stay in the colon, or dehydration, will impact the faeces, both metaphysically and physically, as more water is removed# =onversely, shorter colonic passage durations, the result of excessive prune consumption or gut'damaging infections for instance, will produce loose stools, or diarrhoea# /he sedate pace in the colon makes it a great place for bugs to fester# In fact, it has so much hangout'potential that bacteria reach levels of over 1000 per millilitre of faeces# /he flora in this part of the digestive system include Enterococci, =lostridia and ;actobacilli, but by far the most abundant species are "acteroides and the oxygen'intolerant lactic acid'producing "ifidobacterium# /hankfully the good bugs outnumber potential villains like E#coli by as much as ten thousand to one#

PO#EN#$A P!OB$O#$" #HE!AP$E%


&iarrhoeal diseases are common, particularly amongst children, and in developing countries they are a ma)or cause of death ' estimates suggest that a child somewhere in the world dies every 12 seconds from a diarrhoeal disease# :romisingly, though, recent research indicates that one strain of ;actobacillus, given in capsule or milk form, can help to treat childhood diarrhoea# :robiotics like these could also help in the treatment of inflammatory bowel conditions like =rohn s disease# , cocktail of probiotic bacteria, including strains of ;actobacillus, "ifidobacterium and -treptococcus, has been proven to provide symptomatic relief for some sufferers# "ut the potential clinical uses of probiotics are not limited )ust to these conditions# "acteria such as ;actobacillus and "ifidobacterium may also turn out to be useful tools in the fight against cancers because they have been shown to reduce the levels of cancer'causing substances in the gut# ;actobacillus casei -hirota is one such strain and is present in a well'known <apanese milk'based probiotic drink that is stored in the fridges of approximately @C million people worldwide *but, sadly, not in mine because I don t like the taste' a shame, given its obvious potential+# ,s well as cancers, allergic conditions may be prevented by the use of probiotics# 5hen given to pregnant women and then to their infants in the first weeks of life, certain ;actobacillus strains can also reduce the risk of allergy in the newborn# :robiotics could also represent a cheap alternative to anti'AID drugs# :robiotic strains of ;actobacillus taken by mouth have been shown to colonise the large intestine, and then to transfer from the rectum to the vagina# Aere they are able to modify the vaginal flora to reduce the chances of AID infection# Aistorically, bacteria'laden fermented milk was used to help heal wounds and fight infections# /oday, a surgical patient s only likely exposure to this substance is through his cup of 3A- tea, but it seems our predecessors may have been wiser then we think# 5hen instilled in the gut flora, one particular strain of ;actobacillus has been shown to reduce infection rates amongst abdominal surgery patients#

B &octors are now unearthing mounting evidence for beneficial effects of probiotic use amongst ill people, but there is very little research'based evidence for the benefits of commercially'available products when used by healthy individuals# 5ith no legislation enforcing the proper identification, documentation, and manufacture of over'the'counter probiotics, consumers are currently clueless about the numbers and activities of the bugs they are swallowing# $isleading marketing leads people to believe that live ;actobacillus acidophilus cultures in some yoghurts confer health benefits ' but not all strains of this bacterium are probiotic# :erhaps when we re better informed, our whetted appetites will create a strong market for a range of bug'packed foods and supplements# -o, who knows6 Special K with freeze-dried berries and lactobacilli may soon be on the shelves of a supermarket near you# I ll stick with my plain, prebiotic oatmeal though I think###or should I6 I feel healthyE I don t have the irritable bowel that seems to trouble every man and his dog these days# "ut how healthy is my gut6 9ur stone age ancestors had a diet brimming with bacteria# 5ith Tesco's Finest still a long way off, our forefathers had to settle for what they could forage# 0ood was usually stored in soil and eaten raw or fermented, introducing billions of bugs with every meal# :lants were particularly abundant and stone age people consumed over ten times as many varieties as we do these days# =onse>uently, their varied diet allowed them to nurture a gut flora far richer than we manage to sustain today on a diet of chips and chocolate, bringing with it increased protection from allergies and infections, problems that are becoming increasingly common in our sterility'obsessed modern society# 9ver the last hundred years or so, we have accumulated knowledge of the possible dangers of microbially contaminated foodstuffs which has unfortunately cultured an extreme fear of germs, and a predilection for chic chrome kitchens and -meg fridges# 0unny then, that we now fill our -megs with little bottles of the very things they were originally designed to keep out###

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