Microbiome affects blood glucose levels after eating, can help predict glycemic response to foods

Postprandial (post-meal) glycemic response (PPGR) is the effect that food has on blood glucose levels.   Eating a sugary candy, for example, will raise blood glucose levels, whereas drinking water will not.  PPGR remains an important predictor for metabolic syndrome and type II diabetes, so it has an important role the obesity epidemic.  Unfortunately, PPGR is difficult to predict, and efforts that are based on individual foods themselves have failed.  New research shows that there are many factors, including the microbiome, that are important to predicting blood glucose after a meal.  The research out of Israel and published in the journal Cell presents a new model that can more accurately predict PPGR that is based on personalized factors.

The researchers catalogued 800 peoples’ meals over 7 days while continuously measuring their blood glucose levels.  In addition they monitored their gut microbiota, weight, sleep, and various other lifestyle factors.  After evaluating the data, the scientists realized that identical foods had vastly different PPGRs.  For example, bread could have a 8 fold variation in glycemic response depending on the individual.  In order to explain these differences, the scientists identified several significant associations between the microbiome and the PPGR from specific foods.  For example, on the phyla level high abundances of Proteobacteria and Enterobacteriaceae were associated with poor glycemic controls.  On the species level Eubacterium rectale, which is known to ferment fiber, was correlated with low glycemic response, and Parabacteroides distasonis, which had previously been associated with obesity, was correlated with hight glycemic response.  The scientists then aggregated all of their data, including microbiome data, and created a predictive algorithm for the PPGR from foods for individuals.  This algorithm accurately predicted the glycemic response from foods on a personalized level, and was more informative than general food based predictions.

This study speaks to the power of personalized medicine that is based on the microbiome.  Knowledge of our own microbiome could be used to advise our dietary choices in order to choose foods that will lead to low PPGR, and decrease our risk for metabolic syndrome.  Overall, the scientists determined that of all foods, eating fiber was most beneficial because it lowers glycemic response over the long term.

Understanding spatial relations of gut bacteria in ulcerative colitis patients

To sample the microbial communities in the gut, fecal samples are generally collected from an individual and DNA is sequenced to identify bacteria that are present. This is an overall effective method, however, it does not provide information of the specific spatial location of bacteria within the gut. In a study published in the journal Gut, researchers in Ireland looked to determine differences in the bacterial composition of specific regions of the large intestine between patients with ulcerative colitis and control patients.

Four volunteers undergoing routine colonoscopies were recruited to serve as the controls for this study. Five patients with ulcerative colitis (UC), who were undergoing colectomies, or surgical removal of the colon, were also involved in the study. Samples were taken at four locations in the colon in all individuals: the caecum, traverse colon, descending colon, and rectum. The four locations were sampled three times at three different levels: luminal brush, whole mucosal biopsy, and laser captured sample of mucus gel layer. A total of twelve samples were taken per individual.

After analysis of the many samples it was discovered that there was more variability between the bacterial compositions between subjects than there was within the different locations of an individual’s colon. The findings showed a difference between the luminal and mucus gel microbiota in both the controls and the ulcerative colitis subjects. Three bacterial families were common between this difference shared by controls and UC subjects, namely Bifidobacteriaceae, Peptostreptococcaceae, and Enterobacteriaceae being more abundant in UC patients.

This study has its limitations because of the small sample size, however the researchers state that the small sample allowed for extensive analysis of the individual samples. So what do the findings of this study mean for patients with ulcerative colitis? Better understanding of differences in the spatial relations of bacteria could lead to the modulation of microbial communities to help treat ulcerative colitis. 

Can gut microbes be used to diagnose and treat malnutrition?

Credit: Tanya Yatsunenko

When people think about malnutrition, they often think that not eating enough food leads to stunted growth, neurocognitive issues, weakened immune systems, and other health problems associated with malnutrition. While this is largely true, food scarcity and insecurity does lead to undernutrition, it is not the sole contributing factor to this pervasive global health problem.  Jeffrey Gordon and his group at Washington University School of Medicine in St. Louis have shown once again that gut microbes play an important role in undernutrition in a paper in Science Translational Medicine. 

To show the importance of the microbiome in undernutrition, Gordon’s team studied children in Malawi who were undernourished and others that were not. Specifically, they studied individuals with kwashiorkor, a form of severe undernutrition that occurs in children who often eat similar diets as other healthy children. They studied identical twins, one with the disease and one without the disease and sampled their gut microbes.  They transplanted the bacteria from the sick child into germ-free mice to see what effects the bacteria would have. When transplanted into the mice, the bacteria were very harmful causing weight loss as well as severe damage to the lining of the intestines and colon.

The scientists looked for bacteria that were targeted by an important molecule of the immune system called immunoglobin A (IgA). IgA is prevalent throughout the body and specifically in the gut. It plays an important role in preventing the bacteria in the gut from interacting with the human cells that line our intestines. As we saw in the paper on the blog on Monday about emulsifiers in our food, when gut bacteria in the gut interacts with the epithelial cells of the gut lining, severe health problems can arise. The scientists found that IgA and the immune system largely targeted Enterobacteriaceae, a large family of bacteria found in the gut that includes E. coli, Salmonella, and many others. The scientists were able to prevent weight loss in the mice by transplanting two strains of IgA targeted bacteria from the guts of healthy children into the mice, before they were exposed to the bacteria from the undernourished child.

This is an important study as it not only shows the significant role that gut bacteria have on malnutrition, but it shows that it may be possible to use the microbiome as a diagnostic tool to identify which children are at risk for undernutrition, and it may also be a therapeutic target for intervention. The scientists also studied 19 other groups of twins and found that higher levels of Enterobacteriaceae led to a greater risk of kwashiorkor. By sampling children at a very early age for gut bacteria, it could be possible to identify which children were at greater risk of becoming malnourished and intervening with probiotics or other therapeutic foods to alter the microbiome.

IBD, Crohn's disease, and the microbiome

There have been several large scale studies that show a definite association between the microbiome and inflammatory bowel diseases like Crohn’s and colitis.  While it is becoming clear that the microbiome plays a pivotal role in these diseases, the exact mechanisms of pathogenesis are not known.  One of the reasons it has been so hard to uncover this link is because of a lack of robust studies, that usually contain small sample sizes.  In response, a team of leading scientists in the field, including multiple scientists from our own scientific advisory board, assembled a brand new cohort, the largest of its kind, to study the disease.  The cohort consisted of 447 children with newly diagnosed, still untreated, Crohn’s disease and 221 healthy children.   They then combined this data with two other cohorts that included adult patients to bring the total number of samples to 1,742.  The first results of this study were published in Cell Host and Microbe, and shed many insights into IBD and its relationship to the microbiome.

In the study the researchers sampled and sequenced the microbiome of the gut mucosa and stool.  From this data, they identified specific bacteria that had higher abundances in diseased patients, like Enterobacteriaceae and Veillonellaceae, and others that had lower than normal abundances, such as Clostridiales and Bacteroidales.  According to the samples, these relative abundances were more pronounced in the mucosal samples, rather than the stool samples, meaning that the mucosa may play a more important role in Crohn’s pathogenesis and diagnosis.  Moreover, children under age 10 did not have large populations of the ‘bad’ bacteria, which were negatively correlated with age.

Another important finding from the study is that antibiotic treatment of the Chrohn’s disease further exacerbated the microbial imbalances (dysbiosis), and caused the bad bacteria to proliferate and the good bacteria to die off.  The researchers are quick to dismiss antibiotics as the cause of the disease, rather hypothesizing that the antibiotics allow for opportunistic bacteria to grow which may cause dysbiosis.  They also encourage further research on the subject and question whether antibiotics should be prescribed to IBD patients.

The researchers used this knowledge of the dysbiosis to create a potential diagnostic for IBD.  They were able to calculate a microbiome diversity index by sampling the mucous for the existence of certain bacteria and for overall microbiome diversity.  The index shows remarkable ability to not only accurately predict the existence of IBD, but also the severity of it.  Also, the researchers showed their microbiome dysbiosis index could be combined with clinical data to better predict the future outcome of the disease.

A final conclusion of the paper is that the gut mucous is a more accurate signal for IBD.  They conclude that stool samples are composed of higher levels of aerobic, oxygen using, bacteria than those in gut, and that stool is not representative of the overall microbiome.

This study is the first to rigorously tackle IBD, specifically, Crohn's disease, and the microbiome.  We now know what bacteria are most highly associated (both positively and negatively) with IBDs, and how this this information can be incorporated into early diagnostic screens.