How Gut Microbes May Influence Neuropathy

Today's post from podiatrytoday.com (see link below) is an interesting one looking at the relationship between the millions of bacteria in our digestive system, inflammation of the gut and auto-immune diseases like neuropathy. Written in a way that will appeal to most people at all levels of medical understanding, it discusses a subject which neuropathy patients may come to hear much more about in years to come. How much do we know about keeping our intestines healthy? The antibiotics we take, kill both good and bad bacteria indiscriminately and supplementation with pro-biotics seems more and more a good idea but the idea that gut inflammation may also be directly linked to nerve problems is a relatively new one. See what you think and ask yourself if you're looking after your gastrointestinal tract as much as you should be. 
 

Why Studying Microbiomes May Help In The Treatment Of Diabetic Neuropathy
Stephen Barrett DPM FACFAS Friday, 04/17/15

I had finally had made it back from my much delayed next visit to the Super Brain, the Bari Tass. At first, I did not know what to make of what it had told me. I thought my question was very simple and straightforward. But when I got the answer, I was initially disappointed: “Get some guts.”

“Get some guts,” I thought. What the hell was that for an answer to my question about what the next, landmark discipline of study in medicine was going to be? Then it bellowed at me, “It’s all about the microbiome.”

“Microbiome.” I scratched my head, initially thinking about that biosphere that they built north of Tucson, Ariz. a couple of decades ago.

The super computer snorted a couple of times, hard drives churning, RAM burning, and then it bellowed in that digital voice, “Mucus and poop, you idiot.”

“Oh,” I exclaimed. It then dawned on me that the “brain” thinks those little microbes that live inside our gastrointestinal tract may play a bigger part in our human picture than solely being vilified as the source of serious Gram negative infections or a complication of an antibiotic regimen manifesting as a Clostridium difficile colitis nightmare.

No matter how important and independent you think you are, you are nothing more than a symbiote. You are not alone. In fact, you have about 10 times the living microbes in your gut than you have cells in your body. Chew on that stat for a minute. Now, if that does not cause an a-ha moment, think about the fact that the collective DNA of this “organ” that lives inside each and every one of us has a genome more than 150 times that of human DNA. If you want to put a number on it, like Carl Sagan used to do for us on the show Cosmos, there are maybe 100 trillion organisms living inside you right now, not just “billions and billions.”

So I got some guts and started to do some reading. Interestingly, in the March 2015 Scientific American, they have this really cool section on the microbiome. The biggest point to come out of my reading is that I had to shift my paradigm of looking at this type of thing as a positive rather than just a non-talked about daily function of humans. Most of these 100 trillion microbes are actually good for us and if we do not have them, our immune system is severely debilitated. To illustrate this point, the article talks about a gastroenterologist named Harry Sokol, MD, PhD, who discovered almost eight years ago that a missing microbe was present in sections of colon that surgeons resected from patients with Crohn’s disease.1 To be precise, this little poop bug has a name: Faecalibacterium prausnitzii. The article suggested that rather than “bad” microbes prompting disease, could a single “good” microbe prevent disease? Sokol then proved that to be the case in rats.2

So now it turns out that these symbiotic inner partners of ours are indeed very important. Some are dangerous and we still need to do the neighborhood watch on them.

So not all these little guys are bad actors. They are hugely important, regulating our immune system and specifically inflammation. Bad actors like C. difficile cause havoc on the gut, making it a leaking, inflamed and bleeding mass of tissue. On the other hand, close cousins that we refer to as “clostridial clusters” fight inflammation and soothe the immune system. It seems that the good guys promote T regulatory cells, which the gut boys nicknamed “T regs.” Without T regs, we can get overwhelming inflammation. (They didn’t really provide the nickname. Biologists did. However, that didn’t work in the storytelling here. Work with me.)

What Does This Talk About The Gut Have To Do With The Foot?

Now I know the next question the reader is noodling right now if he or she has made it this far. Bless you if you have as we really need to start thinking about how this can translate clinically. “What the hell does this have to do with podiatric medicine?” Fair question, albeit close-minded.

Well who sees a ton of patients with peripheral neuropathy? You. Now, I cannot think of many, if any, neurophysiological diseases that do not have a significant inflammatory component to them. In fact, many neurological diseases are truly autoimmune, are they not? Multiple sclerosis and ALS come to mind fairly quickly. It seems that there is a “gut-brain axis” as these little travel partners can synthesize GABA, serotonin and norepinephrine to name a few neurotransmitters that affect the central nervous system, helping modulate pain and that jacked up microbiome that has been directly associated with anxiety.3 That right there is enough to stand up straight, wake up and wonder how the anxious patient does perioperatively in comparison to the one who has no anxiety?4 Not good. Now think pain modulation.

When you start to really look at the whole patient, how can we ignore the microbiome? You have a patient post-op with a slight cellulitis and guess what you write for him or her? An antibiotic. Yep, you just killed some good guys trying to get rid of the bad.

After eating all yak products for several weeks, I can say that I was really in tune with my microbiome. I am thinking a lot more about it now. There are many ramifications of messing with the gut and maybe we should also be treating our patient’s microbiomes when we put him or her on an antibiotic with a probiotic? The bottom line is you have to have a “gut” feeling when you start diving into this fascinating subject that patients with good GI microbiota just have to heal faster, have fewer diseases, are happier and no doubt eat better.

Financial disclosure: I have no financial interest in probiotics or any gut microbes.

References

1. Velasquez-Manoff M. Among trillions of microbes in the guy, a few are special. Scientific American. 2015; 312(3).

2. Sokol H, Pigneur B, Watterlot L, et al. Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota of Crohn disease patients. Proc Natl Acad Sci USA. 2008; 105(43):16731-6.

3. Sharma A, Lelic D, Brock C, Paine P, Aziz Q. New technologies to investigate the brain-gut axis. World J Gastroenterol. 2009; 15(2):182-191.

4. Neufeld KA, Foster JA. Effects of gut microbiota on the brain: implications for psychiatry. J Psych Neurosci. 2009; 34(3):230-231.

http://www.podiatrytoday.com/blogged/why-studying-microbiomes-may-help-treatment-diabetic-neuropathy