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Case Report | DOI: https://doi.org/10.31579/2690-4861/060
Hackensack Meridian Health- Ocean Medical Center- Hackensack Meridian School of Medicine, Brick NJ.
*Corresponding Author: Suneeta Kumari, Hackensack Meridian Health- Ocean Medical Center- Hackensack Meridian School of Medicine, Brick NJ.
Citation: S Kumari, S Afzal, S Doumas, E Alcera, R Solhkhah. (2020) Gut Microbiome and Social Determinants of Health (SDOH). International Journal of Clinical Case Reports and Reviews. 4(2);DOI: 10.31579/2690-4861/060
Copyright: © 2020 Suneeta Kumari, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 September 2020 | Accepted: 30 September 2020 | Published: 05 November 2020
Keywords: Gut Microbiome; SDOH; human microbiota
With technological advancements in the medical field, new discoveries have been unfolded about the human microbiota. A tremendous amount of work has been studied within the last two decades. Some of the human microbiota sites include nonsterile areas such as mouth, skin, gut, nose, and vagina. Additionally, there are bacterial cells in areas that were considered sterile such as lungs and placenta before delivery. Out of all the sites, the gut houses the most with an amount of 100 trillion bacteria (Guinane, 2013). Environmental implications have been known to impact these new areas of medicine. There has been a growing interest by the social epidemiologists on how health inequalities impact the role of human gut microbiota.
With technological advancements in the medical field, new discoveries have been unfolded about the human microbiota. A tremendous amount of work has been studied within the last two decades. Some of the human microbiota sites include nonsterile areas such as mouth, skin, gut, nose, and vagina. Additionally, there are bacterial cells in areas that were considered sterile such as lungs and placenta before delivery. Out of all the sites, the gut houses the most with an amount of 100 trillion bacteria (Guinane, 2013). Environmental implications have been known to impact these new areas of medicine. There has been a growing interest by the social epidemiologists on how health inequalities impact the role of human gut microbiota.
The gut microbiome has been linked to multiple behavioral health conditions, including depression, PTSD, anxiety, and bipolar disorder. Like other health conditions, a broader social environment shapes the microbiome over the life course. The gut microbiome is influenced by social disparities. Research shows that environmental factors have a greater impact on gut microbiota compared to genetics. There has been a significant resemblance in the composition of the microbiomes of genetically unrelated individuals who live together (Rothschild, 2018).
In this article, authors aimed to explore how early development in life, socioeconomic inequalities, social stressors, and health behaviors can impact the human intestinal microbiome. This review attempts to highlight the scope and mechanism of these influences and how the social environment can influence the human gut microbiota.
There is a growing awareness and interest that gut microbiota can play a crucial role in maintaining homeostasis in health and contribute to the pathogenesis of variety of diseases including disorders of CNS. Several studies have shown role of gut microbiota to influence gut-brain communication in health and disease (Dinan, 2013, Stantan 2017).
Keywords: human microbiome, gut microbiome, social determinants of health, socioeconomic inequalities, health disparities, early development, social stressors, health behavior
Understanding gut-brain axis
The gut- brain axis is a bidirectional communication system through which the brain modulates/ regulates GI function. In this process several neural, endocrine, and immunological mechanisms play important/ essential role. The intestinal microbiota impacts the GI physiology, including the development and function of enteric nervous system- Also known as second brain- It controls the GI function independently. The enteric system of GI is composed of myenteric and submucosal plexus. Interestingly, recent research findings suggest a potential link of these structures in neurodegenerative disorders- For instance characteristic lewy bodies, pathological hallmarks of Parkinson’s disease, were found in intestinal biopsies of patients with Parkinson’s disease (Lebouvier 2009).
There is increasing evidence that the immune system, inflammation and mucosal barrier function are involved in the pathogenesis of some psychiatric diseases. For instance-in depression, “leaky gut” has been suggested to play a significant pathogenic role- This assumption was based on findings of prevalence and median values for serum IgM and IgA against lipopolysaccharide of enterobacteria in patients with MDD then in normal volunteers (Maes M. Kubera 2008). This study suggested that patient with MDD should be checked for leaky gut by means of IgM and IgA panels and should be treated for leaky gut accordingly.
Effect of gut microbiota on the CNS.
Gut Microbiota and Depression
According to research on animal model- Depression changes the composition of gut microbiota (Park AJ Collins 2013). These data have not been validated in patient with depression. Recent study (Naseribafrouei 2014) examined the composition of fecal microbiota in 46 patients with depression and 30 healthy controls. This study reported significant differences with increased population of Bacteriodetes, Proteobacteria, Antinibacteria and decreased population of Frimicutes in patients with depression. Other evidence that might suggest role of gut microbiota in the pathogensis of depression is from studies that have shown certain probiotics can alleviate depressive symptoms in rodent models (Park AJ Collins 2013).
According to Dinan 2013 study- A variety of strategies have been used to study the impact of the microbiota on brain function and these include antibiotic use, probiotic treatments, fecal microbiota transplantation, gastrointestinal infection studies, and germ-free studies. All these approaches provide evidence to support the view that the microbiota can influence brain chemistry and consequently behavior (Dinan 2013).
Additionally, research from animal demonstrate that there is a distinct perturbation of the composition of gut microbiota in animal models of depression and chronic stress. This has direct implications for the development of psychobiotic-based therapeutic strategies for psychiatric disorders. Moreover, given that affective co-morbidities, such as major depression and anxiety states, are common in patients presenting with irritable bowel syndrome (IBS), it may have implications for functional bowel disorders as well.
Role of psychobiotic/ probiotics:
Normal gut microbiota is essential in preventing colonization of the harmful bacteria. In the absence of normal flora (antibiotic therapy)- pathogenic organisms produce toxins and colonize the gut epithelium (C. Difficile). Probiotic treatment-reduces gut permeability, enhance mucus production, improve physical barrier protecting the epithelial layer (Yarandi 2016) Treatment of rats with probiotics containing B. infantis can reduce the mood disturbance and correct the concentration on norepi (NE) in the brain (Desbonnet L, 2010). In a model of depression post MI, treatment with probiotics reduce the depression, presumably by reducing the pro-inflammatory cytokines and gut permeability (Arseneault-Breard 2012)
Previous research defines a psychobiotic as a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness. As a class of probiotic, these bacteria can produce and delivering neuroactive substances such as gamma-aminobutyric acid (GABA) and serotonin, which act on the brain-gut axis (Dinen 2013). Preclinical evaluation in rodents suggests that certain psychobiotics possess antidepressant or anxiolytic activity. Effects may be mediated via the vagus nerve, spinal cord, or neuroendocrine systems (Dinen 2017).
To date, psychobiotics have been most extensively studied in a liaison psychiatric setting in patients with irritable bowel syndrome, where positive benefits have been reported for several organisms including Bifidobacterium infantis. Evidence is emerging of benefits in alleviating symptoms of depression. Such benefits may be related to the anti-inflammatory actions of certain psychobiotics and a capacity to reduce hypothalamic-pituitary-adrenal axis activity. Results from large scale placebo-controlled studies are awaited.
In one UK study, 13,000 male and female twins within the age group of 18 and 103 studied sociodemographic and health variables that were matched with microbiota from a previous sample study. This was analyzed using 16 S sequence. Socioeconomic status was measured using the Index of Multiple Deprivation 2015 which encompassed income, employment, education, skills and training, health deprivation and disability, crime, barriers to housing and services, and living environment deprivation based on the postcode. These measures were taken from the Scottish and English/Welsh datasets from the Scottish Government and Public Health England. The microbiota composition was measured in relation to alpha diversity, beta diversity, and differential operational taxonomic units (Bowyer, 2019).
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