New Gut Microbiome Publication

• New DNA sequencing techniques are revolutionising our understanding of the gut microbiome, leading to the identification of newer health-promoting species and the prediction of their metabolic pathways that can help determine how to more specifically promote their growth.
• Opportunities to personalise microbiome interventions are at early stages.   These could target not only microbiota diversity but also changes in specific beneficial metabolites, such as short-chain fatty acids (SCFAs).
• A large variety of fermented foods are consumed worldwide, with a long history of safe use. However, their health benefits depend on the specific microbial community present, and few have been subjected to the level of clinical research needed to prove these benefits. Future research should focus on standardisation and quality control around specific strains to maximise understanding of the health benefits of fermented foods.

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• Probiotics can be key players in health, but effects are strain-specific and may rely on very specific mechanisms. Therefore, probiotic foods and supplements should be labelled with the strain.
• Clinical trials of probiotics should be carried out with the specific combination of strains and within the food matrix intended to be used in the final commercial product as these factors can impact on the efficacy of the probiotic.
• Studying probiotics is complex due to a combination of variable factors such as diet, stress, lifestyle as well as individual host interactions and the multiplicity of mechanisms that may be involved.
• Care needs to be taken with interpretation from systematic reviews and meta-analyses due to significant heterogeneity in the data e.g. different strains, doses, durations, population groups.

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• A wide range of substances have been identified that match the definition of a prebiotic but few have the necessary level to support a health benefit from human trials. The prebiotics inulin, galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS) currently demonstrate the highest strength of evidence and mechanistic understanding of health benefits.
• While in vivo studies are essential for confirming health benefits in humans, in vitro studies are useful for revealing candidate prebiotics, or mode of action.
• The identification of previously unknown probiotic species outside of the gut will require the identification of new or alternative prebiotics which support their growth and function to deliver health benefits.

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• A complex bidirectional pathway exists between the gut and brain. Most evidence for the role of the gut microbiota in mood and depressive disorders is pre-clinical and observational, with building evidence in control trial settings.
• Depression is a multi-factorial condition, and specific pathways of pathogenesis are individualised and remain elusive, making the research in this area difficult.
• A small number of initial RCTs have shown the benefits of a healthy diet, certain nutrients, and interventions with psychobiotics, but more research is required. Potential exists for a more holistic approach using diet and other lifestyle factors to modulate the gut microbiome as adjunct therapy.

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• A bidirectional relationship exists between the gut microbiome and sex hormones. The term “estrobolome” has been coined to refer to the sum of all the gut bacterial genes that are capable of metabolising oestrogens.
• Menopause is associated with lower gut microbiome diversity and lower estrobolome potential versus pre-menopause.
• Metabolic interaction of the gut microbiota with oestrogens may increase their retention in the body with implications for symptom management in menopause as well as reducing menopause-related disease risks related to heart and bone health. However, research in this area is in its infancy, and more investigation is needed.

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• Dysbiosis (i.e. imbalance) of the gut microbiota has been associated with various skin conditions, including atopic dermatitis (eczema) and epidermolysis bullosa (rare condition causing skin to blister easily).
• Continued research on specific probiotic strains and dietary modifications may provide a safe adjunct to existing treatments for dermatologic conditions.  rhamnosus, Bifidobacterium lactis, and L. acidophilusprobiotic strains in single- or multi-strain formulations appear to currently hold promise for the prevention and treatment of atopic dermatitis.
• Understanding the complex relationship between the skin and gut microbiome may help develop new therapeutic intervention strategies in the management of various skin disorders that can potentially improve patient’s quality of life.

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• Whilst there is no agreed definition of faecal microbiota transplant (FMT), it is generally understood to represent the process whereby stools collected from a healthy screened individual (“donor”) are homogenised, filtered, and subsequently delivered into the bowel of an unwell recipient with the aim of re-establishing a more diversified and/or less disturbed microbiota within the gut.
• FMT is an important experimental tool for understanding the gut microbiome and teasing out cause-and-effect relationships, but it is also a therapeutic tool in its own right. FMT is currently recommended for those with recurrent Cl. difficile infection, and research is promising in its use in the treatment of some cases of inflammatory bowel disease (IBD).
• There is a greater focus on understanding both donor and recipient factors that affect successful colonisation post-FMT, and there may be the potential to better match donors to recipients based on a microbiota complementarity.

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The study day was approved for continual professional development by the Association for Nutrition and content endorsed by the Gastroenterology specialist group of the British Dietetic Association.