Bowel Research UK’s Patient and Public Involvement Manager Sam Alexandra Rose is joined by Simon Carding, Professor of Mucosal Immunology at the University of East Anglia and head of the Food Microbiome and Health Research programme at Quadram Institute in Norwich, along with Adele Sayers, a consulting colorectal surgeon at Sheffield Teaching Hospitals with an interest in IBD. In this episode, they discuss the gut microbiome, explaining what it is, the impacts it has on our entire body and how it is involved in IBD, the potential benefits we get from having a healthy gut microbiome, and how to keep it healthy.
Transcript
Sam
Welcome to Can I Butt In, the Bowel Research UK podcast where we welcome bowel cancer and bowel disease, patients, researchers, healthcare professionals and carers to butt in and share their experiences. We’re picking a topic every episode and getting to the bottom of it.
I’m your host, Sam Alexandra rose. I’m the patient and public involvement manager at Bowel Research UK. And as a patient myself, I’m excited to bring more patient and researcher voices into the spotlight.
Hi, Sam here, a quick note before we jump into the podcast. This episode was partially recorded in a shared office, and you may notice some background noise with the first 3 minutes, but that disappears for the rest of the episode. So please do stick with it because it’s a very interesting conversation about the gut microbiome with two medical experts and me, enjoy!
Hi, everyone. Today we’re taking a look at the gut microbiome, a topic that’s become increasingly popular recently. So, I’m joined by Simon Carding, professor of Mucosal Immunology at the University of East Anglia and head of the Food Microbiome and Health Research programme at Quadram Institute in Norwich. And I’m also joined by Adele Sayers, a consulting colorectal surgeon at Sheffield Teaching Hospitals with a particular interest in IBD, welcome both of you to the podcast.
Simon Carding
Thank you
Adele Sayers
Hi, thank you
Sam
So, I’m going to start off with a couple of basic questions and then I’ll let the experts talk because I don’t know too much about the microbiome so, I’m here to learn. So, I’m just gonna kick off by asking what is the microbiome?
Simon Carding
OK, so the microbiome refers to a collection of microorganisms, that live in a particular environment. And the microorganisms collectively make up of microbiota, which is another term that, heard a lot in this area of research. And microbiota consist of not just bacteria, also viruses. Ancient bacteria, which we call Archaea. And then there are fungi. As well as well as some protozoan. So, If we include the food that we eat, the gut contains every known kingdom of life. And my particular interest is the gut microbiome and how that interacts with us, to keep us healthy, and also may be involved with disease.
Sam
So there’s a gut microbiome, that implies that there are other microbiomes… Is that right?
Simon Carding
Every surface, external and internal, which is with microbes, which make up unique… so if you think of the skin and all the different parts of the skin. You know the skin on the back of your hands, on your armpits and your groin, et cetera. They all contain unique collections, unique microbiomes of organisms. And then all the internal surfaces of the body are also totally covered with microbes as well. So we are, in essence, probably more microbe than we are human, there’s more microbial cells in or on our body than we have cells in our own bodies so, it’s just been thought that we are probably more microbes than we are humans.
Sam
So where does? The microbiome come from then how do these… this kind of environment? How how does it get created in the gut?
Simon Carding
So, we’re essentially born sterile. So, by conventional births so vaginal birth, mothers are the original source of our microbiomes. Now, if we are born through caesarean section, then we tend to get populated by different microbes depending on where that procedure occurs. But normally the mother is the source of most of the microbiome, and then as the infant develops, it acquires them from its environment, from other people, from pets, from the food, etcetera. So, but it’s initially colonisation by the mother’s microbes. That, particularly during passage through the vaginal canal where the infant gets the initial colonisation.
Sam
Right. OK. Interesting. It’s become such a hot topic recently, hasn’t it? There seems to be a lot of people talking at the moment about the microbiome. You see things on TV about it and on the radio and things. Why do you think that it’s gotten quite popular recently?
Simon Carding
Because it’s essential for our health and well-being… in a nutshell, that’s what it basically comes down. So I think we’ve understood for a long, long time the importance of our gut microbes in processing, digesting the food we eat. But we’re also uncovering other functions of the microbiome that are important for our health and in particular, its interaction with our immune system and keeping the immune system fit and healthy to protect us against infections, invasions, and also from other diseases due to abnormal immune responses like autoimmune disease, for example, of which inflammatory bowel disease or IBD is example.
Sam Alexandra Rose
So the gut microbiome can affect all different parts of the body in all sorts of different conditions then.
Simon Carding
Yes, so, again, over I think the last 10 years we’ve come to appreciate that the influence gut microbes have extends beyond the gut and there’s now a lot of research which we are involved in, looking at the gut-brain axis. So how can microbes in the gut affect the brain? In terms of its development, functioning and also interesting in our behaviour, as well, and what role this may play then in diseases that affect the brain, in particular, dementias like Alzheimer’s disease, Parkinson’s disease. And then there are others in Quadram that are very interested in the gut-liver axis, and the role that gut microbes can play in liver disease. And then we’re also working with groups in other universities in the UK, looking at the gut-joint axis, so potential contribution gut microbes can make to musculoskeletal diseases like rheumatoid arthritis, for example. So, I don’t think there’s an organ in the body that cannot be affected or influenced by gut microbes.
Sam
And you’re also doing some research into the gut microbiome, and ME, is that right? Or chronic fatigue syndrome?
Simon Carding
Yeah, and myalgic encephalomyelitis, chronic fatigue syndrome. ME/CFS. Yep. So, we’ve been working on that for a few years with the invested ME research charity, which funds most of our research. And again, the perspective we’re taking there is looking at the gut microbes in these patients. Because historically ME is triggered by an infection, usually a virus infection and the usual candidates, there are Epstein Barr virus, EBV, cytomegalovirus, herpes viruses. But we’re also looking at the possibility that the viruses in the gut may actually be a cause of ME. So, we’re very interested in gut virus immune cell interactions in ME. And we’re also looking at translating that research and developing clinical trials, to interrogate what impact changing gut microbes might have in ME/CFS.
Sam Alexandra Rose
Really interesting. And yeah, it sounds like the microbiome is just so important to all kinds of different things. Is there anything that people can do to help their microbiome or to kind of improve that environment in their gut?
Simon Carding
Yeah. So, one of the big factors that influences your microbiome and how it functions in the gut is actually lifestyle and behaviour. So, where you live, how you live. Because one of the things in there is diet, what you eat. And it’s important that your diet contains the foods that are beneficial, can be processed, and serve as energy sources for your healthy, beneficial gut microbes. And that basically comes down to the government’s guidance, 5 servings a day of fruit and vegetables. The more colour on your plate, the better. That’s the sort of food that keeps your beneficial microbes happy content and keeps you in turn healthy.
Sam
I’m going to throw a question a bit out of left field here, and I don’t know if there’s a simple answer there may well not be, but I’ve been wondering since hearing about the microbiome, and this may be a question for you or for Adele. What if a person has had part of their bowel removed? Or, like me, they’ve had all of their bowel removed. Do you still have a gut microbiome? Or you know how… How does that affect things? May not be, have a simple answer to it, but something that I’ve been wondering.
Simon Carding
That’s interesting question. So, the important thing to remember here is that every region of your gastrointestinal tract from mouths to anus. Has a microbiome. It’s covered with microbes, and we know that the microbes are different in different regions of the gut. So, your oral microbiome is very different to the microbes that in your stomach, and that’s different to those in your small bowel, which is different again to those in your large bowel. And then going all the way down to the rectum, that also has its own populations of microbes, so taking a piece of the gut out, you know, will impact on all the other microbes above it and beyond it, but you still have a gut microbiome.
Sam
OK, that’s good to know. So, I’ll sort of bring Adele in at this point, cause I know that you have interest in the microbiome and IBD would like to kick off without or ask Simon any questions about that.
Adele Sayers
Yeah. So actually, the last question that you just asked actually kind of goes in quite nicely to one of my questions. So, cause what we do know is there’s been lots of research out there about appendicectomies and actually having your appendix removed. Does that therefore alter the microbiome of your large bowel? And I just wanted to hear kind of Simon’s thoughts on the role of the appendix and, you know, do you fit… Is it, do we know for certain that, that it does re-populate the microbiome and could an appendicectomy change things.
Simon Carding
So, the procedure itself will have an effect, so stress surgery, we know these change the microbes, some benefits, some don’t benefit. But the appendix is an interesting sort of organ. I think. Classically it’s being considered redundant. You know, we don’t need it it’s just, vestigial from our evolution in other animals it performs much more of a defined function in digestion, for example, but there is the possibility that it does contain reservoirs of bacteria which can then seed as needed further down the gut. And I think that’s really. An under investigated area of research, because classically, if you get a lot of microbes growing your appendix, that is, I think the cause of appendicitis, and it will need to be taken out. So, if there are microbes in there, normally they have to be tightly controlled so they don’t become disruptive, overgrow and then cause a severe pain and other info complications from that, resulting in surgery, so I think in a normal, healthy individual. They probably do contribute to the topping up of the microbiome. But interestingly, there’s research saying that actually the microbes in your oral cavity, in your mouth, are the major reservoirs of seeding microbes throughout your GI tract. So, there may be these other smaller reservoirs that can add to that, complement that, and maybe the appendix and gallbladder. These things may all contribute just topping them up. But it looks like your oral microbiome it is one of the major reservoirs that microbes… just we, we compare what’s in your mouth to what’s in your lower bowel. They’re strikingly similar, so that would say there’s, there is some seeding from the mouth, and they move from other organs including the appendix.
Adele Sayers
Brilliant, really interesting. Actually, I didn’t know that about the mouth that’s… cause certainly kind of a lot of the research that just for the guards to definitely ulcerative colitis, all very much concentrates on the appendix. And that’s really interesting. I guess the next thing that I was just, because I know you’ve got a lot of experience with regards to the microbiome and IBD. I know it’s still an awful lot that’s not currently known. But I was just wondering, kind of, what your opinion is on kind of how the microbiome might influence IBD with regards to developing it in the first place, but also with regards to the severity, be very, you know the severity can be very different in different populations.
Simon Carding
Yeah, I think. A lot of the research looking at the role of the gut microbes in disease has sort of been pioneered by looking at IBD. Think that was one of the first autoimmune diseases in which there was a demonstration of antibodies in the blood which were reactive to gut microbes, that the, saying that a patient had antibodies in their blood that reacted with their own gut microbes, now normally that would not be expected, or even anticipated, or be beneficial because your immune system is therefore attacking your gut microbes, which probably is one of the important drivers of the disease process in IBD. So, from that there’s been a lot of research trying to identify, OK, what are the key microbes that may be involved in in inflammatory bowel disease? And you know, there’s no clear picture emerging from this. And that’s probably not surprising, because everybody’s gut microbiome is unique. Even identical twins have different gut microbiomes. So, try to find, you know, one micro that causes IBD in every patient is probably, you know, too aspirational. It’s not going to happen. So instead, I think what we’re sort of, coming to believe is, one of the key events is actually a breach of your gut barrier, your gut wall. This becomes damaged or it becomes leaky through exposed to toxins or antibiotics, or some other drugs, and that leakiness then allows microbes to escape into the blood. They can cross the gut wall, get into the bloodstream, and that’s when that kicks off this sort of massive inflammation. Which then feeds back into the gut and that could lead to inflammatory bowel diseases. So, I think in terms of hunting down the causes, you need to be looking at the microbes that take advantage of the leakiness in the gut to get into the blood to start, interact with the immune cells, to kick off the inflammation and again. That’s probably a collection of organisms. It’s probably not one Organism. So, you know, trying to hunt down one specific microbe to account for all forms of IBD, I think it’s a bit, too ambitious. Instead, we need to be sort of focusing on repairing the gut barrier. To keep the bugs out and then we can… the immune system should calm down, and that should then put patients into remission. So, I think a lot of research that I’ve been aware of now recently is targeting that. You know, can we restore the barrier? To then stop this influx of these microbes, continually stimulating the immune system. And that can be done in various ways, and I’m sure Adele is very aware of all the therapies which are aimed at sort of relieving that, the pressure off, the repairing of the barrier to help patients. So, I think that. That’s key, I think in inflammatory bowel. Disease and as well as if you can replace everything in the gut, all the microbes with a new healthy microbiome. That’s probably going to be beneficial in some patients as well. And I know there are trials underway currently looking at this microbiota transplant procedure as a means of eliminating whatever the, disease causing microbes are, and giving a fresh, healthy microbiome to the patient, and that’s called faecal microbiota transplantation, or FMT.
Adele Sayers
Brilliant. Thank you that, was really, well, you first of all, you’ve just anticipated my next question, which was all about FMT, so thank you. But yeah. No, that’s. Yeah. Really, really interesting. I know that there’s been lots of questions asked as well about actually, could altering the microbiome in itself lead to remission of IBD, but obviously it seems that it’s a lot more complex than perhaps you know than in the reading that I’ve done that I’ve perhaps appreciated. And this also goes into the question about the appendicectomy, because like I said, there’s there was certainly a study that’s been done where we’re trying to induce remission by doing appendectomies. But again, sounds like there’s an awful lot more to it than just a simple appendicectomy to, you know, potentially induce some… remission of IBD. So that’s brilliant. Thank you very much. And another question I did just have is, with regards to the microbiome. And this is not just for IBD patients, this is for all patients out there. What one kind of take-home message would you have for people? What one thing do you think is most important for people to appreciate about their microbiome and the potentially effect it might have on them?
Simon Carding
Yeah. So, I mean, I always get asked this question at the end when I give talks. What can I do to keep my microbes healthier? And it’s quite simple really. It’s your lifestyle and behaviour, you know, everything you do, your lifestyle. The diet you have exercise all these things feed into your gut microbiome and one of the things I think people often forget is that the gut is your second brain. You know, it’s jam packed with nerves, nerve endings, and that’s how microbes communicate with the rest of the body through the nervous system, but also the hormone system. So, there are more hormone producing cells in your gut than anywhere else in your body. And it’s also the largest immune organ in your body. So, the gut microbes can interact with your nervous system, your immune system, your hormonal endocrine system, and, of course, all of these things influence all sorts of behaviours. But collective, they’re all there to sort of keep us fit and healthy. So, it’s very important, therefore, that you maintain your gut microbes through… like healthy diet, healthy lifestyle, you know, eat your 5 servings of fruit and vegetable a day, keep your healthy microbes beneficial. And in turn, you know, they’ll interact with all these sensory systems in the gut to keep the rest of your body fit and healthy, hopefully. And it’s when things go wrong, it’s like when you get an infection. So you know you get food poisoning, for example, that can have a severe impact when you’ve gut microbes and, you know, just get diarrhoea and you feel awful, but you’ve got microbes take a long time to recover, and get back to their pre infection state. Same with antibiotics, of course. You know a lot of antibiotics taken… and that can wipe out a lot of healthy microbes at the same time as targeting some of the more nasty microbes. So, you know, drugs, infections, they’re the two things that will really drastically shift your microbiome, and it can take a while for them to recover. So things that can help your microbiome recover are obviously your diet, but also probiotics. And also, things like superfoods. So fermented foods which are really good, like Kefir for example. And that’s because they contain plant based materials to keep you gut microbes healthy, but they also contain healthy microbes which you consume along with that. So, you get the benefit of a probiotic and prebiotic. In your fermented food, and that can really help you more rapidly restore a healthy microbiome when you’ve had a period of illness, or you’ve had long exposure to antibiotics.
Adele Sayers
Perfect. Thank you. Yeah, that was one thing which might be another question I was going to ask, just with regards to fermented foods, cause I know that’s very popular at the moment. You know, people drinking kombucha and Kefir and also sauerkraut to see an awful lot of that on the shelves at the moment. They’re really good. I think I might start stocking up on Kefir then.
Simon Carding
There’re several people at Quadram that are making their own Kefir, you know, so it’s not difficult to do, and it’s really a super food. They’re all super food.
Adele Sayers
Amazing. Thank you, Simon. Thank you for answering my questions.
Sam
Thanks both of you. I think that’s a really good crash course in the gut microbiome. Useful for me and yes, I think useful for anybody listening as well. Thank you both for taking the time to chat about this today.
Simon Carding
You’re welcome. Thank you very much.
Adele Sayers
No, thank you very much. Welcome.
Sam Alexandra Rose
Thank you for listening to Can I Butt In. This podcast was brought to you by Bowel Research UK. Find out more about the charity, our work and how you can get involved. Visit bowelresearchuk.org where you can join our People and Research Together network or PaRT, read about our research campaigns and fundraising, or make a donation to support the vital work we do. Let’s end bowel cancer and bowel disease.