MADRID, Spain — Healthy lifestyle habits are the most powerful weapon we have to protect against damage to our microbiota, which is increasingly common in our society. Metagenomic analysis and the use of probiotics supplement treatment strategies for more and more diseases.

The endocrinology and nephrology departments at the Jiménez Díaz Foundation Hospital in Madrid sponsored a conference titled “Microbiota in Modern Medicine” to share current knowledge and investigate changes in the microorganisms residing in our bodies, as well as to investigate a few of the many common diseases in which these microorganisms are involved. From scientific evidence to clinical practice, the event featured more than 15 presentations, and more than 250 healthcare professionals attended.

When we use the term “microbiota,” we are referring to the population of microorganisms that inhabit the human body, especially the gastrointestinal tract, but also other locations like the skin, mouth, and airways. The term includes bacteria, viruses, fungi, and an array of microorganisms that may play a significant role in digestion, immunity, and different bodily functions.

“Advancements in our understanding of the important role microbiota play in health and disease are extremely interesting, and there is an overwhelming amount of experimental scientific evidence. However, there is still a massive gap between our understanding and translating it into practice,” said Clotilde Vázquez, MD, PhD, head of endocrinology and nutrition at the Jiménez Díaz Foundation.

Protecting Our Health

The first section of the conference focused on our understanding of the microbiota in a healthy individual: where it is located, how it is studied and measured, and how microbiota products manipulate the host. The conclusion was that a healthy microbiota is our strongest ally against disease.

Vázquez told Medscape‘s Spanish edition, “The metagenomic analysis we use at the foundation consists in isolating DNA from the microorganisms that colonize, in this case, the small intestine, sequencing specific marker genes, and then performing taxonomic and functional analysis on the data with support from bioinformatics. This gives us a very clear picture of the families and strains of known positive or negative function that are present in the small intestine, including their relative abundance, and any that are missing or are present in excessive quantities.

“From this, we can confirm that an excess of proteolytic bacteria impacts our health and generally reduces the number of species present or causes a deficit in beneficial gut bacteria. Once the situation is understood, a corrective strategy is proposed to heal the gut microbiota and correct symptoms,” she explained.

Event organizers emphasized that several groups at the Jiménez Díaz Foundation research healthy microbiota and how it changes during disease. Their aim is to understand its importance and, especially, how to manage it. “We have incorporated metagenomic analysis and the use of specific probiotics in some diseases at our hospital,” said Vázquez.

Dysbiosis in Obesity

Vázquez added, “As to what we currently know about the microbiota and obesity, for many years, a relationship has been observed between changes in two large families (Firmicutes and Bacteroidetes) and a reduction in a very important bacteria from the group of gut symbionts, like Akkermansia muciniphila and Faecalibacterium prausnitzii. There have now been several studies whose results, though conflicting, are promising overall. However, nothing has been proven yet.

“Comprehensive changes in the microbiota (dysbiosis) are common in obesity and are brought on by a poor diet, medications, or a proinflammatory lifestyle. That’s why we need to focus on improving these underlying aspects and, if there are severe symptoms of dysbiosis, a metagenomic study should be performed, and it should be treated accordingly,” she added.

Vázquez also commented on recent studies involving the microbiota in other endocrine diseases. “There are many studies that link type 1 and type 2 diabetes with a microbiota that differs from that of the general population, and fewer studies in the case of the thyroid. But establishing a causal relationship has not yet been possible.

“The crucial message for the general population can be summed up as follows: We must keep our millions of microorganisms in balance to preserve our health. We can achieve this by caring for the environment (the most beneficial bacteria are bacteria in the environment); adhering to a Mediterranean diet rich in pulses, fruits, and vegetables; avoiding processed foods; and living as much as possible a lifestyle with enough rest and physical activity, with both aerobic and strength activities,” said Vázquez.

Mediterranean Diet and Prebiotics

The second group of presentations delved into the potential methods for controlling dysbiosis. They emphasized diet, especially a Mediterranean diet, and the use of prebiotics, probiotics, symbiotics, and postbiotics. Prebiotics are nondigestible components in our diet that beneficially impact the host, selectively promoting the growth and activity of one of the species of bacteria inhabiting the colon, or of a limited number of them, thereby improving the host’s health. Probiotics are living microorganisms that, when taken in appropriate quantities, confer health benefits. Symbiotics are mixtures of probiotics and prebiotics that improve the survival and establishment of dietary supplements composed of living microbes in the host’s digestive system. Postbiotics are food-grade bioactive compounds produced by microorganisms during the process of fermentation, including microbial cells, cell components, and metabolites.

The final set of presentations considered the main microbiota-related diseases from the perspective of different specialties and included participation from multiple experts who study these imbalances in various diseases.

Probiotics’ Growing Importance

The presentations analyzed recent studies that have made noteworthy contributions to our understanding of the relationship between dysbiosis and disease. Emilio González Parra, MD, PhD, associate department head of nephrology at the Jiménez Díaz Foundation, and co-organizer of the conference, said, “Results with probiotics are difficult to analyze, but the experiences of each group within specific fields of knowledge are very promising, as seen in the presentations that were given.”

Regarding the main benefits of probiotics, González told Medscape, “Their benefits are confirmed but produce different results in many diseases, especially in gastrointestinal diseases. The problem is that the results are conflicting. This is because different types of strains are used for the same disease, and using an effective product for each condition is the key to achieving a good outcome. However, in daily practice, results in specific patients are often spectacular when the appropriate strain is chosen. On the other hand, it isn’t a common treatment in the hospital, except during prolonged hospitalizations. It’s a therapy that must be used for a long time (more than one month) to provide an adequate treatment.”

Reducing Uremic Toxins

González spoke about renal and urologic diseases that could benefit from these treatments in light of current knowledge. “In nephrology, my field of research, many promising results have been observed. For several reasons, the intestinal flora of kidney patients is highly altered, and the pathological products that this abnormal flora produces build up, because the patient doesn’t have proper renal excretion. Therefore, using probiotics to modify the flora has shown a clear reduction in toxic products (uremic toxins) and in their harmful effects, such as in the kidneys and heart.

“We have achieved our purpose of taking the first step in multidisciplinary scientific knowledge sharing in this field that is so new and so vital, and an area in which we have gained a certain amount of experience,” he concluded.

This article was translated from Medscape’s Spanish edition.

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