FORGOTTEN ORGAN: INTESTINAL MICROBIOTA

The total surface area of ​​bacteria is the size of a tennis court. While the number of genes in humans is 35,000, the number of genes in intestinal bacteria is over 2 million. The total number of bacteria in our intestines is 1015. The total number of cells in our body is 1014, or one tenth. In this case, a very interesting result emerges. When we look at a person, only one tenth of that person is human and nine tenths is bacteria. The effects of such a large living being on our body on health and disease have been neglected, or rather could not be studied due to technical inadequacy until the last decade. Some scientists call the intestinal microbiota “virtual organ” or “forgotten organ”. Recognizing this situation, the USA, the European Union and China launched the human microbiome (bacterial gene) project 5 years ago. 115 million dollars were allocated for the "Human Microbiome Project" in the USA. The European Union launched the "MetaHIT Project" within the scope of the 7th Framework. Its budget is 21 million Euros. China launched the "Earth Microbiome Project".

The first bacteria that settle in our intestines from birth are beneficial bacteria called Lactobacillus and Bifidobacteri. The method of birth is important here; bacteria from the hospital environment or even the hands of doctors and nurses can settle in the intestines of babies born by cesarean section. In normal birth, since there are lactobacilli in the mother's birth canal, these bacteria settle. Breast milk is the second miracle because breast milk (recent findings show that the beneficial bacteria in the mother's intestine pass to the child through breast milk) contains substances we call prebiotics that will rapidly increase bifidobacteria and lactobacilli. In the first 2 years of age, intestinal bacteria cannot find their full shape, but when supplementary food is introduced, the shape that will be formed throughout life is completed. In other words, roughly the first 5 years of life are the period when our intestinal bacterial structure takes shape and matures.

Antibiotic use during this period can cause permanent damage to our intestinal microbiota. In a study published this year from the Scandinavian Countries, receiving antibiotic treatment twice around the age of 5 increases the risk of obesity and inflammatory bowel disease in adulthood by 2-3 times. Disorders in the intestinal microbiota in children cause autism, allergic diseases, obesity, inflammatory bowel disease, spastic colon, and learning-related disorders.
Adultsd And the situation is no different. The main diseases in which intestinal microbiota disorders are observed are: Rheumatoid arthritis, celiac disease, colon cancer, inflammatory bowel disease, irritable bowel syndrome (a chronic disease that is very common in the society, accompanied by abdominal pain, defecation changes such as constipation and diarrhea, gas, and impairs the quality of life), Diabetes. (Type 1 and type 2), Metabolic syndrome, insulin resistance, etc. A new one is added to this list every year.

Our mental health is closely related to our intestines. You may ask, "What does it have to do with anything?" Actually, there are many, because there are studies showing that serotonin and similar substances produced by intestinal bacteria through a pathway called the gut-brain axis are associated with depression, panic attacks, anxiety, and even schizophrenia. A study conducted this year showed that patients with depression have a bacteria (Oscillobacteria) in their intestines, unlike healthy people. Animal studies have shown that the learning and memory abilities of animals with disrupted intestinal microbiota are reduced.

Obesity is a public health problem. There are many reasons, but primarily the Western lifestyle. Western lifestyle disrupts the intestinal microbiota, fast-food and frozen and ready-made foods change the bacterial structure in the intestine. Also extremely poor hygiene. The change in bacterial structure due to intensive antibiotic use also causes obesity in adults. The map of antibiotic use and the map of obesity in America overlap with each other. Of course, this is a bigger problem for our country. Since we are one of the few countries where antibiotics can be purchased unconsciously and without a prescription from pharmacies, we have started to pay the price for the widespread use of antibiotics that started 20 years ago. Obesity, allergic diseases and inflammatory bowel diseases are increasing rapidly in Turkey. There is an explosion of these diseases today, especially in adults who were around the age of 5 20 years ago. Of course, this coincides with the period when antibiotics were widely used. The best study showing how intestinal bacteria affect our body weight is a mouse study published in the journal Nature. Someone It was shown that when two identical twin mice, one obese and the other thin, were transplanted with bacteria from a thin human, the obese mouse lost weight despite eating the same foods.

The food we eat in our intestines is digested not only by us, but also by bacteria. As a result, sometimes toxic substances may occur. It has been shown in many animal and human studies that colon cancer patients have different bacteria than healthy people and that these bacteria can produce carcinogens, leading to polyps and cancer. Colon cancer may be prevented in the future by better identifying and treating these bacteria.

Today's nutritional treatments are based on calories, fats, proteins, carbohydrates and their balancing. But there is a forgotten factor: If you cannot change the intestinal bacterial structure in a positive way, it is not possible to lose weight. In a study conducted in France, among obese people on a diet, only those with a certain intestinal bacterial structure lost weight. So, even if some people consume few calories, their intestinal bacteria produce calories, making it difficult for them to lose weight. I think many different weight loss diets (for example, microbiota changing diets) will come to the fore in the future.

One of the most fashionable diseases of recent years. It can lead some patients to cirrhosis and even liver cancer. In a study conducted this year, giving probiotics (beneficial bacteria) to obese and fatty liver children for 6 weeks resulted in a weight reduction, a nearly 30% decrease in the amount of liver fat, and an improvement in blood tests. This shows us how important our intestinal bacteria are for our liver health. The same goes for alcohol-related liver disease.

Fecal microbiota transplantation is simply fecal transfer. Although it is repulsive, it is a treatment method that is increasing in the world. It was first used in the USA for chronic C.difficle infection. 96% success rate was achieved in these patients who were resistant to all antibiotics. First It was initially tried in inflammatory bowel disease, but so far the results are variable, meaning that it works very well in some patients and not in others. It also needs to be repeated several times. There are successful results in a few patients with irritable bowel disease. In Amsterdam, transplants are performed for patients with diabetes and insulin resistance. The first results are quite successful, although it does not completely cure diabetes, it significantly reduces insulin resistance. It is possible to apply it to obesity, colon cancer, allergic diseases, rheumatoid arthritis, and many diseases in the future. The interest in this field is so intense that patients abroad put pressure on their doctors to receive this treatment. However, since it is still in the scientific study phase, it will take time to apply this treatment outside of the study. Bacteria banks have begun to be created in France, America and some countries. Enterome company in France took action to produce diagnostic kits for many diseases, and large companies in America started to enter this field.
The intestinal microbiota is still in its infancy, but the first findings indicate that it will be involved in many diseases in medicine and will be involved in diagnosis and treatment. It has been 5 years since developed countries realized this potential. While the past 20 years were the age of genetics, it seems likely that the next 20 years will be microbiota studies. Türkiye has not started in this regard yet, but this field has a different importance for Turkey. Our eating habits (although changing rapidly) are different from Western countries. Therefore, it is likely that we have a unique intestinal bacterial structure. By studying this, specific diagnosis and treatment methods can be developed. I hope that in the future, more scientists in our country will focus on this issue so that we do not fall behind in this race.

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