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Gut Microbiome and Social Determinants of Health (SDOH)

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Case Report | DOI: https://doi.org/10.31579/2690-4861/060

Gut Microbiome and Social Determinants of Health (SDOH)

  • Suneeta Kumari MD, MPH 1*
  • Saba Afzal MD 1
  • Stacy Doumas MD 1
  • Eric Alcera MD 1
  • Ramon Solhkhah MD 1

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

Abstract

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.

Introduction

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 microbiome is an integral part of Gut-Brain axis. The interaction between gut microbiome, gut permeability and CNS is BIDIRECTIONAL. (Yarandi 2016)
  • Presence of healthy and diverse gut microbiota is important to normal cognitive and emotional processing. Chronic stress can change composition of gut microbiome.
  • Alteration in composition of gut microbiome DUE TO STRESS can lead to increased intestinal permeability--- lead to translocation of gut microbiota and metabolic product such as lipopolysaccharides through the intestinal barrier.
  • Exposure of epithelial cells or mucosal immune cell to bacteria or metabolic products leads to activation of immune response and release of pro-inflammatory CYTOKINES
  • Subsequently neuroactive compound gain access to the CNS that regulates cognition and emotional responses.
  • Stress can lead to activation of the hypothamus -pitutary axis and excessive release of corticotropin-releasing factor (CRH). This hormone along with altered vagal activity can cause local activation of mast cells in the intestinal wall and release of CYTOKINES, causing increased gut permeability.
Figure 1: A schematic representation of the effects of chronic stress and depression on brain‐gut axis activity. The bi‐directional communication allows signals from the brain corticolimbic structures to alter gastrointestinal function. The HPA axis and immune system are key regulators of this axis.

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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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann