Possible use of fermented foods in rehabilitation of anorexia nervosa: the gut microbiota as a modulator

Probiotic, prebiotic, synbiotic and fermented food supplementation in psychiatric disorders: A systematic review of clinical trials

The use of probiotics, prebiotics, synbiotics or fermented foods can modulate the gut-brain axis and constitute a potentially therapeutic intervention in psychiatric disorders. This systematic review aims to identify current evidence regarding these interventions in the treatment of patients with DSM/ICD psychiatric diagnoses. Forty-seven articles from 42 studies met the inclusion criteria. Risk of bias was assessed in all included studies. Major depression was the most studied disorder (n = 19 studies). Studies frequently focused on schizophrenia (n = 11) and bipolar disorder (n = 5) and there were limited studies in anorexia nervosa (n = 4), ADHD (n = 3), Tourette (n = 1), insomnia (n = 1), PTSD (n = 1) and generalized anxiety disorder (n = 1). Except in MDD, current evidence does not clarify the role of probiotics and prebiotics in the treatment of mental illness. Several studies point to an improvement in the immune and inflammatory profile (e.g. CRP, IL6), which may be a relevant mechanism of action of the therapeutic response identified in these studies. Future research should consider lifestyle and dietary habits of patients as possible confounders that may influence inter-individual treatment response.

Probiotic and prebiotic interventions in eating disorders: A narrative review

AIMS

The review aimed to summarise and discuss findings focused on therapeutic probiotic and prebiotic interventions in eating disorders (ED).

METHODS

Using PubMed/MEDLINE, Cochrane Library, and Web of Science all published studies were retrieved until February 2023, following PRISMA guidelines. From the 111 initial studies, 5 met the inclusion criteria for this review.

RESULTS

All studies included in this narrative review were focused on anorexia nervosa (AN). Three longitudinal, randomised, controlled trials aimed to evaluate interventions with probiotics (Lactobacillus reuteri, yoghurt with Lactobacillus, and Streptococcus) in children and adolescents. These studies primarily emphasised medical outcomes and anthropometric measures following the administration of probiotics. However, the findings yielded mixed results in terms of short-term weight gain or alterations in specific immunological parameters. With a lower level of evidence, supplementation with synbiotics (probiotic + prebiotic) has been associated with improvements in microbiota diversity and attenuation of inflammatory responses.

CONCLUSIONS

Research on probiotics and prebiotics in ED is limited, primarily focussing on anorexia nervosa (AN). Their use in AN regarding medical and anthropometric outcomes needs further confirmation and future research should be warranted to assess their impact on psychological and ED symptomatology, where there is a notable gap in the existing literature.

Microbiota in anorexia nervosa: potential for treatment

Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected, coupled with an intense fear of gaining weight. Treatment of AN is currently based on psychological and refeeding approaches, but their efficacy remains limited since 40% of patients after 10 years of medical care still present symptoms of AN. The intestine hosts a large community of microorganisms, called the "microbiota", which live in symbiosis with the human host. The gut microbiota of a healthy human is dominated by bacteria from two phyla: Firmicutes and, majorly, Bacteroidetes. However, the proportion in their representation differs on an individual basis and depends on many external factors including medical treatment, geographical location and hereditary, immunological and lifestyle factors. Drastic changes in dietary intake may profoundly impact the composition of the gut microbiota, and the resulting dysbiosis may play a part in the onset and/or maintenance of comorbidities associated with AN, such as gastrointestinal disorders, anxiety and depression, as well as appetite dysregulation. Furthermore, studies have reported the presence of atypical intestinal microbial composition in patients with AN compared with healthy normal-weight controls. This review addresses the current knowledge about the role of the gut microbiota in the pathogenesis and treatment of AN. The review also focuses on the bidirectional interaction between the gastrointestinal tract and the central nervous system (microbiota-gut-brain axis), considering the potential use of the gut microbiota manipulation in the prevention and treatment of AN.

[Anorexia nervosa, microbiota and brain]

Introduction

Anorexia nervosa (AN) is a psychiatric disease with a high prevalence and comorbidities, characterized by a low response rate to treatment. It is considered as a multifactorial disease. In recent years, the focus has been placed on the presence of intestinal dysbiosis and its possible involvement as a causal factor as well as an alternative treatment. The objective of this work has been to review the current state of knowledge of alterations in the intestinal microbiota identified in patients with AN and the possibility of using probiotics as a therapeutic alternative. Significant changes in the diversity of species associated with weight loss have been described that could favor the perpetuation of the disorder, and that would explain many of the nutritional, gastrointestinal, psychological, and cognitive alterations present in these patients. The use of probiotics, still little studied in patients with AN, sheds some light on this matter to improve the treatment response, always hand in hand with conventional treatments.

The inhibitory effects of plant additives on biogenic amine formation in fermented foods - a review

Fermented food has unique properties and high nutritional value, and thus, should constitute a basic element of a balanced and health-promoting diet. However, it can accumulate considerable amount of biogenic amines (BAs), which ingested in excess can lead to adverse health effects. The application of plant-derived additives represents a promising strategy to ensure safety or enhance the functional and organoleptic properties of fermented food. This review summarizes currently available data on the application of plant-origin additives with the aim to reduce BA content in fermented products. The importance of ensuring fermented food safety has been highlighted considering the growing evidence of beneficial effects resulting from the consumption of this type of food, as well as the increasing number of individuals sensitive to BAs. The examined plant-origin additives reduced the BA concentration to varying degrees, and their efficacy depended on the type of additive, matrix, autochthonous, and inoculated microorganisms, as well as the manufacturing conditions. The main mechanisms of action include antimicrobial effects and the inhibition of microbial decarboxylases. Further research on the optimization of bioactive substances extraction, standardization of their chemical composition, and development of detailed procedures for its use in fermented products manufacturing are needed.

The Survival of Psychobiotics in Fermented Food and the Gastrointestinal Tract: A Review

In recent years, scientists have been particularly interested in the gut-brain axis, as well as the impact of probiotics on the nervous system. This has led to the creation of the concept of psychobiotics. The present review describes the mechanisms of action of psychobiotics, their use in food products, and their viability and survival during gastrointestinal passage. Fermented foods have a high potential of delivering probiotic strains, including psychobiotic ones. However, it is important that the micro-organisms remain viable in concentrations ranging from about 10⁶ to 10⁹ CFU/mL during processing, storage, and digestion. Reports indicate that a wide variety of dairy and plant-based products can be effective carriers for psychobiotics. Nonetheless, bacterial viability is closely related to the type of food matrix and the micro-organism strain. Studies conducted in laboratory conditions have shown promising results in terms of the therapeutic properties and viability of probiotics. Because human research in this field is still limited, it is necessary to broaden our understanding of the survival of probiotic strains in the human digestive tract, their resistance to gastric and pancreatic enzymes, and their ability to colonize the microbiota.

Effects of Fermented Food Consumption on Non-Communicable Diseases

The gastrointestinal flora consists of several microbial strains in variable combinations in both healthy and sick humans. To prevent the risk of the onset of disease and perform normal metabolic and physiological functions with improved immunity, a balance between the host and gastrointestinal flora must be maintained. Disruption of the gut microbiota triggered by various factors causes several health problems, which promote the progression of diseases. Probiotics and fermented foods act as carriers of live environmental microbes and play a vital role in maintaining good health. These foods have a positive effect on the consumer by promoting gastrointestinal flora. Recent research suggests that the intestinal microbiome is important in reducing the risk of the onset of various chronic diseases, including cardiac disease, obesity, inflammatory bowel disease, several cancers, and type 2 diabetes. The review provides an updated knowledge base about the scientific literature addressing how fermented foods influence the consumer microbiome and promote good health with prevention of non-communicable diseases. In addition, the review proves that the consumption of fermented foods affects gastrointestinal flora in the short and long term and can be considered an important part of the diet.

Diet and the microbiota - gut - brain-axis: a primer for clinical nutrition

PURPOSE OF REVIEW

Diet is an essential modulator of the microbiota - gut - brain communication in health and disease. Consequently, diet-induced microbiome states can impact brain health and behaviour. The integration of microbiome into clinical nutrition perspectives of brain health is sparse. This review will thus focus on emerging evidence of microbiome-targeted dietary approaches with the potential to improve brain disorders.

RECENT FINDINGS

Research in this field is evolving toward randomized controlled trials using dietary interventions with the potential to modulate pathways of the microbiota - gut - brain-axis. Although most studies included small cohorts, the beneficial effects of Mediterranean-like diets on symptoms of depression or fermented foods on the immune function of healthy individuals shed light on how this research line can grow. With a clinical nutrition lens, we highlight several methodological limitations and knowledge gaps, including the quality of dietary intake information, the design of dietary interventions, and missing behavioural outcomes.

SUMMARY

Findings in diet - microbiome - brain studies can have groundbreaking implications in clinical nutrition practice and research. Modulating brain processes through diet via the gut microbiota raises numerous possibilities. Novel dietary interventions targeting the microbiota - gut - brain-axis can offer various options to prevent and treat health problems such as mental disorders. Furthermore, knowledge in this field will improve current nutritional guidelines for disease prevention.

Anorexia Nervosa-What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011-2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.

Antiviral activity of fermented foods and their probiotics bacteria towards respiratory and alimentary tracts viruses

The recent COVID-19, a viral outbreak calls for a high demand for non-conventional antiviral agents that can reduce the risk of infections and promote fast recovery. Fermented foods and their probiotics bacteria have recently received increasing interest due to the reported potential of high antiviral activity. Several probiotics strains demonstrated broad range of antiviral activities and different mechanisms of action. This article will review the diversity, health benefits, interaction with immune system and antiviral activity of fermented foods and their probiotics bacteria. In addition, the mechanisms of action will be reviewed to determine the broad range potential antiviral activity against the respiratory and alimentary tracts viruses. The probiotics bacteria and bioactive compounds in fermented foods demonstrated antiviral activities against respiratory and alimentary tracts viruses. The mechanism of action was reported to be due to the stimulation of the immune system function via enhancing natural killers cell toxicity, enhance the production of pro-inflammatory cytokines, and increasing the cytotoxic of T lymphocytes (CD3⁺, CD16⁺, CD56⁺). However, further studies are highly recommended to determine the potential antiviral activity for traditional fermented foods.

The association of traumatic brain injury, gut microbiota and the corresponding metabolites in mice

BACKGROUND

Traumatic Brain Injury (TBI) present a significant burden to global health. Close association and mutual regulation exist between the brain and gut microbiota. In addition, metabolites may play an important role as intermediary mediators of the brain and gut microbiota. Consequently, the study sought to investigate the alterations in gut microbiota and metabolites after TBI and conducted a comprehensive analysis of the correlation between gut microbiota and metabolites after TBI in mice.

METHODS

Changes in intestinal microbiota and metabolites in mice after moderate or severe traumatic brain injury were detected through 16S rDNA sequencing and the non-target LC-MS technology. Additionally, Pearson correlation analysis was used to explore the association between the microbiota and metabolites.

RESULTS

TBI was able to change the composition of intestinal microbiota, resulting to a decrease in microbial diversity in the intestinal tract (sham vs sTBI: 8.35 ± 0.12 vs 7.71 ± 0.5, p < 0.01; sTBI vs mTBI: 7.71 ± 0.5 vs 8.25 ± 0.34, p < 0.05). The results also showed that TBI could change the types and abundance of metabolites (723 in mTBI and sham groups; 1221 in sTBI and sham groups; 324 in mTBI and sTBI groups). Moreover, some of the altered gut metabolites were significantly correlated with part of the altered gut microbes after TBI.

CONCLUSIONS

TBI significantly changed intestinal microbiota as well as metabolites. Some of the altered microbiota and metabolites had a significant association. The results from this study provide information that paves way for future studies utilizing the brain gut axis theory in the diagnosis and treatment of TBI.