Management of dysbiosis

The balance between an individual organism and its microbiota is subjected to constant fluctuations, which need to be managed to avoid certain disease risks.

The entire organism and its intestinal microbiota cohabit in almost perfect, delicately balanced symbiosis. Because the slightest imbalance of the microbiota can lead to certain diseases, it is important to correctly treat dysbiosis (a functional and qualitative perturbation of the microbiota). That change can be an excess of harmful bacteria, a lack of essential bacteria or a complete revision of the bacterial ecosystem. 

Reintroduce a healthy equilibrium

Several options have been studied to return to eubiosis, i.e., total symbiosis between the organism and its microbiota. Antibiotics have1 long been used to select, via selective eradication, which bacteria to preserve in the intestinal ecosystem. However, this strategy is now being actively avoided because of its selection pressure and the risks of emergence of antibiotic-resistant bacteria. 
Restoration of dysregulated microbiota is now targeted using oral probiotics.2,3 Balance can also be restored by boosting bacterial growth, with diet playing a key role through prebiotics4 and certain fibers they contain. The latest International Conference on Nutrition in Medicine recommendations5 favor a diet high in vegetables (artichokes, chicory, dandelions, onions, leeks, asparagus) to boost bacterial growth and restore a healthy balance.
Finally, fecal transplantation6 (or fecal therapy), which consists of reintroducing a healthy ecosystem (taken from a healthy individual) into the most seriously ill patients, is used to correct dysbiosis and treat relapsing Clostridium difficile infection.
 

Sources
1. Sanders et al.  Modification of normal flora by antibiotics: effects on individuals and the environment. New Dimensions in Antimicrobial Chemotherapy. 1984, p. 217–241.
2. Santosa et al. Probiotics and their potential health claims. Nutr Rev. 2006; 64:265-74.
3. Parvez S. et al. Probiotics and their fermented food products are beneficial for health. J Appl Microbiol. 2006 ; 100 : 1171-1185.
4. Louis P, Flint HJ, Michel C. How to manipulate the microbiota : prebiotics. Adv Exp Med Biol. 2016 ; 902 : 119-42.
5. Recommandations 2016 de l’ICNM (International Conference on Nutrition in Medicine) : http://www.pcrm.org/health/reports/seven-dietary-guidelines-healthy-microbiota
6. Borody T, Warren E, Leis S, Surace R, Ashman O, Siarakas S, « Bacteriotherapy using fecal flora: toying with human motions », J Clin Gastroenterol, vol. 38, no 6,‎ 2004, p. 475–83

 

Management

There are 3 ways to affect the equilibrium of microbiotas. Each of them has its own specific features.

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