While we're beginning to understand more and more about the #microbiome, research on the #mycobiome (fungi 🍄) is in its infancy. Here is my summary of 🔑 points from @aeprobio's seminar on the latest research on fungi and the gut!
More frequent brushing of teeth is associated with ⬇️ gut Candida
Western diet vs vegetarian diet:
Vegetarian diet has greater fungal diversity, and different composition of fungi (e.g. Candida 63% vs 84%). Fusarium and Aspergillus are common plant pathogens.
Most common reported fungal genera. Most are yeast. On a strain level, Candida are most common.
Factors impacting resident gut fungi versus non-resident (environmental) fungi
Dietary fungi, even if not colonizing the gut, probably have a role in host health. For example, Debaromyces hansenii seem to inhibit Candida albicans and C. tropicalis
Eamonn Quigley on the clinical implications of the #mycobiome. What is the deal with Candida? Is "candida overgrowth" or #SIFO real? Does candidal dysbiosis contribute to #GI symptoms?
Lots of online pseudoscience around "candida overgrowth" claiming that it causes anything and everything, and prescribing "candida killing" diets
Fungal infections in the #GI tract include oropharyngeal and esophageal candidiasis. Immunosuppressed patients predispose to fungal infections.
Candidemia is a potentially life-threatening fungal infection of the blood. This is almost always in immunocompromised hosts.
Critical illness with prolonged use of broad spectrum antibiotics can lead to fungal diarrhea which resolves with nystatin.
What about small intestinal fungal overgrowth (#SIFO)?
In 150 patients with unexplained #GI symptoms (probably DGBIs)
🦠63% had #SIBO or SIFO
🦠Dysmotility was risk factor for SIBO/SIFO
🦠PPI protected against SIFO
❓No evidence that SIBO/SIFO contributed to symptoms
No difference in #mycobiome richness or diversity in #IBS compared to healthy controls, and no difference between IBS subtypes. Minor differences were present.
In another study, #IBS patients were divided into those with and without visceral hypersensitivity. The IBS patients had an altered #mycobiome compared to controls, but VH did not matter. In mice, however, VH was found to be affected by the mycobiome.
Diet is an important contributor to the #mycobiome. Even one bite of bread can ⬆️ gut Saccharomyces!
Brushing teeth 3 (vs 1) times per day ⬇️ gut Candida albicans
Eamonn Quigley summary
Frank Schuren
Fungal dysbiosis may contribute to neurodegenerative diseases
Pyridostigmine & neostigmine
⚡️cholinesterase inhibitors
🧠pyrido should not cross the blood-brain barrier
🚽evidence in chronic idiopathic constipation and acute colonic pseudo-obstruction
🫄pregnancy class C; excreted in breastmilk
🫀cholinergic side effects, esp bradycardia
Acotiamide
⚡️inhibits cholinesterase and enhances ACh release via muscarinic receptors
🎈enhances gastric emptying and accommodation
🔥NERD & FD
🫄no safety data
💊side effects: nausea, abdominal distension, constipation
I gave a talk on inpatient bowel regimens today for the @YaleMed@YaleIMed residents and students, with additional 💎s on outpatient #constipation. Here are the slides!
💨The gut microbiota generates ~0.2L–1.5L of gas per day
💨>99%: hydrogen (H2), carbon dioxide (CO2), & methane (CH4)– *odorless*
💨foul smell of gas from <1%: sulfur–containing gases hydrogen sulfide (H2S), methanethiol (CH3SH), dimethyl sulfide [(CH3)2S] + volatile compounds
🦠bacteria in the colon ferment substrates that are not digested or absorbed in the upper GI tract (e.g. carbohydrates, proteins, fats)
🦠produce short-chain fatty acids, branched-chain fatty acids, ammonia, N-nitro compounds, phenolic and indolic compounds, and various gases