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!

#GITwitter

Bacteria in the #gut outnumber fungi as a class, but at the individual species level can occur in the same numbers.
Most #gut fungi belong to Ascomycota or Basidiomycota
The #mycobiome has low evenness, with different individuals having dominant fungal communities
Fungi play important roles in host health and immunity
On the other hand, fungal dysbiosis has been implicated in many disease states, including #IBD.
The future of #mycobiome research
Summary from @PaulineDScanlan
Just as #diet is an important contributor to the #gut #microbiome, diet also modulates the #mycobiome.

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
Summary from @HallenAdams
@JosephPetrosino on the #mycobiome of infants with type 1 #diabetes
Fungal diversity in healthy individuals the #gut is lower than bacterial diversity.
Fungi interact with #gut bacteria.

Can we use this knowledge to develop fungal-based #probiotics to support good bacteria and suppress the bad?
Fascinating large study identifying determinants in the development of type 1 #diabetes
10 distinct bacterial communities in infants. These get more diverse over time.

Breastfeeding, furry pets, siblings, and antibiotics all had significant effects on the development of the #microbiome.
Specific viral infections are associated with the development of type 1 #diabetes.

Enteroviruses (especially B). Infection with adenovirus C within 6 months of birth appears to be protective.
Fungal diversity increases until 2 years of age and then plateaus.
Sex, asthma, breastfeeding, and #probiotics impact fungal composition
Geography also contributes to fungal composition
No differences in Candida abundance in type 1 #diabetes.
Pichia kudriavzevii was not found to be associated with #asthma
Candida sake was associated with #celiac disease, but not C. albicans
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
@ISAPPscience seminar!

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More from @john_damianosMD

26 Aug
Thank you so much to @DrPraegers for having me to discuss the effects of plant-based diets on the #gut #microbiome! Here are my slides for all to see! 😃

🍅🥑🧅🍑🥦🍒🫑🍊🌶️🍎🍆🍊🫒🍓🥒🍉🥗🥝🦠

#medicine #medtwitter #diet #nutrition #GITwitter #GI #guthealth #health
Just as we do things for heart health and brain health, our #microbiome is an organ of its own (the size of a 🥭), so we need to take care of it!
Read 30 tweets
10 Aug
Buckle up! This 🧵 is a deep dive into the #physiology of defecation, the mechanics of pooping! 🧰 🚽 💩

nature.com/articles/s4157…

#medicine #MedEd #science #GITwitter #GI #gut #motility #constipation #IBS
Defecation requires
1. intact #GI tract
2. coordination of many systems: neural (enteric nervous system, modulated by the peripheral somatic, autonomic and the CNS); muscular (smooth and striated); hormonal (endocrine and paracrine); and cognitive (behavioural and psychosocial)
#Constipation is the3⃣rd most common #GI symptom

💰 Annual cost of fecal incontinence and constipation: $1,594 - $7,522
Read 31 tweets
26 Apr
Here are the new @BritSocGastro guidelines for #IBS in @Gut_BMJ! I'll summarize in 🧵 ⬇️⬇️⬇️!

😖💩🦠🧠🥦🍞💊

#GITwitter #GI #gut #braingut #motility #DGBI #FGID #microbiome #probiotics #MedTwitter #MedEd

gut.bmj.com/content/early/…
🧑‍⚕️-😷
Doctor-patient communication
🧑‍⚕️A strong 🧑‍⚕️-😷 relationship is fundamental to the management of #IBS
😷Patients want their 🧑‍⚕️ to ⬆️empathy, support and information about the nature of IBS, diagnosis, and treatment options
DIAGNOSIS
🩸New pt: CBC, CRP or ESR, celiac serology and, if <45 w diarrhea, fecal calprotectin
➕Make POSITIVE diagnosis based on @RomeFoundation criteria
➡️Refer to #GI when: diagnostic doubt, pt w symptoms that are severe or refractory to 1stline tx,or when pt wants specialist
Read 16 tweets
6 Apr
Foods in our #diet can alter the pro-inflammatory vs anti-inflammatory milieu of the intestinal #microbiome.

See 🧵 below for the findings!

🥬🍑🍅🍠🥚🍎🧀🍆🫒🫓🍇🥦🥑🥥🥯🌶️🧄🥖

#GITwitter #GI #gut #nutrition

gut.bmj.com/content/early/…
🥖 🥜 🐠 🌰
Breads, legumes, fish and nuts⬇️several pro-inflammatory pathways:
🫓⬇️pathogenic growth factors & endotoxins
🫓⬇️ pathogenic E. coli, Bacteroides fragilis, parabacerioides
🫓⬆️ammonia detoxification pathway
🌰🐟 🍑🥦
Nuts, oily fish, fruit, vegetables & cereals ⬆️short-chain fatty acid producers
🫑⬆️Faecalibacterium prausnitzii, roseburia hominis, and more

Bacteria ferment fiber and pectins to acetate and butyrate.

SCFAs have anti-inflammatory effects on the mucosa!
Read 20 tweets
8 Mar
A little late but better late than never! ⌚️ Here's a recap of @AmCollegeGastro Virtual Grand Rounds by @ScottGabbardMD on...... FUNCTIONAL DYSPEPSIA!
🤢🤢🤢

This is a VERY common entity that is underdiagnosed! #MedTwitter take notice!

#GITwitter #GI #gut
DYSPEPSIA = epigastric #pain. (can be associated with any other upper #GI symptom such as epigastric fullness, nausea, vomiting, or heartburn).

Dyspepsia is COMMON, and most cases are FUNCTIONAL (i.e., caused by brain-gut axis dysfunction)!
Like all disorders of gut-brain interactions FD pathophysiology is❌completely understood, but is thought to be complex+multifactorial. Components include
🤢disrupted duodenal barrier
🤢altered duodenal #microbiome
🤢dysmotility
🤢visceral hypersensitivity
🤢psychosocial stress
Read 22 tweets
28 Feb
Let's talk about something common, hard to treat, and often misunderstood: CHRONIC BLOATING AND DISTENSION!

A 🧵 summarizing from the excellent @AGA_CGH article cghjournal.org/article/S1542-…

#GI #GITwitter #motility #IBS #DGBI #FGID #microbiome #health #MedEd
🟢Bloating: subjective sensation of gassiness, trapped💨, or a feeling of pressure or being distended w/o obvious visible distension.

🟢Distension: objective physical manifestation of an⬆️in abdominal girth. Patients commonly say they look like 🎈 or 🤰
Bloating and distension are COMMON

🔴16-31% in the general population

🔴Women > men

🔴66-99% in #IBS

🔴IBS-C > IBS-D

🟢Bloating and distension are distressing to patients and ⬇️quality of life
Read 13 tweets

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