Dr. Wahied Khawar Balwan
Health is wealth. A healthy person has sound body, sound mind and physically fit body. “ASound mind is in a sound body” is an old proverb. In fact, we cannot expect a healthy mind without a healthy body. The future of nation depends upon healthy citizens. In the modern age people's life is busy and full of worries. We are becoming increasingly dependent on computers and machines. Outdoor games and activities are replacing with computer and video games. Obesity cases are increasing day by day due to limited physical activity. Consumption of poor quality adulterated food, excessive intake of food with irregular frequency or pattern and unbalance diet may lead to obesity and other health complications. Obesity is one of burning problems of the present times in the world. Obesity increases risk of heart disease, type 2 diabetes, non-alcoholic fatty liver disease, cancer, osteoarthritis, infertility, neurological disorders, obstructive sleep apnea etc. Common causes of obesity are excessive food energy intake, low physical activity, disturbances in gut microbial ecosystem, genetic factors, endocrine disorders, medications, psychiatric illness and irregular pattern of sleep. A shorter sleep time is related with increased circulating ghrelin level and decreasedleptinlevel. This irregular hormonal pattern leads to decrease energy expenditure and increase appetite and obesity. Leptin, the "satiety hormone," is a hormone produced by adipose cells that helps to regulate energy balance by inhibiting hunger. Leptin is opposed by the actions of the hormone ghrelin, the "hunger hormone". In obesity, a decreased sensitivity to leptin occurs, resulting in an inability to detect satiety despite high energy stores.
APPROACHES TO COMBAT OBESITY AND CONTROL OF OBESITY
Various approaches are being used nowadays to control obesity by consumption of low energy rich food, high fiber intake, dieting, exercise, anti-obesity drugs, surgical approaches. Excessive dieting, unbalance and irregular pattern of food intake may lead to nutritional deficiency and other health complications. Nowadays, regular exercise is becoming a limiting factor due to busy life style.Anti-obesity drugs include appetite suppression drugs (e.g. catecholamine, phentermine, amphetamine etc.), drugs inhibiting digestion and absorption of nutrients via intestine (e.g. Orlistat) and drugs increasing body metabolism etc.are being used in control of obesity. But high cost, requirement of regular use of drugs and side effects of drugs make anti-obesity drugs therapy unsatisfactory. Surgical approach to control the obesity is also costlier and unsafe.Other alternative approaches to control obesity may be through the development of probiotic treatment, alterations in gut microbial ecosystem of obese individual, the development of ribonucleic acid interference (RNAi), deletion or silencing of the RIP140 gene , by regulating the molecular interaction between nuclear hormone receptors and their regulatory cofactors, and normalization of obesity associated insulin resistance through immunotherapy .
INTESTINAL MICROFLORA: PROBIOTICS
The development of intestinal microbiota in the human gastrointestinal tract depends on the original inoculums at birth, living environment and the early feeding practices. Microbial composition is determined by mutual interactions between the host and the microorganisms, and also among different microorganisms. These factors are designated as autogenic. On the other hand, pH in the stomach, digestive enzymes, intestinal peristalsis, nutrients and immunity of the host are termed allogenic factors. The predominance of beneficial species of microorganisms over pathogens is essential for stability of the immune system of the intestine and consequent of the entire body. The intestinal microbiota forms a physical and immunological barrier between the host and the environment. The barrier function of microbiota appears to support the intestinal health and protect the host by a healthy micro-ecology in the gut.
The composition of the microbial communities of an obese individual completely differs from the composition of the microbial communities of a slim person. Obesity affects the diversity of the gut microbiota. Firmicutes are relatively high in proportion in obese person as comparison to lean person. Relative proportion of Bacteroidetes remains low in obese people by comparison with lean people. Intake of a low-fat or low-carbohydrate diet by obese persons lead to decrease in proportion of firmicutes and increase in proportion of Bacteroidetes in their colon but never reach up to the proportion that present in lean person Feeding habits and type of feed may alter the microbial ecosystem up to some extent.
Indigenous gut microbes may regulate bodyweight by influencing the host metabolic, neuroendocrine and immune functions. Specific probiotics, prebiotics and related metabolites may exert beneficial effects on lipid and glucose metabolism, the production of satiety peptides and the inflammatory tone related to obesity and associated metabolic disorders. The bacterial metabolism of nutrients in the gut is able to drive the release of bioactive compounds (including shortchain fatty acids or lipid metabolites), which interact with host cellular targets to control energy metabolism andimmunity. Manipulation of the composition of the microbial ecosystem in the gut might be a novel approach in the treatment of obesity. Such treatment might consist of altering the composition of the microbial communities of an obese individual by administration of beneficial microorganisms, commonly known as probiotics. Probiotic therapy may be cost effective strategy to control obesity. Probiotics are viable microbial food supplements, which confer health benefit to host when administered in adequate quantity. It is not necessarily part of normal microbiota. It causes TLR activation, cytokine induction, immuno-stimulatory effect, beneficial to normal microbiota and suppression of pathobiont and pathogen. A prebiotic is a non-digestible component which beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of colonic bacteria, thereby improving the health of the host. Akkermansia muciniphila is a mucin-degrading bacterium present in abundance in the guts of healthy adults, but numbers are reduced in the intestines of obese humans and in patients with Crohn's disease or ulcerative colitis or type 2 diabetes. It is oval-shaped, strictly anaerobic, non-motile, non-spore-forming Gram-negative bacteria. Mucus can serve as a barrier to protect the underlying epithelium from the attachment of pathogens and also as a source of nutrients for commensal bacteria. Akkermansia muciniphila provides nutrients to commensal bacteria by degrading mucus. Treatment with live A. muciniphilamay be alternative strategy to control obesity because it reverses high-fat diet-inducedmetabolic disorders, including fat-mass gain, metabolic a, adipose tissue inflammation, and insulin resistance. Administration of A. muciniphila increases the intestinal levels of endocannabinoids that control inflammation, the gut barrier, and gut peptide secretion. Prebiotic feeding normalizes A. muciniphila abundance, which correlates with an improved metabolic profile.
Lactobacillus gasseri, Lactobacillus rhamnosus, and the combination of L. rhamnosus and Bifidobacteriumlactis may reduce adiposity, body weight, and weight gain. Lactobacillus is Grampositive, facultative anaerobic or microaerophilic, rod-shaped, non-spore-forming bacteria. Lactobacillus gasseri is part of the vaginal flora and normal inhabitant of the lower reproductive tract in healthy women. Lactobacillus gasseri BNR17, a type of probiotic strain isolated from human breast milk is supposed to be inhibitor of obesity and diabetic complications in the human body. Some strains of L. rhamnosus bacteria are being used as probiotics, and are particularly useful in treating female-related infections such as bacterial vaginosis. L. rhamnosus sometimes is used in yogurt and dairy products such as fermented and un-pasteurized milk and semi-hard cheese. Yakult is a popular probiotic dairy product made by fermenting a mixture of skimmed milk Lactobacillus casei Shirota. L. casei strain Shirota may be effective in alleviation of gastrointestinal pathogenic bacterial diseases such as helicobacter infection, antibioticassociated diarrhea (AAD) and Clostridium difficile infections (CDI). Bifidobacteriumlactis can help fight lactose intolerance and boost the immune system. In addition to these benefits, B. lactis may also support healthy cholesterol levels, ease ulcerative colitis, and even combat the effects of celiac disease.
Probiotic and prebiotic based therapies in obesity are gaining more popularity over anti-obesity drugs, surgical and other approaches as it provide beneficial species of microorganisms which in turn lead to fine Lactobacillus casei is found in the human intestine and mouth which inturn leads tofine tuning of immune system, suppression of pathobiont and restoration of good intestinal health without any side effect. Treatment with Akkermansiamuciniphila,Lactobacillus gasseri, Lactobacillus rhamnosus, L. casei strain Shirota,Bifidobacteriumlactis may be alternative strategy to control obesity.
“Any error in this manuscript is silent testimony of the fat that it was a human effort”
Dr. Wahied Khawar Balwan
Sr. Asstt. Professor
Govt. Degree Bhaderwah
E-mail: [email protected]
Mob. No.: 9419367557