What is the gut microbiome?
Few of us give any importance to our digestive system till it starts giving us trouble. We think about our blood sugar levels, our cholesterol and our heart health after a certain age. But we fail to realise that all of this is linked closely to our digestive health.
To understand this connection, let me explain what the gut “microbiome” is. The term “gut” refers to our digestive tract, especially the small and large intestine. We think our digestive system only deals with the breakdown of food into smaller particles for conversion into nutrients and energy that can be used by our body. The gastrointestinal tract (GIT) is home to more than 1000 different microorganisms (bacteria, fungi, viruses) belonging to over 2,000 species and 12 different phyla. They collectively possess 150- to 500-fold more genes than the DNA in the host or humans. Most of them are in a pocket of the large intestine called the cecum. Together, they form a complex ecosystem known as the gut microbiome.
The Human Microbiome Project (HMP) clearly showed that the diversity of the gut microbiome plays an important role in overall human health, the body’s immune response to infections and in maintaining metabolic homeostasis.
The gut microbiota is unique for every person and it plays a key role in the progression of inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer, among other chronic diseases.
THE IMPORTANCE OF BALANCE AND DIVERSITY IN THE GUT MICROBIOME
Generally, the more diverse your gut bacteria, the healthier you are. The balance of microbes in the gut microbiome is closely connected to the health of other major organs and systems in the body. There are mainly three types of bacteria in the gut—beneficial bacteria, harmful bacteria and opportunistic bacteria.
Beneficial bacteria boost immunity and aid digestion and harmful bacteria can trigger disease and cause ageing. Opportunistic bacteria cause no harm when the gut is healthy but can cause harm when the delicate balance between good and bad bacteria is disturbed.
Gut microbes live in perfect harmony, helping us to digest food, eliminating toxins, producing active molecules and educating our immune system to protect us against harmful microbes including viruses. When this balance is disturbed, it is called dysbiosis. In the long term, such imbalance can trigger chronic inflammation and lead to serious diseases like diabetes and heart issues.
Many scientific studies have found that poor gut health and chronic inflammation leads to poor health in general. 70% of our immune system is located in our gut and 90% of the happy hormone “serotonin” is made in our gut. The gut, therefore, plays an important role in your physical and emotional health.
Conditions caused by poor gut health can include skin breakouts, obesity, digestive issues like bloating and constipation, hormonal imbalances, joint pain and decrease in cognitive functioning. You need to make your gut microbiome as diverse as possible and restore balance if there is a state of dysbiosis.
Research has shown that the gut microbiome of people today is less diverse than it used to be decades ago. This is due to many factors like increase in the use of antibiotics, wider use of processed foods, higher prevalence of a sedentary lifestyle, more stress related to the modern lifestyle, environmental toxins and even excessive hygiene. Less diversity in gut health means poorer gut health.
HOW DO WE IMPROVE GUT HEALTH?
Improving gut health does not have to be difficult. In order to restore a healthy gut, we first need to have an idea of how good or bad it is. Digestive issues like heartburn, bloating and constipation can be a pointer to poor gut health. However, the best way to get an accurate idea about your gut health is to take a test.
It is a simple, at-home test that takes only 10 minutes. It serves as a good starting point as it can give you a snapshot of your gut health. The test report provides you with a clear overview of the microbes in your gut. Your Gut Microbiome Index (GMI) score highlights how diverse your gut bacteria are. The lower your score, the greater the degree of imbalance in your gut. There is no cause for worry, though. This is a situation that can definitely be corrected. Based on your gut microbiome, personalised food recommendations and easy-to-follow diet charts are provided to improve your gut health.
The diversity of your gut microbiome and the status of your gut health depends a lot on your food choices. While broccoli and beans might be considered healthy food choices for most people, they need not necessarily be good choices for you based on your unique gut microbiome. This is where you need expert help and guidance like the kind provided by our team.
Over a period of time, you can tweak your food choices to improve your gut health. It is possible to make your gut microbiome a lot richer and more diversified over three to four months. Correcting your gut microbiome will offer the benefits of better brain health, clearer skin, higher energy levels, smoother digestion, lower risk of disease, and better health overall.
Paying more attention to our gut health can significantly reduce such risks and the costs related to healthcare. It is high time that there is greater awareness of the importance of the gut microbiome and the impact it can have in reducing the risk of chronic diseases.
The writer is founder & CEO, Bione.
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RESEARCHERS USE AI TO ANALYSE LARGE AMOUNTS OF BIOLOGICAL DATA
University of Missouri researchers have applied a form of artificial intelligence (AI), previously used to analyze how National Basketball Association (NBA) players move their bodies, to now help scientists develop new drug therapies for medical treatments targeting cancers and other diseases.
The findings of the study were published in the journal Nature Communications. The type of AI, called a graph neural network, can help scientists with speeding up the time it takes to sift through large amounts of data generated by studying protein dynamics. This approach can provide new ways to identify target sites on proteins for drugs to work effectively, said Dong Xu, a Curators’ Distinguished Professor in the Department of Electrical Engineering and Computer Science at the MU College of Engineering and one of the study’s authors.
“Previously, drug designers may have known about a couple places on a protein’s structure to target with their therapies,” said Xu, who is also the Paul K. and Dianne Shumaker Professor in bioinformatics. “A novel outcome of this method is that we identified a pathway between different areas of the protein structure, which could potentially allow scientists who are designing drugs to see additional possible target sites for delivering their targeted therapies. This can increase the chances that the therapy may be successful.”
Xu said they can also simulate how proteins can change in relation to different conditions, such as the development of cancer, and then use that information to infer their relationships with other bodily functions.
“With machine learning we can really study what are the important interactions within different areas of the protein structure,” Xu said. “Our method provides a systematic review of the data involved when studying proteins, as well as a protein’s energy state, which could help when identifying any possible mutation’s effect. This is important because protein mutations can enhance the possibility of cancers and other diseases developing in the body.”
RESEARCHERS FIND NEW APPROACH FOR TREATMENT OF DEVASTATING BRAIN TUMOURS
The findings from a seven-year research project suggests that there could be a new approach to treating one of the most common and devastating forms of brain cancer in adults, Glioblastoma Multiforme (GBM).
In a peer-reviewed study published by BMC Cancer, scientists from the University of Surrey show that a short chain of amino acids (the HTL-001 peptide) is effective at targeting and inhibiting the function of a family of genes responsible for the growth of GBM – Hox genes. The study was conducted in cell and animal models. The HTL-001 peptide used in the study has undergone safety testing and is suitable for patient trials. These trials are now being considered in GBM and other cancers.
Hardev Pandha, project lead and Professor of Medical Oncology at the University of Surrey, said:
“People who suffer from Glioblastoma Multiforme have a five per cent survival rate over a five-year period – a figure that has not improved in decades. While we are still early in the process, our seven-year project offers a glimmer of hope for finding a solution to Hox gene dysregulation, which is associated with the growth of GBM and other cancers, and which has proven to be elusive as a target for so many years.”
Ironically, Hox genes are responsible for the healthy growth of brain tissue but are ordinarily silenced at birth after vigorous activity in the growing embryo. However, if they are inappropriately ‘switched on’ again, their activity can lead to the progression of cancer. Hox gene dysregulation has long been recognised in GBM.
The project was carried out in collaboration with the universities of Surrey, Leeds and Texas, and HOX Therapeutics, a University of Surrey start-up company based on the University’s Surrey Research Park.
Professor Susan Short, co-author of the study from the University of Leeds, said, “We desperately need new treatment avenues for these aggressive brain tumours. Targeting developmental genes like the HOX genes that are abnormally switched on in the tumour cells could be a novel and effective way to stop glioblastomas growing and becoming life-threatening.”
James Culverwell, CEO of HOX Therapeutics, said, “HOX Therapeutics is excited to be associated with this project and we hope that with our continuing support, this research will eventually lead to novel and effective treatments for both brain and other cancers where HOX gene over-expression is a clear therapeutic target.”
IT’S TIME TO SECURE THE RIGHTS OF MENTAL HEALTH PATIENTS
A recent news report revealed the dire conditions of a Government Mental Health Centre in Peroorkada, a suburb of Thiruvananthapuram, the capital of Kerala. The living conditions of institutionalized patients were worse than in a prison cell. The authorities kept patients confined in tiny, overcrowded cells with poor ventilation and extreme heat, aggravating their existing conditions with dehydration, decreased sleep, and poor drug compliance, among other issues. The description of the mental health centre, with cells covered with grills and iron bars securing windows and doors, is reminiscent of the conditions of the faith-based mental asylum in Ramanathapuram, Tamil Nadu, where a fire in 2001 led to the death of 28 inmates. Overcrowding and confinement are not only disasters waiting to happen but also act as significant impediments to the recovery of persons with mental illnesses. A study on public attitudes to mental health hospitals in 2016-17 in Odisha concluded that the credibility of such institutes has a vital bearing on the negative attitudes that they invoke amongst the populations they serve.
India’s journey towards attaining accessible and safe mental healthcare has been slow and rife with challenges. Following the global trend to shift away from institutional care to community-based treatment, India has enacted laws to ensure better treatment for persons with mental illnesses. However, the battle is ongoing and appears to be a long fight ahead.
According to a recent survey by NIMHANS in 2015-2016, 14% of India’s population lives with some form of mental illness, out of which 1.9% suffer from severe mental illness. The survey also noted a stark treatment gap of 72–92%. Mental health reports released by the National Human Rights Commission in 1999 and 2012 mentioned other infrastructural gaps. The survey also cited severe staff shortages, violations of patients’ rights, involuntary admissions and limited treatments. ActionAid Association’s study on mental illness in Kashmir in 2016 also uncovered severe treatment gaps in a valley widespread with mental illness and extremely high suicidality. Out of the 4000 persons interviewed, only 12.6% could access treatment.
More recently, during the Covid-19 pandemic, mental health needs and gaps were exacerbated. For example, a study of severely mentally ill patients during lockdown found that 80% of patients missed their appointments and failed to contact their mental health professionals, 30% showed features of relapse of symptoms during the lockdown, and 22% stopped their psychiatric medication.
These alarming numbers point to the need for advocacy and evidence-based policy recommendations. ActionAid Association was a member of the National Human Rights Commission Core Group on Health and Mental Health until 2017 and has conducted several research projects and initiatives in mental hospitals in Kashmir, Gwalior, Bhopal, Agra and Ranchi. Learning from these initiatives, ActionAid Association has recommended policy and structural changes to promote mental health.
The Mental Healthcare Act (MHCA) 2017 differs from preceding acts. It treats persons with mental illness equally, protects them from cruel and degrading treatment and makes provisions for community-based treatment. In addition, the law guarantees confidentiality, access to medical records, and legal aid. It also creates barriers against arbitrary institutional care, a practice used by family members against women to resolve disputes.
The Act mandates the creation of regulatory bodies such as State Mental Health Authorities and District Mental Health Review Boards tasked with registering, reviewing, altering, modifying or cancelling advance directives made by individuals.
However, MHCA 2017 does not institute any third-party assessment or monitoring of the human rights situations in mental healthcare facilities. The appointment of an independent human rights monitor would be a transparent mechanism for safeguarding human rights. The Act also misses significant measures for reintegration and rehabilitation of patients with their families. According to a study, one in every four women in mental health centres is abandoned by their families. There is a strong need for a feminist approach to destigmatize mental illness and rehabilitate and reintegrate patients back into mainstream society.
Implementation of the Act has been sluggish. As of 2021, Maharashtra only has eight District Mental Health Review Boards to cater to 36 districts, and Uttar Pradesh has one in Kanpur. In Delhi, the State Mental Health Authority acts as an interim Mental Health Review Board, which leads to the erosion of accountability and the dissolution of responsibilities.
As the MHCA 2017 is on the concurrent list, States are meant to frame rules for the implementation of the Act and set standards concerning mental healthcare facilities. These standards ensure no overcrowding, cruelty or poor sanitation of patients and facilities. However, until October 2021, only eight states and UTs had sent draft rules to the Ministry of Health and Family Welfare for approval.
There also exist lacunae in the budgetary allocations. The preceding four Union Budgets had allocated less than one per cent of the total budget to mental health. In the Union Budget for 2022-2023, an increased allocation amounting to 2.18% of the total budget has been made. However, the lion’s share (94%) of the allocation is towards two centrally run mental health institutes; NIMHANS Bengaluru and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur. There is a measly 6% of the allocation (Rupees 40 Crores) left for the National Mental Health Program, which ensures the availability and accessibility of minimum mental healthcare to all.
For a more comprehensive approach to promoting mental health, we require measures to make family systems more conducive to rehabilitation. Localized mental health centres can facilitate psychoeducation and case management for at-risk families. We need to activate community leaders to destigmatize mental illness and provide financial incentives to community-based structures to enable the rehabilitation of persons with mental illnesses. The use of halfway homes must be increased to reintegrate persons who have recently recovered from mental illnesses.
The swift and effective implementation of the law, independent monitoring of human rights violations, more robust community-based interventions and increased financial allocations are imperative in ensuring that Peroorkada is not the image that comes to mind when one thinks of mental health hospitals. Such an approach will go a long way in preventing another Erwadi-like tragedy and in ensuring the rights and dignity of persons with mental illnesses.
Iyce Malhotra works with the Policy and Research Unit of ActionAid Association. The views expressed here are personal and do not necessarily reflect those of her organisation.
ABHA WILL ENHANCE DIGITAL HEALTHCARE SYSTEM IN THE COUNTRY
The health insurance sector in India is expecting a growth at a rate of 10.1% in the years between 2021 and 2027. Distribution and affordability are two keywords to get a large number of people insured, said experts.
Introducing the challenges and the need for new policies in health insurance in India, a conference on ‘Health Insurance 2042- Let us Plan for Ambitious Target for 2042’ was organised in Vigyan Bhawan, New Delhi. The conference organised by the PHD Chamber of Commerce and Industry (PHDCCI) highlighted the need to boost the digital healthcare system in the country.
Speaking about the Ayushman Bharat Digital Mission (ABDM), Dr. Malti Jaswal, a Senior Consultant, World Bank and Advisor with the National Health Authority, said, “ABDM plans to create a healthcare infrastructure that will bridge the existing gap amongst different stakeholders in the healthcare ecosystem through digital highways.” A health id for all Indian citizens-ABHA (Ayushman Bharat Health Account) will help maintain personal health records digitally and easily accessible.
The Ayushman Bharat scheme has also been able to cover the bottom 50% and several voluntary schemes cover almost 20%. The government must focus on the remaining 30%. Pradeep Multani, President, PHDCCI, said, “The health insurance sector has undergone a lot of change in the last two years of the pandemic, with people realising its importance.” He also focussed on the need for customising products as per the customers.
Also, while discussing the growth of digital healthcare, Dr. Harsh Mahajan, Chair, Hospital & Diagnostics Committee, PHDCCI and Founder & Chief Radiologist, said, “The digital healthcare market, valued at $116 billion in the year 2018 is expected to touch $485 billion by the year 2024, a growth of 3.5 times. The spurt in growth is primarily due to the pandemic, which accelerated the diagnostics sector to grow at a rate of 20.5 percent. It is valued at $32 billion now, up from just $5 billion in the year 2012.”
Mr. S K Sethi, Co-Chair, Banking, Financial Services and Insurance (BFSI) Committee, PHDCCI & Founder & CEO, Insurance Foundation of India, stated that from Rs 690 crore in 2001 to Rs 73,300 crores in 2022, the sector has grown approximately 106 times. He stated that blockchain technology would help in eliminating the fraud taking place in the insurance sector
Although the pandemic taught us the significance of mental health, health insurance policies exclude the challenges of mental health. According to Deepak Singh, CEO and Co-founder of Tatsam, insurance companies have developed plans but, except for psychiatrists, have yet to recognise counselors and therapists. Most people have often faced a treatment gap while claiming their insurance. Dr. Steward Doss, Professor, National Insurance Academy, Pune, stated that there is a significant treatment gap in India. A lot of these issues can be resolved with insurance cover.
The knowledge paper on Health Insurance 2042 was also released at the event. Other members who participated in the event were Kanya Saraswathy C, Head Commercial and Reinsurance Practice, Insurance Advisory Group & Lead – US West Accounts, BFSI, Tata Consultancy Services Limited, Ashish Agrawal, Co-Chair, BFSI Committee, PHDCCI, Ravi Bhati During the seminar, Teena Jain Kaushal, Senior Editor of Business Today, and so on.
Scientists aim to make cancer immunotherapy safer and more effective, says new study
According to new research, scientists are working to improve immune checkpoint inhibitors to better target tumours and reduce their impact on healthy tissues. The findings of the research were published in the journal ‘Cancer Cell’ by Johnson, the lead author of the study with Adi Diab, MD and Yared Hailemichael, PhD. Immune checkpoint inhibitors have revolutionized the treatment of many cancers by using our body’s immune system to kill cancer. These treatments sometimes can cause our immune system to fight healthy tissue instead, resulting in side effects.
A frequent adverse effect of immune checkpoint inhibitors is colitis or inflammation in the colon. When studying patients receiving these immune checkpoint inhibitors, researchers at MD Anderson and Ochsner Health have uncovered that a particular cytokine, or protein that activates certain immune cells, is expressed at higher levels in colitis tissue than in cancer tissue shrinking from these treatments.
They also showed that by blocking this cytokine in lab models, the immune system’s ability to fight cancer improves as side effects lessen. Daniel Johnson, MD, a medical oncologist at Ochsner Health, is the lead author of the study that identifies interleukin-6 (IL-6) as a potential target in refining immunotherapies.
“This study shows that blocking IL-6 could de-couple autoimmunity from antitumor immunity,” said Johnson, who began the research during a fellowship at MD Anderson and has continued it at Ochsner. “By targeting this particular cytokine in patients receiving immune checkpoint inhibitors to treat cancer, we could potentially improve immune responses in cancer while lowering the risk of inflammation in healthy tissue.”
Scientists are working to improve immune checkpoint inhibitors to better target tumours and reduce their impact on healthy tissues.
IMPROVING ACCESSIBILITY, AFFORDABILITY FOR CHRONIC KIDNEY DISEASE PATIENTS
As lifestyle diseases such as hypertension and diabetes continue to affect a large percentage of the population, there is also a rise in related conditions like nephropathy. Unfortunately, End-Stage Renal Disease (ESRD) and CKD (Chronic Kidney Disease) are not rare in India. While the exact figures cannot be ascertained due to the country’s vast population, the prevalence of CKD is approximately 800 per million population.
The disease burden is significantly greater in the country due to a disproportionate socio-economic landscape. As per NITI Aayog’s report, 25.01% of India’s population suffers from multidimensional poverty, with a lack of access to critical services like health and education. It is no surprise, then, that 70% of patients are forced to abandon their dialysis treatment for CKD midway.
Against this backdrop, the following is an overview of how CKD impacts patients, and the need to boost accessibility and affordability to best-in-class dialysis services for patients suffering from the life-threatening illness.
UNDERSTANDING CKD: THE SILENT KILLER
One of the main reasons why ESRD is a huge cause for concern for the population as well as the healthcare sector is because early chronic kidney disease has no signs or symptoms. It cannot be traced without blood and urine tests, and ultrasounds. While there are risk factors such as blood pressure or diabetes that may prompt doctors to carry out tests for kidney disease, kidney health is often ignored until the condition has worsened. Unfortunately, chronic kidney disease does not just go away and if untreated, and can escalate to total kidney failure, leaving patients no option other than dialysis or a renal transplant to prolong life.
Dialysis is a life-saving procedure when a patient loses 85% – 90% of kidney function. In simple terms, dialysis performs the functions of a healthy kidney by removing extra water, salt, and waste from the blood while balancing the levels of potassium, bicarbonate, and sodium. Doing so helps these toxic elements from building up in the body and improves blood pressure levels to help the patient maintain a good quality of life. Dialysis support is needed throughout life or until a kidney transplant takes place in severe cases.
THE ECONOMICS OF DIALYSIS
When it comes to dialysis cases in India, the numbers have hitherto been grim. There are over a million patients in the country who need to be dialyzed regularly, and 3,00,000 new patients are added to this tally annually. This boils down to 209 million treatments in India. However, the dialysis sector, predominantly situated in the country’s urban centres, comprises only 20,000 machines that cater to only 8% of the total demand.
Unsurprisingly, dialysis is a costly treatment. The cost of one session ranges from approximately INR 150 at government hospitals to more than INR 3,000 at private hospitals. The costs can be restrictive for a large percentage of Indians. Since people who have access to dialysis can lead a normal life – travelling, going to work, enjoying their hobbies – with a healthy diet and light physical activity – it is important to look at ways to make dialysis more accessible to people, regardless of their background.
Apart from costs, another impediment to regular dialysis is the fact that dialysis facilities in the Indian hinterlands are few and far between. Even today, people have to travel between 50-200 km up to 3 times a week to reach their closest dialysis centre. This only adds to the already exorbitant costs of dialysis that a patient incurs. Many patients may not be able to travel long distances every other day due to their condition. Fortunately, government and private players are working together to forge a solution.
PROPOSING A SOLUTION: PUBLIC-PRIVATE PARTNERSHIPS CAN LOWER COSTS AND BOOST ACCESS TO DIALYSIS
The Government of India recognizes and has introduced significant initiatives to address the ongoing issue of an inaccessible dialysis landscape. In 2016, thePrime Minister launched the Pradhan Mantri National Dialysis program to make the life-saving procedure more affordable. Under the program, a Public-Private Partnership (PPP) was deemed not only feasible but also pivotal to ensuring that out-of-pocket expenditure is minimized for CKD patients and their families.
Why does the PPP model work best for a nationwide dialysis program? The answer is simple. To make high-quality dialysis treatments available across district hospitals, we require the convergence of leading private healthcare organizations with world-class facilities and public players with low-cost reach across tier-III, tier-IV, and rural areas. It is by partnering with government organizations that private players can successfully set up their services in the remotest corners of the country.
Apart from low costs, there are other advantages to this model. Leading PPP players establish multiple centres across regions to ensure that every individual can benefit from proximity. They also ensure state-of-the-art infrastructure, consultations with renowned nephrologists, flexible dialysis options, and even access to entertainment to enhance the patient experience.
Such players can also help patients by setting up both haemodialysis and peritoneal dialysis at their homes so that patients can be treated where they are most comfortable. With home dialysis, they can get the right treatment while maintaining their lifestyle. Finally, the expert doctors that are a part of the association can guide individuals about their long-term treatment, such as transplants.
THE ROAD AHEAD: REMOVING INEQUITY AND DISPARITY FROM KIDNEY HEALTH
The establishment of PPP mode dialysis centres across the country is a promising move for CKD patients. With several centres being set up across regions like Andhra Pradesh, Madhya Pradesh, and Bihar, among many others, the demand and supply gap impacting CKD patients is bound to ease over the coming years. With concerted efforts from the government, private players, and the entire medical fraternity, we can ensure that all Indians have access to high-quality dialysis services, with no geographical or economic constraints holding them back from getting the best course of treatment and living long, happy lives.
The writer is Founder and CEO, DCDC
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