(Transcript of video discussion, recorded on April 21, 2020. Dr, Vijayagowri, Dr. Debojyoti Dhar and Dr. Shabnam Das Kar in conversation)
Dr. Shabnam Das Kar 00:00:02
Introduction, Guests and Dedication
Hello everybody, welcome to this video on Gut and Covid 19. We are dedicating this episode to all the people who have given up their lives for Covid 19 and also a big shoutout to all the people who are in the front line, not just healthcare workers. It’s also those people who are delivering your provisions, those people in retail who are still, you know, facing this risk. So I have two wonderful guests with me here today. One is Dr.Debojyoti Dhar. He is the co-founder of a company called Leucinerichbio in India, which is one of the first companies in Southeast Asia looking at the gut microbiome. And my other wonderful guest is Dr.Vijayagowri, who is a Pediatrician and a Pediatric Immunologist. I’ll let you introduce yourself. Would you just say a few words about what you do and your background?
Dr. Debojyoti Dhar (DD) 00:01:03
Introduction, Bugspeaks-Gut Microbiome Company
Yes. Thank you, Dr. Kar, for the kind invite. And this is really a pleasure. To give a brief background about myself. I’m a Ph.D. I’ve done my Ph.D. from the Indian Institute of Science. I’m basically a Molecular Biologist. But for the last five years you know, I’ve been running a company called Leucinerichbio, as mentioned by Dr.Kar, which is into you know, primarily microbiome. So we are South Asia’s first microbiome company, and we have commercialized, South Asia’s first microbiome test, rather a gut microbiome test called Bugspeaks. So the expertise that we bring on the table is genomics, molecular biology, big data analytics, and of course a lot of Biology. So gut microbiome is an emerging field. And as we all know, and we would rather discuss also in this episode you know, it’s linked to a lot of diseases, both chronic and infectious. So with that time to Dr. Kar for the kind introduction.
Dr. Shabnam Das Kar 00:02:08
Oh, you’re welcome, Debojyoti. Vijaya, will you say something about yourself? Oh, you’re welcome, Debojyoti. Vijaya, will you say something about yourself?
Dr. Vijayagowri (VG) 00:02:13
Introduction, Pediatric Immunologist.
Yeah. Thank you, Shabnam for a wonderful opportunity. I have been a Pediatrician for a very, very long time. For almost 14 years. And then, yeah, I got an opportunity to do Pediatric Immunology Fellowship. I have successfully completed, I have realized that everything boils down to immunology. If our basics of immunology is clear, I think how the problems since last 14 years, I think I was not treating my patients right or rather, I had no clue about what I was going about. I was lucky that there was never a complication and probably I did not miss out the Primary Immune Deficiency, a sheer luck having said that, if immune deficiencies are not rare, we just need to look for them. Similarly, whatever is happening, whether it is a viral infection or bacterial infection on an endemic or an epidemic or a pandemic, everything basically boils down to immunology. If we know what we are treating, I think then only we are going to be successful. You can not beat around the bush when it comes to treatment.
Dr. Shabnam Das Kar 00:03:16 Every disease is an immune system problem.
Thank you. Vijaya Dr. Vijaya is very humble. So I describe her as a medical detective so she can, you know, find out about the rarest of rare diseases and of course the most simple ones as well. So just a few things that I wanted to state at the beginning of this episode was Vijaya, you’re so right about the immune system. And back when I was in med school, which was a long, long time ago. We didn’t study a lot about the immune system at all. I’m having to learn now and you are so right. Everything is a problem of the immune system. So the few things that we do know and how is the gut related to the Covid 19 situation a few papers came out and there’ve been so many papers coming out. One thing I just wanted to state, I will post a link to the papers we talk about so you don’t have to go looking for them.
SDK 00:04:09 New papers not peer-reviewed.
Anyways, this is to my, to our audience and the other thing is one thing you need to remember is a lot of the papers have not gone through the peer review process, which means they haven’t gone to a due diligence to check exactly how much of it is true. The point being not that the authors wanted to provide wrong information, it’s just that because this is so new, so once the process goes through with the peer review process, some of the information may change. We are recording this on 21st of April and I’m in Alberta in Canada. Debojyoti is in Bangalore. Vijaya is in Mumbai. And I think I didn’t introduce myself actually. So I am a Dr. Shabnam Das Kar. I am a specialist in Functional and Metabolic Medicine and my areas of focus, one of the main ones is autoimmunity and the other one is metabolic dysfunction.
Dr. Shabnam Das…: 00:05:03
And I was an OBGY for many, many years in India, in Mumbai. That’s how I got to know Dr. Vijaya. And so the things that we know and what set us, you know, to invest our time here together, to just talk about a few things. One, some of the things that I want to you know bring up right upfront is three of us are not, not at the front line of, you know, dealing with the Covid 19 situation. But these are the things that we thought were relevant. Number one is Vijaya, I will let you describe what does the coronavirus, what is it like named and what is what is going on with the virus? How does it in infect the body and more importantly, one question, which I think a lot of people are asking is what does it mean that the virus is undergoing change? So Vijaya over you.
Dr. Vijayagowri: 00:06:04 Host-environment interaction
It is always an interaction between the host and the environment. By host we mean us and also the innumerable organisms rather for that matter, the animals are also hosts and it is an interplay between the host and the environment, which would indicate what kind of balance is struck, what kind of an immune response or a capacity to fight against any infection is achieved at or to protect yourself. Immunity does not mean you have to fight. Immunity is protection also. So if we see a, what is an immunological disease? Immunological diseases, not just immune deficiency, it does autoimmunity. It does malignancy, everything. These are three arms of immunology. So you have a Primary Immune Deficiency, not the ones which are acquired. So Primary Immune Deficiency, all three are the three important arms of immunity, immunology. Now, what about people who don’t have any kind of immune deficiency?
Dr. Vijayagowri: 00:07:15
Mid-gut and respiratory tract have the same embryological origin.
That host is also going to come across viruses and bacteria or fungi for that matter. The entire microbiome, they would react to it differently. And every virus for that matter because we are talking about viruses, I restrict myself to viruses. Every virus has got its own survival strategy. This is something that is very important and based on its own survival strategy, the response of the body also differs. When it comes to Covid19 with one very important thing. People have been talking about Covid 19 affecting the gut. One very important thing which I realized when I was this examination for immunology was the midgut and the respiratory tract have the same embryological vestigial origin. So you know the receptor that is there in the mid-gut
SDK 00:08:14 Immune Resilience
Sorry, I’m just going to pause a little while and explain what some of the things that you are saying. Many people may not be aware of all the immunological things. So when Vijaya you are saying a Primary Immunological Deficiency that is not something that is very common in an adult will be dealing with, versus the, you know, the generic sort of, do you have a strong immune system that people talk about? Immune system cannot be strong or weak or anything. It’s just that is it helping you or is it harming you? So the simpler term would be resilience is is what I would think of this as. And the other thing is what you’re talking about the, so this is the interesting part that really got my, got my thinking. You know this thing, there is a big connection between the gut and the lungs.
SDK The Gut-Lung Axis
The gut lung axis (1) Refis what Vijaya is talking about. So embryologically that means when the baby, when you were a baby in your mother’s uterus and all your different systems were growing and developing. So that is so fascinating. Yeah. And I had no clue about that. The midgut and the lung, you said have a common embryological origin.
Dr. Vijayagowri: 00:09:26 Covid 19 and gut symptoms. Similar embryological origin and similar receptors.
Yeah, I was not aware about it either. It is only when I was going to appear for this examination and I thought, I don’t know what the examiner is going to come and what kind of questions they are going to pose, that is when I started reading about Covid and then I realized that people are saying that a lot of patients come with diarrhea. A lot of patients who come and then there was all this confused. There were people who are saying that the patient has got a surfactant deficiency because pneumocyte type 2 are affected, not the type 1. And then you look at pneumocyte type 2, okay, I’m sorry, I’m jumping from one place to another. So many thoughts which are crowding my mind. But at the same time, one very important thing is everything boils down to embryology. So if you have an embryological origin which is similar for two organs of the body, you have all the receptors which are also similar to two organs of the body.
Dr. Vijayagowri: 00:10:23 ACE 2 receptors in respiratory tract, esophagus, ileum, colon.
We just need to remember that. So if you have your esophagus, up to ileum, mid-gut ileum, which is coming out of the same mesoderm, ectoderm, endoderm origin as the respiratory tract and the lungs. We have the same receptors there on both the surfaces. So whatever affects the lung is possibly going to affect the gut also and we will see a similar kind of response in both the places. Just that when you have a respiratory tract infection, then you have respiratory symptoms. When you have a gut affection then you will have gut symptoms. That is very important. That is why ACE 2 receptors, is not just seen in the respiratory tract, it is also seen in the gut, esophagus, up to the ileum and also colon. So that is very important so Gut-lung axis comes from there. It is embryologically same, ectoderm, mesoderm, endoderm combination. It has come from the same place. Therefore same receptors. Similarly renal, hepato-renal. So when you have a renal affection, you have a liver affection.
Dr. Vijayagowri:Liver and Cholangioles. Possible cholestatic jaundice later?
When I spoke about the liver, I just wanted to tell you something, the cholangioles, that ducts which are formed from the liver to the gallbladder, cholangioles are derived from the same mesoderms. So when you have a Covid 19 affecting the liver, you have cholestasis. It is cholestatic hepatitis, which will manifest over a period of time. Unfortunately patient doesn’t survive for that long to see cholestasis. Suppose if that is somebody who is going to come with a secondary infection or he is going to manifest as in China we are seeing that the patient got treated, went back home, and have come back again. Probably will come with cholestasis, which has a similar origin, from the same mesoderm, endoderm combination.
Dr. Vijayagowri: 00:12:28
Wow, interesting. Very, very interesting.
Dr. Shabnam Das…: 00:12:30
So before we move on to the, you know, the change in the RNA virus and all that, how normal is it that is expected? I’ll just, Debojyoti, would you like to add something to that? Vijaya, that is so fantastic an explanation.
Dr. Debojyoti D…: 00:12:44 Increased TNF alpha and CRP, allergy, asthma and gut dysbiosis.
Yeah, I mean, so as Dr. Vijaya was pointing out, a Gut-lung axis is something which is well-researched in the animal models, but there are there are certain anecdotes or anecdotal evidences that you know, this exists experiment wise in humans as well. You know I just, you know, cite one small example here. You know it was found that you know patients or infants or not even infants, children with allergy or asthma, they have increased TNF alpha and CRP in their blood.
Dr. Shabnam Das…: 00:13:24
Sorry, Debojyoti, I’m going to interrupt you again. Not everyone may know what is TNF alpha and what is CRP. So will you just explain
Dr. Debojyoti D…: 00:13:37
These are pro-inflammatory markers. So they were found to be upregulated in the blood. And incidentally, all the, you know, the patients had a gut dysbiosis. When I say gut dysbiosis, what do I mean? So before we get down to the gut microbiota and all those things let me, let me take a few steps back.
Gut microbiota, gut microbiome
See, initially, the microbiology era, which started in the 90s or early two-thousands, they were hampered by the fact that not all microorganisms could be cultured and therefore we knew very little of the microorganisms and those microorganisms, which were actually cultured also needed various different you know, growth media, which, which probably was not available in all the labs. And you know, all those paraphernalia were absent. Now things started to change with the advent of something called Next Generation Sequencing (NGS).
Dr. Debojyoti D…: 00:14:40 Next Generation Sequencing
Now with Next Generation Sequencing, we you know, the scientists, the researchers, need not culture, any microorganisms. They just need to take the DNA, sequence it. And when you take the DNA sequencing, you would come to know, which microorganisms were present because the DNA, this genetic material is coming to from that aspect. So with the advent of in it NGS, the microbiology or the microbiome field, you know, exploded. And now you have all the research which is happening, the gut lung axis, the gut, liver axis, the gut-brain axis, the gut-skin axis, all these axes, what we are mentioning right now is mainly because of the advent of NGS and the power that it gives us to, you know, look at all the microorganisms. Now coming back to the Gut-lung axis, as Dr. Vijaya and Dr, Kar is mentioning, this is a really unique and interesting you know, link that was probably hidden from the mainstream scientific community,
Dr. Debojyoti D…: 00:15:44 New interest in bidirectional Gut-lung axis with Covid 19. Possible evidence of Gut-lung axis in humans
Thanks to Covid 19 that axis is now getting a lot of interest. To add one or one more example. You know syncytial virus, which causes upper respiratory infection. It was shown that when you have an infection with that particular virus, it decreases appetite and the way it does, you know, they had done some very good research on this one, one animal model, but they had found what is the mechanism by which it is doing. So yes. So that probably exists and it is, and by the way, it’s a bi-directional axis. It’s not like, you know, it’s from the lung to the gut. It is also from the gut to the lung. So, so as we move on we can discuss much more.
Dr. Shabnam Das…: 00:16:37
So thank you Debojyoti, that was wonderful. So Vijaya moving on to the, what is a type of virus, RNA, virus, DNA, virus, and the change in the type of virus. What is going on? What is true? Because a lot of people are very concerned that the virus is undergoing change. But from my limited knowledge, I thought that was kind of normal.
Dr. Vijayagowri: 00:16:58 Different viruses present in Primary Immune Deficiency in children.
Yeah. Let’s see. If you go by Darwinian theory also, it is important that to survive you have to mutate. And we have all mutated over a period of time to an extent that the basic axis which was dividing us from the microbiota is already breached. So we are as much a part of microbiome as a microbiome is a part of us. So when we were at Wadia Children’s Hospital, was sent a nasopharyngeal swab for most of our PID(Primary Immune Deficiency) patients. And you won’t believe that a nasopharyngeal bio fire we would see norovirus, respiratory syncytial virus this is something which we have seen always. But norovirus, gokar virus, which I never thought of, which in Pediatrics, I always left thinking that I won’t have to read it again, have become a part of our microbiota. That’s because of basically the line is breached. So that is the reason. Now what happens viruses can broadly, be divided into a DNA virus and RNA virus and what we are [inaudible]
Dr. Vijayagowri: 00:18:21 Endothelium receptors, entry into endothelium
Because RNA virus, beta subtype has the capacity to get attached to the surface of endothelial cell. Then [inaudible] various organs of our body. They are endothelium, but we have on the surface is an epithelium or we have underneath the surface board is the mesothelium we have inside the organs, the linings, they are the endothelium. Endothelium has got various receptors because [inaudible] the skin, because they are the organs of our body, the largest organs of the body which comes in contact with various microbiomes. Dr. Dhar will be able to explain it much better than me, but as they come across since these are the places which come across these organisms or the viruses, they have all the receptors to which these viruses can actually get attached to. They gain entry into the endothelial cells, and from there on starts the process of translation and then the viral capsid formation and then the cells exploring the lightest as we use into the circulation. There are multiple mechanisms through which they do.
ACE 2 and serine-threonine receptors. Perhaps carriers lack one receptor?
But now that we are hearing about a lot of receptors here, we have ACE2 receptor, which is serine-threonine receptor basically to which it gets attached. Both the receptors have to be present to be capable of causing an infection. And I think such people are actually carriers. We are not sure about it, but I think such people are carriers. The others who have both the receptors, to which the virus can actually get attached, and can gain entry into the host endothelium turn out to be a Coronavirus infection. Dr. Dhar if I am wrong somewhere, please correct me.
Dr. Debojyoti D…: 00:20:27
No, no you are absolutely right! That’s a paper check come up. I think in Gut it’s a BMJ publication of it. It’s a single-cell analysis what they had done. They had taken AT1 and AT2 alveolar cells where they had found that you know, the presence of serine-threonine proteus something like that.
Dr. Vijayagowri: 00:20:55
TMPRSS2 (Trans membrane serine protease 2). Yes.
Dr. Debojyoti D…: 00:20:57
Yes, yes. And they had found that these two were ACE 2 as well as this, this proteus receptors they are present together in, in cells and presence of these two receptors in is important for the Covid SARS CoV2 virus to infect those cells. So that is right, absolutely right.
Dr. Vijayagowri: 00:21:18 Serine threonine receptor is absent in less than five-year-old children. Protective?
And another interesting paper which I read today, was in the pediatric population, this serine-threonine receptor is absent in less than five-year-old children. It is not, it’s, and I’m not saying it is absent. It is sub-cytoplasmic. It is not on the surface of the cells, but it is sub-cytoplasmic or intra-cytoplasmic. As a result of which the kids are not getting affected. That explains why the children are not getting affected. I think so. But then these are things which these are, there are so many things which I have read. I’m not sure what is right, what is wrong, but then probably this explains why in kids less than five years are not getting affected in spite of being very close to the patient or the mother or the father who is actually infected.
Dr. Shabnam Das…: 00:22:14
Thank you Vijaya. I mean we could talk until kingdom come. This is so interesting and, and love the intellectual, you know, challenge, and all of that. So the question that I wanted Vijaya for you to answer is what does it, does it really mean that the virus is changing and it’s not changing? We can, the interesting thing that you brought up about how the human you know, humans have incorporated parts of the virus and bacteria and everything into our bodies. This change has not happened overnight. This has happened over millions of years just to, just to this thing for the audience. And another thing is I just wanted to mention to our audience that sometimes our voices and you know all that may go a little off the air and all that, that’s not our fault. We can’t help it. It’s the internet connection. So Vijaya does it mean that the virus is changing and what are the implications from that from a perspective of treatment or a vaccine or any of that.
Dr. Vijayagowri: 00:23:13 Mutation of virus. More virulent or less virulent.
Okay. changing of the virus, rather we would call it a new mutation can affect us in two ways. One because of mutation it becomes more pathogenic, it becomes more virulent. Or we can have strains which are less virulent, less pathogenic. Almost 3 or 4 sub-strains they have found of Coronavirus. It is a change in the genomic sequence which can occur, which would make it either more virulent or less virulent.
Difficulty in typing Epstein-Barr Virus (EBV) in India.Typing Coronavirus in India.
It is difficult to say as to the number of strains because I looked at that, please Dr. Dhar let me know because we have not been able to type EBV (Epstein-Barr Virus) virus in India. I doubt if we are tying Covid in India. We have not been able to type EBV two and three because we have rampant EBV infection. We have not been able to type it. I notice we are typing Corona. Of course, our virologists are doing an excellent job, but from what I got to know from Dr. Mohanty, who is a virologist at Johns Hopkins when they were isolating strains from patients who came to Mumbai from outside, the strain that is in circulation right now, is a different form of strain from, which is not the same as the original one. But what is the level of pathogenicity, it is difficult for us to understand.
Dr. Shabnam Das…: 00:24:39 SARS CoV2 typing India.
Well, I think yesterday I think I saw one paper from India where they looked at that. Debojyoti, am I right? (2) Ref
Dr. Debojyoti D…: 00:24:45 SARS CoV2 typing
I’m not sure what that Indian paper, but there was a paper I mean all the papers are recent. So there was one paper I think someone from Europe had published. They had typecasted a virus into three typical you know, strains, strains A, B, and C, and they wanted to look at their origin and how they have shifted and if my memory serves me right you know, they had found that the strain in the US and the Europe and the Singaporean strains are different. So I have forgotten the crux of that paper, but, but that’s what they had done. So yeah, so the genotyping of the viruses or the strains are happening as we speak and as Dr. Vijaya is saying maybe the Indians are also working on the same aspect. (3) Ref
Dr. Debojyoti D…: 00:25:42 Controversy, conspiracy theory?
It is a topic which is very controversial right now because of, of, because the origin of the virus is still in doubt. Of course you know, the current academic thought is that this virus has come from the bats. No, because the, the sequence identity with the bat viruses is pretty high. And then there is an intermediate called the intermediate called pangolin, which also known to have the same kind of virus. But there are other theories also which, which we will get into the conspiracy angle. So that’s why I didn’t want to get into that yet.
Dr. Shabnam Das…: 00:26:21
So that’s right, Debojyoti, what you brought up is, again, I am not a virologist. My knowledge in this is just going by what I’m reading. What I understand is most people in people who, who know what they’re talking about have been saying that it’s unlikely to be a lab-grown one. But again, like I said, I’m not knowledgeable in that. I think for now we’ll leave that because again, I don’t want to get into conspiracy theory and all that cause whatever the cause was, the issue now is how are we going to deal with it? What does it mean for us in the future as practitioners and all of that, which is much more relevant? So a Vijaya what do you think, sorry, go ahead.
Dr. Debojyoti D…: 00:27:01 People at higher risk of Covid 19. Reduced gut microbiome diversity in older people.
Can I add one, one, one thing here and taking up where Dr. Vijaya had left? See, there are two aspects and as a person who is looking at the gut microbiome this is a theory that I think I, I would rather put it on, on record. You see there are three aspects or three one vulnerable sections of, of patients, right? One is the elderly, one is the immunocompromised. Particularly these two. I mean, most of these patients are going into the complications of the disease, which is respiratory distress and pneumonia and so on, so forth. Now if you pick one part of your gut microbiome, one aspect of your gut microbiome, which is called gut diversity into picture, then you would see that it makes sense because it is a well-known fact that with age, your gut microbiome diversity decreases.
Dr. Debojyoti D…: 00:28:02 The more diverse your gut bacteria the better it is.
It is also known that in many immunocompromised patients, gut microbiome diversity decreases. Now as we speak, we know that gut microbiome diversity, when I say diversity, it means, you know, it’s like if you do have an example of genetic pool, you know, more the genetic, the genetic pool is enriched, the better it is. Similarly, the more diverse your gut microbiota, the better it is. Not always, but that is the general norm. Like you can put these two things into the picture and try to complete the puzzle with, with also the receptors taking a centre stage, as Dr. Vijaya was saying, that the infants or children who have you know, less ACE 2 receptors on the cell surface and then you, you know, add this gut microbiome diversity also into the picture. Everything then starts making sense and then again, you, the Gut-lung axis becomes quite relevant. So, so yeah, so coming to that point that, you know, the gut diversity in the vulnerable section of the society which is facing the maximum clinical manifestation of the thing of this disease. Then there’s possibly a link with the gut microbiome.
Dr. Shabnam Das…: 00:29:24
Thank you Debojyoti. I just wanted to mention is we are, we’ve been talking about the gut microbiome with the assumption that everyone knows what it is. So Debojyoti, I think I’ll just ask you to explain it. You’ve done it more often than me, what the gut microbiome is. And one more thing. I just wanted to add to your comment on the elderly and the immunocompromised. The highest risks have been the ones with comorbidities. So that means the ones who have other diseases, diabetes, hypertension, heart disease, these were the main ones. And so the thing is in all those conditions, the gut microbiota is not healthy. So will you just explain absolutely in basic terms what is the gut microbiome? And then, later on, I’ll talk about how you can manipulate it. I focus mostly on the stuff that you can control. Things like genetics you cannot control. So Debojyoti, over to you to explain what the microbiome is. (4) Ref
Dr. Debojyoti D…: 00:30:26 Gut microbiome. Basic concepts.
Yeah, so, so the gut microbiome and gut microbiota, these are the two terms which are interchangeably used, but they’re actually two different terms. The gut microbiota is the sum total of all the microorganisms present in the gut. When I say all microorganisms, I mean fungus, virus, bacteria, bacteriophage, and amoeba, so on and so forth. Right. Gut microbiome is basically the sum total of the genome of all these microorganisms put together. So they mean the same thing, but technically they are different, right? So so the gut microbiota basically as, as we’re all discussing is the sum total of the good, bad, ugly microorganisms present in the gut. Right? And when we say dysbiosis or eubiosis, what do we mean? So the eubiosis is a healthy balance of all the microorganisms, good, bad, and ugly. And every one of us has that balance to some extent the balance tilts towards the bad, then it becomes dysbiotic.
Dr. Debojyoti D…: 00:31:36 Gut eubiosis, dysbiosis
If it is a completely balanced and we call it eubiotic. So dysbiosis is something which happens when there’s a there’s more abundance of let’s say pathobionts or abundance of microorganisms, which can lead to increased inflammation in the gut. Okay? Now, then we use the term dysbiosis. Now when I say dysbiosis there the balance goes awry. That means the good microorganisms do not have the potential to keep a check on the bad microorganisms. And when the band microorganisms grow more, they can cause a lot of problems. And I as Dr. Kar, you were mentioning. Sorry. I, I, the third category of people which I started off was actually Type 2 diabetic or hypertensive and obese comorbid patients. And in all those patients there are plenty of reports which suggest that there is dysbiosis or there is the gut microbiota is not in shape. Okay. so, but there’s always a debate whether it’s a cause or an effect. That’s a different debate that we can give it on a different platform or any day. But yes, that, that dysbiosis definitely plays a role in all the comorbidities. And also as I said, the diversity plays a role in immunocompromised and elderly people and if you put one on one together, it makes sense, especially in Covid 19.
Dr. Shabnam Das…: 00:33:10 “Who is there, who are they with, what are they doing together?”
So just a few things I’ll add to that. I saw how I explained to you know, patients is it’s not just what bacteria are there in your gut because the bacteria’s genetic material is also interacting with your genetic material. It’s also who they are with and what are they doing? So three things. One is, you know, so Debojyoti, just correct me if I’m wrong. What I understand is there are a lot of you know, bacteria present in the gut, which sometimes are not shown to cause a disease, but they are hanging around. So one is that, and what are they doing to the other bacteria that is also very important. And more importantly, they secrete substances, which we call metabolites, microbial metabolites. Those metabolites are also very important. Now we can go on and on talking about the gut microbiome. I think we are going to have that as a separate session.
Dr. Shabnam Das…: 00:34:01 1200 different types of gut bacteria. Less gut bacterial diversity in the elderly.
So who is present, who are their friends and what are they doing together is how I describe it. So it’s not like you have one particular type of bacteria and that is a healthy bacteria. No, it’s also important about who they are with. So I hope it’s clear what I’m trying to explain. So it’s not just, which are the bacteria, present there. I think what is the last number? Every time I have to change my slide, I think the last was 1200 different types so far identified. Yeah. So the thing that Debojyoti was mentioning about immunocompromised elderly. So what happens in the elderly is the type of bacteria, the diversity changes. So that’s probably a part of the normal ageing process. But in the interest of time, I’m going to go back to Vijaya now.
Dr. Shabnam Das…: 00:34:54 Gut biggest immune organ in the body. Mucosal immunity.
So Vijaya, one of the things we are taught is that the gut is the biggest immune organ in the body. So the mucosa mucosal immune system. Will you just explain very briefly, so the mucosa is there in the lungs as well and it’s there in the vagina as well. So, so many different areas where the mucosa is present. And that is one of the first barriers that any, you know, harmful, any harmful, not even harmful, any bacteria or virus or any such substance comes across. So Vijaya, will you explain a little bit about, you know, the mucosal immunity in the gut and in the lung as well.
Dr. Vijayagowri: 00:35:39 Mucosal barrier, Payer’s patches.
The mucosa acts as a barrier against all infections or invasion by any infective organisms. We just need to remember that. Apart from that, the gut has got lymphoid follicles, in the Payer’s patches. These lymphoid follicles develop at the same time when our lymph nodes developing. But developmentally, they are all of the same, they are all originating from the same place, migrating to various other places. So they would have gone to the Payer’s patches, they would have gone to white pulp of the spleen from a few of them would have gone to the lymph nodes, few of them would have gone to the thymus. The germinal centre of the thymus, where the B cells would develop. At all these places of development of the lymphoid organs, lymphoid progenitors would develop. Many of these places apart from the bone marrow. This way, they’re looking at the surface area of the gut. If we remember that it covers one full basketball court. If we open it, then they look at the number of lymphoid follicles and Payer’s patches, which indicates that that’s the largest lymphoid organ of our body and since when we eat, when we swallow, we have saliva, starting from saliva itself, we have lysozymes, we have lecithins, we have a lot of substances present in our saliva, which itself act as a mucosal barrier, which coats the tongue and mucosal surfaces of the mouth and prevents invasion by the microorganisms.
Dr. Vijayagowri: 00:37:01 Fungus killing property of saliva.
They have the capacity to be fungicidal. We don’t develop oral thrush (fungal infection) so easily. In my 49 years of life, I don’t think I have developed oral thrush. Normally we don’t develop oral thrush because saliva has a fungicidal property also. Then when we swallow, there is the stratified epithelium of the esophagus per se, is such a good mucosal barrier that even if you end up swallowing one big piece or a big chunk of food which is not fully cooked, it is not fully chewed or not properly chewed, would not damage the esophagus. Because that is the level of interaction which our body has with the surrounding or the environment. And expecting that these are the things which are going to happen, our epithelium is designed in such a way that it can take the brunt of whatever is happening. As we eat, as we grow, as we drink, mucosal mechanisms evolve in such a manner that the lymphoid organs of the intestine, the Payer’s patches, the germinal centres, evolve, the B cells develop, they throw in antibodies and the IgA gets secreted not just from the gut epithelium, but also from the respiratory tract and it is the immunoglobulin A (IgA) which provides us with the basic baseline immunity against most of the invading microorganisms, which we eat, which we breathe and which we drink.
Dr. Shabnam Das…: 00:38:45. Smokers and Covid 19.
Thank you, Vijaya. So that was excellent. And for, for the audience, if any of these terms are difficult for you to understand, don’t worry, we’ll post notes which will have the basic definitions. And so moving forward now the things that impact the gut microbiome and of course the gut lung axis. Now we know that because this is a respiratory virus, most of the serious infections and people who have died have been from respiratory failure. Am I right? Some have been from cardiac failure as well. So going forward with that. So respiratory failure is one of the events that happen with the coronavirus. However, we are talking today about what are the things you can do, you know, to impact the gut microbiome and hopefully along with that, the gut lung axis as well. So one of the things that we found out from the recent studies is that smokers have done much worse.
Dr. Shabnam Das…: 00:39:44. Lockdown and less exposure to environmental pollutants.
So obviously smokers did not have a healthy immune system in the lung. That was one of the reasons because the virus enters through there. And the other thing is so one of the best things which is happening already is because of the lockdown, you are not exposed to a lot more of the, you know, environmental toxins because of the, you know, the smoke. All of you have probably had received enough forwards of, you know, where the animals are coming out and all that. So, and the pollution levels are much lower. So, which is good. So one more reason for, you know, if you’re feeling awful about being on lockdown in India this is, this is good for you. So “you are safe at home, not stuck at home”, as someone said. So that is one thing that moving forward Debojyoti, again, the gut microbiome can be impacted by many things, but you know, I am a control freak and as a clinician, I’m going to look at things that I can control.
Dr. Shabnam Das…: 00:40:37. Things that impact the gut microbiome. Food, medications.
So one of the things, big, big ones that impact the gut microbiome is the food you eat. And the other thing is, of course, all the medications you take. And now, of course, we are not suggesting you stop your medications.No, that is not what we are talking about. And incidentally, we can go on and on about that. The medications that impact the gut microbiome are not just antibiotics, there are a whole lot of others as well. One thing I just wanted to mention in relation to the mucosal immunity. So obviously the level of mucosal immunity would also depend on the thickness of the mucosal layer. Am I right? Vijaya and Debojyoti?
Dr. Shabnam Das…: 00:41:21. Proton-pump inhibitors and gut mucosal lining.
I think Vijaya’s screen has frozen. So the other thing is one of the common medications is the proton pump inhibitors. Drugs like omeprazole, lansoprazole, Yeah. So those would impact the mucosal lining. Correct me if I’m wrong. Vijaya, am I right? So that is just, I just wanted to bring out the clinical correlation about should you be abusing PPIs? Oh, I’m sorry about that. So you can’t hear us. Folks, sorry. That those are problems beyond our control. Again, Vijaya, what it was saying is the mucosal thickness of the mucosal lining would be one of the things that impact mucosal immunity, right? The gut mucosal lining. And I was talking about the abuse of PPIs, like omeprazole, lansoprazole, all these drugs which affect the mucosal lining. So that would also be an impact on mucosal immunity.
Dr. Shabnam Das…: 00:42:39. More things that impact the gut microbiome.Diet, sleep, stress.
Just wanted to highlight that because people sometimes, you know, I know many of my patients have been taking PPIs for years. Like it’s like a prop. They don’t want to give it up, but they feel that it’s, Oh, it’s something that’s helping me. Sometimes it may not be. So anyway, PPI is a different story. So moving further ahead. The gut microbiome is impacted by diet, sleep, stress. These are the three main ones. So Debojyoti and Vijaya, I would, I would like you all to talk about those three impacts. Food is number one. So I will talk about what food can do and cannot do, but both of you have. Please feel free to add to that. So Debojyoti, these are the three things that we want to talk about today. There are of course, lots of other things we can talk until, you know, a long, long time sleep stress, food are the main ones because those are the ones that are impacted in a big way, now with the Covid19 situation. So Debojyoti, would you say something about the sleep and the stress?
Dr. Debojyoti D…: 00:43:38. Stress and gut microbiome. Vitamins secreted by gut microbes. Serotonin in the gut.
Yes, yes, stress definitely. I mean, see the thing is, so gut microbiota, one of the major roles of gut microbiota is, is metabolizing food. But it also helps us you know, provide with vitamins. Mmm. In fact, you’d be surprised that serotonin is a major, you know, mood uplifted or the neurotransmitter. Much of the serotonin is actually produced in the gut and there are serotonin receptors in the gut as well. Of course, there’s a, there’s a debate with the serotonin-producing the gut can cross the blood-brain barrier and in fact the brain. But that’s, that’s for the research. But the fact that you know, there’s definitely a link between the mood and the gut. And then there’s where, you know the very famous, the gut-brain axis also comes in. I know there are plenty of reports, research where people have looked at the vagus nerve, and how that impacts the gut.
Dr. Debojyoti D…: 00:44:48. Gut-brain axis.
There are reports where the metabolites secreted by the microorganisms in the gut influence the brain or you talked about Alzheimer’s. We talk about Parkinson’s. You know, everything you know, has some association with the gut. Not brain, I mean when I say brain, you know, it’s a very complicated organ. We all know that when you eat good food when you are not feeling good, you feel butterflies in the stomach. When you, when you eat good food, you feel happy. So how does it happen? So these are some things which we, if every one of us experiences in life, but that and that goes to show how these impact the gut microbiome. So food as Dr. Kar, you were mentioning, gut microbiota, unlike your genome, is much more malleable. So that means it can change it. You can modulate the gut microbiota, you cannot modulate or you cannot change your genome.
Dr. Debojyoti D…: 00:45:49. Caffeine metabolisers, genetic variation.
So, so for example, there are many tests which people do, which they look at the variance in a particular gene, right? And then then that is correlated with whether you are a good caffeine metabolizers so you can have more coffee or less coffee and so on and so forth. It works definitely, but there are issues with respect to the race. You know, how the variant will work in a particular community versus other communities, whereas in the gut microbiota, a particular food will impact a particular micro organisms in the same way.
That’s why Mediterranean diet reports are pretty fresh now, it has been shown that the Mediterranean diet is very good for your health. Primarily, one of the ways it helps is through your gut microbiome. Similarly, you know, drugs that you take so PPIs is what you had mentioned, but there’s a drug that I think all diabetologists love to give. That is Metformin. Metformin is again known to cause positive effects in the gut microbiome. There’s a well-known bacteria called Akkermansia Municiphila. Now, this particular microorganism is known to be very, very beneficial for health. And Metformin is known to increase Akkermansia Municiphila. So what I’m trying to say is not only your food, your stress level, your drugs, everything plays a role in modulating the gut microbiota, and thereby modulating our health and wellness.
Dr. Shabnam Das…: 00:47:35. Sleep and immune system.
Thank you., Debojyoti.So a comment I wanted to add about sleep was, because I receive WhatsApp messages at times, which I know in India is like the middle of the night and everyone is either on social media or something. And my concern is, you know, not prioritizing sleep is very bad for the immune system. So, in fact, I sent a message to somebody, “Sleep loss on your immune system are not good friends.” So my, the point I wanted to highlight this with sleep, there are two kinds of problems. One kind is the type of people who do not prioritize sleep and I think that is happening quite a lot with a lot of people now because they don’t have to go out in the morning anywhere, you know, all that stuff. So it’s easy to binge-watch TV or something like that or be on social media.
Dr. Shabnam Das…: 00:48:21. Prioritize sleep for your immune resilience.
What do we it is that that is, that is for you or you might be, you know, staying up late at night communicating with your family or something? But the fact is sleep loss does have very adverse effects on your immune resilience. That is what I wanted to highlight. So my goal is please prioritize your sleep. If there is one thing you want to do for you, you know, your own resilience, please prioritize sleep. So at least seven to eight hours of sleep and it’s not seven to eight hours of time in bed anyway, I can talk about sleep and all that on a different, we have actually done one event recently. So sleep loss is not good for your immune system. That is the message I wanted to go wanted to mention. And the other thing is stress, now stress we can talk until kingdom come.
Dr. Shabnam Das…: 00:49:10 Stress and how you deal with it. Eat real food.
It’s like it’s not just the stress, it’s also how you deal with the stress, which is very important. So the gut bacteria and food, again, we can talk and talk until you know, for a long time. My basic, very simple recommendation is to eat real food, eat food that maybe your great grandparents or your grandparents knew as food and that food did not come out of boxes and bags. That is number one.
Insulin Resistance and Indians. Carbohydrate tolerance. Sugar is not your friend. Gut bacteria provide carbohydrate digesting enzymes.
Number two, particularly for the, you know, for the Indian people, insulin resistance is such a big problem being pre-diabetic and that is directly related to how much of carbohydrates you are eating and carbohydrate is not an essential nutrient. And interestingly the gut bacteria provide how many is it, 23 different enzymes for the digestion of the carbohydrates? So at this point in time, sugar is not your friend. These are the few things I just wanted to mention for that matter, neither are non-calorie sweeteners, but we can go on and on.
Dr. Shabnam Das…: 00:50:10. Low-calorie sweeteners are bad too!
So those affect the gut microbes in a very bad way. So if you think that you’re not having the table sugar, the regular sugar crystals, and you’re going to have, you know, one of these others like sucralose or aspartame, you’re probably not doing the right thing because those can mess up your gut microbes completely So sugar is not your friend. And Vijaya would you like to add a little bit more about, you know, the high carbohydrate diet and its impact on the immune system and the entire immunometabolism thing? These can go on and on forever. This conversation is so interesting
Dr. Vijayagowri: 00:50:43
A few few things which I would like to add to what Dr. Dhar said, Is the first paragraph of Best and Taylor Physiology (textbook), which we read way back, said that the first neurological mechanism of digestion starts the moment you smell the food.
Dr. Shabnam Das…: 00:51:08
Sorry, Vijaya’s connection has gone. We can’t hear you. I just send a message on chat so we can hear now. We missed the last bit that you’re saying. I’m sorry about that.
Dr. Vijayagowri: 00:51:28 Neurological mechanism of digestion starts as soon as you smell food.
Yeah. Well what I was saying was the neurological mechanism of digestion starts the moment you smell the food. So the gut-brain axis is summed up in that first particular sentence of that Best and Taylor gastroenterology chapter. It is the first sentence. That’s one.
And the second thing when it comes to sleep, melatonin is a very important sleep hormone. All of us know it starts at the melatonin production starts at around 6:00 PM in the evening. It peaks at around 10:30, remains plateaued for some time, and by 1: 30 or so in the night, middle of the night it starts coming down so that by 6 in the morning it has already touched the baseline. It has come down. When are you supposed to catch your asleep unless you hit your bed at 9:30? At 10:30 your melatonin is at the peak, because if you miss the boat then if you are in front of the blue light of your mobile, blue light is a melatonin inhibitor. So you are going to be in a state of perpetual jetlag. You are in India, but you are living the life of somebody who is in the US. You are in a state of perpetual jetlag. What happens to the immune system then? It seems that all the light, TNF alpha, and something called IL-18 (Interleukin 18) which is produced by gut epithelial cells and gut immune system. It is a cytokine produced by the gut immune system. IL-18 production increases and IL-18 is responsible for all the gastritis associated with late-night or overnight awakening. You have not slept for a long, you’ve been going around eating the wrong food, so IL-18 production increases. At the same time, there is another cytokine, which is produced by the gut and other cells of the body also. IL-18 is produced by many other cells in the body.
Dr. Vijayagowri: 00:53:28. IL-10, an anti-inflammatory cytokine. IL-18 pro-inflammatory. Melatonin increases IL-10.
There is another cytokine, IL-10, which is an inhibitor of inflammation. It is an anti-inflammatory cytokine.IL-18 is a pro-inflammatory cytokine. Whenever one increases, the other reduces. So if there is an increase of IL-18 production, IL-10 reduces. And it has been seen that when melatonin production increases, IL-10 production also increases. So if you sleep well, you digest your food well you have, anti-inflammatory cytokines circulating in your body. So the risk of all the autoimmune diseases is low.
Dr. Shabnam Das…: 00:54:04
Sorry. Vijaya we lost you. Okay. So while Vijaya joins us back, I’m just going to add two comments on melatonin. So melatonin is a chemical produced by the body. Sorry, you lost your connection. So I started talking about melatonin. Will you just repeat what you said the last minute?
Dr. Vijayagowri: 00:54:28
No, I just said that melatonin as the concentration of melatonin increases IL-10 production also increases. So when you have good melatonin, you are sleeping well, you have anti-inflammatory cytokines in your circulation, you have less risk of auto-inflammatory disease. All the infections which you are having is taken care of by IL-10.So you have anti-inflammatory cytokines, so you will do well.
Dr. Shabnam Das…: 00:55:00. Melatonin produced by pineal gland.
Thank you, Vijaya. That is excellent. So melatonin I was just talking about what is melatonin? Melatonin is a substance produced naturally in your body by the pineal gland and as we age, our melatonin levels fall. But what we are doing to our melatonin levels because of our lifestyle is actually way more significant. So melatonin is secreted as Vijaya mentioned during the day and released in the evening. And the other thing that Vijaya was talking about, I didn’t know the mechanisms of how melatonin was like so beneficial for the immune system. So melatonin works as an antioxidant also and Vijaya has explained the IL-10 pathway, which is very interesting. So the next thing that I wanted to mention is that it doesn’t mean you just take a melatonin supplement and everything is going to be hunky-dory. No, there are natural ways of managing your melatonin levels first.
Dr. Shabnam Das…: 00:55:52. Prioritise sleep for melatonin.
That is what in my practice, we recommend. Prioritize sleep. So excessive daylight or artificial light that we subject ourselves to from our devices or even at home. Actually that is also something that impacts your melatonin levels. That is one of the biggest ones. And the other thing is if you are reading in bed, you’re using lighted or backlit devices. You get a lot of devices which are cheap and not backlit. So maybe if you can actually get physical books, which at this point with the Covid 19 you know electronic version would be probably better. So make sure that you know, to manage your melatonin levels better. The work has to start earlier on in the day. It’s not just one hour before bedtime I decide, okay now I need to dim down the lights. It needs to start earlier.
Switch-Off-Devices (SOD) off time. Set time to switch off back-lit devices
But one of the things I recommend to people is why not have a switch-off device time. I call that SOD off time.
Dr. Shabnam Das…: 00:56:49
So if you have the option, if you have the option of switching off your lighted backlit devices, set a time and nowadays phone settings are so wonderful, you can get it done on that. And if you don’t have an option of, you know, switching off your devices, it’s related to your work or whatever. There are some apps and I’ll post the link. One is called the flux, which you can have working in the background of your laptop or your phone as well, which would reduce. So the basic goal is to reduce the light exposure for you. Then you’ve got the blue-blocking glasses and all those things. But my point is you’re going if you’re thinking that I’m just going to take a melatonin supplement, yes some people will need a supplement but I’m just going to take a melatonin supplement and not bother with the backlit devices or any of these things, it may not be the best.
Dr. Shabnam Das…: 00:57:35. Summary. Prioritize sleep, eat real food.
So that is fantastic. Vijaya you explanation of melatonin and how it impacts the immune system. So we are, yeah, I’ve actually gone over time. So I’m just going to conclude with what are the things we discussed today. One is Vijaya explained and Debojyoti and Vijaya, both of them explained so beautifully. Thank you so much for that explanation of the immune system and the Gut_lung axis, that is so important. And the other thing that I wanted to focus on more is how, what are the things you can do to, you know, affect your immune system rather to help your immune system build your resilience. If I want to deliver two messages, one is sleep, right? Prioritize your sleep. And the next thing is what are you eating? Like I know it’s very difficult when you’re at home and you have access to food that is probably not the best for you.
Dr. Shabnam Das…: 00:58:29. Eating during shortened intervals of time. TRE
And these are the two big ones. And another thing too that I will add is are you looking at eating in shortened intervals of time. So Time Restricted Eating. And again, you don’t have time to get into that. So if you’re eating in a shortened interval of time, that is way more anti-inflammatory rather than, you know, munching the whole day and night. And people do that. I’m sure many of you are thinking, I’m not one of those. You need to track it. You’d be surprised by what you see. So that is one thing.
Mediterranean diet is a low carb diet.
The other thing I wanted to mention is there was, Debojyoti mentioned the Mediterranean diet. Now for Indians, the Mediterranean diet is not something that they would normally, you know, embrace. But few things I wanted to highlight on the Mediterranean diet were, one of the things is it does not include sugar and the Mediterranean diet is not just having olive oil, you know, also the way of life and they don’t eat processed food.
Dr. Shabnam Das…: 00:59:25. Same traditional food but different processing and different metabolic response.
So there’s no processed food in the Mediterranean diet. And the other thing is it is lower in carbohydrates than what we are used to. And I can talk until kingdom come about you know, how most Indians have not changed what they eat traditionally. So if I’m in India, I’m still eating rice. That’s what I, that’s a question I get very often or roti. But the fact is the rice, the production of rice has undergone a lot of change and the production of all of these other grains as well. So the metabolic response you are getting from that same food, which you think is the same traditional food that you have been eating since you know your grandparents have been eating, that has undergone a big change. So the metabolic response is different than obviously if the metabolic response is different, your immune system impact is very different.
Dr. Shabnam Das…: 01:00:14
So it’s not just, Oh, I’m just still eating my traditional food. Dosa and idli you know, rice or roti that has not changed. The name has not changed, but it has undergone other kinds of changes. So the metabolic response and the noon response to many of those things are different. And one more thing that both of you have been talking about is the ACE 2 receptor. I think we need to have a separate, you know, a conversation about all those antihypertensive medications, and what are they doing? Should they be, you know, stopped. Should they not be stopped? Are they helping or harming? That’s for another episode. I’m sure our audience clinicians in the audience would love to know more about that. So yes.
Dr. Debojyoti D…: 01:01:00. The fibre in food. Food for gut bacteria.Segmented filamentous bacteria, Th17 differentiation.
Add one more line on the food thing. You know, it’s always better to have more fibre in the food. Especially when you are looking at the gut microbiota. And there are reports you know because many of the fibres actually help increase what we call good bacteria. For example the B Fragilis and the segmented filamentous bacteria. And taking a cue from Dr. Vijaya, Segmented Filamentous Bacteria increases T-Regs or T regulatory cells. So it helps in Th17 differentiation. Now both of these, both of these activities lead to a better, you know, immunotolerance so, so helpful. How food can modulate the gut microbiota and hence the immune system is also very, very important. So I’m sorry.
Dr. Shabnam Das…: 01:02:02. Fibre, from food versus supplement.
No, you’re absolutely right. So a comment on fibre, now that doesn’t mean you take a fibre supplement. We would much rather you get your fibre from real food. So vegetables contain a lot of fibre and if you are going to, you know, have only the orange juice and not the whole orange, that is a very different metabolic response. You know, we don’t recommend juice. Juice is not healthy food. I can go on and on. So Vijaya and Debojyoti, last few comments on what we talked about today and I will conclude. Vijaya, over to you.
Dr. Vijayagowri: 01:02:39. The Coronavirus will teach us more immunology.
You can say is at this juncture we have come across a virus, which will teach you more immunology than an immunologist would actually know. So as you come across the disease spectrum, what we need to do is we have to change ourselves based on how the virus behaves. Otherwise the virus will have much of us rather than we having control over the virus. That’s very important. So the basics we already know washing hands and all those things which we have been talking about. All these things we already know, but we all know also need to know something.
Commensal Corona OX43 strain in nostrils.
There are a lot of commensals like the Corona OX43 strain is a normal commensal in the nostril. It’s there. But when this commensal Corona OX43 gets replaced by Covid 19 (SARS CoV2), that’s when you get Covid 19.
Dr. Shabnam Das…: 01:03:40
Sorry about that.
Dr. Vijayagowri: 01:03:45
So if you need [inaudible] to go along with that, I’m going to recommend Phil is actually going to
Dr. Shabnam Das…: 01:03:51
Did, yeah, I’m very sorry. Okay. The last minute. Will you just repeat that?
Dr. Vijayagowri: 01:03:55. Commensals prevent harmful viruses to take hold.
Yeah. Yeah. So what I was saying is we have a lot of commensals in our nostrils, so don’t pick your nose. Let the commensal be there. As long as the mucosal barrier doesn’t get disrupted, these commensals will stay there and prevent the pathogenic organisms to gain the route. Because if Corona OX 43 is there, it will not let SARS CoV2 take its place. We have to maintain the mucosal barrier. That’s very, very important. Another important disruption of the mucosal barrier has been seen, with aerated drinks and coronavirus. I chanced upon something today. A simple experiment with aerated drinks and they have seen that it disrupts the mucosal barrier and increases the permeability o the mucosal barrier. We need to practice it.
Dr. Shabnam Das…: 01:05:01
Thank you Vijaya. So Debojyoti, some last comments.
Dr. Debojyoti D…: 01:05:18. Better quality, more diverse food, more gut bacterial diversity.
No, taking a cue from you.No problem. But still, I mean, the better the quality of food is very important. It’s not the quantity. So the more diverse kind of food you can have, you know, just increase the repertoire of your microbiome. Because as Dr. Vijaya was saying, you know, these are commensals. They also play a protective role. They actually fight against the pathobionts. So just increase the reservoirs of these good microorganisms by having good food, good sleep, and be happy.
Dr. Shabnam Das…: 01:05:50
Thank you, Debojyoti. So in conclusion, stay safe. Wash your hands. So as Calgary mayor said, and I’m probably paraphrasing it, “clean hands, sharp brain, and a hopeful heart.” So that is what I, I am wishing for all of you. We will go through this together and we will have answers from science. Thank you very much.
Dr. Debojyoti D…: 01:06:13
Thank you doctor. Thank you for having me.
- Ectoderm, endoderm, mesoderm. (5) Ref
- TNF Alpha – Tumor necrosis factor-alpha, is a protein produced by certain cells of the body that is involved in cell signalling and inflammation.
- Akkermensia muciniphila – It is a bacteria found in the human intestine with potential health benefits.
- Segmented filamentous bacteria – These are a type of bacteria found in rats, mice and humans and have been shown to modulate the immune response.
- Surfactant (6) Ref
- Cholangiole (7) Ref
- Primary Immunodeficiency (8) Ref
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