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A large study by researchers at the State University of NY, of 65,869 postmenopausal women found that those who have a history  of gum or periodontal disease also have an overall higher risk of cancer. The women with a history of periodontal disease also had an increased risk for several specific cancers: breast, esophageal, gallbladder, lung and melanoma cancers. This cancer and gum disease association occurred in both nonsmokers and smokers.

How is periodontal disease "promoting" cancer? How it occurs is still unclear, but one theory suggests the gum disease bacteria are in the saliva, which is swallowed, and so the bacteria get into the gut, esophagus, or lungs. Or bacteria from diseased gum tissues get into "systemic circulation" and so get to distant sites in the body.  One of the researchers pointed out that "Certain periodontal bacteria have been shown to promote inflammation even in tiny amounts, and these bacteria have been isolated from many organ systems and some cancers including esophageal cancers."

From Medscape: Gum Disease and Increased Link to Many Cancers

Brushing, flossing, and regular dental checkups appear to do much more than maintain a healthy smile. Now, a large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gallbladder, and melanoma skin cancers.

The study authors note that these results add to the growing body of evidence from smaller studies and studies in men that link periodontal disease to total cancer risk. The Centers for Disease Control and Prevention (CDC) estimate that 47% of adults 30 years of age and older in the United States have some form of periodontal disease, ranging from mild to severe. At age 65 years and older, however, 70% of adults have moderate to severe periodontal disease, according to the CDC.

The study involved almost 66,000 postmenopausal women in the United States, who were enrolled in the ongoing Women's Health Initiative Observational Study (WHI-OS). During a mean follow-up of 8.32 years, the team identified 7149 cancers and found that periodontal disease history was associated with a 14% increased total cancer risk. When analyses were limited to 34,097 never-smokers, there was also an increased risk for overall cancer.

An association between periodontal disease and site-specific cancers was observed in breast, lung, esophageal, gallbladder, and melanoma skin cancers. There was a borderline association with stomach cancer, the study authors report, and periodontal disease was not associated with cancers of the pancreas; liver; lower digestive tract organs; or lip, oral cavity, and pharynx combined. Similarly, there was no association with genitourinary and lymphoid and hematopoietic malignancies.

For the study, the investigators looked at periodontal disease information in 65,869 women aged 54 to 86 years at 40 US centers. Mean age was 68 years. Most women were non-Hispanic whites with some college education. All participants answered the question "Has a dentist or dental hygienist ever told you that you had periodontal or gum disease? (No/Yes)" between 1999 and 2003 on the annual Year-5 WHI-OS follow-up questionnaire. Cancer outcomes were documented through September 2013 with a maximum 15-year follow-up period.

 Women who reported a history of periodontal disease were also more likely to report a history of smoking, secondhand smoke exposure, alcohol use, hormone therapy (estrogen plus progestin), and a cancer diagnosis, the study authors report. At the same time, no significant differences were observed in body mass index, physical activity levels, or history of diabetes between women with periodontal disease and those without. [Original study.]

A recent study found that significantly increasing  dietary fiber intake after a diagnosis of colorectal cancer was associated with a lower death rate - from both colorectal cancer and overall mortality (from any cause). The 1575 men and women (all healthcare professionals) in the study had received a nonmetastatic colorectal cancer diagnosis (it had not spread beyond the colon), and the follow-up was about 8 years. These results were from food, not supplements.

How much did extra dietary fiber lower the death rate? For each additional 5  grams of fiber added to their daily diet (after diagnosis) was associated with a 18% lower colorectal cancer death rate, and a 14% lower death rate from any cause. In this study, whole grains, especially in cereals, were found to be the most beneficial. Current dietary guidelines recommend a fiber intake of 25 to 38 grams per day, but most Americans eat far lessDietary fiber is found in plant foods, such as beans, whole grains, nuts, seeds,  vegetables, and fruits. Plant fiber feeds the millions of gut microbes, especially beneficial microbes (here, here, and here) - something that was not really discussed in the study.

The researchers pointed out that a high fiber diet (especially from whole grains and cereals) is linked to a lower risk of getting colorectal (colon) cancer in the first place.  Also, that "higher intake of fiber, especially cereal fiber", has been linked to improved insulin sensitivity, reduced inflammation, type 2 diabetes, cardiovascular disease, and total mortality. Other studies have found that  vitamin D supplementation, exercise, and eating fish all increase survival from colorectal cancer. From From Medical Xpress:

Fiber-rich diet boosts survival from colon cancer

A diet rich in fiber may lessen the chances of dying from colon cancer, a new study suggests. Among people treated for non-metastatic colon cancer, every 5 grams of fiber added to their diet reduced their odds of dying by nearly 25 percent, said lead researcher Dr. Andrew Chan. He is an associate professor in the department of medicine at Harvard Medical School.

"What you eat after you've been diagnosed may make a difference," Chan said. "There is a possibility that increasing your intake of fiber may actually lower the rate of dying from colon cancer and maybe even other causes." Chan cautioned, however, that the study does not prove that the additional fiber caused people to live longer, only that the two were associated.

Fiber has been linked to better insulin control and less inflammation, which may account for better survival, he suggested. In addition, a high-fiber diet may protect people from developing colon cancer in the first place. The greatest benefit was attributed to fiber from cereals and whole grains, according to the report. Vegetable fiber was linked to an overall reduction in death, but not specifically in death from colon cancer, and fiber from fruit was not linked to a reduction in death from any cause. 

For the study, Chan and his colleagues collected data on 1,575 men and women who took part in the Nurses' Health Study and Health Professionals Follow-up Study, and who had been treated for colon or rectal cancer that had not spread beyond the colon. Specifically, the study looked at total fiber consumption in the six months to four years after the participants' cancer diagnosis. The researchers also looked at deaths from colon cancer and any other cause. In an eight-year period, 773 participants died, including 174 from colorectal cancer. [Original study.]

Another study has shown health benefits from eating a diet rich in whole grains, as compared to one with lots of refined grains (think bagels, muffins, white bread). Fifty overweight Danish adults were randomly assigned to either a group where all grains eaten were whole grains or a group where all grain products were of refined grains. They did this for 8 weeks, then ate their usual diet for a few weeks (the "washout period"), and then were assigned to the other dietary group for 8 weeks.

They found that eating the diet rich in whole grains resulted in: consuming fewer calories (the whole grains made them feel fuller), losing weight, and a decrease in chronic low-grade inflammation (by measuring blood inflammation markers). The whole grain rye seemed to be especially beneficial. But interestingly, the researchers found that the whole grain diet did not significantly change the gut microbe composition. But they did find that 4 strains of Faecalibacterium prausntzii and one of Prevotella copri increased in abundance after whole grain and decreased after refined grain consumption. F.prausnitzii is a desirable and beneficial keystone species in the gut (here and here).

Other studies show that eating a diet rich in whole grains (rather than refined grains) is associated with a decreased risk of several diseases, including type 2 diabetes and cardiovascular diseases. Bottom line: choose whole grains whenever possible. From Science Daily:

Several reasons why whole grains are healthy

When overweight adults exchange refined grain products -- such as white bread and pasta -- with whole grain varieties, they eat less, they lose weight and the amount of inflammation in their bodies decreases. These are some of the findings of a large Danish study headed by the National Food Institute, Technical University of Denmark. 

The study included 50 adults at risk of developing cardiovascular disease or type 2 diabetes. Blood tests showed that the participants had less inflammation in their bodies when eating whole grains. In particular, it appeared that rye had a beneficial effect on the blood's content of inflammatory markers. Inflammation is the natural response of the body to an infection, but some people have slightly elevated levels of inflammation (so-called low-grade inflammation) even though there is no infection. This is particularly the case in overweight people. In overweight people, an increased level of 'unnecessary' (subclinical) inflammation may lead to increased risk of developing type 2 diabetes.

The study also shows that participants eat less when whole grain products are on the menu -- presumably because whole grain consumption causes satiety. While eating the whole grain diet, participants have generally lost weight. The researchers used DNA sequencing to analyze stool samples from the participants in order to examine whether the different diet types affected the participants' gut bacteria composition. Overall, the analysis did not shown major effects of the dietary grain products on the composition of the gut bacteria. [Original study.]

A while ago I posted the results of studies showing differences in infant  microbiomes (community of microbes) depending on whether the babies were delivered vaginally or by C-section, and also that "vaginal seeding" may eliminate some of these differences. [C-section babies also have a higher incidence of some health issues, such as allergies, asthma, etc.] Well....that research generated a lot of controversy both for and against, and resulted in many women requesting that "vaginal seeding" be done to their babies after they were delivered by C-section. Even the noted microbiome researcher Rob Knight publicly admitted that the procedure was done to his baby after his partner received a C-section.

Vaginal seeding is the process of swabbing the bodies of C-section babies (including the mouth and nose) with a gauze pad containing the vaginal fluids from their mothers in the minutes after birth - so that the baby is exposed to the same maternal microbes as a baby born vaginally (because mothers transmit microbes to the baby as it moves through the birth canal). Initial research showed this made the microbiomes of the C-section babies look a lot like vaginally born babies, especially their skin and oral microbiomes, but whether these differences persist after a few months is unclear.

Now the American College of Obstetrics and Gynecology (ACOG) has come out with a position paper that vaginal seeding should not be done to babies, except as part of an official clinical trial. Their main opposition to the procedure is fear of transmitting pathogenic bacteria or viruses (e.g. group B streptococci, and STDs). The main reasons in support of doing the  vaginal seeding procedure is the body of research finding differences among C-section and vaginally delivered babies (allergies, asthma, etc.), and the concern that at least some of this may be due to lack of  exposure to maternal vaginal microbes during delivery. Instead, ACOG suggests breastfeeding the baby to transmit maternal microbes to the baby to "seed the gut". And if "a patient insists on performing the procedure herself, ACOG recommends ob-gyns have a documented discussion of the potential risks".

As can be expected, there is an outcry and rejection by some (many?) of the ACOG position paper. At least the ACOG paper acknowledges that every woman can make her own decision regarding this issue, even though they may not support it. And absolutely everyone agrees that more research is needed. From Ars Technica:

Doctors warn new parents: Step away from the vaginal fluid swabs

To slather, or not to slather—that is the question that has been roiling doctors, scientists, and new parents recently. And a new ruling by a doctor’s group stands to muck up the debate further. Amid the birth of microbiome research, some scientists have advocated for smearing bacteria-laden vaginal secretions on any newborns who missed out—namely those born via Caesarian section. Scientists keenly hypothesize that such a gooey glaze can “seed” a more-or-less sterile infant with life-long microbial companions. These wee chums may help train an infant's immune system and dodge issues like allergies and asthma later in life. Several studies have indeed found correlations between C-section deliveries and higher risks of those conditions.

In the latest turn to the controversy, the American College of Obstetricians and Gynecologists’ (ACOG) Committee on Obstetric Practice issued a November opinion firmly wiping up the slimy idea. In its opinion, the committee said it: “…does not recommend or encourage vaginal seeding outside of the context of an institutional review board-approved research protocol, and it is recommended that vaginal seeding otherwise not be performed until adequate data regarding the safety and benefit of the process become available.”

The few studies we do have on infant microbiomes provide no clear answers on the significance of an early “seeding” for health. A 2016 review looking at the patterns of microbial communities in the guts of infants in their first year found that C-section babies did show differences in the first three months. However, those differences disappeared by six months. Similarly, a small study of 18 babies also published last year found that vaginal seeding could eliminate microbial differences between vaginally and C-section delivered babies. But the study only looked at the infants' microbiomes in that first month, and the health effects—if any—are unknown.

The most concerning thing about vaginal seeding, the committee argues, is the potential for transmitting pathogens, such as herpes simplex virus, human papilloma virus (HPV), group B streptococci, and Neisseria gonorrhea. .... If a woman insists on the seeding, the committee recommended she be thoroughly tested and informed of the risks—as well as discouraged.

The following is a nice article about a recently published study finding a link between some bacteria commonly found in the mouth and inflammatory bowel diseases (IBD). The researchers found that some strains of oral bacteria are also found in the gut of people with inflammatory bowel diseases.

They theorize that these bacteria make it down to the gut when saliva is swallowed - and for susceptible people this may trigger inflammatory disease. They did a number of experiments to determine that the antibiotic-resistant, inflammation causing species of Klebsiella pneumoniae and Klebsiella aeromobilis could be triggering IBD. These bacteria are able to replace normal colon microbes after antibiotic therapy.

However, it must be noted that other studies also find other microbial differences among those with IBD and healthy people - e.g. low or absent levels of Faecalibacterium prausnitzii, and even fungal and viral differences. From Harvard Magazine:

Gut Health May Begin in the Mouth

Chronic gastrointestinal problems may begin with what is in a patient’s mouth. In a study published Thursday in Science, an international team of researchers—including one from Harvard—reported on strains of oral bacteria that, when swallowed in the 1.5 liters of saliva that people ingest every day, can lodge in the gut and trigger inflammatory bowel conditions like Crohn’s disease and ulcerative colitis.

“For some time now, we’ve noticed that when we look at the microbiome of patients with inflammatory bowel disease, or IBD, we’ve found microbes there that normally reside in the oral cavity,” says study co-author Ramnik Xavier, chief of gastroenterology at Massachusetts General Hospital (MGH)....

Simultaneously, “There’s always been this other search, asking, ‘Are there pathobionts?’”—in other words, microbes that live innocuously in one part of the body but can turn pathogenic when moved to another. “For some time we have been looking for pathobiont organisms for Crohn’s and colitis.”

The researchers believe they have found them: two strains of Klebsiella bacteria, microbes commonly found in the mouth. ....the researchers pinpointed a strain of Klebsiella pneumoniae as the trigger for the immune response. A subsequent experiment using samples from two ulcerative colitis patients turned up another inflammation-causing strain, of Klebsiella aeromobilis

Checking databases of thousands of IBD patients at MGH and the Hospital of the University of Pennsylvania, Xavier and others found that people with inflammatory bowel conditions had significantly more Klebsiella bacteria in their gut microbiome than healthy patients did. Most likely, he explains, oral bacteria, including Klebsiella, traffics through everyone’s gut in the saliva we swallow. Usually it passes through harmlessly; but in people with a genetic susceptibility to IBD that alters the gut microbiome, the Klebsiella has a chance to take hold in the intestine and proliferate, inducing an immune response that causes the disease. 

And there is another twist: Klebsiella bacteria are often extremely resistant to multiple antibiotics. That explains, Xavier says, “why antibiotics have limited value in treating patients with Crohn’s disease and ulcerative colitis....  “Because we also showed in a 2014 paper that patients who took antibiotics—and this has been seen in the old clinical data accumulated before the microbiome was even examined in IBD—that patients who took antibiotics early in the disease had more complicated outcomes.” 

Klebsiella  pneumoniae Credit: Wikipedia

A number of recent studies have suggested that as people age, the community of gut microbes (gut microbiota or gut microbiome) becomes less diverse than in younger people. And note that greater gut microbial diversity is generally viewed as healthy and good. However, now a study done in China finds a different result. The study examined the gut microbes of more than 1000 very healthy people, from ages 3 to over 100, and found that the gut microbial communities were very similar among very healthy people in their mid 30s to over 100 years in age.

Whether this is cause or effect is unknown. But the researchers speculate that the similarities in the gut microbiota among people from their 30s to 100+ is a consequence of an active healthy lifestyle and diet. And it suggests that somehow changing an elderly person's gut microbial community (if it's not "normal") to that of a 30-year-old might help promote health. From Science Daily:

'Ridiculously healthy' elderly have the same gut microbiome as healthy 30-year-olds

In one of the largest microbiota studies conducted in humans, researchers at Western University, Lawson Health Research Institute and Tianyi Health Science Institute in Zhenjiang, Jiangsu, China have shown a potential link between healthy aging and a healthy gut.

With the establishment of the China-Canada Institute, the researchers studied the gut bacteria in a cohort of more than 1,000 Chinese individuals in a variety of age-ranges from 3 to over 100 years-old who were self-selected to be extremely healthy with no known health issues and no family history of disease. The results showed a direct correlation between health and the microbes in the intestine. ....The study, published this month in the journal mSphere, showed that the overall microbiota composition of the healthy elderly group was similar to that of people decades younger, and that the gut microbiota differed little between individuals from the ages of 30 to over 100.

"The main conclusion is that if you are ridiculously healthy and 90 years old, your gut microbiota is not that different from a healthy 30 year old in the same population," said Greg Gloor, the principal investigator on the study and also a professor at Western's Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute. Whether this is cause or effect is unknown, but the study authors point out that it is the diversity of the gut microbiota that remained the same through their study group.

"This demonstrates that maintaining diversity of your gut as you age is a biomarker of healthy aging, just like low-cholesterol is a biomarker of a healthy circulatory system," Gloor said. The researchers suggest that resetting an elderly microbiota to that of a 30-year-old might help promote health. "By studying healthy people, we hope to know what we are striving for when people get sick," said Reid. [Original study.]

Centenarian in Bama County, China. Credit: National Geographic.

OK, this study was done in mice, but it's the kind of study results that everyone hopes (and thinks) is also true for humans. So drink a nice cuppa black tea and think about how you're increasing bacteria in the gut associated with weight loss.

Black tea (as well as green tea) has polyphenols that stimulate the growth of gut bacterium and the formation of short-chain fatty acids. By the way, the mice were given decaffeinated tea extracts, so theoretically both decaf and caffeinated tea should have benefits. The big question though is - will drinking black tea daily actually result in weight loss? From Medical Xpress:

Black tea may help with weight loss, too

UCLA researchers have demonstrated for the first time that black tea may promote weight loss and other health benefits by changing bacteria in the gut. In a study of mice, the scientists showed that black tea alters energy metabolism in the liver by changing gut metabolites. The research is published in the European Journal of Nutrition. The study found that both black and green tea changed the ratio of intestinal bacteria in the animals: The percentage of bacteria associated with obesity decreased, while bacteria associated with lean body mass increased.

Previous studies indicated that chemicals in green tea called polyphenols are absorbed and alter the energy metabolism in the liver. The new findings show that black tea polyphenols, which are too large to be absorbed in the small intestine, stimulate the growth of gut bacterium and the formation of short-chain fatty acids, a type of bacterial metabolites that has been shown to alter the energy metabolism in the liver.

The researchers also collected samples from the mice's large intestines (to measure bacteria content) and liver tissues (to measure fat deposits). In the mice that consumed either type of tea extract, there was less of the type of bacteria associated with obesity and more of the bacteria associated with lean body mass. However, only the mice that consumed black tea extract had an increase in a type of bacteria called Pseudobutyrivibrio, which could help explain the difference between how black tea and green tea change energy metabolism.

The new study also concluded that both green tea and black tea have different effects on liver metabolism. According to Henning, the molecules in green tea are smaller and can more readily be absorbed into the body and reach the liver directly, while black tea molecules are larger and stay in the intestine rather than being absorbed. When black tea molecules stay in the intestinal tract, they enhance the growth of beneficial bacteria and the formation of microbial metabolites involved in the regulation of energy metabolism. [Original study.]

Another article was published this month raising the issue of whether Alzheimer's disease is caused by a microbe - which can explain why all the medicines and experimental drugs aimed at treating the "tangles" or amyloid plaques in the brain are not working as a treatment (because that's the wrong approach). The microbe theory of Alzheimer's disease has been around for decades, but only recently is it starting to be taken seriously. Some of the microbes found in patients with Alzheimer's disease (from analyses of both normal brains and Alzheimer patient brains after death): fungi, Borrelia burgdorferi (Lyme disease), herpes simplex virus Type 1 (HSV1), and Chlamydia pneumoniae.

The general hypotheses seem to be that Alzheimer’s disease is caused by infection, but it isn't linked to any one pathogenic microbe.  Instead, the evidence seems to support that "following infection, certain pathogens gain access to brain, where immune responses result in the accumulation of amyloid-β, leading to plaque formation". So the microbes act as "triggers" for Alzheimer's disease - the microbes get into the brain, and immune responses somehow eventually result in the amyloid plaques and Alzheimer's disease. From The Scientist:

Do Microbes Trigger Alzheimer’s Disease?

In late 2011, Drexel University dermatology professor Herbert Allen was astounded to read a new research paper documenting the presence of long, corkscrew-shape bacteria called spirochetes in postmortem brains of patients with Alzheimer’s disease. Combing data from published reports, the International Alzheimer Research Center’s Judith Miklossy and colleagues had found evidence of spirochetes in 451 of 495 Alzheimer’s brains. In 25 percent of cases, researchers had identified the spirochete as Borrelia burgdorferi, a causative agent of Lyme disease. Control brains did not contain the spirochetes.

Allen had recently proposed a novel role for biofilms—colonies of bacteria that adhere to surfaces and are largely resistant to immune attack or antibiotics—in eczema....  Allen knew of recent work showing that Lyme spirochetes form biofilms, which led him to wonder if biofilms might also play a role in Alzheimer’s disease. When Allen stained for biofilms in brains from deceased Alzheimer’s patients, he found them in the same hippocampal locations as amyloid plaquesToll-like receptor 2 (TLR2), a key player in innate immunity, was also present in the same region of the Alzheimer’s brains but not in the controls. He hypothesizes that TLR2 is activated by the presence of bacteria, but is locked out by the biofilm and damages the surrounding tissue instead.

Spirochetes, common members of the oral microbiome, belong to a small set of microbes that cross the blood-brain barrier when they’re circulating in the blood, as they are during active Lyme infections or after oral surgery. However, the bacteria are so slow to divide that it can take decades to grow a biofilm. This time line is consistent with Alzheimer’s being a disease of old age, Allen reasons, and is corroborated by syphilis cases in which the neuroinvasive effects of spirochetes might appear as long as 50 years after primary infection.

Allen’s work contributes to the revival of a long-standing hypothesis concerning the development of Alzheimer’s. For 30 years, a handful of researchers have been pursuing the idea that pathogenic microbes may serve as triggers for the disease’s neuropathology..... In light of continued failures to develop effective drugs, some researchers, such as Harvard neurobiologist Rudolph Tanzi, think it’s high time that more effort and funding go into alternative theories of the disease. “Any hypothesis about Alzheimer’s disease must include amyloid plaques, tangles, inflammation—and, I believe, infection.”

Herpes simplex virus type 1 (HSV1) can acutely infect the brain and cause a rare but very serious encephalitis. In the late 1980s, University of Manchester molecular virologist Ruth Itzhaki noticed that the areas of the brain affected in HSV1 patients were the same as those damaged in patients with Alzheimer’s disease. Knowing that herpes can lie latent in the body for long periods of time, she began to wonder if there was a causal connection between the infection and the neurodegenerative disorder.

Around the same time, neuropathologist Miklossy, then at the University of Lausanne in Switzerland, was detailing the brain damage caused by spirochetes—both in neurosyphilis and neuroborrelia, a syndrome caused by Lyme bacteria. She happened upon a head trauma case with evidence of bacterial invasion and plaque formation, and turned her attention to Alzheimer’s. She isolated spirochetes from brain tissue in 14 Alzheimer’s patients but detected none in 13 age-matched controls. In addition, monoclonal antibodies that target the amyloid precursor protein (APP)—which, when cleaved, forms amyloid-β—cross-reacted with the spirochete species found, suggesting the bacteria might be the source of the protein.

Meanwhile, in the U.S., a third line of evidence linking Alzheimer’s to microbial infection began to emerge. While serving on a fraud investigation committee, Alan Hudson, a microbiologist then at MCP-Hahnemann School of Medicine in Philadelphia, met Brian Balin.... Soon, Balin began to send Hudson Alzheimer’s brain tissue to test for intracellular bacteria in the Chlamydia genus. Some samples tested positive for C. pneumoniae: specifically, the bacteria resided in microglia and astrocytes in regions of the brain associated with Alzheimer’s neuropathology, such as the hippocampus and other limbic system areas. Hudson had a second technician repeat the tests before he called Balin to unblind the samples. The negatives were from control brains; the positives all had advanced Alzheimer’s disease. "We were floored,” Hudson says.

Thus, as early as the 1990s, three laboratories in different countries, each studying different organisms, had each implicated human pathogens in the etiology of Alzheimer’s disease. But the suggestion that Alzheimer’s might have some microbial infection component was still well outside of the theoretical mainstream. Last year, Itzhaki, Miklossy, Hudson, and Balin, along with 29 other scientists, published a review in the Journal of Alzheimer’s Disease to lay out the evidence implicating a causal role for microbes in the disease.

The microbe theorists freely admit that their proposed microbial triggers are not the only cause of Alzheimer’s disease. In Itzhaki’s case, some 40 percent of cases are not explained by HSV1 infection. Of course, the idea that Alzheimer’s might be linked to infection isn’t limited to any one pathogen; the hypothesis is simply that, following infection, certain pathogens gain access to brain, where immune responses result in the accumulation of amyloid-β, leading to plaque formation.

Image result for chlamydia wikipediaThe annual Sexually Transmitted Disease Surveillance Report was released today by the US Centers for Disease Control and Prevention (CDC) and the news wasn't good. More than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016 - the highest number ever. But the CDC acknowledges that the actual numbers are far higher - that most cases of STDs are not reported to the CDC. The CDC estimates that there are actually 20 million new STDs in the U.S. each year, including other sexually transmitted diseases such as genital herpes and human papillomavirus, and half of these are among young people ages 15 to 24 years.

The report discusses the four STDs (sexually transmitted diseases) that are reported to the CDC. The 4th one is chancroid, but there were only 7 cases reported last year. Most of the new cases of STDs involved chlamydia, a bacterial infection that affects both men and women - about 1.6 million cases were reported to the CDC. Gonorrhea also increased among men and women last year, but the steepest rise was among men, especially among men who have sex with men (MSM). The CDC is especially concerned about the threat of gonorrhea becoming resistant to all treatments. Untreated STDs have serious health consequences (e.g. infertility, still-birth in infants)

This report stresses the need for STD screening and treatment, especially among pregnant women (make it part of prenatal care). There is also a need for STD education, and greater use of condoms to reduce risk of STDs. The CDC has a page on STD prevention (practice abstinence, use condoms, have fewer sexual partners and exclusive relationships, get the HPV vaccine, and talk with your partner about safe sex).  Excerpts from CDC:

STDs at record high, indicating urgent need for prevention

More than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016, the highest number ever, according to the annual Sexually Transmitted Disease Surveillance Report released today by the Centers for Disease Control and Prevention (CDC).

The majority of these new diagnoses (1.6 million) were cases of chlamydia. There were also 470,000 gonorrhea cases and almost 28,000 cases of primary and secondary syphilis – the most infectious stages of the disease. While all three of these STDs can be cured with antibiotics, if left undiagnosed and untreated, they can have serious health consequences, including infertility, life-threatening ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission.

While young women continue to bear the greatest burden of chlamydia (nearly half of all diagnosed infections), surges in syphilis and gonorrhea are increasingly affecting new populations.

Syphilis rates increased by nearly 18 percent overall from 2015 to 2016. The majority of these cases occur among men – especially gay, bisexual and other men who have sex with men (MSM) – however, there was a 36 percent increase in rates of syphilis among women, and a 28 percent increase in syphilis among newborns (congenital syphilis) during this period. More than 600 cases of congenital syphilis were reported in 2016, which has resulted in more than 40 deaths and severe health complications among newborns. The disease is preventable through routine screening and timely treatment for syphilis among pregnant women.

While gonorrhea increased among men and women in 2016, the steepest increases were seen among men (22 percent). Research suggests that a large share of new gonorrhea cases are occurring among MSM. These trends are particularly alarming in light of the growing threat of drug resistance to the last remaining recommended gonorrhea treatment.

Image result for chlamydia wikipedia Chlamydia trachomatis (chlamydia) - in brown. Credit: Wikipedia

Finally - research is being done on ear microbiomes (the community of microbes that live in the ears) and how they differ in people with ear infections and those without ear infections. A recently presented ear microbiome study (at the annual American Academy of Otolaryngology meeting) makes perfect sense, and ties in perfectly with sinus microbiome research. Specifically, that there are microbial communities or microbiomes in the ears, and if the microbial communities go out of whack (dysbiosis) it can cause symptoms (ear infection).

This research reminds me of a wonderful anecdote about ear infections and how they could possibly be treated - an ear wax transplant. From a 2012 article in ENT Today: Restoring Microbial Balance Key to Keeping Sinuses Healthy

Andrew Goldberg, MD, never tires of telling people about how he was outsmarted by a patient while working as a second-year otolaryngology resident at the University of Pittsburgh. Now the director of rhinology and sinus surgery at the University of California San Francisco Medical Center, Dr. Goldberg recalled how he assisted in the examination of a patient with a history of chronic otiti sexterna [ear infection] in one ear. Despite repeated trips to doctors for antibiotics, vinegar washes and drops, the patient’s ear trouble always came back.

Not this time. The doctors assumed that their treatments had finally done the trick, only to be told by the patient that he had likely cured himself by taking earwax from his good ear and sticking it in his bad ear. “I had no idea what that meant. I’m sure that we assumed, at the time, that what he was telling us was nonsense, that he was a little nutty,” Dr. Goldberg said. “We never thought anything more about it.”

The home remedy, however, now seems prescient in light of accumulating research suggesting that microbiomes, or distinct bacterial communities that coexist with us throughout our bodies, may play key roles in maintaining human health. When he began conducting his own microbiome research about five years ago, Dr. Goldberg realized that his former patient may have taken an intact, healthy microbiome and used it to re-inoculate the disrupted bacterial community in his bad ear.

Description of the recently presented study - unfortunately no details were given about specific microbes. From Health Day News at Medline Plus: 'Microbiomes' May Hold Key to Kids' Ear Infections

Recurrent ear infections are the bane of many children -- and the parents who have to deal with their care. Now, research suggests that naturally occurring, "helpful" bacterial colonies in the ear -- called "microbiomes" by scientists -- may help decide a person's vulnerability to these infections. "The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes," concluded a team of Japanese researchers led by Dr. Shujiro Minami of the National Institute of Sensory Organs in Tokyo.

These bacterial ear infections -- called otitis media -- typically start in the middle ear, and 5 out of 6 kids will develop at least one ear infection by the time they turn 3. In the new study, Minami and colleagues wanted to see what role the ear's microbiome might play in these outbreaks. To do so, they took swab samples of the middle ears of 155 children and adults who were having ear surgery due to recurrent ear infections (88 cases) or some other condition.

Among patients with a history of ear infections, the researchers found significant differences in the makeup of microbial communities for people with active ("wet") or inactive ("dry") inflammation. In fact, people whose ear infection was dormant "had similar middle ear microbiomes as the normal [no ear infection] middle ears group," the researchers said. On the other hand, the researchers found that people with an active ear infection had bacterial communities that differed widely from those of people not suffering such outbreaks.