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Microbiome","An introduction to the world of microbes living inside your gut.",3,5,[38,125,267,334],{"id":39,"data":40,"type":25,"version":42,"maxContentLevel":35,"summaryPage":43,"introPage":51,"pages":58},"a752dee6-1ab0-48c4-aaea-c0aacc296c16",{"type":25,"title":41},"Understanding the Microbiome",4,{"id":44,"data":45,"type":35,"maxContentLevel":35,"version":24},"80cd93a6-44f9-4130-8ac3-1d96a9d92c9a",{"type":35,"summary":46},[47,48,49,50],"The microbiome is a diverse ecosystem of trillions of microbes living in our gut, skin, mouth, and nose","The gut microbiota can influence mental health and obesity","Modern innovations like antibiotics have harmed our gut microbiome","The large intestine has the highest microbial density on Earth",{"id":52,"data":53,"type":54,"maxContentLevel":35,"version":24},"19a56954-97f3-4982-a90b-584fede38c4f",{"type":54,"intro":55},10,[56,57],"How do antibiotics affect the gut microbiome?","What modern lifestyle factors are harming our gut health?",[59,82,97],{"id":60,"data":61,"type":24,"maxContentLevel":35,"version":35,"reviews":64},"7076349e-9bc3-4537-88b4-88c7821a8f32",{"type":24,"markdownContent":62,"audioMediaId":63},"The microbiome is an incredibly complex and diverse ecosystem that lives within us. It consists of trillions of bacteria, fungi, viruses and other microorganisms that live in our gut, skin, mouth and nose.\n\nThese microbes play a vital role in keeping us healthy by helping to digest food, produce vitamins and regulate the immune system. They also help protect against disease-causing pathogens by competing for resources or producing antimicrobial compounds.\n\n![Graph](image://4017a303-68c9-46c0-81c2-5b28a8f4ae77 \"Bacteria in the human gut. Image: Public domain via Wikimedia\")\n\nRecent research has revealed just how important the microbiome is for human health; it can influence everything from mental health to obesity levels. For example, studies have shown that people with depression tend to have different microbial populations than those without depression.\n\nSimilarly, changes in the gut microbiota are associated with obesity as well as metabolic diseases such as type 2 diabetes. This suggests that maintaining a healthy balance of microbes could be key to preventing these conditions from developing in the first place.","4cbd5fd5-d70e-4e3f-9189-069e89753024",[65,73],{"id":66,"data":67,"type":68,"version":24,"maxContentLevel":35},"44d82c79-8f67-4734-a548-888213f7e34a",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":69,"clozeWords":71},11,[70],"The gut microbiome consists primarily of bacteria, fungi, and viruses.",[72],"fungi",{"id":74,"data":75,"type":68,"version":24,"maxContentLevel":35},"15b71562-7a52-4075-a95c-391d5a7909bf",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":76,"binaryCorrect":78,"binaryIncorrect":80},[77],"What is the collective name given to the ecosystem of microscopic organisms found in the human body?",[79],"Microbiome",[81],"Macrobiome",{"id":83,"data":84,"type":24,"maxContentLevel":35,"version":25,"reviews":87},"be3f1a6a-3be3-4b37-bb6c-4b81b2d93c15",{"type":24,"markdownContent":85,"audioMediaId":86},"Our modern lifestyles may be fueling chronic disease. These diseases have reached such epidemic proportions that Martin Blaser, Head of the Human Microbiome Program at New York University, describes them as modern plagues. Blaser notes, 'Unlike most lethal plagues of the past that struck relatively fast and hard, these are chronic conditions that diminish and degrade their victims’ quality of life for decades'.\n\nThe same innovations that revolutionized public health in the late 19th and early 20th centuries by eradicating most infectious diseases have also led to harmful changes in our gut microbiome. According to Alanna Collen, evolutionary biologist and science writer, these innovations include vaccination, hygienic medical practice, water sanitation, and the discovery and development of penicillin.\n\nPerhaps the most pernicious of these innovations was the discovery and development of penicillin. Effective in their mission to destroy bacteria – and once considered a panacea to cure all ills – antibiotics have been over-prescribed for decades. We realized too late that antibiotics do not discriminate; they destroy the good bacteria in our guts along with the bad. We also discovered that overuse promotes antibiotic resistance.","8e29beaa-4fce-4869-a46d-978073498fe5",[88],{"id":89,"data":90,"type":68,"version":24,"maxContentLevel":35},"6be5a205-3392-4784-84eb-231d4e201e82",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":91,"binaryCorrect":93,"binaryIncorrect":95},[92],"According to Martin Blaser, what should be considered as 'modern plagues'?",[94],"Chronic health conditions",[96],"Respiratory viruses",{"id":98,"data":99,"type":24,"maxContentLevel":35,"version":42,"reviews":102},"b40d874d-6133-4d51-84ee-4f99700e9b1f",{"type":24,"markdownContent":100,"audioMediaId":101},"There are over 100 trillion bacterial cells in the human body; outnumbering human cells at a ratio of 10:1. We are therefore, as Alanna Collen puts it in her book by the same title, just 10% human. To put these numbers into perspective, consider that if you were to line up your bacterial cells end-to-end, they would reach the moon.\n\nThe gut is the center of microbial activity in the human body. The community of microbes (bacteria, viruses, fungi and archaea – but mostly bacteria) living inside our intestines is called the microbiota.\n\n![Graph](image://9a9a5477-31e5-4c6c-ab44-540bd9fa3c1b \"Human digestive system. Image: Public domain via Wikimedia\")\n\nSome microbiota live in the stomach and small intestine, but the vast majority reside in the large intestine. The bacteria in the large intestine live in such close quarters that each teaspoon of intestinal contents contains 500 billion cells. This is the highest microbial density recorded in any habitat on Earth.","47dc24ae-27b9-4a7d-b8c7-bc45868a6ffa",[103,114],{"id":104,"data":105,"type":68,"version":24,"maxContentLevel":35},"79c0eb29-5c9c-4c33-9145-7b29e468c34e",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":106,"multiChoiceCorrect":108,"multiChoiceIncorrect":110,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[107],"Which type of drugs, which are over-prescribed, pose a threat to our microbiomes?",[109],"Antibiotics",[111,112,113],"Anti-inflammatories","Antihistamines","Immunosuppressants",{"id":115,"data":116,"type":68,"version":35,"maxContentLevel":35},"2d0a8789-449f-4212-a6fb-e753ae14a4b3",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":117,"multiChoiceCorrect":119,"multiChoiceIncorrect":121,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[118],"According to Alanna Collen, what is ratio of bacteria to human cells in our bodies?",[120],"10:1",[122,123,124],"12:1","3:1","13:1",{"id":126,"data":127,"type":25,"version":35,"maxContentLevel":35,"summaryPage":129,"introPage":137,"pages":143},"1f7d40b2-84e5-4d1c-b276-0d93746c00f6",{"type":25,"title":128},"Threats to Gut Health",{"id":130,"data":131,"type":35,"maxContentLevel":35,"version":24},"8e730e32-0cc0-40e8-bad9-edc0a6c2a1fc",{"type":35,"summary":132},[133,134,135,136],"Overuse of antibiotics is driving ancient gut microbes to extinction","By 2050, half the world's population could be obese","The cecum is the gut's microbial epicenter, digesting tough plant fibers","The large intestine feeds its microbes with a nutrient-rich mucosal layer",{"id":138,"data":139,"type":54,"maxContentLevel":35,"version":24},"ff9dd46a-3f77-433e-816e-0d9bd9cde0cd",{"type":54,"intro":140},[141,142],"Why is the cecum considered the epicenter of microbial activity in the gut?","How does the large intestine support its resident microbes during times of famine?",[144,228],{"id":145,"data":146,"type":24,"maxContentLevel":35,"version":35,"reviews":149},"b930776a-b4dc-4088-b1ab-90e5a684813f",{"type":24,"markdownContent":147,"audioMediaId":148},"Neglecting our gut microbiota has profound consequences for human health, not just on the level of individuals, but also for the entire species. In *Missing Microbes*, Martin Blaser raises the alarm about rare, ancient gut microbes becoming extinct due to the overuse of antibiotics. He also describes modern epidemics (such as asthma, metabolic disease, allergies and obesity) as *'external signs of internal change'*.\n\nAlanna Collen estimates that **by 2050, 50% of the world’s population will be obese**. She notes that for future generations, the 20th century will be known not only for its two world wars and the invention of the internet, but for being the *age of obesity*.\n\nAlthough the large intestine houses the highest density of microbes, other components of the digestive tract are important for normal gut function. Under optimal conditions, the stomach is highly acidic and kills most of the harmful microbes that enter it.","26c13289-af02-4051-a8fd-af7b120b6786",[150,159,179,190,209],{"id":151,"data":152,"type":68,"version":25,"maxContentLevel":35},"4161936e-8797-4032-9f59-c3a28be71ad1",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":153,"binaryCorrect":155,"binaryIncorrect":157},[154],"What term did Alanna Collen use for the 20th century?",[156],"The age of obesity",[158],"The age of antibiotics",{"id":160,"data":161,"type":68,"version":25,"maxContentLevel":35},"4c1ffd2d-d9a0-4909-b127-5bf139ffcc68",{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":162,"multiChoiceQuestion":166,"multiChoiceCorrect":168,"multiChoiceIncorrect":170,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":174,"matchPairsPairs":176},[163,164,165],"efccf43b-09ea-45c5-8f9e-24f9bd99c54f","2ad34353-de1e-4956-b05c-7d3fe5bc3c69","60c4d04f-bd3a-44d3-accf-78348b0bc072",[167],"Which of the following most closely applies to Martin Blaser?",[169],"Author of Missing Microbes",[171,172,173],"Commentator on obesity trends","Transferred vaginal microbiota to his daughter","Trying to develop a vaccine for cholera",[175],"Match the pairs below:",[177],{"left":178,"right":169,"direction":35},"Martin Blaser",{"id":163,"data":180,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":181,"multiChoiceQuestion":182,"multiChoiceCorrect":184,"multiChoiceIncorrect":185,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":186,"matchPairsPairs":187},[160,164,165],[183],"Which of the following most closely applies to Alanna Collen?",[171],[169,172,173],[175],[188],{"left":189,"right":171,"direction":35},"Alanna Collen",{"id":191,"data":192,"type":68,"version":24,"maxContentLevel":35},"87e7c09a-520f-4e47-ac60-df07361cbeda",{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":193,"multiChoiceQuestion":197,"multiChoiceCorrect":199,"multiChoiceIncorrect":201,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":205,"matchPairsPairs":206},[194,195,196],"ed9705e0-7c53-4556-a631-5d0aca6af86d","015e4d5d-ab1d-4a01-a99c-d043a9e5e1c6","46ec728a-fca0-4e06-a70a-11ec65bbc48b",[198],"Which of the following best applies to obesity?",[200],"Estimated to affect 50% of world population by 2050",[202,203,204],"Co-existence of different species for mutual benefit.","Disruption of the normal balance of microbial communities.","The types and amounts of microbes present",[175],[207],{"left":208,"right":200,"direction":35},"Obesity",{"id":210,"data":211,"type":68,"version":24,"maxContentLevel":35},"63d2072d-f943-4f30-a49a-324e2d61b1a2",{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":212,"multiChoiceQuestion":216,"multiChoiceCorrect":218,"multiChoiceIncorrect":220,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":224,"matchPairsPairs":225},[213,214,215],"40d40582-b248-4d61-9fc7-68eda6236504","4b63cc9f-ae98-47fb-a112-b7df8d924275","fd87a4ae-6a4e-4b4a-a353-0522f3f29108",[217],"Which of the following most closely applies to the stomach?",[219],"Highly acidic under optimal conditions",[221,222,223],"7-meter-long","Small pouch in the intestine","Houses trillions of microbes",[175],[226],{"left":227,"right":219,"direction":35},"Stomach",{"id":229,"data":230,"type":24,"maxContentLevel":35,"version":35,"reviews":233},"71984266-982c-4d97-a482-7f5540f20ecc",{"type":24,"markdownContent":231,"audioMediaId":232},"Stripped of some of its accompanying microbes, food from the stomach travels through the **7-meter-long small intestine**, where it is digested by enzymes and absorbed into the bloodstream.\n\n![Graph](image://4f9846ec-9471-4c63-b72b-041cc3f4b378 \"The digestive system in detail. Image: Public domain, Mariana Ruiz and Jmarchn via Wikimedia\")\n\nThe juncture where the small and large intestine meet is the epicenter of microbial activity in the gut. Meet the **cecum**, a small pouch shaped like a tennis ball, forming the first part of the large intestine. In the cecum, trillions of microbes tackle partially digested food from the small intestine. The tough bits, like resistant starches from plant fibers, are digested in the large intestine.\n\nThe large intestine provides food for its resident microbes (it houses trillions of them), as well as a nutrient-rich mucosal layer (literally, a layer of mucus), which microbes can feed off in times of famine.","ee878649-9a62-453a-a9c6-0ce01df692bd",[234,245,256],{"id":213,"data":235,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":236,"multiChoiceQuestion":237,"multiChoiceCorrect":239,"multiChoiceIncorrect":240,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":241,"matchPairsPairs":242},[210,214,215],[238],"Which of the following most closely applies to the small intestine?",[221],[219,222,223],[175],[243],{"left":244,"right":221,"direction":35},"Small intestine",{"id":214,"data":246,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":247,"multiChoiceQuestion":248,"multiChoiceCorrect":250,"multiChoiceIncorrect":251,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":252,"matchPairsPairs":253},[210,213,215],[249],"Which of the following most closely applies to the cecum?",[222],[219,221,223],[175],[254],{"left":255,"right":222,"direction":35},"Cecum",{"id":215,"data":257,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":258,"multiChoiceQuestion":259,"multiChoiceCorrect":261,"multiChoiceIncorrect":262,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":263,"matchPairsPairs":264},[210,213,214],[260],"Which of the following most closely applies to the large intestine?",[223],[219,221,222],[175],[265],{"left":266,"right":223,"direction":35},"Large intestine",{"id":268,"data":269,"type":25,"version":42,"maxContentLevel":35,"summaryPage":271,"introPage":279,"pages":285},"26822762-f448-46ea-9c13-d0f1384a4501",{"type":25,"title":270},"Microbial Diversity and the Gut-Brain Axis",{"id":272,"data":273,"type":35,"maxContentLevel":35,"version":25},"3bd0452b-7fed-4268-b6cf-37a2f6701871",{"type":35,"summary":274},[275,276,277,278],"A healthy gut has a diverse range of microbes, making it resilient","Our unique microbial signature is like a fingerprint","Humans share 99.9% of their DNA but only 90% of their microbiomes","The gut sends more signals to the brain than the brain sends to the gut",{"id":280,"data":281,"type":54,"maxContentLevel":35,"version":24},"8200b59e-fc16-4b11-b6d1-8dc078cea122",{"type":54,"intro":282},[283,284],"What is a microbial signature?","How does the gut communicate with the brain?",[286,301],{"id":287,"data":288,"type":24,"maxContentLevel":35,"version":25,"reviews":291},"47109b59-3c02-4eac-a09e-fc6637574648",{"type":24,"markdownContent":289,"audioMediaId":290},"Just as any healthy ecosystem contains a diverse range of species, **a healthy gut contains a wide array of microbes**. This diversity makes our microbiota more capable and resilient, because if one microbe cannot fulfill its function, another one can step in to lend a hand.\n\nWhen we talk about microbial diversity, we’re referring to the **number** and **distribution** of different species of microbes in our gut. The microbiota living inside each of us are as unique as our fingerprints. We call this unique pattern of microbes a *microbial signature*.\n\nNowhere was this better illustrated than when the results of the much-anticipated **Human Genome Project** were compared to those of the **Human Microbiome Project** (which mapped the DNA of microbes taken from healthy young adults). These studies concluded that while all **humans share 99.9% of the same genetic material, we share only roughly 90% of our microbiomes**.","8b9cb324-f785-4ece-a2f1-a6cbb8ceba8f",[292],{"id":293,"data":294,"type":68,"version":24,"maxContentLevel":35},"19ef6aed-6e03-46eb-b7d9-59a9990478b0",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":295,"binaryCorrect":297,"binaryIncorrect":299},[296],"Which of these terms refers to the presence of different kinds of microbes in the gut?",[298],"Microbial diversity",[300],"Microbial map",{"id":302,"data":303,"type":24,"maxContentLevel":35,"version":35,"reviews":306},"2efb21ad-4208-4e03-a3fa-1972274cf89f",{"type":24,"markdownContent":304,"audioMediaId":305},"Have you ever wondered why we have so many expressions relating to the gut and emotions? We speak about having a *gut feeling* to describe our intuition, or instinct. When we’re nervous, we say we have *butterflies in our stomach*. These expressions are rooted in biology, as our gut communicates directly with our brain.\n\nThe average human gut weighs about 3 pounds (1.4 kilograms) and has its own nervous system, called the **enteric nervous system**. It is frequently referred to as the *second brain*, and with good reason. The vagus nerve provides a physical link between the gut and the brain and allows them to talk to each other.\n\n![Graph](image://643d9bfb-6e67-484e-b9f4-5df3c765633b \"The vagus nerve running from the brain to the stomach. Image: Public domain via Wikimedia\")\n\nEven when the physical link is severed, these two organs can continue to communicate. While we used to think that most signals were sent from the brain to the gut, we now know that **the majority are sent from the gut to the brain**.","0fa75928-8816-47ab-93bc-eceed548b8a4",[307,316,325],{"id":308,"data":309,"type":68,"version":24,"maxContentLevel":35},"6d49b31e-7ac0-45ec-9b8d-98ddd7055a49",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":310,"binaryCorrect":312,"binaryIncorrect":314},[311],"Which is the nervous system located in the gut?",[313],"The enteric nervous system",[315],"The central nervous system",{"id":317,"data":318,"type":68,"version":24,"maxContentLevel":35},"a7a0f1cc-2e99-4472-afc0-9eb95bcc8cbd",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":319,"binaryCorrect":321,"binaryIncorrect":323},[320],"The majority of signals in the enteric nervous system are sent from ...",[322],"The gut to the brain",[324],"The brain to the gut",{"id":326,"data":327,"type":68,"version":25,"maxContentLevel":35},"549a09bb-7f6b-4e2e-ba45-7977a4add1eb",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":328,"binaryCorrect":330,"binaryIncorrect":332},[329],"By estimation, how much does the average human gut weigh?",[331],"3 pounds",[333],"6 pounds",{"id":335,"data":336,"type":25,"version":25,"maxContentLevel":35,"summaryPage":338,"introPage":346,"pages":352},"190a01f8-2230-4d01-98f3-337ed21789fa",{"type":25,"title":337},"Functions and Future of Gut Microbes",{"id":339,"data":340,"type":35,"maxContentLevel":35,"version":24},"255c244c-be53-43b6-bf42-e29e3e7b6fb6",{"type":35,"summary":341},[342,343,344,345],"Gut microbes help digest food, fight infection, and regulate metabolism","Stress, antibiotics, and unhealthy diets can disrupt the gut microbiome, leading to illnesses","DNA studies and bioinformatics platforms revolutionize our understanding of gut microbes","Projects like the American Gut Project and ZOE offer insights into personalized gut health",{"id":347,"data":348,"type":54,"maxContentLevel":35,"version":24},"6b35631e-ce16-454f-948e-9de1cb9aa9a8",{"type":54,"intro":349},[350,351],"How do gut microbes first colonize a newborn's gut?","What factors influence the initial development of a baby's gut microbiome?",[353,375,402],{"id":354,"data":355,"type":24,"maxContentLevel":35,"version":25,"reviews":358},"df9de4e4-db24-4bd6-af8b-935b2bdd4d72",{"type":24,"markdownContent":356,"audioMediaId":357},"Gut microbes play a fundamental role in human health. They help us *digest food, fight infection and illness, and regulate metabolism*. They also play a key role in early life development. They may *influence our mood and behavior*, as well as the long-term health of our brain. Recent research suggests that our microbes may even *influence our personality and choice of partner*.\n\nIn a healthy body, human and bacterial cells co-exist peacefully in the gut microbiome. Their relationship is a mutually beneficial one, known as *symbiosis*. Stress, antibiotics, an unhealthy diet, and parasites can disrupt the balance of the microbiome. This imbalance, called *dysbiosis*, can lead to a range of illnesses.\n\nA disrupted gut microbiome has been associated with physical illnesses (such as obesity, asthma, heart disease, certain cancers, allergies, autoimmune disease, skin disorders, digestive disorders, and diabetes) and mental illnesses, including anxiety, depression, ADHD, bipolar disorder and schizophrenia.\n\nSome recent studies have also made links between gut dysbiosis and autism spectrum disorders, though the line between correlation and causation in this area remains a subject of debate among scientists.","9ffc7df8-2f1e-48de-bb7d-3f789fb8816c",[359,368],{"id":360,"data":361,"type":68,"version":24,"maxContentLevel":35},"2be5391e-2a7c-4a36-8088-362361b62f83",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":362,"binaryCorrect":364,"binaryIncorrect":366},[363],"Which of these is a proven effect of gut dysbiosis?",[365],"Heart disease",[367],"Sickle cell anemia",{"id":369,"data":370,"type":68,"version":24,"maxContentLevel":35},"f0874c3f-4ba7-4fb7-a848-edef0531039c",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":371,"activeRecallAnswers":373},[372],"What is the term used to describe a state of imbalance in the gut microbiome?",[374],"Dysbiosis",{"id":376,"data":377,"type":24,"maxContentLevel":35,"version":25,"reviews":380},"c32bb4e6-96f5-4197-825d-1430b44dbfea",{"type":24,"markdownContent":378,"audioMediaId":379},"The study of human gut microbiota is an interdisciplinary field that has exploded in recent years. Studies of gut microbes are no longer limited to microbiologists. The microbiome has caught the attention of geneticists, evolutionary biologists, epidemiologists, gastroenterologists, hepatologists, and even neuroscientists.\n\nHistorically, microbiology was limited to visualization techniques, like **microscopy**, and **culturing microbes** (in other words, growing them in isolation in a laboratory). Thanks to recent advances, microbiologists can now use DNA in addition to microscopy and culturing. **DNA studies** give a much more accurate understanding of our microbiota because we can see everything – not just what is grown in a lab.\n\nHuman stool contains about **4,000 species** of bacteria, so fecal samples are a common method of analysis. Samples are also taken during **colonoscopy** (a thin tube attached to a camera, inserted into the anus, to examine the digestive organs) and **biopsy** (taking a sample of tissue to check for the presence of cancerous or pre-cancerous cells).\n\nThanks to **bioinformatics platforms**, scientists can analyze data and visualize the composition of the gut microbiome. Stanford University’s Center for Human Microbiome Studies focuses on connecting scientists from different disciplines and leveraging technology to harness the biomedical potential of our microbiota.","4ccc1ecf-a58f-4a02-8f48-5716135206b2",[381,392],{"id":382,"data":383,"type":68,"version":24,"maxContentLevel":35},"a9fcaa0f-7d0f-4929-9e0f-bb2d07462a5d",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":384,"multiChoiceCorrect":386,"multiChoiceIncorrect":388,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[385],"What term is used for growing microbes in a laboratory?",[387],"Culturing",[389,390,391],"Harvesting","Nurturing","Nourishing",{"id":393,"data":394,"type":68,"version":24,"maxContentLevel":35},"b1ac3946-1998-4881-90d8-6f1e7baaab51",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":395,"multiChoiceCorrect":397,"multiChoiceIncorrect":399,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[396],"Of these techniques, which gives the most accurate understanding of microbiota?",[398],"DNA studies",[400,387,401],"Microscopy","Fecal samples",{"id":403,"data":404,"type":24,"maxContentLevel":35,"version":25,"reviews":407},"c71c6f45-f4cd-4bfa-973a-4b3480e29226",{"type":24,"markdownContent":405,"audioMediaId":406},"This is where bacteria with the potential to heal the gut are genetically engineered and research is conducted to understand the health impact of changes to the microbiota that have occurred with industrialization.\n\n\\\nCurrent studies on gut health give us insight into future trends. **The American Gut Project**, based at the laboratory of Professor Rob Knight at the University of Colorado, is the world’s largest citizen science microbiome project. The Project analyzes human stool samples to learn more about the species in our guts and their health impacts.\n\nAdvancements in technology are fueling the gut health revolution. The innovative **ZOE Project**, co-founded by Professor Tim Spector, has developed a home test kit that tracks and analyzes gut, blood fat and blood sugar responses. With a promise to improve gut health and reduce inflammation, ZOE is one of several projects aiming to offer personalized nutrition guidance based on test kit results.","09a122af-7d0f-40ff-b3be-5bc667a09195",[408,419],{"id":194,"data":409,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":410,"multiChoiceQuestion":411,"multiChoiceCorrect":413,"multiChoiceIncorrect":414,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":415,"matchPairsPairs":416},[191,195,196],[412],"Which of the following best describes symbiosis?",[202],[200,203,204],[175],[417],{"left":418,"right":202,"direction":35},"Symbiosis",{"id":195,"data":420,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":421,"multiChoiceQuestion":422,"multiChoiceCorrect":424,"multiChoiceIncorrect":425,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":426,"matchPairsPairs":427},[191,194,196],[423],"Which of the following best describes dysbiosis?",[203],[200,202,204],[175],[428],{"left":374,"right":203,"direction":35},{"id":430,"data":431,"type":27,"maxContentLevel":35,"version":42,"orbs":434},"b286a868-ab4f-49e3-bb79-abe027f39d8a",{"type":27,"title":432,"tagline":433},"Gut Microbes Through the Lifespan","How your microbiome changes over time.",[435,533,623,681],{"id":436,"data":437,"type":25,"version":42,"maxContentLevel":35,"summaryPage":439,"introPage":447,"pages":453},"ab5a1da7-ab21-44cd-8487-a0189ca11a28",{"type":25,"title":438},"The Birth and Early Life of the Microbiome",{"id":440,"data":441,"type":35,"maxContentLevel":35,"version":24},"2e72b1ac-069c-4379-816d-224e447b62cb",{"type":35,"summary":442},[443,444,445,446],"Babies get their first bacteria from the mother's birth canal during vaginal delivery","*Lactobacilli* in the birth canal and breast milk help protect the baby from bad bacteria","Dendritic cells transport lactic acid cells from the intestine to the breasts","C-section babies miss out on the mother's vaginal bacteria, affecting their immunity",{"id":448,"data":449,"type":54,"maxContentLevel":35,"version":24},"97991269-5612-4c15-887e-40f7eaf5f8d5",{"type":54,"intro":450},[451,452],"How does vaginal delivery help a newborn's gut microbiome?","What are the long-term health impacts of being born via C-section?",[454,478,511,516],{"id":455,"data":456,"type":24,"maxContentLevel":35,"version":42,"reviews":459},"501e7b5b-2de2-4cd8-b636-8d02ab7dda45",{"type":24,"markdownContent":457,"audioMediaId":458},"The first 24 hours of life are crucial for the development of the gut microbiome, and the mode of delivery – vaginal or Caesarean-section – can impact the long-term health of the child. Before childbirth, the microbiota is basically sterile.\n\nOur first exposure to bacteria, fungi, and other crucial microorganisms, has historically been through the mother’s birth canal, where, like intrepid explorers, pioneering species of bacteria begin to populate the baby’s body in a process known as **colonization**.\n\nThe bacterial cells that are most abundant in the mother’s vagina are bacteria that produce lactic acids, called *Lactobacilli*. These are friendly bacteria which crowd out the bad bacteria (pathogens) in the baby’s developing digestive tract.","ca5bf1d4-ca26-403c-88df-b0efb29e45c2",[460,469],{"id":461,"data":462,"type":68,"version":24,"maxContentLevel":35},"897b37c9-cbe5-4f05-a42a-6655a836cd97",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":463,"binaryCorrect":465,"binaryIncorrect":467},[464],"Where do babies typically get their first exposure to crucial microorganisms?",[466],"The mother's birth canal",[468],"Inside the womb",{"id":470,"data":471,"type":68,"version":25,"maxContentLevel":35},"1bb28827-8eb3-4f7e-8e51-c5909c57f4bd",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":472,"binaryCorrect":474,"binaryIncorrect":476},[473],"Which of these terms refers to the friendly bacteria found in a baby's developing digestive tract before birth?",[475],"Lactobacilli",[477],"Listeria",{"id":479,"data":480,"type":24,"maxContentLevel":35,"version":25,"reviews":483},"e88a4937-dd9f-4f8c-bebf-d8b2edf04018",{"type":24,"markdownContent":481,"audioMediaId":482},"The same lactic-acid producing bacteria – *Lactobacilli* – that dominate in the vagina are also present in the mother’s breast milk, along with another beneficial bacteria, called *Bifidobacteria*. These bacteria – along with lactic acid cells – are transported between different parts of the body.\n\n![Graph](image://d372247b-0bad-4728-baad-453c0a4b0c71 \"A baby breastfeeding. Image: David Leo Veksler, CC BY-SA 2.0 \u003Chttps://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons\")\n\nIn the case of lactic acid cells, the journey takes them from the large intestine, through the blood stream, to the breasts. This movement relies on dendritic cells, which pluck them up and carry them where they need to be. The main function of dendritic cells is engulfing pathogens, as part of the immune system, but they serve this secondary function too.","ae034756-c42b-405d-b239-54f71907302a",[484,493,502],{"id":485,"data":486,"type":68,"version":24,"maxContentLevel":35},"6fa1dde9-0675-40e6-8732-cdc880a1bb66",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":487,"binaryCorrect":489,"binaryIncorrect":491},[488],"Lactobacilli and which other beneficial bacteria is present in breast milk?",[490],"Bifidobacteria",[492],"A. muciniphila",{"id":494,"data":495,"type":68,"version":24,"maxContentLevel":35},"0825cfc9-c78e-45d7-8b87-2d4f60696422",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":496,"multiChoiceCorrect":498,"multiChoiceIncorrect":500,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[497],"Which of these are examples of good bacteria that may be found in a mother's breast milk?",[499],"Both of these",[490,475,501],"Neither of these",{"id":503,"data":504,"type":68,"version":24,"maxContentLevel":35},"dd980ace-50d3-471f-bf3c-c35e62ac5cc6",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":505,"binaryCorrect":507,"binaryIncorrect":509},[506],"Which of these comes with birth canal delivery of babies?",[508],"Exposure to valuable microbes",[510],"Reduced exposure to viruses",{"id":512,"data":513,"type":24,"maxContentLevel":35,"version":35},"7462e381-4c4e-4ceb-9d0b-c3a377b8bea2",{"type":24,"markdownContent":514,"audioMediaId":515},"Because of this link between immune cells and lactic acid cells, evolutionary biologist Alanna Collen believes that the cross-talk between gut, vaginal and breast milk microbes helps to prime a newborn baby’s immune system after childbirth.\n\nVaginal delivery provides a *valuable microbial starter pack*, gifting the new-born a generous sprinkling of the founding colonies for her own microbiome as she journeys through the birth canal.\n\nBreastfeeding further encourages colonization of the baby’s gut microbiome by beneficial microbes, prevents colonization by bad bacteria, and trains the baby’s developing immune system to distinguish between friend and foe. So, what happens in the case of births by Caesarean-section?","b62a043f-96af-49df-97e7-dac45914cd17",{"id":517,"data":518,"type":24,"maxContentLevel":35,"version":25,"reviews":521},"a135e6a1-01a2-421f-8f78-d3036547039f",{"type":24,"markdownContent":519,"audioMediaId":520},"By skipping the trip through the birth canal, babies miss out on the bacterial starter pack from their mothers’ vaginal microbiota. These babies are first exposed to environmental microbes outside the birth canal. C-section delivery can have a lasting impact on the child’s immunity. They are more prone to developing infections and allergies. While you can match the microbiotas of the child’s gut with that of the mother’s vagina following a natural birth, the microbes of C-section babies cannot be matched with their mothers’.\n\nWhen microbiome researcher Rob Knight’s wife had to give birth by emergency C-section in 2012, Knight waited for the medical staff to leave the room, then used a swab to transfer vaginal microbiota from his wife to his daughter, to give his child the opportunity to benefit from her mother’s vaginal microbiota.","470f7e3b-b02d-4864-b08d-91844bc93cce",[522],{"id":164,"data":523,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":524,"multiChoiceQuestion":525,"multiChoiceCorrect":527,"multiChoiceIncorrect":528,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":529,"matchPairsPairs":530},[160,163,165],[526],"Which of the following most closely applies to Rob Knight?",[172],[169,171,173],[175],[531],{"left":532,"right":172,"direction":35},"Rob Knight",{"id":534,"data":535,"type":25,"version":35,"maxContentLevel":35,"summaryPage":537,"introPage":545,"pages":551},"b31ae3f8-fe3b-4997-a98a-63a9ac996d9b",{"type":25,"title":536},"The Impact of Birth Method on the Microbiome",{"id":538,"data":539,"type":35,"maxContentLevel":35,"version":24},"5c8b98c0-ac03-4ce6-8aeb-107dba8c7de9",{"type":35,"summary":540},[541,542,543,544],"Babies born via C-section have lower levels of IgA, an infection-fighting antibody","C-section births are linked to higher risks of asthma and type 1 diabetes due to different microbial exposure","Formula-fed babies are more prone to infections and chronic diseases compared to breastfed babies","The type of infant formula can influence a baby's gut bacteria, affecting their microbiome development",{"id":546,"data":547,"type":54,"maxContentLevel":35,"version":24},"fc302c67-04e7-4877-86cd-f0c89a2323fb",{"type":54,"intro":548},[549,550],"How does a C-section birth affect a baby's gut microbiome?","Why might formula-fed babies have different gut bacteria than breastfed babies?",[552,576,589],{"id":553,"data":554,"type":24,"maxContentLevel":35,"version":25,"reviews":557},"7c8e4942-35aa-418c-94de-bde0137721f1",{"type":24,"markdownContent":555,"audioMediaId":556},"C-sections can have a significant impact on the development of an infant’s immune system. Studies have found that babies born via C-section had lower levels of IgA, an antibody which helps protect against infection, compared to those delivered naturally. This suggests that exposure to maternal microorganisms during delivery is important for establishing a healthy immune system in newborns.\n\nFurthermore, research has also linked C-sections with increased risk of autoimmune diseases such as asthma and type 1 diabetes later in life due to differences in microbial composition at birth. It is thought that this could be because infants born by Caesarean section lack exposure to their mother’s vaginal microbiota which helps stimulate the development of regulatory T cells (Treg) – specialized white blood cells involved in controlling inflammation and preventing autoimmunity.","8eb50187-b2be-4bc1-8645-66ada20765ac",[558,567],{"id":559,"data":560,"type":68,"version":24,"maxContentLevel":35},"6fe813fd-e1ef-4b9c-8a40-220edbd46064",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":561,"binaryCorrect":563,"binaryIncorrect":565},[562],"Babies born via C-section were found to have lower levels of which antibody?",[564],"IgA",[566],"AiG",{"id":568,"data":569,"type":68,"version":24,"maxContentLevel":35},"added69b-1b91-4aa5-bb86-1f1d4b7f8297",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":570,"binaryCorrect":572,"binaryIncorrect":574},[571],"The development of which cells is stimulated by vaginal delivery of babies?",[573],"Regulatory T Cells",[575],"Regulatory B Cells",{"id":577,"data":578,"type":24,"maxContentLevel":35,"version":25,"reviews":581},"4aeee86f-4788-44ff-b022-796fd957c44e",{"type":24,"markdownContent":579,"audioMediaId":580},"These findings suggest that natural childbirth may be preferable when it comes to setting up a healthy microbiome and developing immunity early on in life, although further research is needed into how best we can support babies born via C-section so they too benefit from optimal gut health throughout their lives.\n\nWe now know that formula feeding may pose health risks for babies. Mostly derived from cow’s milk, modern baby formulas are supplemented with many essential extras, but they don’t usually contain *immune cells and antibodies*, *oligosaccharides* or *live bacteria* that are found in breast milk.","707a8217-da58-4546-b9c0-ba06aae8138f",[582],{"id":583,"data":584,"type":68,"version":24,"maxContentLevel":35},"512f94b5-015c-467a-8820-e78118a7fc16",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":585,"activeRecallAnswers":587},[586],"What is the primary ingredient for most modern-day baby formulas?",[588],"Cow's milk",{"id":590,"data":591,"type":24,"maxContentLevel":35,"version":35,"reviews":594},"72c654ec-0ee7-4670-bc27-9e14e66f2616",{"type":24,"markdownContent":592,"audioMediaId":593},"Formula-fed babies tend to be more prone to infections, and are at greater risk of developing eczema, asthma, leukemia, type I diabetes, appendicitis, tonsillitis, multiple sclerosis, rheumatoid arthritis, and obesity later in life.\n\nThe risk of obesity correlates with the length of time spent breast-feeding: one study found that the risk of children becoming overweight drops for each extra month of breast-feeding up to the age of nine months. Interestingly, research has also shown that the composition of infant formulas can affect the development of their microbiome.\n\nFor example, one study found that babies fed cow’s milk-based formulas had higher levels of Firmicutes bacteria than those fed soy-based formulas – this difference was not seen in breastfed infants. These findings suggest that different types of infant formula can influence microbial diversity during early life stages, so it is important to consider these factors when choosing a suitable option for your baby.","c7c40919-2ae0-457c-a0cb-d76ebffadb35",[595,604,612],{"id":596,"data":597,"type":68,"version":24,"maxContentLevel":35},"95e37057-7d94-4249-8de0-f0064ee01a9c",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":598,"binaryCorrect":600,"binaryIncorrect":602},[599],"Which kind of baby formula leads to higher levels of the Firmicutes bacteria in children?",[601],"Cow's milk-based",[603],"Soy-based",{"id":605,"data":606,"type":68,"version":24,"maxContentLevel":35},"efc35253-3732-421f-bf99-b84b61904898",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":607,"binaryCorrect":609,"binaryIncorrect":610},[608],"Which common health concern has been found to correlate with the length of time spent breast-feeding?",[208],[611],"Gastritis",{"id":196,"data":613,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":614,"multiChoiceQuestion":615,"multiChoiceCorrect":617,"multiChoiceIncorrect":618,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":619,"matchPairsPairs":620},[191,194,195],[616],"Which of the following best describes microbial composition?",[204],[200,202,203],[175],[621],{"left":622,"right":204,"direction":35},"Microbial composition",{"id":624,"data":625,"type":25,"version":25,"maxContentLevel":35,"summaryPage":627,"introPage":635,"pages":641},"f394a4d8-6e95-493a-b8ed-b6a0a9c40807",{"type":25,"title":626},"The Microbiome in Childhood and Adolescence",{"id":628,"data":629,"type":35,"maxContentLevel":35,"version":24},"d0a9de22-c11a-4fad-9df1-01199be752b3",{"type":35,"summary":630},[631,632,633,634],"The microbiome keeps evolving in kids beyond age 3","Pre-school and primary school kids' microbiota develop for at least another decade","Frequent antibiotics in young kids can harm their gut microbiota","Losing friendly gut microbes early can lead to obesity",{"id":636,"data":637,"type":54,"maxContentLevel":35,"version":24},"56d61bae-b3fd-4803-b12e-c0ee3a6b1cdf",{"type":54,"intro":638},[639,640],"How does the gut microbiome of a 6-year-old differ from that of a 3-year-old?","Why is early childhood considered a key window of vulnerability for gut microbiome development?",[642,657],{"id":643,"data":644,"type":24,"maxContentLevel":35,"version":25,"reviews":647},"39356ee4-f9d0-48d1-9b6b-0c3f780348c6",{"type":24,"markdownContent":645,"audioMediaId":646},"Since the explosion of interest in the human gut microbiome, there has been extensive commentary on the microbiotas of infants up to the age of 3 years and adults. The microbiota of pre-schoolers (3–6 years), primary-school children (6–12 years), and teenagers (12–18 years) have been largely overlooked.\n\nUntil recently, it was thought that the microbiota undergoes most of its development very early in life, and that by the age of three, the child’s microbiome resembles that of an adult. Recent studies suggest the microbiome continues to evolve beyond these early years.\n\n![Graph](image://b2045a23-8b4a-41a4-8365-fe3d39d5802f \"Children eating ice cream. Image: Nationaal Archief, No restrictions, via Wikimedia Commons\")\n\nBased on the findings of several studies of the microbiota of pre-school and primary school children (up to the age of 12 years) around the world, it seems that the microbiota continues to develop for at least another decade. As new studies on the subject continue to emerge, so will opportunities for microbiome-based interventions to promote health among this age group, particularly through diet.","c79a24d8-1638-4f71-9abb-0ff7bbb3e85c",[648],{"id":649,"data":650,"type":68,"version":24,"maxContentLevel":35},"0fe984aa-97b6-447b-a4dd-4706d419c3f0",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":651,"binaryCorrect":653,"binaryIncorrect":655},[652],"Which of these statements about microbiota is more accurate?",[654],"The child's microbiota continues to develop well beyond the early years",[656],"The child's microbiota reaches full maturity by the age of 3",{"id":658,"data":659,"type":24,"maxContentLevel":35,"version":25,"reviews":662},"fa19d160-d5ff-4db4-a4e4-a177b3e3f284",{"type":24,"markdownContent":660,"audioMediaId":661},"Some scientists speculate that exposing young children to pets and dirt is beneficial for their gut microbiota. However, **Martin Blaser** begs to differ, claiming that *'the microbes in our pets and farm animals are not deeply rooted in our human evolution.'*\n\nFar more important, says Blaser, are changes to the microbiota that occur when young children are prescribed antibiotics too frequently. In 2014, Blaser and his team were running more than twenty projects on mice and human subjects to test the effects of antibiotics on resident microbes and their hosts.\n\nThe results of their experiments on mice uncovered some key findings: early life is *'a key window of vulnerability'*, as young children have periods that are critical for their growth and development; and the loss of friendly gut microbes at this early stage of development drives obesity.","e24ddad0-50ff-46c0-b027-b9e7df7f3154",[663,672],{"id":664,"data":665,"type":68,"version":24,"maxContentLevel":35},"ac786f00-fe00-48b9-bb43-496d7e2ac93e",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":666,"binaryCorrect":668,"binaryIncorrect":670},[667],"According to Martin Blaser, the early life is a ...",[669],"Key window of vulnerability",[671],"Time to stay protected",{"id":673,"data":674,"type":68,"version":24,"maxContentLevel":35},"2f284478-0018-457a-b96b-cdfab8c94cb4",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":675,"binaryCorrect":677,"binaryIncorrect":679},[676],"Which of these statements is Martin Blaser more likely to agree with?",[678],"Overexposure to antibiotics poses a grave threat to the child's gut microbiota.",[680],"Exposure to pets and dirt is beneficial to the child's gut microbiota.",{"id":682,"data":683,"type":25,"version":25,"maxContentLevel":35,"summaryPage":685,"introPage":693,"pages":699},"2cc64314-c916-4e1e-9ea0-be4c3620e7ba",{"type":25,"title":684},"The Microbiome in Adulthood",{"id":686,"data":687,"type":35,"maxContentLevel":35,"version":24},"24696992-9c70-493b-bcdd-42e5acaf5994",{"type":35,"summary":688},[689,690,691,692],"Our gut microbes change dramatically in response to illness, injury, fever, stress, and diet","Critically injured patients experience significant microbiota changes within 72 hours of trauma","Stress, fever, and illness can disrupt gut microbes, leading to dysbiosis and disease","Heart disease, cancer, and stroke are linked to inflammation from an unhealthy lifestyle, not just old age",{"id":694,"data":695,"type":54,"maxContentLevel":35,"version":24},"2b55b69f-dd5b-4abb-be9c-2c8c68a8627d",{"type":54,"intro":696},[697,698],"How do changes in diet impact the balance of our gut microbiota?","What role does inflammation play in diseases like heart disease and cancer?",[700,705,731],{"id":701,"data":702,"type":24,"maxContentLevel":35,"version":25},"cbcca638-4a39-48a3-91a7-e5e7735fd089",{"type":24,"markdownContent":703,"audioMediaId":704},"In tandem with our progress into adulthood, our resident microbes evolve and adapt in response to changes in the environment. By this stage, our tiny companions are decidedly more a product of nurture than nature. As we subject our bodies to dramatic changes – *illness, injury, fever, stress and changes to our diet* – our microbes shapeshift and reshuffle in response to external stressors.\n\nOur tiny hitchhikers can’t seem to catch a break. When we injure ourselves, our bodies suffer trauma and inflammation. Studies of critically injured patients show that their microbiotas undergo significant changes in the first 72 hours following the trauma. These changes alter the diversity and composition of the microbiota.","5b6672c1-8d9a-42a2-8856-dd149d1b897d",{"id":706,"data":707,"type":24,"maxContentLevel":35,"version":25,"reviews":710},"2cc69bac-a183-4f39-9061-b1de98c82173",{"type":24,"markdownContent":708,"audioMediaId":709},"Stress, fever and illness can disrupt the microbial balance in the gut, leading to dysbiosis, and laying fertile ground for diseases to flourish. By the time we reach adulthood, diet is by far the factor with the greatest capacity to shift the microbial balance.\n\n![Graph](image://045eae76-775b-4057-ad64-97eb3337dade \"A plate of salad. Image: fir0002  flagstaffotos [at] gmail.com\t\tCanon 20D + Canon 17-40mm f/4 L, GFDL 1.2 \u003Chttp://www.gnu.org/licenses/old-licenses/fdl-1.2.html>, via Wikimedia Commons\")\n\nAs our human cells start showing signs of their collective age, so too do our microbial passengers. Many of us have come to associate old age with ill health, but emerging medical research suggests that the top three leading causes of death in 2005–heart disease, cancer and stroke– are not diseases of old age, but rather, *diseases of inflammation*.","586381b0-ff46-419e-94f2-dce523685292",[711,720],{"id":712,"data":713,"type":68,"version":24,"maxContentLevel":35},"ca68721f-2b39-43d7-b21f-cf456f2c4028",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":714,"binaryCorrect":716,"binaryIncorrect":718},[715],"Which of these has the greater impact on a human's microbes during adult years?",[717],"Nurture",[719],"Nature",{"id":721,"data":722,"type":68,"version":24,"maxContentLevel":35},"cf3a124a-c4a0-4221-ab42-16d2e8c962f6",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":723,"multiChoiceCorrect":725,"multiChoiceIncorrect":727,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[724],"Which of these is a factor responsible for changes to the adult's microbiota?",[726],"All of these",[728,729,730],"Illness","Stress","Diet",{"id":732,"data":733,"type":24,"maxContentLevel":35,"version":25,"reviews":736},"3a5ab7bf-18a2-4107-a0a9-d42d7dc2dc51",{"type":24,"markdownContent":734,"audioMediaId":735},"According to Alanna Collen, the processes of heart tissue hardening (heart disease), uncontrollable multiplication of cells (cancers) and sudden bursting of blood vessels (strokes) are not entirely related to the advancement in age. She postulates instead that it is the *'modern insults'* of an unhealthy lifestyle that leads to inflammation, and results in these catastrophes.\n\nIf we look after our microbes, then we can – in theory – mitigate the extent of damage caused by inflammation.","892b5c22-8a44-4f24-a2c4-7db4de79135b",[737],{"id":738,"data":739,"type":68,"version":24,"maxContentLevel":35},"916168c2-8173-427f-87dc-113d453e1ac7",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":740,"clozeWords":742},[741],"Research suggests that the top three leading causes of death – heart disease, cancer and stroke – are diseases of inflammation.",[743],"inflammation",{"id":745,"data":746,"type":27,"maxContentLevel":35,"version":35,"orbs":749},"23b03290-c0d0-4c6d-8c18-94cd9e71731d",{"type":27,"title":747,"tagline":748},"How Microbiota Benefit the Body","The effect of microbiota on maintaining your health.",[750,842,917],{"id":751,"data":752,"type":25,"version":35,"maxContentLevel":35,"summaryPage":754,"introPage":762,"pages":768},"60f140a2-eb3b-47bb-852d-cea17424bcc7",{"type":25,"title":753},"Understanding Microbiota",{"id":755,"data":756,"type":35,"maxContentLevel":35,"version":24},"4dbc133b-5875-4df4-8ab5-ed0cb3013cf2",{"type":35,"summary":757},[758,759,760,761],"Microbiota help break down complex carbs and produce essential vitamins like B12 and K2","Bifidobacteria in breastfed babies produce SCFAs like butyrate, acetate, propionate, and lactate","SCFAs help ferment indigestible fibers and train our immune system","GPR43 receptors on immune cells need SCFAs to prevent inflammation and diseases like asthma",{"id":763,"data":764,"type":54,"maxContentLevel":35,"version":24},"4280b43e-ef5c-4056-b85a-5353e7e5b55c",{"type":54,"intro":765},[766,767],"How do Bifidobacteria help babies' immune systems?","What role do SCFAs play in digesting plant foods?",[769,782,815,827],{"id":770,"data":771,"type":24,"maxContentLevel":35,"version":35,"reviews":774},"bbc5b335-d3ea-48cb-b0fa-3c3e438174b3",{"type":24,"markdownContent":772,"audioMediaId":773},"The microbiota in our bodies are incredibly beneficial, providing us with a range of health benefits. For example, they help to break down complex carbohydrates and produce essential vitamins such as B12 and K2.\n\nThey also play an important role in the immune system by producing antimicrobial peptides that protect against infection. Furthermore, they can reduce inflammation throughout the body and even influence neurotransmitter synthesis in the brain via the gut-brain axis.\n\nIt’s no exaggeration to say that our microbes are essential to our health. Harnessing these benefits can have an incredible impact on people’s health and wellbeing.","c571a723-573b-4772-97a2-2466b6745988",[775],{"id":776,"data":777,"type":68,"version":24,"maxContentLevel":35},"6581b89d-c0a3-437a-9aa3-e356cbf3fcde",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":778,"clozeWords":780},[779],"Microbiota can influence neurotransmitter synthesis in the brain via the gut-brain axis.",[781],"neurotransmitter",{"id":783,"data":784,"type":24,"maxContentLevel":35,"version":25,"reviews":787},"9dae38c9-73d3-45b3-b9a8-1212026d585e",{"type":24,"markdownContent":785,"audioMediaId":786},"Two species of bacteria dominate the microbiota of breastfed babies: Lactobacilli (the friendly bacteria we met in Colonization in the birth canal and Breast-feeding, natural birth, and immunity, part 1), and Bifidobacteria. Bifidobacteria feed on oligosaccharides and produce compounds called short-chain fatty acids (SCFAs) as a waste product.\n\nThe three major SCFAs are called butyrate, acetate and propionate. Bifidobacteria also produce a fourth SCFA that’s very beneficial for babies – lactate, or lactic acid. (Yes, this is the same compound that’s found in the mother’s vaginal and breast-milk microbiota). SCFAs 'feed the cells of the large intestine and play a crucial role in the development of a baby’s immune system.'","0fd750f7-04d6-46e7-b6b7-48f71c727238",[788,799,808],{"id":789,"data":790,"type":68,"version":24,"maxContentLevel":35},"ce1fb06f-c675-41e0-9511-c11eb573b9bc",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":791,"multiChoiceCorrect":793,"multiChoiceIncorrect":795,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[792],"What class of compounds are generated when Bifidobacteria feed on oligosaccharides?",[794],"Short-chain fatty acids",[796,797,798],"Amino acids","Antimicrobial peptides","Enzymes",{"id":800,"data":801,"type":68,"version":24,"maxContentLevel":35},"8a8dec9a-eed4-425e-bbb4-0a759af5717e",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":802,"binaryCorrect":804,"binaryIncorrect":806},[803],"Which of these is true about Bifidobacteria?",[805],"They are 'good' bacteria",[807],"They only develop in a child after 3 years",{"id":809,"data":810,"type":68,"version":24,"maxContentLevel":35},"ee1a66bd-e5b7-4784-9729-7bc5084c735f",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":811,"clozeWords":813},[812],"After eating plant foods, large amounts of the three major SCFAs – butyrate, acetate and propionate – are present in the large intestine.",[814],"propionate",{"id":816,"data":817,"type":24,"maxContentLevel":35,"version":25,"reviews":820},"4628e1f0-ee6b-4122-b828-8150698b7b35",{"type":24,"markdownContent":818,"audioMediaId":819},"The SCFAs produced by Bifidobacteria perform another essential function: they help us ferment indigestible fibers, such as tough food particles from plant foods, which we’re unable to digest on our own. Without the help of our microbial companions, we wouldn’t be able to fully digest plant foods and extract the essential nutrients they contain.\n\nShort-chain fatty acids (SCFAs) play a key role in training our immune system as we journey through life. After eating plant foods, large amounts of the three major SCFAs – butyrate, acetate and propionate – are present in the large intestine. According to evolutionary biologist and science writer Alanna Collen, these compounds 'are the keys to a thousand locks, and their importance to our health has been underestimated for decades.'","1cde03a5-54a5-4057-bc4a-b10c21c6c6b0",[821],{"id":822,"data":823,"type":68,"version":24,"maxContentLevel":35},"f8ce21c8-232e-4ea9-a71d-5682da072306",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":824,"activeRecallAnswers":826},[825],"In Alanna Collen's 'lock and key' analogy, what is the key that unlocks GPR43 receptors?",[794],{"id":828,"data":829,"type":24,"maxContentLevel":35,"version":25,"reviews":832},"fec616fe-e3a6-4761-8853-58e05dc82088",{"type":24,"markdownContent":830,"audioMediaId":831},"One such lock is GPR43 (G-Protein-coupled Receptor 43). It can be found on immune cells, where it waits patiently for SCFA keys to unlock it.\n\nBut what does GPR43 do? Some researchers conducted experiments on mice to answer this question. The studies revealed that without these receptors, mice suffer from terrible inflammation and are prone to developing inflamed colons, arthritis or asthma. The same effect occurs if you leave the locks (GPR43) in place but take away the keys (SCFAs).","12293c7c-2825-49cb-a2bf-3daf19c2291c",[833],{"id":834,"data":835,"type":68,"version":24,"maxContentLevel":35},"62730410-a87c-4703-b1ff-1fc7fcef907f",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":836,"binaryCorrect":838,"binaryIncorrect":840},[837],"What happened to mice who were lacking in GPR43 receptors?",[839],"They suffered terrible inflammation",[841],"They were more likely to develop cancer",{"id":843,"data":844,"type":25,"version":25,"maxContentLevel":35,"summaryPage":846,"introPage":854,"pages":860},"b6937aec-b29a-4117-9eb2-fcc7bf048109",{"type":25,"title":845},"Microbiota and Nutrient Synthesis",{"id":847,"data":848,"type":35,"maxContentLevel":35,"version":24},"28d54d04-6ff1-4f22-bf19-f60c52caef0a",{"type":35,"summary":849},[850,851,852,853],"Germ-free mice can't produce SCFAs and are prone to inflammatory diseases","GPR43 on fat cells helps store energy healthily and triggers leptin release","Microbes in our gut synthesize essential vitamins like B12 and K","Babies' microbiotas make folic acid from breast milk",{"id":855,"data":856,"type":54,"maxContentLevel":35,"version":24},"58a604ee-71b3-4114-9a5f-89efbd1de6a4",{"type":54,"intro":857},[858,859],"How do SCFAs help prevent inflammatory diseases?","Why do gut microbes make you feel full after eating fiber?",[861,887,902],{"id":862,"data":863,"type":24,"maxContentLevel":35,"version":25,"reviews":866},"66754fb4-dc52-4224-b1ea-c6dcb237ae76",{"type":24,"markdownContent":864,"audioMediaId":865},"Germ-free mice – mice which are bred without microbiota – are unable to produce SCFAs, because they lack the microbes needed to break down fiber. Their GPR43 locks stay closed and these mice are prone to developing inflammatory diseases.\n\nThis points to an interesting fact: GPR43 allows our microbes to talk to our immune system. Our microbes, intriguingly, produce keys in the form of SCFAs so they can tap into the locks on our immune cells, and tell them not to attack.","b0553481-f8c0-4917-a34f-1da3913fff90",[867,876],{"id":868,"data":869,"type":68,"version":24,"maxContentLevel":35},"19b48248-cb7c-47ab-a6c1-00a927109493",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":870,"binaryCorrect":872,"binaryIncorrect":874},[871],"What does GPR43 do?",[873],"Allows our microbes to talk to our immune system",[875],"Improves the signalling in the gut-brain axis",{"id":877,"data":878,"type":68,"version":24,"maxContentLevel":35},"cc3138e6-5565-406f-a92b-a513dc524986",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":879,"multiChoiceCorrect":881,"multiChoiceIncorrect":883,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[880],"Which of these is true about 'germ-free' mice - mice bred without microbiota?",[882],"They are unable to break down fiber",[884,885,886],"They actively produce SCFAs","They are immune to inflammatory diseases","Their GPR43 receptors are unlocked",{"id":888,"data":889,"type":24,"maxContentLevel":35,"version":25,"reviews":892},"8760ed7f-3965-4700-9f59-7486624162a6",{"type":24,"markdownContent":890,"audioMediaId":891},"There is another place where you can find GPR43: on fat cells. Studies on obese people have found they have bigger fat cells than lean people. When a GPR43 lock is unlocked by its matching key, it forces the fat cells to divide instead of growing larger.\n\nThis causes energy to be stored in a healthy way. Unlocking SCFAs also triggers the release of leptin – the satiety hormone. This explains why eating fiber makes you feel full. Our gut microbes synthesize vitamins and amino acids that are essential for our health, and which our bodies might otherwise not be able to produce.","bb9fc112-e56b-43b4-bd0a-211d932333be",[893],{"id":894,"data":895,"type":68,"version":24,"maxContentLevel":35},"218f17d9-4dea-4870-bef7-c830f36b2ea5",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":896,"binaryCorrect":898,"binaryIncorrect":900},[897],"When unlocked, GRP43 has this interesting effect on fat cells:",[899],"It forces the fat cells to divide",[901],"It forces the fat cells to grow bigger",{"id":903,"data":904,"type":24,"maxContentLevel":35,"version":25,"reviews":907},"0c15e4bf-f9bd-4c9e-a3ca-ffedb76ce816",{"type":24,"markdownContent":905,"audioMediaId":906},"Klebsiella, for instance, contains a gene for a protein that makes Vitamin B12. An essential vitamin, B12 balances the nervous system and is critical for brain function. Thanks to the help of Bacteroides, we can borrow genes from our microbes to shape our intestinal walls. The same cells have been found to occur in large numbers in the microbiota of lean humans.\n\nBabies need a lot of folic acid, but they can’t eat foods that contain it. Their microbiotas contain genes that synthesize folic acid from breast milk. Some of us have bacteria that manufacture Vitamin K, which we need for our blood to clot, but which we don’t make ourselves. This is just another way our tiny companions have co-evolved with us; it would take us a very long time to evolve the genes we need to produce these health-promoting vitamins and acids on our own.","e4f7e655-fe13-44ca-b013-66d1882f0648",[908],{"id":909,"data":910,"type":68,"version":24,"maxContentLevel":35},"7ae945c2-33a8-4550-8b50-a1216ac879f7",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":911,"binaryCorrect":913,"binaryIncorrect":915},[912],"Which bacteria helps our bodies produce Vitamin B12?",[914],"Klebsiella",[916],"Bifidobacterium",{"id":918,"data":919,"type":25,"version":25,"maxContentLevel":35,"summaryPage":921,"introPage":929,"pages":935},"f21a87f8-c968-40e0-9114-3d32ad274368",{"type":25,"title":920},"Harmful Bacteria Overgrowth",{"id":922,"data":923,"type":35,"maxContentLevel":35,"version":24},"8da0e348-1571-43a7-90c7-944f6d76a125",{"type":35,"summary":924},[925,926,927,928],"Gut microbes protect the mucosal layer, preventing leaky gut","Leaky gut lets toxins and pathogens into the bloodstream, causing inflammation","Butyrate, an SCFA, seals the gut wall, preventing leaks","Phagocytes eat and destroy pathogens through phagocytosis",{"id":930,"data":931,"type":54,"maxContentLevel":35,"version":24},"7951274a-3615-4d8a-a7e0-cdf360e17559",{"type":54,"intro":932},[933,934],"How do gut microbes prevent leaky gut?","What role do phagocytes play in defending our gut?",[936,969],{"id":937,"data":938,"type":24,"maxContentLevel":35,"version":25,"reviews":941},"6d4d9cd4-4912-4956-a43d-473b2a843c77",{"type":24,"markdownContent":939,"audioMediaId":940},"Our gut microbiota play an important role in protecting the integrity of the mucosal layer and safeguarding our immune system. Like soldiers holding down the fort, they keep intruders at bay. However, the reverse is also true: in the presence of illness or infection, dysbiosis can threaten the integrity of the mucosal layer and compromise immunity. When the mucosal layer is damaged, the gut wall becomes porous, and all sorts of toxic compounds, pathogens included, are able to gain a foothold by infiltrating the blood. This is what is known as leaky gut.\n\n![Graph](image://1a0f52a2-c409-4473-8578-30edc21da20e \"A permeable gut lining. Image: BallenaBlanca, CC BY-SA 4.0 \u003Chttps://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons\")\n\nLeaky gut causes harm, as these bad bacteria provoke the immune system, triggering inflammation. It’s this inflammation that’s the culprit behind many of our 21st century illnesses. So, how do our microbes hold down the fort and keep our borders safe from attack? Butyrate – one of the three major SCFAs – is responsible for patrolling the gut wall and plugging the leaks. Butyrate is a real immune warrior because it seems to be the missing puzzle piece in leaky gut, which is associated with a host of auto-immune diseases.","0d37e42f-6146-403d-a52b-7b437ca707ed",[942,953,960],{"id":943,"data":944,"type":68,"version":24,"maxContentLevel":35},"b799114d-b955-4765-ba59-0342561bba94",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":945,"multiChoiceCorrect":947,"multiChoiceIncorrect":949,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[946],"Which of the three major SCFAs is considered the missing puzzle piece in addressing leaky gut?",[948],"Butyrate",[950,951,952],"Propionate","Acetate","All of them",{"id":954,"data":955,"type":68,"version":24,"maxContentLevel":35},"441b51c0-2ef7-4fa7-afad-90964ae01cb6",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":956,"clozeWords":958},[957],"When the mucosal layer is damaged, the gut wall becomes porous, causing a leaky gut.",[959],"leaky gut",{"id":961,"data":962,"type":68,"version":24,"maxContentLevel":35},"426d9c7a-b3a6-4ace-b6c6-519e783988e8",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":963,"binaryCorrect":965,"binaryIncorrect":967},[964],"What happens to the gut wall when it is damaged?",[966],"It becomes porous",[968],"It does not allow compounds to pass through",{"id":970,"data":971,"type":24,"maxContentLevel":35,"version":25,"reviews":974},"089bb47e-00cb-49d5-a1c1-33eca34b1248",{"type":24,"markdownContent":972,"audioMediaId":973},"We now know that our gut microbes are like our own personal army; deploying troops to the border to keep enemy forces at bay. One way they do this is by sealing off the porous areas of our gut wall to prevent intruders from slipping into our bloodstream. Another way that our gut microbes eliminate invading pathogens is by a process called phagocytosis. Dendritic cells are long-armed immune cells that pluck the good bacteria from the mother’s large intestine and transport them to her breast tissue, to feed her newborn baby.\n\nDendritic cells and other immune cells, which go by the name of macrophages and mast cells, are also tasked with the very important function of clearing out pathogens. If you think of your gut microbiome as a garden, it’s the job of these immune cells to pull out the weeds. During phagocytosis, white blood cells that go by the name of phagocytes bind themselves to foreign bodies, including pathogens.\n\nAfter attaching to the pathogen, phagocytes engulf and absorb the intruders; they are skilled defenders against unwanted foreign bodies. In case you’re wondering what’s behind these names, the prefix ‘phago’ is a Greek word that means to ‘eat’, ‘consume’, or ‘destroy’. Clearly our clever phagocytes do all three. ‘Cytosis’ is the name we use in biology for a process used by cells to intake and expel molecules.","a072015c-26da-4e2c-bdb1-a986f36731a8",[975,984,992],{"id":976,"data":977,"type":68,"version":24,"maxContentLevel":35},"ca3650ad-dc9a-43df-96b6-005b5c605425",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":978,"binaryCorrect":980,"binaryIncorrect":982},[979],"What term is used for dendritic and other immune cells?",[981],"Macrophages",[983],"Autophages",{"id":985,"data":986,"type":68,"version":24,"maxContentLevel":35},"a16ca673-eb74-452e-87a1-2aa8c5b508d4",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":987,"binaryCorrect":989,"binaryIncorrect":991},[988],"Which of these is a process by which human gut microbes eliminate invading pathogens?",[990],"Phagocytosis",[418],{"id":993,"data":994,"type":68,"version":24,"maxContentLevel":35},"ef0eff7f-c9c0-4264-a274-6a8b00f332f2",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":995,"binaryCorrect":997,"binaryIncorrect":999},[996],"What term is used in biology for the process used by cells to intake and expel molecules?",[998],"Cytosis",[1000],"Osmosis",{"id":1002,"data":1003,"type":27,"maxContentLevel":35,"version":25,"orbs":1006},"585f9cdd-a9c8-4933-85c8-9ee0ecb936d3",{"type":27,"title":1004,"tagline":1005},"Antibiotics and Immunity","How antibiotics could be destroying your good microbes.",[1007,1068,1126,1205],{"id":1008,"data":1009,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1011,"introPage":1019,"pages":1025},"2d7f65e3-332c-4863-a467-8072b210267f",{"type":25,"title":1010},"Understanding Antibiotics",{"id":1012,"data":1013,"type":35,"maxContentLevel":35,"version":24},"afe652b8-2d91-476c-a51c-6f519936523a",{"type":35,"summary":1014},[1015,1016,1017,1018],"Martin Blaser survived paratyphoid fever thanks to co-trimoxazole","Only 5-20% of upper respiratory infections are bacterial","Pediatricians often prescribe antibiotics due to cautiousness and pressure","Broad-spectrum antibiotics can harm the gut microbiome and child immunity",{"id":1020,"data":1021,"type":54,"maxContentLevel":35,"version":24},"4c45c6a1-35c5-413c-ab4d-d19bffd3c981",{"type":54,"intro":1022},[1023,1024],"Why are broad-spectrum antibiotics compared to carpet bombing?","How can antibiotics impact a child's immunity if given before age three?",[1026,1031,1055],{"id":1027,"data":1028,"type":24,"maxContentLevel":35,"version":25},"abacbcfb-12d0-42c6-82bb-72984d6c8e55",{"type":24,"markdownContent":1029,"audioMediaId":1030},"In 1980, Martin Blaser, an infectious disease expert at the Centers for Disease Control and Prevention (CDC) was infected with paratyphoid fever while on assignment in India. He had purchased a watermelon from a street vendor, which, he would later discover, had been injected with contaminated river water to increase its weight.\n\nNo one knew better than Blaser that were it not for the course of co-trimoxazole he was prescribed shortly after his return to Atlanta, he probably wouldn’t have survived the illness. But he also knew that antibiotics were not a panacea.","1cd1b4f8-a1ce-4c0e-9808-ebcfae4a6a27",{"id":1032,"data":1033,"type":24,"maxContentLevel":35,"version":25,"reviews":1036},"d3c4da05-f25a-4cbd-bd01-5a1841610fbd",{"type":24,"markdownContent":1034,"audioMediaId":1035},"Our fixation with antibiotics is a perfect illustration of the adage, ‘too much of a good thing’. One indicator of our over-reliance on antibiotics is the tendency of doctors to use them as a first line of defense against upper respiratory tract infections (URIs). Here’s the problem, though: only a fraction of URIs – between 5% and 20% – are caused by bacteria, and antibiotics have no effect on viruses. Most of the time, the attending doctor can’t tell whether an infection is caused by a bacterium or a virus using the diagnostic tools at his disposal.\n\n![Graph](image://b934d653-becc-437e-af46-bbb6b3e1feb9 \"Antibiotics tablets. Image: Ragesoss, CC BY-SA 3.0 \u003Chttps://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons\")\n\nIn the United States, health-care providers prescribed 258 million courses of antibiotics to their patients in 2010. The highest prescription rate – 1,365 courses per 1000 babies – was for children under the age of two. If this seems odd, consider that young children are prone to developing ear infections and URIs.\n\nThen consider the tendency of pediatricians to be overly cautious of extremely rare but serious complications such as rheumatic fever, the looming threat of lawsuits in the event of misdiagnosis, pressure from anxious parents (who often do not have a good grasp of the way antibiotics actually work), and scheduling pressures, and you have the perfect storm of factors conspiring to push them towards an unnecessary antibiotic prescription.","a5660d64-8807-4726-b2c6-41ffc47e6829",[1037,1046],{"id":1038,"data":1039,"type":68,"version":24,"maxContentLevel":35},"b8e07a8c-f275-4cc9-9d5d-3535fe597138",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1040,"binaryCorrect":1042,"binaryIncorrect":1044},[1041],"Doctors often misuse antibiotics as a first line of defense against what kind of infections, which are rarely caused by bacteria?",[1043],"URIs",[1045],"UTIs",{"id":1047,"data":1048,"type":68,"version":24,"maxContentLevel":35},"877ebcd0-1cb9-42eb-bf97-7569b4809778",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1049,"binaryCorrect":1051,"binaryIncorrect":1053},[1050],"Which of these is generally true about prescription of antibiotics for children in the United States?",[1052],"Pediatricians are pressured by various factors to over-prescribe antibiotics for children",[1054],"Most parents are well informed about how antibiotics work and potential effects on children",{"id":1056,"data":1057,"type":24,"maxContentLevel":35,"version":25,"reviews":1060},"295b5410-dd7e-4027-9558-af936f444035",{"type":24,"markdownContent":1058,"audioMediaId":1059},"Even more alarming is the tendency to prescribe broad-spectrum antibiotics on a ‘just in case’ basis, to cover their bases and increase the chances of wiping out the pathogen completely. In cases where the cause of an infection is not clear-cut, broad-spectrum antibiotics allow for a margin of error; they can also be developed more cheaply than narrow-spectrum antibiotics.\n\nFor Blaser, however, prescribing broad-spectrum antibiotics by default is excessive. He explains: '\\[Here’s\\] the crux of this problem: there are always innocent bystanders, lots and lots of them. All mixed populations of bacteria include both susceptible and resistant bacteria. The antibiotic eliminates susceptible microbes all over the body along with the pathogen that usually is present in one place. It is like carpet bombing when a laserlike strike is needed.'\n\nBroad-spectrum antibiotics are much more damaging to the gut microbiome than narrow-spectrum antibiotics and cause more collateral damage. Blaser also found that when prescribed at a critical stage in the child’s development (before the age of three), antibiotics can have a lasting impact on the child’s immunity.","b8ff8caa-cd07-4d55-a33d-bf02611bca86",[1061],{"id":1062,"data":1063,"type":68,"version":24,"maxContentLevel":35},"7aac5102-7da9-4519-bce1-2b8836bc203d",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1064,"activeRecallAnswers":1066},[1065],"Which category of antibiotics does Blaser consider particularly damaging to the gut microbiome?",[1067],"Broad-spectrum antibiotics",{"id":1069,"data":1070,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1072,"introPage":1080,"pages":1086},"211608fe-a86b-434e-871c-ed60eb9a4472",{"type":25,"title":1071},"Antibiotic Resistance and Its Consequences",{"id":1073,"data":1074,"type":35,"maxContentLevel":35,"version":24},"bbd19b53-0082-4844-a273-99c536519c09",{"type":35,"summary":1075},[1076,1077,1078,1079],"Overusing antibiotics shrinks gut microbiome diversity","Less diverse microbiomes speed up antibiotic resistance","Antibiotics can make you more prone to new infections","Salmonella cases are rising due to antibiotic resistance",{"id":1081,"data":1082,"type":54,"maxContentLevel":35,"version":24},"c184e58e-c0d6-4a29-8f6a-4b9f80ccabe2",{"type":54,"intro":1083},[1084,1085],"How does a less diverse microbiome speed up antibiotic resistance?","Why does antibiotic use make people more vulnerable to Salmonella?",[1087,1102],{"id":1088,"data":1089,"type":24,"maxContentLevel":35,"version":25,"reviews":1092},"98a54664-7182-4601-99c0-3e23df5d602c",{"type":24,"markdownContent":1090,"audioMediaId":1091},"The overuse of antibiotics has been linked to a decrease in the diversity of our gut microbiome, and this can have serious consequences. Antibiotic resistance is one such consequence, where bacteria become resistant to certain types of antibiotics and no longer respond to treatment. But why would a less diverse microbiome lead to antibiotic resistance? The answer lies in a principle called Horizontal Gene Transfer (HGT), which is the movement of genetic material between different species of bacteria.\n\nIn a less diverse microbiome, HGT occurs more frequently. This is because there are greater concentrations of particular species of bacteria, that will have the opportunity to transfer genes between themselves. Thus, paradoxically, a less diverse microbiome will see accelerated evolution among its bacterial population. This allows bacteria to develop antibiotic resistance more quickly in dysbiotic gut environments.","4873ccf1-c7f4-4cc2-870f-4d762292fe72",[1093],{"id":1094,"data":1095,"type":68,"version":24,"maxContentLevel":35},"fb01818a-819c-46ad-8baf-8c2b81ca26a1",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1096,"binaryCorrect":1098,"binaryIncorrect":1100},[1097],"What is Horizontal Gene Transfer (HGT)?",[1099],"The movement of genetic material between species",[1101],"The movement of genetic material between generations of a species",{"id":1103,"data":1104,"type":24,"maxContentLevel":35,"version":25,"reviews":1107},"44bc9cc7-67a4-40b1-9842-341a6725dbc9",{"type":24,"markdownContent":1105,"audioMediaId":1106},"In addition to antibiotic resistance, one of the hidden costs of antibiotic use is increased susceptibility to new infections, which may be lethal. This may seem counterintuitive, but it’s a logical side-effect of a degraded ecosystem – when the good bacteria are obliterated along with the bad, the gut microbiome is compromised and vulnerable to attack. Consider Salmonella, a common bacterial disease. Salmonella is contracted by consuming contaminated animal products (eggs, chicken, meat and fish). Despite the widespread practice of sanitation that successfully eliminated most water- and food-borne infectious diseases, cases of Salmonella in the developed world are on the rise.\n\n![Graph](image://24bc8728-f1ac-43be-9e2f-db40e2e7807b \"Raw chicken. Image: kakyusei, CC0, via Wikimedia Commons\")\n\nThis baffled the scientific community until it was discovered that the bacterium that causes it had developed an ability to evade antibiotic treatment. Studies also show exposure to antibiotics leaves people more susceptible to contracting Salmonella. As you can see, the two major drawbacks to antibiotics – resistance and increased susceptibility to infection – are related.","cecd2a05-104a-4d93-8b4f-76dc9d0249a5",[1108,1119],{"id":1109,"data":1110,"type":68,"version":24,"maxContentLevel":35},"538fe085-5e66-44ef-850c-7dca2634f486",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1111,"multiChoiceCorrect":1113,"multiChoiceIncorrect":1115,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1112],"Which of these has been shown to be a factor in the rise in cases of Salmonella?",[1114],"Antibiotic resistance",[1116,1117,1118],"Declining hygiene","Changes to cooking practices","Increased egg consumption",{"id":1120,"data":1121,"type":68,"version":24,"maxContentLevel":35},"61251805-a70b-420b-8bb4-ff6cf9331493",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1122,"activeRecallAnswers":1124},[1123],"Which widespread, hygienic practice has helped eliminate most water- and food-borne  infectious diseases in the developed world?",[1125],"Sanitization",{"id":1127,"data":1128,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1130,"introPage":1138,"pages":1144},"93dede07-8d57-45fc-9b6a-f7cb94c4489d",{"type":25,"title":1129},"Autoimmune Diseases and Antibiotics",{"id":1131,"data":1132,"type":35,"maxContentLevel":35,"version":24},"3bb65c22-76ab-4a54-9ada-6b6a066c80cd",{"type":35,"summary":1133},[1134,1135,1136,1137],"Dr Alessia Fasano discovered zonulin, which makes the gut leaky","Excess zonulin in celiac patients lets gluten seep through the gut wall","Misuse of antibiotics can cause dysbiosis, leading to a leaky gut","Elevated zonulin levels link leaky gut to autoimmune diseases like type 1 diabetes",{"id":1139,"data":1140,"type":54,"maxContentLevel":35,"version":24},"0acc08e3-1893-4f7d-a9c9-f742d7459576",{"type":54,"intro":1141},[1142,1143],"How does misuse of antibiotics lead to a leaky gut?","What role does zonulin play in autoimmune diseases?",[1145,1180],{"id":1146,"data":1147,"type":24,"maxContentLevel":35,"version":25,"reviews":1150},"4d4fe712-9e9b-4ae8-8a15-d5c0fa87b15d",{"type":24,"markdownContent":1148,"audioMediaId":1149},"In 2000, Italian gastroenterologist, Dr. Alessia Fasano, was trying to develop a vaccine for cholera at the Massachusetts General Hospital for Children in Boston when she accidentally made an unexpected discovery of zonulin: a protein that increases the permeability of the intestinal wall, making it leaky. She realized that zonulin was the culprit behind the autoimmune condition celiac disease.\n\n![Graph](image://a958ea11-2811-4b2f-8c2d-a7c4f284a89b \"Wheat - the source of gluten. Image: Public domain via Wikimedia\")\n\nAn excess of zonulin was allowing gluten (a protein found in wheat, barley and rye) to seep through the gut walls of celiac patients. When gluten crosses the border in celiac patients, their bodies start to treat gluten as a foreign object rather than a food. This causes the immune cells to ‘go rogue’ and attack the cells of the patients’ guts instead of turning on intruders.","9455d9cb-826d-4e7b-96b9-d51ddf182add",[1151,1160,1169],{"id":1152,"data":1153,"type":68,"version":24,"maxContentLevel":35},"5392e37e-4b05-4002-bd6b-3640988c7622",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1154,"binaryCorrect":1156,"binaryIncorrect":1158},[1155],"What is a cause of celiac disease?",[1157],"An excess of zonulin in the gut",[1159],"An excess of lactobacilli in the gut",{"id":1161,"data":1162,"type":68,"version":24,"maxContentLevel":35},"a95d46c2-3288-4633-bed5-d08f0613aa3a",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1163,"binaryCorrect":1165,"binaryIncorrect":1167},[1164],"Which protein increases the permeability of the intestinal wall?",[1166],"Zonulin",[1168],"Ferritin",{"id":165,"data":1170,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":1171,"multiChoiceQuestion":1172,"multiChoiceCorrect":1174,"multiChoiceIncorrect":1175,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":1176,"matchPairsPairs":1177},[160,163,164],[1173],"Which of the following most closely applies to Dr. Alessia Fasano?",[173],[169,171,172],[175],[1178],{"left":1179,"right":173,"direction":35},"Dr. Alessia Fasano",{"id":1181,"data":1182,"type":24,"maxContentLevel":35,"version":25,"reviews":1185},"ab17c3fd-6164-45b6-9774-60d703a3d436",{"type":24,"markdownContent":1183,"audioMediaId":1184},"This rogue reaction to gluten triggered by zonulin is known as an autoimmune response. Somehow, zonulin was sending the immune system of celiac patients into a frenzy, causing the immune system to become overactive and instructing the immune cells to attack their tissues. In addition to producing excess zonulin, two other factors make celiac sufferers susceptible to developing an autoimmune response: a genetic predisposition to gluten intolerance, and an altered gut microbiome, or dysbiosis.\n\nThe main driver behind dysbiosis is misuse of antibiotics. Dysbiosis triggers the release of zonulin, which increases the permeability of the intestinal wall. This, in turn, kicks off an inflammatory process by triggering the release of inflammatory messengers called cytokines. This is called a cytokine storm. The more permeable the intestinal wall, the more likely we are to develop a leaky gut.\n\nBut elevated zonulin levels aren’t exclusive to celiac patients. They’re also found in people living with type 1 diabetes, suggesting a causal link between leaky gut and other 21st century diseases. Some researchers believe that leaky gut syndrome is behind a number of autoimmune diseases, such as childhood asthma, rheumatoid arthritis and lupus.","ffb4b51c-a2ca-4dd2-838b-bf2b540f141a",[1186,1194],{"id":1187,"data":1188,"type":68,"version":24,"maxContentLevel":35},"8c810313-ba74-42eb-8d52-11985a02304b",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1189,"binaryCorrect":1191,"binaryIncorrect":1193},[1190],"Which inflammatory messengers are released due to an increase in the permeability of the intestinal wall?",[1192],"Cytokines",[1166],{"id":1195,"data":1196,"type":68,"version":24,"maxContentLevel":35},"7e9ed60d-32bb-4fe4-860f-eb86eea076dc",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1197,"multiChoiceCorrect":1199,"multiChoiceIncorrect":1201,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1198],"Which of the following is the correct sequence leading up to a \"cytokine storm\"?",[1200],"Excess zonulin makes the intestinal wall permeable, triggering the release of 'inflammatory messengers' called cytokines",[1202,1203,1204],"Cytokines are released, causing the intestinal wall to become permeable","Zonulin causes dysbiosis in the gut, leading to a cytokine storm","None of these",{"id":1206,"data":1207,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1209,"introPage":1217,"pages":1223},"2db7bc41-a713-459f-8fd6-3a45fdeedd2e",{"type":25,"title":1208},"Antibiotics and Immune Dysfunction",{"id":1210,"data":1211,"type":35,"maxContentLevel":35,"version":24},"0cb41048-61ad-4dcb-9986-30bb82ed366e",{"type":35,"summary":1212},[1213,1214,1215,1216],"H pylori might protect kids from allergies but antibiotics wipe it out","Antibiotics can mess up your immune system, especially if you're under three","Overusing antibiotics can lead to tough-to-treat infections and more allergies","Antibiotic resistance kills 700,000 people a year and could lead to a superbug apocalypse",{"id":1218,"data":1219,"type":54,"maxContentLevel":35,"version":24},"e3d84979-3b7d-4d2c-90c0-3188b04219a8",{"type":54,"intro":1220},[1221,1222],"How can antibiotics in early life lead to obesity?","What role do gut bacteria play in preventing obesity?",[1224,1248,1265],{"id":1225,"data":1226,"type":24,"maxContentLevel":35,"version":25,"reviews":1229},"ea7f4d07-39f4-4cc8-a770-368301e5035d",{"type":24,"markdownContent":1227,"audioMediaId":1228},"Since its discovery in 1982, Helicobacter pylori (or H. pylori) – the bacterium associated with stomach ulcers – has had a bad reputation. But Martin Blaser’s pioneering research has provided the infamous bacterium an opportunity to cast off its villain’s cloak, at least in some circumstances.\n\n![Graph](image://d44d56fa-8f27-42b9-b724-b254f2abe196 \"H. pylori bacteria. Image: Yutaka Tsutsumi, M.D.ProfessorDepartment of PathologyFujita Health University School of Medicine, Copyrighted free use, via Wikimedia Commons\")\n\nBlaser had noticed that asthma, hay fever and allergic rhinitis were becoming more common in children and set out to discover what was behind the alarming rise in allergies and their increasingly early age of onset. He found that among sufferers of childhood-onset asthma (i.e. asthma diagnosed before the age of 15), the presence of H. pylori was low or absent. This was consistent with his findings for hay fever and allergic rhinitis.\n\nWhile it wreaks havoc in adults, Blaser argues that the presence of H. pylori in a child’s stomach might offer protection against these allergies, and that it appears to have 'some general effect on immunity, on people’s ability to turn off an allergic response.' The reason behind the disappearance of H. pylori was – you guessed it – antibiotic use in early life.","a9f12749-03e9-42f5-a455-ffb7971623ef",[1230,1239],{"id":1231,"data":1232,"type":68,"version":24,"maxContentLevel":35},"b3d745e8-c553-4504-b805-71fd17306c03",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1233,"binaryCorrect":1235,"binaryIncorrect":1237},[1234],"Which bacteria is often associated with stomach ulcers?",[1236],"H. pylori",[1238],"E. coli",{"id":1240,"data":1241,"type":68,"version":24,"maxContentLevel":35},"afd68455-8f38-4a40-8e3a-e02d264141fe",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1242,"binaryCorrect":1244,"binaryIncorrect":1246},[1243],"Which conditions are associated with low levels of H. pylori in children?",[1245],"Asthma and hayfever",[1247],"Crohn's disease and colitis",{"id":1249,"data":1250,"type":24,"maxContentLevel":35,"version":25,"reviews":1253},"58a535d2-d006-4bb5-86cd-4d7c328042ac",{"type":24,"markdownContent":1251,"audioMediaId":1252},"In *Missing Microbes*, Martin Blaser writes, 'To reiterate my central idea, as our resident microbes succeed each other, we develop with them as an integrated circuit that includes our metabolism, immunity, and cognition. But we face unprecedented insults to our resident microbes.'\n\nEighty years after the mass roll-out of penicillin, Alexander Fleming’s warning upon acceptance of the Nobel Prize has come back to haunt us. Once touted as a wonder drug, antibiotics can provide a much-needed lifeline in situations where their use is warranted. However, a single dose of antibiotics can have a lasting impact on immunity, particularly in children under the age of three.\n\nThe common practice of prescribing broad-spectrum antibiotics for minor infections exacerbates the risk of resistance, presenting a major risk to human health.","4d185c7a-52c9-4947-9b5d-22276a641e00",[1254],{"id":1255,"data":1256,"type":68,"version":24,"maxContentLevel":35},"18f261ae-f6c9-4c18-92de-e78187ee022d",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1257,"multiChoiceCorrect":1259,"multiChoiceIncorrect":1261,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1258],"Which kind of antibiotics is most harmful to our microbiome?",[1260],"Broad-spectrum",[1262,1263,1264],"Narrow-spectrum","Short-course","Long-term",{"id":1266,"data":1267,"type":24,"maxContentLevel":35,"version":25,"reviews":1270},"180bb114-1774-46f5-ae61-19e594b89342",{"type":24,"markdownContent":1268,"audioMediaId":1269},"Misusing antibiotics can also make us more susceptible to infection. This is because these drugs don’t discriminate between healthy and unhealthy bacteria and disrupt the fragile microbial ecosystem in our guts.\n\nThe overuse of antibiotics has had a profound impact on both individuals and society as a whole. On an individual level, antibiotic resistance can lead to recurrent infections that are difficult to treat, while collateral damage from antibiotics can weaken the immune system and increase the risk of allergies, obesity, and autoimmune diseases. In addition, studies have suggested that certain species of bacteria may be able to protect against autoimmunity by producing anti-inflammatory molecules or stimulating regulatory T cells (Tregs).\n\nAntibiotic resistance is estimated to cause 700,000 deaths each year worldwide. Many countries around the world are implementing policies aimed at reducing unnecessary prescriptions for antibiotics. For example, in the UK, there is now an Antibiotic Guardian campaign which encourages healthcare professionals and members of the public alike to exercise responsible use of antibiotics.\n\nMartin Blaser warns of a post-microbial endgame –an ‘antibiotic winter’ – where humanity comes face-to-face with a resistant superbug that has successfully managed to evade antibiotics. It’s a bleak scenario, but one which is not implausible when we consider the extent of the ‘germ warfare’ we’ve waged on our microbiotas.","e7d21f5f-47b9-4372-9756-31f94f1a63a6",[1271],{"id":1272,"data":1273,"type":68,"version":24,"maxContentLevel":35},"8d4fc325-63e3-4a25-876f-5f4bcfa2aa3f",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1274,"multiChoiceCorrect":1276,"multiChoiceIncorrect":1278,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1275],"How many deaths are caused by antibiotic resistance each year?",[1277],"700,000",[1279,1280,1281],"70,000","7 million","70 million",{"id":1283,"data":1284,"type":27,"maxContentLevel":35,"version":35,"orbs":1287},"141598b2-90ea-4d90-b8e5-00f8f071a668",{"type":27,"title":1285,"tagline":1286},"Gut Microbes and Metabolic Health","The role of the microbiome in maintaining a healthy weight.",[1288,1350,1459,1523],{"id":1289,"data":1290,"type":25,"version":35,"maxContentLevel":35,"summaryPage":1292,"introPage":1300,"pages":1306},"04b49fb4-0f68-4694-885e-3d334bd2b3c7",{"type":25,"title":1291},"Understanding Obesity",{"id":1293,"data":1294,"type":35,"maxContentLevel":35,"version":24},"e33d2e60-355a-4861-8613-32bd18588737",{"type":35,"summary":1295},[1296,1297,1298,1299],"Over half of people in the Western world are overweight or obese","Obesity increases the risk of type 2 diabetes, PCOS, and some cancers","Visceral fat around abdominal organs raises the risk of heart disease, hypertension, and stroke","The microbes in our gut can influence how much energy we extract from food",{"id":1301,"data":1302,"type":54,"maxContentLevel":35,"version":24},"d3bfe66e-dbad-4b25-a1d2-14b0a870e3cf",{"type":54,"intro":1303},[1304,1305],"How do gut microbes influence energy extraction from food?","What did Peter Turnbaugh's experiments with germ-free mice reveal about obesity?",[1307,1320,1335],{"id":1308,"data":1309,"type":24,"maxContentLevel":35,"version":25,"reviews":1312},"8ba3ad6f-9155-43b1-a0aa-b90931ead18e",{"type":24,"markdownContent":1310,"audioMediaId":1311},"We are living in an age of obesity. In *10% Human*, evolutionary biologist and science writer Alanna Collen notes that over half of the people in the Western world are either overweight or obese. When future generations learn about the twentieth century, she says, it will be remembered not only as the century in which two world wars were fought, or for the invention of the internet, but also as the age of obesity.\n\nOur collective struggle with obesity has disastrous consequences for our health. Being obese puts you at risk of developing type 2 diabetes and other endocrine disorders such as polycystic ovarian syndrome (PCOS), which affects female fertility. It even increases the risk of some cancers.","b6dbc27d-5292-48af-935b-adcb7e56abd5",[1313],{"id":1314,"data":1315,"type":68,"version":24,"maxContentLevel":35},"804de11e-7084-4faa-b464-e67852a2db34",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":1316,"clozeWords":1318},[1317],"Alanna Collen argues that our era will be remembered as the era of obesity.",[1319],"obesity",{"id":1321,"data":1322,"type":24,"maxContentLevel":35,"version":35,"reviews":1325},"8936c399-a9a5-4c69-8d13-3dae361ff2bd",{"type":24,"markdownContent":1323,"audioMediaId":1324},"Visceral fat – fat accumulated and stored around the abdominal organs, typical of fat distribution in obese people – increases the risk of heart disease, hypertension, and stroke. But the struggle is not only personal: public health-care systems all over the world are groaning under the weight of the obesity epidemic.\n\n![Graph](image://8bdfed32-e1d5-4ac5-b607-ee21becc69bc \"Obesity rates around the world. Ly.n0m, CC BY 4.0 \u003Chttps://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons\")\n\nIn response to the alarming rise in obesity levels worldwide, in the past few decades we have seen a societal obsession with restrictive diets and calorie counting. The age-old debate, according to Professor Tim Spector, author of *The Diet Myth*, has been whether low-fat or low-sugar diets yield better results.","c21d577d-eebb-4f44-bf09-900197461fd1",[1326],{"id":1327,"data":1328,"type":68,"version":25,"maxContentLevel":35},"adb5bddc-cc00-444e-808b-a7372f8edec3",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1329,"binaryCorrect":1331,"binaryIncorrect":1333},[1330],"What is associated with visceral fat, commonly found in obese individuals?",[1332],"Increased risk of heart disease, hypertension, and stroke",[1334],"Decreased risk of type 2 diabetes and endocrine disorders",{"id":1336,"data":1337,"type":24,"maxContentLevel":35,"version":25,"reviews":1340},"271d575a-4495-40b8-a104-33b288c5b461",{"type":24,"markdownContent":1338,"audioMediaId":1339},"But the rise in obesity has taken place against the backdrop of 60 years of scientific research into effective strategies for weight loss and weight maintenance. Some studies suggest that there may be more to the obesity struggle than calories in, calories out – and that it is not simply the calories we consume that make a difference to our weight, but the calories we absorb.\n\nWe can look, once again, to our microbiota for clues. In experiments with germ-free mice, former PhD student Peter Turnbaugh, now a professor at UCSF, discovered that it’s the particular set of microbes we harbor that determines our ability to extract energy from our food.","3e5feb01-598c-4e2a-8d9f-fc204c5ea90c",[1341],{"id":1342,"data":1343,"type":68,"version":24,"maxContentLevel":35},"afa51e21-0d15-4d6f-b58e-83e3713dd032",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1344,"binaryCorrect":1346,"binaryIncorrect":1348},[1345],"What factor determines our ability to extract energy from food, according to Peter Turnbaugh's experiments with germ-free mice?",[1347],"Our microbiota",[1349],"Calorie counting",{"id":1351,"data":1352,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1354,"introPage":1362,"pages":1368},"a7e06193-e280-4bb4-8de6-96272c2c5444",{"type":25,"title":1353},"The Role of the Microbiome in Metabolic Health",{"id":1355,"data":1356,"type":35,"maxContentLevel":35,"version":24},"d0518b3f-823e-4471-819e-f2ed89f5a9d4",{"type":35,"summary":1357},[1358,1359,1360,1361],"Gut microbiota acts like an endocrine organ, maintaining body balance","Disruptions in gut microbiota can lead to chronic inflammation and insulin resistance","Higher LPS levels in the gut are linked to obesity and lower leptin production","Probiotics and prebiotic fibers can reduce LPS levels and improve metabolic health",{"id":1363,"data":1364,"type":54,"maxContentLevel":35,"version":24},"539a4ed3-77fd-43d2-8139-b8f09479ffa4",{"type":54,"intro":1365},[1366,1367],"How does LPS influence insulin resistance?","What effect does LPS have on leptin production?",[1369,1394,1427,1444],{"id":1370,"data":1371,"type":24,"maxContentLevel":35,"version":25,"reviews":1374},"5e9bd147-d07c-4822-a2db-1efefaf80f09",{"type":24,"markdownContent":1372,"audioMediaId":1373},"The gut microbiota is, in fact, considered a separate endocrine organ involved in maintaining systemic homeostasis within the host, much like the main endocrine organs – pituitary, thyroid, and adrenal glands. In this sense, our tiny hitchhikers are shapeshifters, able to emulate the functions of other organs.\n\nShifts in the composition of the gut microbiota caused by external factors (such as diet and antibiotics) can dramatically alter the symbiotic relationship between gut microbes and host. Common anti-bacterial household cleaning products like those containing triclosan can also disrupt the microbial composition of the gut. Triclosan has also been found to interfere with the action of thyroid hormones, and to block the action of estrogen and testosterone in human cells in petri dishes.","1fa56ab3-8d36-4d44-ad46-2fd9f8f52108",[1375],{"id":1376,"data":1377,"type":68,"version":24,"maxContentLevel":35},"29079da0-6960-4cbb-b661-ad7bb4b231d1",{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":1378,"multiChoiceQuestion":1382,"multiChoiceCorrect":1384,"multiChoiceIncorrect":1386,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":1390,"matchPairsPairs":1391},[1379,1380,1381],"a69c9d0e-b186-4cf2-b3cd-a8958fb1f61e","df670885-0279-45f1-8f16-aadf765969f6","3cbbd6c9-1799-48dd-8ce3-a8e81d5d70fa",[1383],"Which of the following best describes systemic homeostasis?",[1385],"Balance within the body's systems",[1387,1388,1389],"Overproduction of immune cells","Associated with the development of cancer cells","A classification of bacteria cell-wall types",[175],[1392],{"left":1393,"right":1385,"direction":35},"Systemic homeostasis",{"id":1395,"data":1396,"type":24,"maxContentLevel":35,"version":25,"reviews":1399},"e0142c71-1396-445d-bf5a-8092084f9de3",{"type":24,"markdownContent":1397,"audioMediaId":1398},"This disruption to immune homeostasis – referred to as dysbiosis – promotes the development of metabolic disease. In a state of dysbiosis, the immune system is activated by the production of cytokines, which leads to chronic, low-grade inflammation (this is called a ‘cytokine storm’). Mature immune cells are then recruited and activated in metabolic tissues – in particular, adipose tissues (body fat).\n\nThe result is that insulin signaling pathways are desensitized and the affected individual develops insulin resistance. The lipopolysaccharide (LPS) molecule is a major component of the outer membrane of certain bacteria, and its levels in the gut can influence metabolic health. Studies have shown that higher LPS levels are associated with increased inflammation and obesity.","25182305-0bdc-4371-9363-f4387f99835f",[1400,1407,1418],{"id":1401,"data":1402,"type":68,"version":24,"maxContentLevel":35},"fa29c1b6-28a3-40ae-b15c-bdabc17e12cb",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1403,"binaryCorrect":1405,"binaryIncorrect":1406},[1404],"What is the term used to describe the disruption of immune homeostasis caused by shifts in gut microbiota composition?",[374],[418],{"id":1379,"data":1408,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":1409,"multiChoiceQuestion":1410,"multiChoiceCorrect":1412,"multiChoiceIncorrect":1413,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":1414,"matchPairsPairs":1415},[1376,1380,1381],[1411],"Which of the following best describes a cytokine storm?",[1387],[1385,1388,1389],[175],[1416],{"left":1417,"right":1387,"direction":35},"Cytokine storm",{"id":1419,"data":1420,"type":68,"version":24,"maxContentLevel":35},"1f154427-c76a-4311-b6d7-23630962e326",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1421,"binaryCorrect":1423,"binaryIncorrect":1425},[1422],"What is the potential effect of lipopolysaccharide (LPS) on metabolic health and appetite regulation?",[1424],"Increased inflammation and interference with leptin production",[1426],"Decreased inflammation and enhanced insulin sensitivity",{"id":1428,"data":1429,"type":24,"maxContentLevel":35,"version":25,"reviews":1432},"b07fcada-7e68-4238-b93f-184bde9c3c99",{"type":24,"markdownContent":1430,"audioMediaId":1431},"Additionally, research suggests that LPS may interfere with leptin production - a hormone which helps regulate appetite - leading to overeating and weight gain. Interestingly, some studies suggest that probiotics may help reduce LPS levels in the gut by competing for nutrients with pathogenic bacteria. This could potentially lead to improved metabolic health as well as reduced inflammation.\n\nFurthermore, prebiotic fibers such as those found in fruits and vegetables can also help promote healthy microbial populations which produce beneficial metabolites like short-chain fatty acids (SCFAs). SCFAs have been linked to improved insulin sensitivity and decreased risk of type 2 diabetes. The relationship between LPS levels and leptin production is complex, but it appears that higher levels of LPS can lead to decreased leptin production.","d30d72ab-87ed-4144-8ce8-a057c1b0709c",[1433],{"id":1434,"data":1435,"type":68,"version":24,"maxContentLevel":35},"714367d6-d4a5-4d49-83ae-e59610f30ecf",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1436,"multiChoiceCorrect":1438,"multiChoiceIncorrect":1440,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1437],"Which molecules are associated with higher levels of obesity?",[1439],"LPS",[1441,1442,1443],"PDS","SIBO","FODMAP",{"id":1445,"data":1446,"type":24,"maxContentLevel":35,"version":25,"reviews":1449},"c235130e-9147-4f19-8466-12345096cf00",{"type":24,"markdownContent":1447,"audioMediaId":1448},"This could explain why some people with obesity have lower than normal levels of the hormone. Additionally, research suggests that certain probiotics may help reduce LPS levels in the gut by competing for nutrients with pathogenic bacteria. For example, a study on mice found that supplementing their diet with Bifidobacterium longum reduced their body fat mass and improved glucose tolerance compared to those without supplementation. Interestingly, prebiotic fibers such as those found in fruits and vegetables can also help promote healthy microbial populations which produce beneficial metabolites like short-chain fatty acids (SCFAs).\n\nSCFAs are thought to play an important role in regulating energy metabolism by increasing insulin sensitivity and decreasing inflammation associated with metabolic disorders. In fact, one study showed that consuming a high-fiber diet was linked to lower concentrations of circulating LPS molecules - suggesting fiber intake may be beneficial for reducing inflammation related to metabolic diseases.","8cb7e6c2-d987-43d8-98d0-7437aa0323e6",[1450],{"id":1451,"data":1452,"type":68,"version":24,"maxContentLevel":35},"0bae3f10-efef-470d-be5b-cefe8d24fea5",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1453,"binaryCorrect":1455,"binaryIncorrect":1457},[1454],"What is the potential benefit of consuming a high-fiber diet in relation to metabolic diseases?",[1456],"Decreasing inflammation by lowering circulating LPS molecules",[1458],"Increasing leptin production directly",{"id":1460,"data":1461,"type":25,"version":35,"maxContentLevel":35,"summaryPage":1463,"introPage":1471,"pages":1477},"ae20a07a-561d-4388-9e95-abbecae53831",{"type":25,"title":1462},"Microbes and Energy Storage",{"id":1464,"data":1465,"type":35,"maxContentLevel":35,"version":24},"6ddab3b0-b17b-4930-b1fd-b89609a2f1a2",{"type":35,"summary":1466},[1467,1468,1469,1470],"LPS in the blood triggers inflammation and prevents new fat cells from forming","Obese people overfill existing fat cells instead of making new ones","Akkermansia bacteria boost mucus production, reducing LPS in the blood","Mice given Akkermansia lost weight and stored fat healthily",{"id":1472,"data":1473,"type":54,"maxContentLevel":35,"version":24},"41583f69-16da-46eb-87d0-af8f4aadea8e",{"type":54,"intro":1474},[1475,1476],"How does LPS affect fat cells in obese people?","What role does Akkermansia play in weight regulation?",[1478,1493,1508],{"id":1479,"data":1480,"type":24,"maxContentLevel":35,"version":25,"reviews":1483},"3ec2cc7a-0eb5-4360-83f7-88d4882c2cca",{"type":24,"markdownContent":1481,"audioMediaId":1482},"When lipopolysaccharide (LPS) gets into the blood, it behaves like a toxin. Through his research Cani learned that obese people had high levels of LPS in their blood, and it was the LPS that was responsible for triggering inflammation in their fat cells. More importantly, he discovered that LPS was preventing new fat cells from forming – existing fat cells were simply being overfilled.\n\nThis tied in with the existing knowledge that when lean people store energy, they make new cells and fill them with small amounts of fat, whereas when obese people gain weight, they overfill existing fat cells, making the fat cells larger.","0b3a8bd4-2ce4-4d07-a7ce-cef634f2c909",[1484],{"id":1485,"data":1486,"type":68,"version":24,"maxContentLevel":35},"381f1b44-dce5-4750-909b-612bcab43e0b",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1487,"binaryCorrect":1489,"binaryIncorrect":1491},[1488],"What is the role of lipopolysaccharide (LPS) in obesity according to Cani's research?",[1490],"It triggers inflammation in fat cells and prevents new fat cells from forming",[1492],"It helps in the formation of new fat cells and reduces inflammation in existing ones",{"id":1494,"data":1495,"type":24,"maxContentLevel":35,"version":25,"reviews":1498},"76596f70-33d5-4fac-bad7-7ec2ebeb4ae5",{"type":24,"markdownContent":1496,"audioMediaId":1497},"This was an important discovery, because it showed that the fat of obese people was not just layers of stored energy, it was fat tissue that had biochemically malfunctioned, and LPS seemed to be causing that malfunction to occur.\n\nCani’s findings also challenged the traditional thinking about weight gain, by demonstrating that 'obesity is not always a lifestyle disease caused by overeating and being under-active. Rather, it is a dysfunction of the body’s energy-storage system.' If lipopolysaccharide (LPS) was causing the fat tissue of obese people to malfunction, the logical next step in the obesity puzzle was to figure out how to prevent LPS from seeping into the blood.","870de7d0-9fbc-4760-a0ab-c69fcbd88cec",[1499],{"id":1500,"data":1501,"type":68,"version":24,"maxContentLevel":35},"f0a37502-4d97-4e51-885e-cb1fca46c1b7",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1502,"binaryCorrect":1504,"binaryIncorrect":1506},[1503],"Which of these would be a good way of preventing obesity, according to Cani?",[1505],"Preventing LPS from entering the blood",[1507],"Encouraging more LPS production in the gut",{"id":1509,"data":1510,"type":24,"maxContentLevel":35,"version":35,"reviews":1513},"76b29536-b378-458c-bec4-792a45dae742",{"type":24,"markdownContent":1511,"audioMediaId":1512},"Akkermansia muciniphila is a bacterium that lives on the mucosal layer of the gut lining (‘muciniphila’ means mucus-loving). This mucus forms a protective barrier that prevents the microbiota from sneaking into the blood. In healthy individuals, Akkermansia accounts for about 4% of the intestinal bacteria. The more you have, the thicker your mucus layer, and the less LPS you’ll have in your blood. Akkermansia is responsible for persuading the cells in the gut lining to produce more mucus.\n\nCani tried supplementing the diets of a group of mice with Akkermansia. Their LPS levels dropped, they started to store fat in healthy ways, and – most importantly, they lost weight. Akkermansia also made the mice more sensitive to leptin, so their appetites decreased. Cani’s work showed that mice had gained weight not because they ate too much, but because the LPS was forcing their bodies to store energy instead of expending it.","0ada3c20-462b-4e8b-b9b6-71b57e9f07da",[1514],{"id":1515,"data":1516,"type":68,"version":24,"maxContentLevel":35},"14feb7ee-9e5d-4e9d-bdab-177eed218095",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1517,"multiChoiceCorrect":1519,"multiChoiceIncorrect":1521,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1518],"Which bacteria is good for strengthening the mucus on the gut lining?",[1520],"Akkermansia",[475,1522,916],"H. Pylori",{"id":1524,"data":1525,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1527,"introPage":1535,"pages":1541},"75e8a631-5c97-4f01-95d0-26671d519973",{"type":25,"title":1526},"Antibiotics and Obesity",{"id":1528,"data":1529,"type":35,"maxContentLevel":35,"version":24},"6f782425-bcc4-4c14-9a64-b742b5f1eb72",{"type":35,"summary":1530},[1531,1532,1533,1534],"Obesity rates spiked after antibiotics became widespread post-WWII","Antibiotics in farming likely ended up in our food, contributing to obesity","Early childhood antibiotic use can lead to obesity later in life","Gut bacteria influence weight more than genes, and can be changed",{"id":1536,"data":1537,"type":54,"maxContentLevel":35,"version":24},"d211e768-944a-4bfd-ba87-e41c14695482",{"type":54,"intro":1538},[1539,1540],"How do antibiotics in early childhood affect obesity risk later in life?","What did Ruth Ley discover about the microbiota of obese vs. lean individuals?",[1542,1559,1574],{"id":1543,"data":1544,"type":24,"maxContentLevel":35,"version":25,"reviews":1547},"dc627166-aad4-4a17-97cb-a5afaff92b26",{"type":24,"markdownContent":1545,"audioMediaId":1546},"If you track the trajectory of the obesity epidemic, you’ll notice a rise in obesity levels worldwide starting in the 1950s, followed by a dramatic spike in the 1980s. In 10% Human, Collen surmises that this is no accident, as the timing of our expanding waistlines coincided with the mass roll-out of antibiotics after the end of the Second World War.\n\nLikewise, the spike in the 1980s occurred around the same time that we switched to intensive farming operations, which relied heavily on feeding antibiotics to livestock to promote growth. Collen speculates that the antibiotics used to fatten farm animals probably made their way onto our plates and into our tissues. Her view is backed up by Martin Blaser, whose studies showed a correlation between increased size (in terms of both weight and height) of humans and the accelerated use of antibiotics in farming, in the past few decades.","d52f258c-5ea3-4116-bc50-236cf19f8048",[1548],{"id":1549,"data":1550,"type":68,"version":24,"maxContentLevel":35},"d0f2bebc-d61a-495c-9f8a-cdcb85b73175",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1551,"multiChoiceCorrect":1553,"multiChoiceIncorrect":1555,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1552],"What factor is believed to have contributed to the rise in obesity levels worldwide starting in the 1950s and spiking in the 1980s?",[1554],"Mass roll-out of antibiotics and their use in intensive farming operations",[1556,1557,1558],"Increased consumption of painkillers","The development of opioids such as Oxycontin","Mass roll-out of chemical pesticides",{"id":1560,"data":1561,"type":24,"maxContentLevel":35,"version":25,"reviews":1564},"11b63e78-0942-42a5-92c1-540c7d637092",{"type":24,"markdownContent":1562,"audioMediaId":1563},"Blaser’s studies also showed that antibiotic use in young childhood predisposes you to obesity in later life. This is especially true before age 3, which is a critical period for early life development.\n\nIn 2004, Fredrik Bäckhed, a professor of microbiology at Gothenburg University in Sweden, cultivated germ-free mice in his lab. They were delivered by Caesarean-section, then kept in sterile chambers. Each mouse was a blank canvas – bred without microbiota, which meant that his team could colonize them with whichever microbes they wished to test their theories.\n\nBäckhed observed that the germ-free mice were leaner and had lower body fat than mice colonized with conventional microbiota. When colonized with the conventional gut microbiota, the germ-free mice gained weight and their body fat increased by 50%, despite the fact that they were eating less. This proved that the gut microbiota are essential for helping us extract energy from food and deposit fat in the body.","0e8106c9-1fca-4d56-bc10-b03d49fa1f7c",[1565],{"id":1566,"data":1567,"type":68,"version":24,"maxContentLevel":35},"ad6bffab-da90-4399-ab56-f3df288ac331",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1568,"binaryCorrect":1570,"binaryIncorrect":1572},[1569],"What was the significant observation made by Fredrik Bäckhed in his germ-free mice experiment?",[1571],"The germ-free mice were leaner and had lower body fat than mice with conventional microbiota",[1573],"The germ-free mice had higher body fat and gained weight despite eating less",{"id":1575,"data":1576,"type":24,"maxContentLevel":35,"version":25,"reviews":1579},"a32483bc-0bcb-469e-a1b0-8751effea0e1",{"type":24,"markdownContent":1577,"audioMediaId":1578},"Bäckhed’s research was furthered by microbiologist Ruth Ley in 2005. Using DNA sequencing, Ley compared the microbiotas of obese and lean mice. In both types of mice, two groups of bacteria were dominant: the Bacteroidetes and the Firmicutes. But the obese mice contained half as many Bacteroidetes as the lean mice. Ley then checked the microbiotas of lean and obese humans and found the same ratio – the obese people had far more Firmicutes and the lean people had a greater proportion of Bacteroidetes.\n\nPeter Turnbagh, a PhD student from the same lab, took the experiment one step further by transplanting the microbes of the obese mice into germ-free mice. At the same time, he transferred the microbes of lean mice into a second set of germ-free mice. Both sets of mice were fed exactly the same amount of food, but fourteen days later, the mice colonized with the ‘obese’ microbiota had gotten fat, and those with the ‘lean’ microbiota had not.\n\nThese findings were promising because they showed that our microbiota have a bigger influence on our metabolism than our genes – and our microbiota can be altered.","2f3b6982-b781-4118-96d8-ff6fb6803669",[1580],{"id":1581,"data":1582,"type":68,"version":24,"maxContentLevel":35},"5b222b0f-15f8-4e7f-88ea-0e27668bc249",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1583,"multiChoiceCorrect":1585,"multiChoiceIncorrect":1587,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1584],"What was the difference in the proportion of Bacteroidetes and Firmicutes between obese and lean mice in Ruth Ley's research?",[1586],"Obese mice had half as many Bacteroidetes as lean mice.",[1588,1589,1590],"Obese mice had twice as many Bacteroidetes as lean mice","Obese mice had equal amounts of Bacteroidetes and Firmicutes","Lean mice had three times as many Bacteroidetes as obese mice",{"id":1592,"data":1593,"type":27,"maxContentLevel":35,"version":35,"orbs":1596},"0a80894f-62a5-45e7-8da4-162ef65ac9c0",{"type":27,"title":1594,"tagline":1595},"The Microbiota-Gut-Brain Axis","The complex world of the enteric nervous system and its relationship with the microbiome.",[1597,1722],{"id":1598,"data":1599,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1601,"introPage":1609,"pages":1615},"d6652e6a-2d60-4030-b0a6-81b29e6af44b",{"type":25,"title":1600},"Understanding the Microbiota-Gut-Brain Axis",{"id":1602,"data":1603,"type":35,"maxContentLevel":35,"version":24},"7aefe644-6fee-4248-af54-e17d29143ad1",{"type":35,"summary":1604},[1605,1606,1607,1608],"The gut-brain axis is a two-way communication link between the gut and the brain","The vagus nerve is the longest nerve in the body, connecting the brainstem to the large intestine","Most signals in the gut-brain axis are sent from the gut to the brain","Neurotransmitters like serotonin and dopamine play key roles in the microbiota-gut-brain axis",{"id":1610,"data":1611,"type":54,"maxContentLevel":35,"version":24},"841b9dc9-11f1-409b-89fb-7bf094fd0a9d",{"type":54,"intro":1612},[1613,1614],"How does the vagus nerve connect the gut and brain?","Which neurotransmitter produced by gut microbes is linked to mental health issues like depression?",[1616,1644,1659,1683,1707],{"id":1617,"data":1618,"type":24,"maxContentLevel":35,"version":25,"reviews":1621},"5ad4a269-b92b-42fe-8852-66600573aa84",{"type":24,"markdownContent":1619,"audioMediaId":1620},"Have you ever had a ‘gut feeling’ about something, or experienced the sensation of ‘butterflies in your stomach’ when you felt nervous or excited? Well, as it turns out, the gut has long been considered the seat of emotion, and these common expressions are rooted in biology.\n\nPut simply, the gut-brain axis is the two-way connection and communication that takes place between the gut and the brain, linking the central nervous system (CNS) to the enteric nervous system (ENS).\n\n![Graph](https://upload.wikimedia.org/wikipedia/commons/6/63/Gut-Brain_Axis.png \"Gut-brain communication. Image: Suganya, Kanmani, and Byung-Soo Koo, CC BY 4.0 \u003Chttps://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons\")\n\nThere are other systems involved, but we’ll focus on the CNS and ENS in this tile.\n\nWe’ve known about the gut-brain axis for a long time, but as interest in the microbiota has soared, we’ve come to learn that the microbes in our gut are intimately involved in this conversation between brain and gut. For this reason, we’ll refer to the two-way link as the microbiota-gut-brain axis (MGBA).","ac2d4783-d260-4b91-b035-593964434355",[1622,1633],{"id":1623,"data":1624,"type":68,"version":24,"maxContentLevel":35},"2a5289a5-fafc-49c4-8abd-58eb5ca2e6d8",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1625,"multiChoiceCorrect":1627,"multiChoiceIncorrect":1629,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1626],"What term is used to describe the two-way connection and communication between the gut and the brain?",[1628],"Microbiota-gut-brain axis (MGBA)",[1630,1631,1632],"Gut-emotion axis","Brain-microbe connection","Central-enteric system",{"id":1634,"data":1635,"type":68,"version":24,"maxContentLevel":35},"dfeb3989-fec7-4054-b660-af564ac6b1e4",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1636,"multiChoiceCorrect":1638,"multiChoiceIncorrect":1641,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[1637],"What are the two nervous systems linked by the gut and the brain?",[1639,1640],"Central Nervous System (CNS)","Enteric Nervous System (ENS)",[1642,1643],"Digestive Nervous System (DNS)","Gut Nervous System (GNS)",{"id":1645,"data":1646,"type":24,"maxContentLevel":35,"version":25,"reviews":1649},"e5f52f03-54e2-48ae-a373-40af75a977ef",{"type":24,"markdownContent":1647,"audioMediaId":1648},"The enteric nervous system (ENS) is made up of a vast network of neurons, or nerve cells. The exact number is disputed but estimates range from 100 million to between 200 and 600 million – the same number of neurons found in the human spinal cord. No wonder, then, that the ENS is referred to as the 'second brain'!\n\nThe neurons in the ENS talk to the microbes in the gut and send signals to the brain via a network of nerve endings in the intestinal wall – allowing the ENS to talk to the CNS without having to cross the blood-brain barrier. The blood-brain barrier protects the central nervous system from toxins and pathogens in the blood. Most of these signals are sent via the vagus nerve, which is one of several pathways of communication between these two systems.","a3469bef-93cf-4034-9538-be75b600102e",[1650],{"id":1651,"data":1652,"type":68,"version":24,"maxContentLevel":35},"cb4cc94a-2231-44fa-b4f4-f9116b21bf93",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1653,"binaryCorrect":1655,"binaryIncorrect":1657},[1654],"What is the nickname for the enteric nervous system (ENS)?",[1656],"The second brain",[1658],"The gut-brain axis",{"id":1660,"data":1661,"type":24,"maxContentLevel":35,"version":25,"reviews":1664},"58097d88-6268-43bd-b39d-80fd1a494713",{"type":24,"markdownContent":1662,"audioMediaId":1663},"The vagus nerve is the longest nerve in the human body, reaching all the way from the brainstem to the large intestine. It provides a physical link between gut and brain and allows these two organs to talk to each other.\n\nVagus is a Latin word meaning ‘wandering’. Although its name is singular, it’s actually a pair of nerves. The right vagus nerve travels down the right side of your body, while the left vagus nerve travels down the left side of your body, like a divided highway, relaying traffic in the form of signals through your neurons, from the brain to the gut, and vice versa.","8abfab30-6f58-409d-a833-882894c88103",[1665,1672],{"id":1666,"data":1667,"type":68,"version":24,"maxContentLevel":35},"90a48759-dc3b-4402-9bdc-dd7c2a511738",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":1668,"clozeWords":1670},[1669],"The vagus nerve is the longest nerve in the human body, reaching all the way from the brainstem to the large intestine.",[1671],"vagus",{"id":1673,"data":1674,"type":68,"version":24,"maxContentLevel":35},"56348103-8f1a-4e45-97b8-aed33c8e2306",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1675,"multiChoiceCorrect":1677,"multiChoiceIncorrect":1679,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1676],"Vagus is a Latin word meaning what?",[1678],"Wandering",[1680,1681,1682],"Feeling","Capturing","Swallowing",{"id":1684,"data":1685,"type":24,"maxContentLevel":35,"version":25,"reviews":1688},"ead0127f-bc64-46ef-b4d7-d729f10a407e",{"type":24,"markdownContent":1686,"audioMediaId":1687},"The vagus nerve is an essential part of the gut-brain axis and is involved in controlling inflammation, regulating food intake and satiety, and maintaining energy homeostasis in the gut. Research also seems to suggest a poorly functioning vagus nerve could lead to psychiatric disorders, obesity, and other diseases brought on by stress and inflammation. In fact, vagal nerve stimulation – where electrical impulses are sent to the brain via the vagus nerve – is now a well-known treatment for depression, particularly in cases that don’t improve with therapy and medication.\n\nThe conversation that goes on between brain and gut happens both ways, but most of the signals – around 80% – are sent from the gut to the brain. Several pre-clinical studies have shown this ‘bottom-up’ signaling can affect cognitive development and mood.","64cdc990-15fd-4f04-97a9-d5dfb56efcea",[1689,1696],{"id":1690,"data":1691,"type":68,"version":24,"maxContentLevel":35},"c0f2a7d0-312f-42c2-ba62-52a2ce222765",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1692,"activeRecallAnswers":1694},[1693],"What is the function of the vagus nerve in the human body?",[1695],"Providing a physical link between the gut and brain",{"id":1697,"data":1698,"type":68,"version":24,"maxContentLevel":35},"1b3b2eae-de3a-4f43-ac58-48e81e58e6da",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1699,"multiChoiceCorrect":1701,"multiChoiceIncorrect":1703,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1700],"What percentage of signals between the gut and brain are sent from the gut to the brain?",[1702],"80%",[1704,1705,1706],"70%","60%","90%",{"id":1708,"data":1709,"type":24,"maxContentLevel":35,"version":25,"reviews":1712},"c070ffeb-8bfb-4552-8d7c-45dea1a6ca14",{"type":24,"markdownContent":1710,"audioMediaId":1711},"This is important for our understanding of the role of the microbiota in health and disease. We used to think that gastrointestinal disorders like irritable bowel syndrome caused depression, but we now know that signals for depression are mostly sent from the gut to the brain.\n\nNeurotransmitters are chemical messengers that play a key role in the microbiota-gut-brain axis. Serotonin, produced by both neurons in the brain and enterochromaffin cells in the gut, has been linked to depression and anxiety disorders. Dopamine is another neurotransmitter involved in this system; prebiotic fibers can modulate dopamine release from enteroendocrine cells which could potentially improve cognitive function. Acetylcholine is also important for cognition and memory formation; stimulating the vagus nerve may increase levels of acetylcholine, leading to improved performance on cognitive tasks.\n\nGABA, short for gamma-aminobutyric acid, is a neurotransmitter believed to play a role in behavior, cognition and the body’s response to stress, fear, and anxiety. GABA is produced by some Lactobacilli and specific strains of Bifidobacterium. Low GABA levels are associated with a range of mental health issues, including depression and schizophrenia.","e22fff35-d8fa-4667-ad15-1e243f92191b",[1713],{"id":1714,"data":1715,"type":68,"version":24,"maxContentLevel":35},"625d7235-92f3-4fbf-9103-40a04b6c058e",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1716,"binaryCorrect":1718,"binaryIncorrect":1720},[1717],"Which neurotransmitter is associated with stress, fear, and anxiety and is produced by some Lactobacilli and specific strains of Bifidobacterium?",[1719],"GABA (gamma-aminobutyric acid)",[1721],"Serotonin",{"id":1723,"data":1724,"type":25,"version":35,"maxContentLevel":35,"summaryPage":1726,"introPage":1734,"pages":1740},"7d1982dc-2e28-467d-adf4-f218287a46c6",{"type":25,"title":1725},"The Role of Metabolites in the Microbiota-Gut-Brain Axis",{"id":1727,"data":1728,"type":35,"maxContentLevel":35,"version":24},"4b8ddc12-f07a-4317-892c-04a1d7fb562d",{"type":35,"summary":1729},[1730,1731,1732,1733],"SCFAs from gut microbes can reduce inflammation and improve insulin sensitivity","Indolepropionic acid (IPA) from gut bacteria boosts cognitive performance and lowers Alzheimer's risk","Gut bacteria produce essential vitamins like K2 and B12, crucial for calcium regulation and energy metabolism","The metabolite 4EPS from gut bacteria can travel to the brain and increase anxiety",{"id":1735,"data":1736,"type":54,"maxContentLevel":35,"version":24},"171f2be9-3731-4f58-8a81-ee706f38ffff",{"type":54,"intro":1737},[1738,1739],"How do short chain fatty acids (SCFAs) benefit gut health?","Which vitamins are produced by gut bacteria and why are they important?",[1741,1754,1771],{"id":1742,"data":1743,"type":24,"maxContentLevel":35,"version":25,"reviews":1746},"04bdb477-b260-402c-99f3-03cd51fd4ff8",{"type":24,"markdownContent":1744,"audioMediaId":1745},"The microbiota-gut-brain axis is not only involved in the production of neurotransmitters, but also in the production of metabolites. Metabolites are small molecules produced by bacteria that can have a wide range of effects on our health. For example, short chain fatty acids (SCFAs) such as acetate and propionate are produced when dietary fiber is fermented by gut microbes.\n\nSCFAs can reduce inflammation, improve insulin sensitivity and even act as appetite suppressants – all beneficial for maintaining good health. Another important metabolite is indolepropionic acid (IPA), which has been linked to improved cognitive performance and reduced risk of neurodegenerative diseases like Alzheimer’s disease.","1fa0990b-2fbd-4cc6-864b-adccf578590a",[1747],{"id":1748,"data":1749,"type":68,"version":24,"maxContentLevel":35},"bd252098-9839-4d47-95c6-e8b75b613c09",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1750,"activeRecallAnswers":1752},[1751],"What kind of chemical are short chain fatty acids (SCFAs)?",[1753],"Metabolites",{"id":1755,"data":1756,"type":24,"maxContentLevel":35,"version":25,"reviews":1759},"2678d779-f4fc-401d-a04f-226fdfc206c5",{"type":24,"markdownContent":1757,"audioMediaId":1758},"In addition to these metabolic benefits, certain bacterial species produce vitamins essential for human nutrition such as vitamin K2 and B12. Vitamin K2 helps regulate calcium levels in the body while B12 plays an important role in energy metabolism and red blood cell formation.\n\nThese vitamins cannot be synthesized by humans so it’s essential that we get them from our diet or through supplementation with probiotics containing these bacteria strains. By understanding how metabolites interact with our bodies we can gain insight into how they affect our overall wellbeing – both physical and mental!","2518c4ea-9b1e-49f6-bb65-f384a7f93b1d",[1760],{"id":1761,"data":1762,"type":68,"version":24,"maxContentLevel":35},"b24ff09b-eb60-4bc5-8671-9578fa07d653",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1763,"multiChoiceCorrect":1765,"multiChoiceIncorrect":1768,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[1764],"Which vitamins are produced by our microbiome?",[1766,1767],"Vitamin K2","Vitamin B12",[1769,1770],"Vitamin A","Vitamin C",{"id":1772,"data":1773,"type":24,"maxContentLevel":35,"version":35,"reviews":1776},"a6e14f04-894a-4c86-b359-9dbc61ab4580",{"type":24,"markdownContent":1774,"audioMediaId":1775},"The community of microbes in our gut has been shown to play a role in the onset of mental illness. Several studies have linked the presence of an overgrowth of the Toxoplasma gondii parasite to obsessive compulsive disorder, or OCD. A recent study on mice revealed that a metabolite called 4EPS produced by bacteria in the gut can travel to the brain and alter the function of brain cells, leading to increased anxiety.\n\nNeurological research suggests that microbiota also play a role in neurodegenerative diseases. This lends support to the idea that an aging gut microbiota could be linked to immune and neuron dysfunction in Alzheimer’s and Parkinson’s disease.\n\nAs is typical with dysbiosis, these pathogens are able to proliferate, destroy the good bacteria and colonize the guts of patients whose microbiotas have been dysregulated by illness or antibiotics.","c71faee1-6524-4341-81c7-9cbe2e87f8e8",[1777],{"id":1778,"data":1779,"type":68,"version":25,"maxContentLevel":35},"2ea1b883-1971-4991-9271-326657747c77",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":1780,"clozeWords":1782},[1781],"A recent study on mice revealed that a metabolite called 4EPS produced by bacteria in the gut can travel to the brain and alter the function of brain cells, leading to increased anxiety.",[1783],"4EPS",{"id":1785,"data":1786,"type":27,"maxContentLevel":35,"version":25,"orbs":1789},"77fa81df-0b28-45da-8198-0deeb260e64b",{"type":27,"title":1787,"tagline":1788},"How to Optimize Your Gut Health - Nutrition","What to eat and drink to keep your microbes happy and healthy.",[1790,1871,1955],{"id":1791,"data":1792,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1794,"introPage":1802,"pages":1808},"dd55e303-3fdb-42e7-b947-d93190421653",{"type":25,"title":1793},"Diet and Gut Health",{"id":1795,"data":1796,"type":35,"maxContentLevel":35,"version":24},"c249b2a8-b66b-420e-9fca-e5ff14f0b11d",{"type":35,"summary":1797},[1798,1799,1800,1801],"Eating fresh, whole foods like fruits and veggies boosts beneficial gut bacteria","Fermented foods like yogurt and kimchi can balance your gut microbiome fast","Fiber from plants feeds good microbes, producing SCFAs that protect your gut","Long-term diet changes lead to a healthier, more diverse gut microbiome",{"id":1803,"data":1804,"type":54,"maxContentLevel":35,"version":24},"a94253bd-b8b9-4ea8-a797-4fe065554b52",{"type":54,"intro":1805},[1806,1807],"How does fiber help beneficial bacteria in the gut?","Name three fiber-rich foods that support gut health.",[1809,1835,1853],{"id":1810,"data":1811,"type":24,"maxContentLevel":35,"version":25,"reviews":1814},"d38d2155-09b3-4758-9b53-7dab4b25a62b",{"type":24,"markdownContent":1812,"audioMediaId":1813},"Diet is a key modifiable factor when it comes to optimizing gut health. Eating a variety of fresh, whole foods such as fruits, vegetables, nuts and seeds can help promote the growth of beneficial bacteria in the microbiome. Fermented foods like yogurt and kimchi are also great sources of probiotics that can help maintain balance in the gut. Additionally, limiting processed foods high in sugar and saturated fat can reduce inflammation and improve overall digestive health.\n\nIncluding dietary fiber from plant-based sources is essential for maintaining healthy levels of beneficial bacteria in the gut. Fiber helps feed these microbes which then produce short-chain fatty acids (SCFAs) that nourish cells lining our intestines and protect against disease-causing pathogens. Studies have shown that diets rich in SCFAs may even reduce risk factors associated with obesity, diabetes, heart disease and cancer! So make sure to include plenty of fiber-rich foods like legumes, oats and barley into your diet for optimal gut health!","fd91fbb9-09c7-487d-828a-40bda4818fb7",[1815,1826],{"id":1816,"data":1817,"type":68,"version":24,"maxContentLevel":35},"b300e0a7-78e8-48f5-9057-b51603287a91",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1818,"multiChoiceCorrect":1820,"multiChoiceIncorrect":1822,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1819],"What is an essential component of a diet for maintaining healthy levels of beneficial bacteria in the gut?",[1821],"Dietary fiber from plant-based sources",[1823,1824,1825],"High sugar intake","Saturated fat consumption","Excessive intake of processed foods",{"id":1827,"data":1828,"type":68,"version":24,"maxContentLevel":35},"a261bc19-01a8-4790-869d-aa496b307c6d",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1829,"binaryCorrect":1831,"binaryIncorrect":1833},[1830],"What is an important aspect of optimizing gut health?",[1832],"Focusing on whole foods and including healthy fats",[1834],"Only consuming high-fiber foods",{"id":1836,"data":1837,"type":24,"maxContentLevel":35,"version":25,"reviews":1840},"9a1ce5bb-6c0d-43e6-a38a-559681f36465",{"type":24,"markdownContent":1838,"audioMediaId":1839},"When it comes to optimizing gut health, permanent dietary changes are more effective than acute ones. For example, a study of over 1,000 people found that those who made long-term dietary changes had significantly higher levels of beneficial bacteria in their microbiome compared to those who only made short-term adjustments. This suggests that making sustainable lifestyle modifications is the best way to promote healthy microbial diversity and balance in the gut.\n\nIn addition, research has shown that certain foods can have an immediate impact on our microbiota composition. Eating probiotic-rich fermented foods like yogurt or kimchi can help increase levels of beneficial bacteria within 24 hours!\n\n![Graph](image://f3daf27a-c6d9-448d-8128-3d30f8a09ca1 \"Kimchi. Image: Nagyman, a flickr user, CC BY-SA 2.0 \u003Chttps://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons\")\n\nSimilarly, consuming prebiotics such as garlic and onions can stimulate growth of good microbes within just a few days. So while permanent diet changes are important for maintaining optimal gut health over time, incorporating these types of food into your daily routine may also provide quick relief from digestive issues or other symptoms associated with dysbiosis.","dfdc3424-6f22-4adf-8f9e-b34e8798c0e1",[1841],{"id":1842,"data":1843,"type":68,"version":24,"maxContentLevel":35},"aba89279-5021-46f8-a7bf-13bc4de81fa7",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1844,"multiChoiceCorrect":1846,"multiChoiceIncorrect":1849,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[1845],"Which of these are fermented foods?",[1847,1848],"Yogurt","Kimchi",[1850,1851,1852],"Fresh fruit","Legumes","Nuts",{"id":1854,"data":1855,"type":24,"maxContentLevel":35,"version":25,"reviews":1858},"0e319504-11a2-4e13-8eeb-ba241d0d9022",{"type":24,"markdownContent":1856,"audioMediaId":1857},"When it comes to optimizing gut health, focusing on whole foods is key. Whole foods are unprocessed and contain all the essential nutrients our bodies need for optimal functioning. Eating a variety of fresh fruits, vegetables, nuts and seeds can provide an abundance of vitamins, minerals and fiber that help nourish beneficial bacteria in the microbiome. Additionally, these plant-based sources are rich in polyphenols which have been shown to reduce inflammation and improve digestive health.\n\n![Graph](image://53f75c55-fefd-49ed-a76d-fcb6769342db \"Sources of polyphenols. Image: Frankie Fouganthin, CC BY-SA 4.0 \u003Chttps://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons\")\n\nIncluding healthy fats from sources like avocados, olive oil or fatty fish can also be beneficial for gut health as they provide energy for microbes to thrive. Studies have even found that omega-3 fatty acids may help protect against dysbiosis by reducing levels of pro-inflammatory molecules in the gut! So make sure you’re getting enough healthy fats into your diet for optimal microbial balance!","05cd0601-fccf-43b0-887c-25be6794990c",[1859],{"id":1860,"data":1861,"type":68,"version":24,"maxContentLevel":35},"0d0304df-21c6-460b-9763-9f853aeaeb1f",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1862,"multiChoiceCorrect":1864,"multiChoiceIncorrect":1868,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[1863],"Which of these contain so-called 'healthy fats'?",[1865,1866,1867],"Avocados","Olive oil","Fatty fish",[1869,1870],"Processed meat","Seed oils",{"id":1872,"data":1873,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1875,"introPage":1883,"pages":1889},"785a08fb-adda-481e-a6ef-dc145bd3c644",{"type":25,"title":1874},"Fiber and Gut Health",{"id":1876,"data":1877,"type":35,"maxContentLevel":35,"version":24},"2bc0519a-979e-45f7-9cfb-83517cefbecb",{"type":35,"summary":1878},[1879,1880,1881,1882],"Fiber feeds good gut bacteria, which produce short-chain fatty acids that nourish intestinal cells","Prebiotic fibers like garlic and onions boost beneficial bacteria and reduce harmful ones","Polyphenols in foods like dark chocolate and green tea reduce inflammation and improve gut bacteria diversity","A diverse diet with many ingredients keeps gut microbes healthy; restrictive diets harm them",{"id":1884,"data":1885,"type":54,"maxContentLevel":35,"version":24},"a445caa5-7b0c-4543-b6da-8db42e2382da",{"type":54,"intro":1886},[1887,1888],"What are prebiotic fibers, and why are they good for your gut?","How do polyphenols help with gut health?",[1890,1906,1921,1938],{"id":1891,"data":1892,"type":24,"maxContentLevel":35,"version":25,"reviews":1895},"3b08a072-8216-4186-a6ff-bd7ed729480f",{"type":24,"markdownContent":1893,"audioMediaId":1894},"Fiber is an essential part of a healthy diet and plays an important role in maintaining gut health. It helps to feed beneficial bacteria, which produce short-chain fatty acids that nourish the cells lining the intestine and reduce inflammation. Eating plenty of fiber can also help keep you regular by promoting bowel movements.\n\n![Graph](image://827616bb-11ff-4c2e-a277-9689174d80a5 \"High-fiber foods. Image: The U.S. Food and Drug Administration, Public domain, via Wikimedia Commons\")\n\nGood sources of dietary fiber include fruits, vegetables, legumes, nuts and seeds. For example, one cup of cooked lentils contains 15 grams of fiber – almost half your daily recommended intake! Other great sources are raspberries (8g per cup), black beans (15g per cup) and almonds (4g per ounce). Adding these foods to your meals will not only boost your fiber intake but also provide other essential nutrients like vitamins A & C as well as minerals such as iron and magnesium.","13457c81-8f4b-4c4b-bc73-b84bfff22d2d",[1896],{"id":1897,"data":1898,"type":68,"version":24,"maxContentLevel":35},"166f9f3d-16bf-4e20-96c3-4470e7c08996",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1899,"activeRecallAnswers":1901},[1900],"What are some good sources of dietary fiber that can help maintain gut health and promote regular bowel movements?",[1902,1903,1851,1904,1905],"Fruits","Vegetables","Nut","Seeds",{"id":1907,"data":1908,"type":24,"maxContentLevel":35,"version":25,"reviews":1911},"da779784-bb26-4e94-a5f4-046fc2946420",{"type":24,"markdownContent":1909,"audioMediaId":1910},"Including prebiotic fibers like garlic, onions or Jerusalem artichokes can be especially beneficial for gut health since they act as food for probiotics in the microbiome. Prebiotics have been shown to increase levels of beneficial bacteria while reducing levels of harmful ones – making them a powerful tool for optimizing gut health!\n\nPolyphenols are a type of antioxidant found in many plant-based foods, such as dark chocolate, green tea and red wine. They have been shown to reduce inflammation and improve the diversity of beneficial bacteria in the microbiome. Polyphenols can also help protect against oxidative stress caused by free radicals, which can damage cells and lead to chronic diseases like cancer or heart disease.","75521345-d224-499f-a70d-39b285f88750",[1912],{"id":1913,"data":1914,"type":68,"version":24,"maxContentLevel":35},"ad02db4b-bc88-4b4f-9858-f3342759df93",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1915,"binaryCorrect":1917,"binaryIncorrect":1919},[1916],"Which of these foods is high in polyphenols?",[1918],"Green tea",[1920],"Butter",{"id":1922,"data":1923,"type":24,"maxContentLevel":35,"version":25,"reviews":1926},"79aba7e6-8d13-4efa-834e-4cb90ae7b516",{"type":24,"markdownContent":1924,"audioMediaId":1925},"In addition to their anti-inflammatory properties, polyphenols may also play a role in regulating blood sugar levels. Studies have shown that consuming polyphenol-rich foods can help reduce insulin resistance and lower fasting glucose levels. This is especially important for people with diabetes who need to keep their blood sugar under control.\n\nInterestingly, some research suggests that polyphenols may even be able to cross the blood-brain barrier – meaning they could potentially influence brain health too! For example, one study showed that consuming cocoa flavanols (a type of polyphenol) improved memory performance in healthy adults aged 50–69 years old. So if you’re looking for an excuse to indulge in some dark chocolate every now and then – this might just be it!","4e215aa6-2dda-4c60-a6bb-2918ffd30c07",[1927],{"id":1928,"data":1929,"type":68,"version":24,"maxContentLevel":35},"4adc192f-b362-4fac-894b-11935efbfc2e",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1930,"multiChoiceCorrect":1932,"multiChoiceIncorrect":1934,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1931],"Which of these in high in polyphenols?",[1933],"Dark chocolate",[1935,1936,1937],"Milk chocolate","Chocolate-chip cookies","Chocolate ice cream",{"id":1939,"data":1940,"type":24,"maxContentLevel":35,"version":25,"reviews":1943},"82d626e9-defd-44ad-aa7a-ac50dc37e80a",{"type":24,"markdownContent":1941,"audioMediaId":1942},"The key to keeping our colony of gut microbes healthy and happy through diet is diversity. In *The Diet Myth*, Tim Spector points out that our forager ancestors probably regularly ingested around 150 ingredients in a week. These days, most people consume fewer than twenty separate food items in a week, many of which are artificially refined, and 'come depressingly from just four main ingredients: corn, soy, wheat or meat.'\n\nAccording to Spector, the trend towards highly restrictive eating plans that we’ve observed in the last few decades – first by eliminating fat, then carbohydrates – is harmful to our health as it depletes the diversity of our resident microbes.' The exception to this, he claims, is intermittent fasting, which has the potential to stimulate friendly gut microbes, provided the ‘background diet’ is healthy and diverse.","3d9a83e5-05f7-4a1f-b0e3-90ee6fc5a66a",[1944],{"id":1945,"data":1946,"type":68,"version":24,"maxContentLevel":35},"c573da44-e4b8-4ca2-b405-e3063d38e4bc",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1947,"multiChoiceCorrect":1949,"multiChoiceIncorrect":1951,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1948],"What is the key to maintaining a healthy gut microbiome according to Tim Spector in *The Diet Myth*?",[1950],"Dietary diversity",[1952,1953,1954],"Eliminating fat","Eliminating carbohydrates","Intermittent fasting only",{"id":1956,"data":1957,"type":25,"version":25,"maxContentLevel":35,"summaryPage":1959,"introPage":1967,"pages":1973},"b4846739-27f9-4f08-b7c2-3177f94f1d27",{"type":25,"title":1958},"Dietary Choices and Gut Health",{"id":1960,"data":1961,"type":35,"maxContentLevel":35,"version":24},"d83e27dc-8dc1-4bd9-b1ce-88e9573883ba",{"type":35,"summary":1962},[1963,1964,1965,1966],"Vegetarians have different gut microbes than omnivores","Red meat can increase harmful bacteria and cancer risk","Probiotics are live cultures that boost gut health","Fermented foods lower inflammation-related microbes",{"id":1968,"data":1969,"type":54,"maxContentLevel":35,"version":24},"5866845a-a6e6-40a2-b29a-ae7c966f6387",{"type":54,"intro":1970},[1971,1972],"What is the first prebiotic we are exposed to?","How do oligosaccharides in breastmilk benefit the gut microbiome?",[1974,2010,2025,2042],{"id":1975,"data":1976,"type":24,"maxContentLevel":35,"version":25,"reviews":1979},"61c853ab-4557-4c8a-8931-2d233709991a",{"type":24,"markdownContent":1977,"audioMediaId":1978},"Vegetarians have different resident microbes than omnivores, and some studies have shown that a plant-based diet may benefit the gut microbiome. However, it’s unclear whether this is due to a lack of meat or the high fiber content that a plant-based diet provides. Researchers have found that heme iron found in red meat increases the abundance of bacteria that can permeate the immunity-protective mucosal layer of the colon.\n\nRed and processed meats also have high levels of saturated fats, which increase the secretion of bile acids. Those that aren’t absorbed in the small intestine are converted into secondary bile acids in the colon, which can trigger DNA damage and resistance to apoptosis (programmed cell death). Apoptosis resistance is associated with the development of cancer cells. Sulfur – present in amino acids from red meat and used as a preservative in processed meat – can also promote cancer development.","66d19450-ece3-4b8e-9dc9-4609cf46f4a6",[1980,1989,2000],{"id":1981,"data":1982,"type":68,"version":24,"maxContentLevel":35},"ca14b06f-f58b-47f2-8c6b-6e10451c5c29",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1983,"binaryCorrect":1985,"binaryIncorrect":1987},[1984],"Heme iron found in red meat may have what effect on the microbiome?",[1986],"Increasing the abundance of bacteria that can permeate the colon lining",[1988],"Increasing the strength of the mucosal colon lining",{"id":1990,"data":1991,"type":68,"version":24,"maxContentLevel":35},"bce731ed-44eb-4031-9e45-5dc295e0e108",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":1992,"multiChoiceCorrect":1994,"multiChoiceIncorrect":1996,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[1993],"What factor in red meat consumption is associated with the development of cancer cells?",[1995],"Apoptosis resistance",[1997,1998,1999],"High fiber content","Presence of heme iron","Increased secretion of bile acids",{"id":1380,"data":2001,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":2002,"multiChoiceQuestion":2003,"multiChoiceCorrect":2005,"multiChoiceIncorrect":2006,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":2007,"matchPairsPairs":2008},[1376,1379,1381],[2004],"Which of the following most closely applies to apoptosis resistance?",[1388],[1385,1387,1389],[175],[2009],{"left":1995,"right":1388,"direction":35},{"id":2011,"data":2012,"type":24,"maxContentLevel":35,"version":25,"reviews":2015},"4aaca80d-4a72-403c-96a9-2d7c2ab3e6d9",{"type":24,"markdownContent":2013,"audioMediaId":2014},"Probiotics are live cultures that provide health benefits by improving or restoring gut flora. They can take the form of foods (such as yogurt, kombucha and miso) or supplements – but many supplements claiming to confer probiotic health benefits have not been subjected to rigorous testing by regulatory bodies. Tim Spector offers the following helpful analogy to describe prebiotics: 'Whereas probiotics are selected microbes that benefit the health of the host, prebiotics are the constituent parts of foods that act as fertilisers for the microbes in the colon.\n\nThese largely non-digested fibres allow beneficial microbes to thrive, and they come in several forms.' The first prebiotics we’re exposed to are the oligosaccharides in breastmilk (see 'How microbiotas benefit the body'). Most prebiotics come in the form of resistant starches – dietary fibers found in certain fruits, vegetables and other plant-based foods. Some studies have shown that eating specific prebiotics can reduce cortisol levels in humans.","d734df29-3578-4366-ac2a-8a0c4199ad7c",[2016],{"id":2017,"data":2018,"type":68,"version":24,"maxContentLevel":35},"6d449a12-880b-45b1-911c-04ca14911b30",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2019,"binaryCorrect":2021,"binaryIncorrect":2023},[2020],"What is the term for live cultures that provide health benefits by improving gut flora?",[2022],"Probiotics",[2024],"Prebiotics",{"id":2026,"data":2027,"type":24,"maxContentLevel":35,"version":25,"reviews":2030},"25b1672e-e9a1-4555-b02b-00b28ba4aaa2",{"type":24,"markdownContent":2028,"audioMediaId":2029},"Omega-3 is an essential fatty acid that we can’t make ourselves, belonging to the group of fats known as polyunsaturated fatty acids (PUFAs). The main dietary sources of Omega-3 are oily wild fish, leafy greens, and certain plants such as linseed (flaxseed). These appear to be beneficial for the heart as they reduce lipids and inflammation, dampening the body’s reaction to threats of infection in the process.\n\n![Graph](image://959022af-fe91-4bfd-833e-e3abbf0155bc \"Salmon, a good source of Omega-3. Image: Gwen, CC BY 2.0 \u003Chttps://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons\")\n\nAccording to Ruairi Robertson, the typical western diet is deficient in Omega-3 – and this imbalance in dietary fat can contribute to a number of chronic diseases, especially across generations. Research on mice fed a diet deficient in Omega-3 found changes to the microbiota that included an abundance of bacteria associated with metabolic diseases. The studies also showed decreased production of the metabolites, SCFAs, in Omega-3-deficient mice.","0c5efc39-af3c-434e-9784-4640c73ac697",[2031],{"id":2032,"data":2033,"type":68,"version":24,"maxContentLevel":35},"49ed77e0-6b3d-42ff-8212-ca7b88ed1659",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2034,"multiChoiceCorrect":2036,"multiChoiceIncorrect":2038,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2035],"According to Ruairi Robertson, the typical western diet is deficient in which dietary fat?",[2037],"Omega-3",[2039,2040,2041],"Saturated fat","Polyphenols","Short chain fatty acids (SCFAs)",{"id":2043,"data":2044,"type":24,"maxContentLevel":35,"version":25,"reviews":2047},"a083d823-cdb0-4412-8183-7285c04c88af",{"type":24,"markdownContent":2045,"audioMediaId":2046},"Fermented foods such as kimchi, sauerkraut and tempeh tend to be rich in the beneficial bacteria, Lactobacilli. Apple cider vinegar is a fermented liquid that is high in the SCFA, acetate. The fermentation process enhances the number of live cultures, or beneficial organisms, particularly Lactobacillus. People who eat these foods typically have lower levels of Enterrobacter in their guts. This is a type of microbe associated with inflammation and chronic disease – so having lower levels of it makes you less at risk of developing chronic illness.\n\n![Graph](image://18f41eba-c384-412c-97d8-6e139a53551e \"Apple cider vinegar. Image: JFVelasquez Floro, CC0, via Wikimedia Commons\")\n\nThe traditional Japanese diet (which is rich in fermented foods) and the Mediterranean diet (which is rich in polyphenols) are good examples to follow, as they resemble the prehistoric human diet most closely. Fermented foods also belong to a group of foods known as ‘synbiotics’. Synbiotics are foods that contain a mix of prebiotics and probiotics. Other sources of synbiotics are onions and garlic, which are a good source of prebiotics.","2b896c7c-3bbf-479d-b580-86a253b433ea",[2048],{"id":2049,"data":2050,"type":68,"version":24,"maxContentLevel":35},"2a33d62e-0b21-4cc3-9184-f4f275dccb11",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2051,"multiChoiceCorrect":2053,"multiChoiceIncorrect":2054,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2052],"Fermented foods such as kimchi, sauerkraut and tempeh tend to be rich in which bacteria?",[475],[1520,2055,1522],"Enterrobacter",{"id":2057,"data":2058,"type":27,"maxContentLevel":35,"version":35,"orbs":2061},"5271e03a-6c20-41f9-8824-b2e0d64839eb",{"type":27,"title":2059,"tagline":2060},"How to Optimize Your Health - Lifestyle","Adjustments you can make to your lifestyle to keep your microbiome healthy.",[2062,2128,2174,2248],{"id":2063,"data":2064,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2066,"introPage":2074,"pages":2080},"83b37dd6-5316-4a69-b55b-63e23b187e10",{"type":25,"title":2065},"Optimizing Health through Birth and Nutrition",{"id":2067,"data":2068,"type":35,"maxContentLevel":35,"version":24},"c3e1b789-ab4f-4ed6-8f9a-94ef91ec5e17",{"type":35,"summary":2069},[2070,2071,2072,2073],"Babies get their first microbes from the birth canal during natural birth","Breastfeeding for over six months boosts a baby's immune system and gut health","Breastmilk oligosaccharides feed good gut bacteria and fight off pathogens","Limiting antibiotics in infants helps maintain a healthy gut microbiome",{"id":2075,"data":2076,"type":54,"maxContentLevel":35,"version":24},"90b94dee-4519-461e-8bfd-50c56e72d9d5",{"type":54,"intro":2077},[2078,2079],"How does regular physical exercise influence gut microbiota diversity?","What role do short-chain fatty acids play in overall wellbeing?",[2081,2098,2113],{"id":2082,"data":2083,"type":24,"maxContentLevel":35,"version":25,"reviews":2086},"ad6748d6-1864-4d3e-8e43-2629eff0cfd6",{"type":24,"markdownContent":2084,"audioMediaId":2085},"Our first encounter with the microbial planet is during childbirth, when we are gifted with a smattering of microbes in our mother’s birth canal. By opting for an elective Cesarean section, we skip the baby’s trip through the birth canal, and deprive it of this microbial ‘starter pack.’ C-sections can be a lifesaving procedure for mother and baby when a vaginal delivery isn’t an option.\n\nHowever, public health officials and healthcare professionals would do well to appropriately educate and encourage pregnant women to opt for natural births where possible, and to only resort to C-sections where absolutely necessary (in other words, where a natural birth would put the mother or child at risk).\n\nIn cases where birth by C-section is non-negotiable, swabbing the infant with bacteria from the birth canal is a good workaround, and offers some of the immune protection to the baby that a vaginal birth would have.","3333023e-1dcf-4972-bb19-e88a75a6bffc",[2087],{"id":2088,"data":2089,"type":68,"version":24,"maxContentLevel":35},"aa2daa53-db67-4173-bb4e-f88f4dc059b5",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2090,"multiChoiceCorrect":2092,"multiChoiceIncorrect":2094,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2091],"What is the microbial \"starter pack\" obtained from?",[2093],"Mother's birth canal",[2095,2096,2097],"The womb","The mother's diet","The environment in which the baby is delivered",{"id":2099,"data":2100,"type":24,"maxContentLevel":35,"version":25,"reviews":2103},"f30af6cc-a8d7-4f88-b259-ede1ae40152b",{"type":24,"markdownContent":2101,"audioMediaId":2102},"Mothers should be encouraged to breastfeed for as long as possible – ideally more than six months – unless medical reasons prevent them from doing so. This confers a host of benefits on the child, with lasting health implications. These include training its immune system, reducing its risk of developing obesity or metabolic disease later in life, and providing protection against allergies and infection.\n\nBreastmilk also contains oligosaccharides, which circumvent the baby’s small intestine and travel straight to its gut microbiota. Here, they remove pathogens from the intestinal wall, and are a food source for Bifidobacteria – one of two beneficial bacteria that dominate the baby’s microbiota.\n\nBifidobacteria feed on oligosaccharides and produce short-chain fatty acids (SCFAs) – butyrate, acetate, propionate, and lactate. Lactate is very beneficial for babies, as it feeds the cells in the colon and plays a key role in developing its immune system. SCFAs also help the baby digest insoluble fibers and extract essential nutrients.\n\nExclusive breastfeeding is ideal, but where the mother doesn’t produce enough breastmilk, then combining breastfeeding with bottle feeding is the next best option to optimize gut health. ","6ad544cd-50dc-47e7-8e97-dd04a58e1f80",[2104],{"id":2105,"data":2106,"type":68,"version":24,"maxContentLevel":35},"2322c90a-ab04-4041-9182-a0bbc6a0c0a4",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2107,"binaryCorrect":2109,"binaryIncorrect":2111},[2108],"What is the main benefit of oligosaccharides found in breastmilk for a baby's gut health?",[2110],"Feeding Bifidobacteria and producing short-chain fatty acids",[2112],"Preventing the growth of any bacteria in the gut",{"id":2114,"data":2115,"type":24,"maxContentLevel":35,"version":25,"reviews":2118},"f8ad4391-186a-42c9-889f-839166b48a62",{"type":24,"markdownContent":2116,"audioMediaId":2117},"Limiting antibiotic usage is essential for maintaining a healthy microbiome. Antibiotics can disrupt the delicate balance of bacteria in our gut, leading to dysbiosis and an increased risk of infection. This is particularly true in young children, whose immune systems are still developing and who may be more vulnerable to the effects of antibiotics.\n\nStudies have shown that infants exposed to multiple courses of antibiotics before their first birthday had significantly lower levels of Bifidobacteria than those who were not exposed. This genus has been linked with improved health outcomes such as reduced risk of obesity and diabetes later on in life. Furthermore, research suggests that early exposure to antibiotics increases the risk for asthma and allergies by up to 50%.\n\nIt’s important to remember that antibiotics should only be used when absolutely necessary – they cannot treat viral infections like colds or flu, so it’s best to consult your doctor before taking them unnecessarily. If you do need an antibiotic course, consider supplementing with probiotics afterwards as this can help restore microbial diversity in your gut.","60f699c0-70ab-4113-8500-76719b693489",[2119],{"id":2120,"data":2121,"type":68,"version":24,"maxContentLevel":35},"38ed8a93-7b1c-4bd4-a900-130f7e13c2ee",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2122,"binaryCorrect":2124,"binaryIncorrect":2126},[2123],"What is the potential consequence of infants being exposed to multiple courses of antibiotics before their first birthday?",[2125],"Decreased levels of Bifidobacteria and increased risk of obesity and diabetes later in life",[2127],"Increased levels of Bifidobacteria and reduced risk of obesity and diabetes later in life",{"id":2129,"data":2130,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2132,"introPage":2140,"pages":2146},"5dca84fb-e3d5-4275-b364-32d16846dee7",{"type":25,"title":2131},"Optimizing Health through Exercise",{"id":2133,"data":2134,"type":35,"maxContentLevel":35,"version":24},"3ba9b641-e95e-4e47-95b7-b34c3bee7c08",{"type":35,"summary":2135},[2136,2137,2138,2139],"Exercise boosts gut microbiome diversity, especially in athletes","Athletes with low BMI have more Akkermansia muciniphila, linked to leanness","Women who exercise regularly have more health-promoting bacteria","Exercise increases butyrate production, which strengthens the gut barrier",{"id":2141,"data":2142,"type":54,"maxContentLevel":35,"version":24},"22f1cef8-62ad-4203-a975-9cf52c964cc6",{"type":54,"intro":2143},[2144,2145],"How does exercise affect gut microbiota diversity?","What role does butyrate play in gut health?",[2147,2161],{"id":2148,"data":2149,"type":24,"maxContentLevel":35,"version":25,"reviews":2152},"c1d475e7-c595-4897-8cda-736811932129",{"type":24,"markdownContent":2150,"audioMediaId":2151},"We all know the host of health benefits associated with regular physical exercise, notably, its ability to regulate weight and metabolic activity, increase insulin sensitivity and improve overall health. There is growing evidence to suggest that regular physical activity also benefits our microbial companions by regulating our gut microbiome.\n\n![Graph](image://ba2577f9-9b3e-455d-b2b7-1c4c17dabfdb \"Exercizing in the in the gym. Image: Rwebogora, CC BY-SA 4.0 \u003Chttps://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons\")\n\nIn one study, researchers observed professional rugby players and found that exercise increases diversity in the gut microbiota compared to the sedentary control group. They found that protein consumption correlates with microbial diversity, and that the athletes with a low body mass index, or BMI (calculated by dividing weight by height squared) had substantially higher proportions of Akkermansia muciniphila, the microbe associated with leanness. They also found that athletes have 'lower inflammatory and improved metabolic markers relative to controls.'","b4706ba2-d715-4521-914a-71577bb8a602",[2153],{"id":2154,"data":2155,"type":68,"version":24,"maxContentLevel":35},"456cc3a0-c61a-429b-a273-a02516fc3883",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2156,"multiChoiceCorrect":2158,"multiChoiceIncorrect":2160,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2157],"What microbe is associated with leanness in athletes?",[2159],"Akkermansia muciniphila",[1522,490,475],{"id":2162,"data":2163,"type":24,"maxContentLevel":35,"version":25,"reviews":2166},"cc37a05c-27be-450c-93bf-9881853ec965",{"type":24,"markdownContent":2164,"audioMediaId":2165},"Another study showed that women who exercised three times a week had a higher abundance of health-promoting bacteria, including Bifidobacterium and Akkermansia. These results suggest that regular physical activity, even at a low to moderate intensity, can be beneficial for gut health.\n\nAnother group of researchers conducted studies on mice and found that five weeks of exercise training resulted in an increased production of the short-chain fatty acid, butyrate. Butyrate is a product of the fermentation of dietary fiber that humans are unable to digest by themselves. It’s fermented and digested by friendly gut bacteria such as Bifidobacteria.\n\nButyrate is very beneficial for humans as it regulates the immune system and gene expression and promotes the integrity of the gut barrier – the layer of mucus that acts as a gatekeeper to prevent harmful bacteria from slipping into the bloodstream and potentially causing disease. Overall, then, physical exercise can benefit our gut microbes by improving microbial diversity and increasing butyrate production.","fcb5fd98-bb28-44b1-a477-2b4cbd5f7916",[2167],{"id":2168,"data":2169,"type":68,"version":24,"maxContentLevel":35},"49ac68c4-1043-4d92-b72e-1dc825078b87",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":2170,"clozeWords":2172},[2171],"Regular physical activity, even at a low to moderate intensity, can be beneficial for gut health.",[2173],"low to moderate",{"id":2175,"data":2176,"type":25,"version":24,"maxContentLevel":35,"summaryPage":2178,"introPage":2186,"pages":2192},"7e7adf5a-8fb1-4f47-8aef-f77fe8bdb066",{"type":25,"title":2177},"Optimizing Health through Stress Management and Sleep",{"id":2179,"data":2180,"type":35,"maxContentLevel":35,"version":24},"5ccae6eb-7074-48e8-8951-73263c854b20",{"type":35,"summary":2181},[2182,2183,2184,2185],"Stress messes with your gut by altering microbiota and causing inflammation","The HPA axis links stress to gut health, affecting blood flow and sensitivity","Sleep disorders can lead to obesity, metabolic disease, and cognitive decline","Disrupted circadian rhythms can change gut microbiota and promote obesity",{"id":2187,"data":2188,"type":54,"maxContentLevel":35,"version":24},"3b772b53-2247-49e6-9428-cd8dc8cf8dd7",{"type":54,"intro":2189},[2190,2191],"How does smoking affect gut health?","What are two strategies to quit smoking?",[2193,2208,2231],{"id":2194,"data":2195,"type":24,"maxContentLevel":35,"version":24,"reviews":2198},"6895f420-a7fb-4ba6-b585-3e10c9be0a6c",{"type":24,"markdownContent":2196,"audioMediaId":2197},"The effect of stress on our gut microbiota falls under the banner of the brain-gut axis. Research suggests that stress alters the permeability of the mucosal layer, triggering the secretion of cytokines, which leads to inflammation. Not only that, but stress can significantly alter the structure and activity of our gut microbiota, and may be one of the causes of dysbiosis.\n\nResearch also suggests that there is a close interaction between the gut microbiota and the hypothalamic-pituitary-adrenal (HPA) axis – the major neuroendocrine system that regulates our response to stress. Stress can also increase sensitivity and reduce blood flow in the gut. Studies on mice have shown that different types of stress – such as isolation, crowding and heat stress – can reduce the diversity of gut flora. Stress is an inevitable part of our modern lives, but we can mitigate it – and its effect on our gut health – by practicing stress reduction techniques, such as meditation, yoga and breathing exercises.\n","50eadeff-92d1-4dbd-a397-c0438f4dce2b",[2199],{"id":2200,"data":2201,"type":68,"version":24,"maxContentLevel":35},"7d2b7f68-3551-4ea8-8892-0c6facb0e550",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2202,"binaryCorrect":2204,"binaryIncorrect":2206},[2203],"There is a close interaction between the gut microbiota and which axis, associated with stress?",[2205],"Hypothalamic-pituitary-adrenal (HPA) axis",[2207],"Hypopituitary-sympathetic-nervous (HSN) axis",{"id":2209,"data":2210,"type":24,"maxContentLevel":35,"version":24,"reviews":2213},"0cde77b9-d144-43a5-b5df-88fee7b217b5",{"type":24,"markdownContent":2211,"audioMediaId":2212},"\nThe importance of sleep for our overall health – and that of our microbiota – cannot be overstated. Sleep disorders have been associated with lowered immunity, neurodegenerative diseases, and cognitive decline. They also place us at greater risk of becoming obese or developing metabolic disease or type 2 diabetes. You might have heard of the circadian rhythm: the system of hormones that are deployed at different times of day that governs our internal ‘body clock’.\n\nThe gut microbiota, while not exposed to this light and dark cycle, are still affected by it. Intriguingly, variations in our circadian rhythm can affect the availability of nutrients and our production of auto-antibodies and peptides. Auto-antibodies are found in people with autoimmune diseases. Peptides are short chains of amino acids that help us fight infection and promote wound healing. They also play a role in muscle growth and may assist with weight loss.\n","f240b7eb-2413-428f-8305-089b270cb4d5",[2214,2222],{"id":2215,"data":2216,"type":68,"version":24,"maxContentLevel":35},"c46f21c3-2a5f-4297-bb27-503fe2912fa9",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":2217,"activeRecallAnswers":2219},[2218],"What is the role of peptides in our body?",[2220,2221],"Fight infection","Promote wound healing",{"id":2223,"data":2224,"type":68,"version":24,"maxContentLevel":35},"74694062-9a99-47a1-9692-4beb222dcfd4",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2225,"binaryCorrect":2227,"binaryIncorrect":2229},[2226],"What is one potential consequence of sleep disorders on our overall health?",[2228],"Increased risk of obesity and type 2 diabetes",[2230],"Improved cognitive function",{"id":2232,"data":2233,"type":24,"maxContentLevel":35,"version":24,"reviews":2236},"3d199926-38fb-474f-b4ea-e5db9c3ec84b",{"type":24,"markdownContent":2234,"audioMediaId":2235},"\nFluctuations in the circadian rhythm can also affect our absorption of lipids, which is regulated by our gut microbes. These disruptions may promote diet-induced obesity. Two common disruptors of the body’s internal clock are jetlag and disrupted sleep patterns (for instance, in shift workers). Studies have suggested that these disruptions can lead to changes in the microbiota that can increase dietary intake, promote an inflammatory response leading to metabolic changes, and promote glucose intolerance and obesity.\n\nThese findings are significant because they show that while diet plays an important role in shaping our gut health, the interplay between diet and lifestyle factors – such as sleep duration and quality – has the potential to alter our feeding behaviors and amplify the effect of diet on gut health. Specifically, feeding behaviors have a 'powerful training effect' on the liver and intestine. This means that it’s possible that by manipulating feeding time, duration, and frequency we can influence the gut microbiota and, by extension, our health. In another study of young individuals of normal weight, partial sleep deprivation subtly changed gut composition by increasing the ratio of Firmicutes to Bacteroidetes.\n","1dd5c0e9-d227-4472-9fe5-680bf4083f4d",[2237],{"id":2238,"data":2239,"type":68,"version":24,"maxContentLevel":35},"0f01238b-6d9b-4e6e-8764-36d28fa62f81",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2240,"multiChoiceCorrect":2242,"multiChoiceIncorrect":2245,"multiChoiceMultiSelect":21,"multiChoiceRevealAnswerOption":6},[2241],"What factors can disrupt the body's internal clock?",[2243,2244],"Jetlag","Disrupted sleep patterns",[2246,2247,2041],"Elevated bifidobacteria","High-fiber diets",{"id":2249,"data":2250,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2252,"introPage":2260,"pages":2266},"2537ddd0-8dd4-4928-85e7-c770bc764e30",{"type":25,"title":2251},"Optimizing Health through Lifestyle Changes",{"id":2253,"data":2254,"type":35,"maxContentLevel":35,"version":24},"5465ea87-6cda-43b5-88eb-0e5be4b6fc82",{"type":35,"summary":2255},[2256,2257,2258,2259],"Smoking wrecks your gut bacteria and ups harmful toxins","Quitting smoking boosts mental health and gut bacteria in two weeks","Alcohol messes with gut balance and can cause infections","Light red wine drinking might help gut health, but stick to 14 units a week",{"id":2261,"data":2262,"type":54,"maxContentLevel":35,"version":24},"218faead-8010-4b99-ba80-a8c9b1e66b19",{"type":54,"intro":2263},[2264,2265],"How does smoking affect gut bacteria diversity?","What gut bacteria increase after quitting smoking?",[2267,2282,2287],{"id":2268,"data":2269,"type":24,"maxContentLevel":35,"version":24,"reviews":2272},"b33d989e-95f8-4103-a612-1680ab04af82",{"type":24,"markdownContent":2270,"audioMediaId":2271},"Smoking is one of the most damaging lifestyle habits for our gut microbiome. Studies have shown that smoking can reduce the diversity and abundance of beneficial bacteria in the gut, leading to an increased risk of inflammation and disease. Smoking also increases levels of harmful toxins such as cadmium which can damage cells in the digestive tract, impairing their ability to absorb nutrients from food.\n\nQuitting smoking has been linked with improved mental wellbeing, reduced stress levels and a healthier microbiome. Research suggests that quitting smoking may even reverse some of its negative effects on our gut health; within just two weeks after quitting, there was an increase in beneficial bacterial species such as Bifidobacterium and Lactobacillus which are important for digestion and immune function.\n","1ddafcbe-1ee8-4a71-87a5-85d01c48ca46",[2273],{"id":2274,"data":2275,"type":68,"version":24,"maxContentLevel":35},"d6039cbc-bdd1-476a-b649-bfce5cbe9aba",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2276,"binaryCorrect":2278,"binaryIncorrect":2280},[2277],"How does smoking negatively affect the gut microbiome?",[2279],"Increasing cadmium",[2281],"Increasing harmful bacteria such as H. Pylori",{"id":2283,"data":2284,"type":24,"maxContentLevel":35,"version":25},"7967b314-9965-4ae7-b4fb-903bb145ac54",{"type":24,"markdownContent":2285,"audioMediaId":2286},"\nIt’s never too late to quit smoking – if you’re looking for support, then consider joining a local stop-smoking group or speaking to your doctor about nicotine replacement therapy (NRT). There are also many online resources available including apps like Smokefree which provide tailored advice on how to quit successfully.\n\nLimiting alcohol consumption is another important part of maintaining a healthy microbiome. Alcohol can disrupt the delicate balance of bacteria in our gut, leading to dysbiosis and an increased risk of infection. Studies have shown that even moderate drinking can reduce levels of beneficial bacteria such as Bifidobacterium and Lactobacillus, while increasing levels of harmful toxins like acetaldehyde which can damage cells in the digestive tract.\n","8bcd048f-b770-4b7a-ac7d-815b737d2c70",{"id":2288,"data":2289,"type":24,"maxContentLevel":35,"version":24,"reviews":2292},"51e3fe34-80d7-41e9-89c9-df7c136844ab",{"type":24,"markdownContent":2290,"audioMediaId":2291},"\nHeavy drinking has been linked to inflammation, leaky gut syndrome and liver disease. It’s not all bad news though – research suggests that occasional light drinking may actually be beneficial for your microbiome; one study found that red wine drinkers had higher levels of Akkermansia muciniphila, a type of bacteria associated with improved metabolic health.\n\nHowever, it’s best to stick to recommended guidelines; no more than 14 units per week for men or women (equivalent to 6 pints/bottles beer or 10 small glasses wine). If you are concerned about your alcohol intake then speak to your doctor who will be able to provide advice on how best to manage it safely.\n","0db86462-acba-4c75-be96-3b1c60712365",[2293],{"id":2294,"data":2295,"type":68,"version":24,"maxContentLevel":35},"a7ebc4ff-11fc-435e-a659-5a5829ba119c",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2296,"multiChoiceCorrect":2298,"multiChoiceIncorrect":2300,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2297],"What is the recommended weekly alcohol limit for men and women?",[2299],"14 units",[2301,2302,2303],"16 units","12 units","10 units",{"id":2305,"data":2306,"type":27,"maxContentLevel":35,"version":35,"orbs":2309},"1f768fe3-2e0f-406c-a2bd-1a4d629395d2",{"type":27,"title":2307,"tagline":2308},"The Future of Gut Health","The state of gut health in the 21st century.",[2310,2361,2411,2473],{"id":2311,"data":2312,"type":25,"version":35,"maxContentLevel":35,"summaryPage":2313,"introPage":2321,"pages":2327},"9e22e45f-0d2a-4f32-a464-01f3d03effd3",{"type":25,"title":41},{"id":2314,"data":2315,"type":35,"maxContentLevel":35,"version":24},"c9a79ef1-9989-4e1f-8728-1ec7c6d8c920",{"type":35,"summary":2316},[2317,2318,2319,2320],"The study of gut microbiota now involves experts from many fields, not just microbiologists","DNA studies give a clearer picture of our microbiota than traditional methods","Swabbing newborns with vaginal microbiota can mimic the benefits of natural birth","Babies swabbed with vaginal microbes have gut microbiotas closer to their mothers'",{"id":2322,"data":2323,"type":54,"maxContentLevel":35,"version":24},"ffef142b-ecc4-4d11-bb57-04d0c5a56a4f",{"type":54,"intro":2324},[2325,2326],"How did DNA studies revolutionize our understanding of the microbiome?","What was the impact of swabbing C-section babies with vaginal microbiota?",[2328,2333,2356],{"id":2329,"data":2330,"type":24,"maxContentLevel":35,"version":25},"cf35dbcd-bf60-442a-aaa7-dd5b5c571ed2",{"type":24,"markdownContent":2331,"audioMediaId":2332},"We may have neglected our microbes until a few decades ago, but the study of human gut microbiota is an interdisciplinary field that has exploded in recent years. Research on gut microbes is no longer limited to microbiologists.\n\nThe microbiome has caught the attention of geneticists, evolutionary biologists, epidemiologists, gastroenterologists, nutritionists, endocrinologists, hepatologists, and even neuroscientists. Experts from these disciplines are becoming aware of the vast potential that our gut microbes hold for optimizing health and preventing or combating disease.","019e0e11-c0e5-4aab-8ddc-ac90d4665cb5",{"id":2334,"data":2335,"type":24,"maxContentLevel":35,"version":35,"reviews":2338},"481c4689-b333-4399-9b8a-c53ccd89c6ce",{"type":24,"markdownContent":2336,"audioMediaId":2337},"Historically, microbiology was limited to visualization techniques, like microscopy, and the culturing of microbes (in other words, growing them in isolation in a laboratory). Thanks to recent advances, microbiologists can now use DNA in addition to microscopy and culturing. DNA studies give a much more accurate understanding of our microbiota because we can see everything – not just what is grown in a lab.\n\nProfessor Rob Knight and his wife, fellow microbiologist Gloria Dominguez-Bello, came up with the idea of swabbing their new-born with microbiota from Dominguez-Bello’s vagina, when an emergency C-section left them with no possibility of having a natural birth. Knight had been involved in several research studies on the development of the infant gut microbiota at the University of Colorado in Boulder and was concerned that his daughter would be deprived of the health benefits associated with a vaginal delivery.","f01b9c4a-3b7a-467a-9ee2-e7ee2fd1715f",[2339,2349],{"id":2340,"data":2341,"type":68,"version":24,"maxContentLevel":35},"c112f4d0-7a88-4dc8-b08d-8f9ab71a6100",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2342,"multiChoiceCorrect":2344,"multiChoiceIncorrect":2345,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2343],"What has significantly improved the study of human gut microbiota in recent years?",[398],[2346,2347,2348],"Microscopy techniques","Culturing of microbes","Neuroscience advancements",{"id":2350,"data":2351,"type":68,"version":25,"maxContentLevel":35},"d2392ba7-ccd5-4e5a-bdfd-4357de9c9acb",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":2352,"clozeWords":2354},[2353],"Professer Rob Knight and his wife Gloria Dominguez-Bello are credited with pioneering the vaginal swab technique for improving children's microbiomes at birth.",[2355],"vaginal swab",{"id":2357,"data":2358,"type":24,"maxContentLevel":35,"version":25},"0e23998b-63dd-4b89-8148-205cb79c91d2",{"type":24,"markdownContent":2359,"audioMediaId":2360},"Since pioneering this experimental technique, the couple replicated it in a large clinical trial to establish whether transferring microbes from a woman’s vagina to her new-born might improve some of the short- and long-term effects of C-sections.\n\nThe intervention, while simple, is effective, and preliminary results showed that the inoculated babies had gut microbiotas that were far closer to their mothers’ microbiotas compared to babies delivered by C-section but not swabbed.","f8d28c7d-0d66-4c1a-b01f-0cceeb3f811b",{"id":2362,"data":2363,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2365,"introPage":2373,"pages":2379},"f0f9665c-6115-498d-82ea-6dba98dc18db",{"type":25,"title":2364},"Citizen Science and Gut Health",{"id":2366,"data":2367,"type":35,"maxContentLevel":35,"version":24},"2d35b2d4-d362-45e4-806a-52e21e63614f",{"type":35,"summary":2368},[2369,2370,2371,2372],"The American Gut Project analyzes stool samples to study gut bacteria and health","British Gut sends samples to the American Gut lab for analysis","The ZOE Project offers home test kits for personalized nutrition guidance","Advances in AI and machine learning have boosted personalized nutrition",{"id":2374,"data":2375,"type":54,"maxContentLevel":35,"version":24},"994cfca4-d478-4724-85f6-485c13e71afb",{"type":54,"intro":2376},[2377,2378],"What is the main goal of the ZOE Project?","How has artificial intelligence impacted personalized nutrition?",[2380,2397],{"id":2381,"data":2382,"type":24,"maxContentLevel":35,"version":25,"reviews":2385},"febbc1a3-bbd9-4bd7-98fd-94999578f2fb",{"type":24,"markdownContent":2383,"audioMediaId":2384},"Professor Rob Knight co-founded the world’s largest citizen science microbiome project in 2012. The American Gut Project is a crowd-sourced, open platform housed in the Knight laboratory at the University of Colorado. The team analyzes stool samples from people all around the world, to learn more about the species in our guts and their impact on our health. Human stool contains about 4,000 species of bacteria – making up an estimated 70% of its contents.\n\nA twin project, British Gut, was founded in the UK in 2014 by Professor Tim Spector – the genetic epidemiologist and author of The Diet Myth – to make the project accessible to people across the Atlantic. The samples collected by the British Gut Project are sent to the American Gut laboratory for analysis. All resulting data are open source and will form part of the Earth Microbiome Project, a 'collaborative international push to characterise microbial life on Earth.'","4858875b-0f41-4deb-9344-2bd4c41785e8",[2386],{"id":2387,"data":2388,"type":68,"version":24,"maxContentLevel":35},"343500cc-f1f4-4c94-ad50-7aab1774158f",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2389,"multiChoiceCorrect":2391,"multiChoiceIncorrect":2393,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2390],"What is the world's largest citizen science microbiome project?",[2392],"American Gut Project",[2394,2395,2396],"European Gut Project","Chinese Gut Project","Indian Gut Project",{"id":2398,"data":2399,"type":24,"maxContentLevel":35,"version":25,"reviews":2402},"87f0d7a3-1c2c-404a-a681-ae64d5cb384d",{"type":24,"markdownContent":2400,"audioMediaId":2401},"In the future, we are likely to continue to see large-scale projects based on massive datasets and the use of machine learning to expand on existing gut microbiota knowledge. Professor Tim Spector also co-founded the ZOE Project in Britain in 2018. The ZOE Project has developed a home test kit to track and analyze the gut, blood fat and blood sugar responses of individuals.\n\nThe idea is to provide personalized nutrition guidance to improve gut health and reduce inflammation – allowing for targeted, tailored interventions for individuals as opposed to a one-size-fits-all approach, and empowering people to take their health into their own hands.\n\nThe success of the project is multi-factorial: many people are frustrated with the medical system and the diet industry, self-monitoring technology is on the rise, and interest in personalization is growing.\n\nAccording to Spector, 'The quality of the genetic sequencing on your microbiome just wasn’t good enough, even three years ago, at an affordable price.' Thanks to the breakthrough in artificial intelligence and machine learning, personalized nutrition has taken off.","38e6a36a-8e03-4386-99fa-53523b7b2c97",[2403],{"id":2404,"data":2405,"type":68,"version":24,"maxContentLevel":35},"9919c638-88b9-45d7-904f-9ed0321a7e04",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2406,"multiChoiceCorrect":2408,"multiChoiceIncorrect":2410,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2407],"Which project, founded by Tim Spector, allows people to test their microbiomes from home?",[2409],"ZOE project",[2392,2395,2396],{"id":2412,"data":2413,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2415,"introPage":2423,"pages":2429},"15fecc5e-67f5-4c4c-841d-b588bb77b2ae",{"type":25,"title":2414},"Future Interventions in Gut Health",{"id":2416,"data":2417,"type":35,"maxContentLevel":35,"version":24},"701d541e-ff6e-4743-8268-290276daae9e",{"type":35,"summary":2418},[2419,2420,2421,2422],"Postbiotics are inanimate microorganisms or their components that benefit gut health","Phage therapy uses viruses to target harmful bacteria while sparing beneficial ones","Fecal microbiota transplantation (FMT) involves transferring fecal matter from a healthy donor to a recipient","FMT has over a 95% cure rate for recurrent C diff infections after two transplants",{"id":2424,"data":2425,"type":54,"maxContentLevel":35,"version":24},"de4b815a-bd6c-44a7-9ce4-147da36db632",{"type":54,"intro":2426},[2427,2428],"What makes bacteriophages different from antibiotics in targeting bacteria?","Why is fecal microbiota transplantation (FMT) considered highly effective for treating C. difficile infections?",[2430,2445,2460],{"id":2431,"data":2432,"type":24,"maxContentLevel":35,"version":25,"reviews":2435},"c85abc62-f8a1-49d2-b884-724f3c89082c",{"type":24,"markdownContent":2433,"audioMediaId":2434},"It’s likely that many future gut health interventions will focus on diet. The latest ‘biotics’ in the gut health sphere are postbiotics, which are 'a preparation of inanimate microorganisms and/or their components that confers a health benefit on the host.'\n\nThese are metabolites (the product of prebiotics metabolized in our guts by probiotics). In other words, they’re short-chain fatty acids. Food-based sources of postbiotics include fermented foods, which we discussed in 'How to optimize your gut health, part 1: Nutrition'. They can also be taken in supplement form.","b7b666fe-9f93-441d-b317-8ea58479e403",[2436],{"id":2437,"data":2438,"type":68,"version":24,"maxContentLevel":35},"647d6fb9-27f4-4ca7-8310-25d761a2e8af",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2439,"binaryCorrect":2441,"binaryIncorrect":2443},[2440],"What are postbiotics and how can they be obtained?",[2442],"Short-chain fatty acids derived from fermented foods or supplements",[2444],"Inanimate microorganisms found only in probiotic supplements",{"id":2446,"data":2447,"type":24,"maxContentLevel":35,"version":25,"reviews":2450},"aa022920-f2a4-4575-8210-688ce33eae93",{"type":24,"markdownContent":2448,"audioMediaId":2449},"Phage therapy is another new intervention in the gut health space. Phagocytes are the cells that destroy pathogens by engulfing and consuming them. Phage therapy involves the use of bacteriophages, which are a type of virus that infects bacteria (‘bacteriophage’ literally means ‘bacteria eater’).\n\nThese phages are known for being selective in the bacteria they target, making them particularly useful for targeting harmful bacteria and leaving beneficial bacteria intact – unlike antibiotics, which tend to eliminate the good bacteria along with the bad.","38eb7a86-2885-4839-9535-6f7fb74e00df",[2451],{"id":2452,"data":2453,"type":68,"version":24,"maxContentLevel":35},"a6a8d715-f13d-41ee-9349-3e7974045c69",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2454,"binaryCorrect":2456,"binaryIncorrect":2458},[2455],"How does phage therapy intervene in the gut microbiome?",[2457],"By using viruses to infect bacteria",[2459],"By using antibiotics to kill bacteria",{"id":2461,"data":2462,"type":24,"maxContentLevel":35,"version":25,"reviews":2465},"6cfa9219-e448-4d51-8f78-f1ad776348ae",{"type":24,"markdownContent":2463,"audioMediaId":2464},"Fecal microbiota transplantation, or FMT, involves 'the administration of a solution of a fecal suspension from a healthy donor into the intestinal tract of a recipient.' It’s a simple but effective procedure that has shown great promise, particularly where harmful, antibiotic-resistant bacteria such as H. pylori or C. difficile are present in the guts of recipients.\n\nAlanna Collen offers the following compelling argument for FMT:\n\n'Treating recurrent C. diff infections with antibiotics has about a 30% cure rate. Over a million people are infected each year, and tens of thousands die. But treating C. diff with a single faecal transplant has a greater than 80% cure rate. For those who relapse after the first transplant \\[…\\], a second transplant brings the cure rate up to over 95 per cent. It’s hard to think of any other life-threatening disease that can be treated in a single non-surgical procedure, without the need for drugs, at a cost of just a few hundred dollars, with such a high success rate.'","a47b2362-0f00-4618-b6a4-2599e1851d7f",[2466],{"id":2467,"data":2468,"type":68,"version":24,"maxContentLevel":35},"57e2e580-5624-47c8-ad4b-af945f1ecf25",{"type":68,"reviewType":42,"spacingBehaviour":24,"clozeQuestion":2469,"clozeWords":2471},[2470],"FMT involves the administration of a solution of a fecal suspension from a healthy donor into the intestinal tract of a recipient.",[2472],"fecal suspension",{"id":2474,"data":2475,"type":25,"version":35,"maxContentLevel":35,"summaryPage":2477,"introPage":2485,"pages":2491},"e858e541-34fd-4bae-ad9f-2fc2b157054c",{"type":25,"title":2476},"Bioinformatics and Gut Health",{"id":2478,"data":2479,"type":35,"maxContentLevel":35,"version":24},"46e54fde-5da1-4254-8d0b-ae3bfefcf3d3",{"type":35,"summary":2480},[2481,2482,2483,2484],"Bioinformatics helps scientists analyze and visualize the gut microbiome","Stanford's Center for Human Microbiome Studies connects researchers to study gut health","More clinical trials on humans are needed to understand gut microbes and health","Narrow-spectrum antibiotics are better for gut health than broad-spectrum ones",{"id":2486,"data":2487,"type":54,"maxContentLevel":35,"version":24},"967ee732-ffee-4e6c-b974-f17a7f8452df",{"type":54,"intro":2488},[2489,2490],"How did scientists first discover penicillin?","What was the process used to isolate penicillin for medical use?",[2492,2507,2512,2540],{"id":2493,"data":2494,"type":24,"maxContentLevel":35,"version":25,"reviews":2497},"29b5d747-be7d-41f4-b051-f2ff971f8437",{"type":24,"markdownContent":2495,"audioMediaId":2496},"‘Bioinformatics’ is the science of collecting and analyzing complex biological data such as genetic codes. Thanks to bioinformatics platforms, scientists can analyze data and visualize the composition of the gut microbiome. Stanford University’s Center for Human Microbiome Studies focuses on connecting scientists from different disciplines and leveraging technology to harness the biomedical potential of our microbiota.\n\nThe Center’s goals are to fund scientific studies focused on the connections between the microbiome and human health and disease; provide resources to include the microbiome in existing or planned studies; bring together a collaborative, multi-disciplinary network of researchers to study the microbiome; and translate findings to inform medical practice, provide therapy, and inform dietary and lifestyle habits.","ab219efc-268a-4abc-8348-92d453517252",[2498],{"id":2499,"data":2500,"type":68,"version":24,"maxContentLevel":35},"0a5d71da-0b74-48e6-85f0-a4c769fbbdba",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2501,"binaryCorrect":2503,"binaryIncorrect":2505},[2502],"What term describes the science of collecting and analyzing complex biological data?",[2504],"Bioinformatics",[2506],"Microbiology",{"id":2508,"data":2509,"type":24,"maxContentLevel":35,"version":25},"383170bc-2d56-4704-8948-434d9454ea45",{"type":24,"markdownContent":2510,"audioMediaId":2511},"Current research conducted by the Center includes genetic engineering of bacteria to heal the gut and understanding the health impact of microbiome changes that have occurred with industrialization. Given the huge interest in the field of gut health and the wide range of disciplines that can benefit from further research into the microbiota, information and knowledge sharing will become even more important in the future.\n\nWe are already seeing this happen in the context of large-scale citizen science projects. However, some researchers have pointed out one major gap in the study of the gut microbiome: many of the studies that have been conducted to date are in the pre-clinical phase, and challenges arise when we move from animal to human models, due to differences in biology.","8c27cf4b-b506-47ab-ab34-7559d6329690",{"id":2513,"data":2514,"type":24,"maxContentLevel":35,"version":35,"reviews":2517},"8271f581-f5c2-45ec-a002-6b1dfbc6d971",{"type":24,"markdownContent":2515,"audioMediaId":2516},"For better understanding of the link between gut microbes and human health, we need more clinical trials (i.e. trials conducted on humans rather than animals). Researchers have also suggested that we need a gold standard of testing, at least double-blind, with bigger cohorts of subjects. \n\nIn Missing Microbes, Martin Blaser offers several solutions to improve gut health and reduce our over-reliance on antibiotics. He highlights the need to develop new types of antibiotics to combat antibiotic resistance, urges patients and doctors alike to use antibiotics judiciously, and stresses the need for better diagnostic tools to be made available to doctors. This, he claims, should prevent doctors from prescribing antibiotics when it isn’t clear whether an infection has a bacterial or viral origin.","87ae34c4-8d82-4458-92e6-19bc0bbba3ac",[2518,2529],{"id":2519,"data":2520,"type":68,"version":24,"maxContentLevel":35},"16953c0a-ab91-4761-b07b-6389f9936bb2",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2521,"multiChoiceCorrect":2523,"multiChoiceIncorrect":2525,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2522],"What is a major gap in the study of the gut microbiome?",[2524],"More clinical trials on humans are needed",[2526,2527,2528],"Lack of interest in the field","Too many animal studies","No need for a gold standard of testing",{"id":2530,"data":2531,"type":68,"version":24,"maxContentLevel":35},"a531740e-c779-4dbc-865c-8ff36b5a4773",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2532,"multiChoiceCorrect":2534,"multiChoiceIncorrect":2536,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2533],"Martin Blaser advises against antibiotics in situations where...",[2535],"It could be bacterial or viral",[2537,2538,2539],"It isn't life-threatening","There are natural alternatives","It's clearly a bacterial infection, but a mild one",{"id":2541,"data":2542,"type":24,"maxContentLevel":35,"version":25,"reviews":2545},"444d15b9-ae3a-45d5-a0f5-fef07a471398",{"type":24,"markdownContent":2543,"audioMediaId":2544},"In cases where antibiotics are absolutely necessary, Blaser says narrow-spectrum antibiotics should be favored over broad-spectrum antibiotics, which cause more collateral damage among beneficial communities of gut microbes. While these are more expensive to develop, Blaser notes that it’s better to pay upfront than down the line with an expensive, chronic illness. This sentiment of ‘prevention is better than cure’ is echoed by Alanna Collen in 10% Human.\n\nThe interaction between the gut, microbiome and brain is described by some as the ‘final frontier’ in gut health research. Nutritional psychiatry is a relatively new field based on the notion that the food we eat impacts how we feel emotionally. Some individuals are interested in finding complementary treatments, such as so-called ‘food mood’ interventions (now known as ‘psychobiotics’), in addition to western medicine, in an effort to improve their mood and anxiety.\n\nScientists are pioneering innovative methods of studying the interplay between gut health and mental health. For instance, Dr. Emma Allen-Vercoe, has developed a crude model she calls ‘Robogut’ – an oxygen-free culture chamber designed to emulate the human gut. Therapies such as vagal nerve stimulation for the treatment of common psychiatric disorders like depression and anxiety are also gaining ground. One thing’s for sure though: interest in the human gut microbiome is here to stay.","707839da-475e-4fa4-b0a8-1bd7080adce4",[2546],{"id":2547,"data":2548,"type":68,"version":24,"maxContentLevel":35},"dfe51f2e-e029-4e56-a0de-eaf6ac50f0a7",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2549,"binaryCorrect":2551,"binaryIncorrect":2553},[2550],"What is the term used to describe interventions that focus on the impact of food on mood and mental health?",[2552],"Psychobiotics",[2554],"Nutritional neuroscience",{"id":2556,"data":2557,"type":27,"maxContentLevel":35,"version":35,"orbs":2560},"8df489b3-e180-4177-9f44-70cae8db21c8",{"type":27,"title":2558,"tagline":2559},"Penicillin","The first antibiotic, and its game-changing effect on our microbiomes.",[2561,2636,2703],{"id":2562,"data":2563,"type":25,"version":35,"maxContentLevel":35,"summaryPage":2565,"introPage":2573,"pages":2579},"64a5fc42-7d9f-4dd0-89c4-0f002ced3fba",{"type":25,"title":2564},"Discovery and Early Development of Penicillin",{"id":2566,"data":2567,"type":35,"maxContentLevel":35,"version":24},"c14a4ddd-3496-47ae-aa59-fba2e1d7659b",{"type":35,"summary":2568},[2569,2570,2571,2572],"Alexander Fleming discovered penicillin in 1928 when a mold killed his staphylococcus bacteria","Fleming named the mold penicillin but couldn't purify it","In 1939, the Oxford team purified penicillin and tested it on mice","The first human treated with penicillin in 1941 showed improvement but died when supplies ran out",{"id":2574,"data":2575,"type":54,"maxContentLevel":35,"version":24},"7435a078-5282-4ca8-9293-0fada3d638a8",{"type":54,"intro":2576},[2577,2578],"Why did the Oxford team turn to the US for help with penicillin?","What was the impact of penicillin on early patients?",[2580,2585,2602,2619],{"id":2581,"data":2582,"type":24,"maxContentLevel":35,"version":35},"5cbeda4f-f295-4647-b04b-d2c61da03cc9",{"type":24,"markdownContent":2583,"audioMediaId":2584},"It has been almost 100 years since the discovery of penicillin and, to this day, its profound impact in medicine and the fight against diseases is indisputable. According to British hematologist Gwyn Macfarlane, the discovery of penicillin was a 'series of chance events of almost unbelievable improbability.'\n\nIn 1928, Alexander Fleming, a Scottish physician and microbiologist at St. Mary’s Hospital in London, returned to his laboratory after being away on holiday to find that one of his *staphylococcus* bacteria cultures had been overgrown by a fungus in the petri dish. Rumor has it that he was quite disorganized and messy. What’s more, he noticed that the staphylococcus colonies close to the fungus had died, whereas the ones further away had survived.","f6be4777-1fc4-4bff-a331-0e0beea78a66",{"id":2586,"data":2587,"type":24,"maxContentLevel":35,"version":25,"reviews":2590},"4dcec91e-0cd0-4d29-9bb0-156846178460",{"type":24,"markdownContent":2588,"audioMediaId":2589},"Fleming isolated the mold and, upon examination, identified that it belonged to the *Penicillium* genus, hence the name *penicillin*. Fleming determined that penicillin had an anti-bacterial effect on staphylococci and other gram-positive bacteria (bacteria that give a positive result in the Gram stain test which classifies bacteria according to their cell wall type) and published his findings in 1929.\n\n![Graph](image://b18074c5-78e4-4507-99c3-04256861b4c8 \"Alexander Fleming. Image: Official photographer, Public domain, via Wikimedia Commons\")\n\nWhile Alexander Fleming made the monumental discovery of penicillin in 1928, he was unsuccessful in his efforts to purify the unstable compound from the extract of the mold, and, for about a decade, no progress was made. In the hope of making headway, Fleming sent samples of his *penicillium* mold to anyone who was interested; one of those samples had been sent to, and saved at, Oxford University.","e02f400e-1582-4707-8282-988c7de3cfc1",[2591],{"id":1381,"data":2592,"type":68,"version":24,"maxContentLevel":35},{"type":68,"reviewType":35,"spacingBehaviour":24,"collapsingSiblings":2593,"multiChoiceQuestion":2594,"multiChoiceCorrect":2596,"multiChoiceIncorrect":2597,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6,"matchPairsQuestion":2598,"matchPairsPairs":2599},[1376,1379,1380],[2595],"Which of the following best describes Gram-positive?",[1389],[1385,1387,1388],[175],[2600],{"left":2601,"right":1389,"direction":35},"Gram-positive",{"id":2603,"data":2604,"type":24,"maxContentLevel":35,"version":35,"reviews":2607},"6e8ddfbc-9082-4080-bb0d-ff33838dc9db",{"type":24,"markdownContent":2605,"audioMediaId":2606},"In 1939, pathologist Howard Florey, fungal expert Norman Heatley, and biochemist Ernst Chain successfully purified penicillin and began experiments on mice. The results were so astonishing that, in 1940, the researchers published their findings in *The Lancet* – one of the world's oldest and best-known general medical journals. The published article explained how experimental use of penicillin had been potent enough to treat mice that had been infected with *staphylococcus aureus, streptococcus pyogenes*, and *Clostridium septique*.\n\nIn 1945, Alexander Fleming, Howard Florey and Ernst Chain were awarded the Nobel Prize for Medicine and Physiology. The researchers at Oxford University – known as the Oxford team – had been successful in their penicillin experiments on mice and had purified enough amounts of the drug to start testing its clinical effectiveness in humans.","959f9abf-e7e5-4b06-9edc-a729d209ea71",[2608],{"id":2609,"data":2610,"type":68,"version":25,"maxContentLevel":35},"44d9cb86-85ee-46be-a413-b7cf0d20ef6d",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2611,"multiChoiceCorrect":2613,"multiChoiceIncorrect":2615,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2612],"What year was penicillin successfully purified?",[2614],"1939",[2616,2617,2618],"1839","1739","1639",{"id":2620,"data":2621,"type":24,"maxContentLevel":35,"version":25,"reviews":2624},"e4b95103-715a-44e0-83b9-009289ff357f",{"type":24,"markdownContent":2622,"audioMediaId":2623},"The first patient to receive penicillin treatment was an Oxford policeman in 1941, who was exhibiting signs of a serious infection with abscesses all over his body. His improvement over 24hrs was remarkable, but the supplies of purified penicillin ran out before he had a chance to fully recover, and he died a few weeks later.\n\nHowever, other patients with less advanced infections received the drug and recovered successfully. The Oxford team quickly realized that they had to find a way to mass produce penicillin. As the British pharmaceutical industry was fully engaged in the WWII effort, Florey and his colleagues decided to turn to the US for assistance.","29afe817-98b9-4d94-a2f6-e3e8389f1d34",[2625],{"id":2626,"data":2627,"type":68,"version":24,"maxContentLevel":35},"55144151-1be9-4f22-bdab-f8973fd85263",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2628,"multiChoiceCorrect":2630,"multiChoiceIncorrect":2632,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2629],"What was the first step taken by the Oxford team after observing the success of penicillin treatment in humans?",[2631],"Seeking assistance from the US to mass produce penicillin",[2633,2634,2635],"Continuing experiments on mice","Focusing on the British pharmaceutical industry","Waiting for more purified penicillin supplies",{"id":2637,"data":2638,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2640,"introPage":2648,"pages":2654},"66e3d85f-25fd-4cf1-b6b8-d8437ca38a5f",{"type":25,"title":2639},"Mass Production and the Antibiotic Era",{"id":2641,"data":2642,"type":35,"maxContentLevel":35,"version":24},"3cdd1ac5-e80e-4c13-8465-1c64c36858b2",{"type":35,"summary":2643},[2644,2645,2646,2647],"The Oxford team turned to the US to mass-produce penicillin before WWII","The US ramped up penicillin production after entering WWII in 1941","Penicillin kills bacteria, while antibiotics like erythromycin stop bacteria from growing","The discovery of penicillin in 1928 kicked off the antibiotic era, transforming medicine",{"id":2649,"data":2650,"type":54,"maxContentLevel":35,"version":24},"d54a9682-a5f3-4fa6-b2c1-9114e064f50c",{"type":54,"intro":2651},[2652,2653],"How do bactericidal antibiotics affect bacteria?","Why is antibiotic resistance a growing concern?",[2655,2672,2686],{"id":2656,"data":2657,"type":24,"maxContentLevel":35,"version":25,"reviews":2660},"7438a6cf-b7e0-4fb2-b70d-dad56c440b27",{"type":24,"markdownContent":2658,"audioMediaId":2659},"The Oxford team of researchers that had been successful in isolating purified penicillin from mold decided to turn to the U.S. for help in finding a way to mass-produce the drug. As the USA still wasn’t involved in WWII, Florey and Heatley were hopeful they would be able to interest the American pharmaceutical industry in assisting with the production of penicillin on a large scale.\n\nTheir evidence on the drug’s ability to treat infection was so substantial that the U.S. Office of Scientific Research and Development agreed to participate in the increased production of penicillin.","1227dddb-6790-4f31-bd9e-cd6d59b1d12c",[2661],{"id":2662,"data":2663,"type":68,"version":24,"maxContentLevel":35},"7b358ad1-86af-4c45-97c5-ee05eabeda5a",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2664,"multiChoiceCorrect":2666,"multiChoiceIncorrect":2668,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2665],"Where did the team from Oxford go to try to mass-produce antibiotics?",[2667],"The USA",[2669,2670,2671],"Germany","France","Japan",{"id":2673,"data":2674,"type":24,"maxContentLevel":35,"version":25,"reviews":2677},"6c66f664-bde3-46d0-93df-1283d0b11007",{"type":24,"markdownContent":2675,"audioMediaId":2676},"In December 1941, Japan attacked Pearl Harbor and the United States entered WWII, making the need for large supplies of penicillin even more urgent, and the USA took over all production of the drug. By 1943, due to unprecedented collaboration between Britain and the USA, enough quantities of penicillin were being produced to satisfy the demands of the Allied Armed Forces, saving thousands of soldiers’ lives.\n\nAntibiotics are classified in 2 categories: those that act as *bactericidal agents*, causing bacteria cell death, and those that act as *bacteriostatic agents*, restricting growth and reproduction of bacteria.","fb85a7f2-f726-4258-95fd-c865b9631e88",[2678],{"id":2679,"data":2680,"type":68,"version":24,"maxContentLevel":35},"c3ff44a4-bcdd-4c90-ba71-3e53dcfd860d",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":2681,"activeRecallAnswers":2683},[2682],"What are the two categories of antibiotics and their respective functions?",[2684,2685],"Bactericidal agents, which cause bacteria cell death","Bacteriostatic agents, which restrict bacteria growth and reproduction",{"id":2687,"data":2688,"type":24,"maxContentLevel":35,"version":25,"reviews":2691},"6f65cec3-8339-4dcb-8379-c25f717c4084",{"type":24,"markdownContent":2689,"audioMediaId":2690},"Penicillin and penicillin-derived antibiotics such as amoxicillin, belong to the first category and treat infections such as tonsillitis and bacterial pneumonia. Antibiotics such as erythromycin belong in the second category and prevent the further growth of bacterial infections, including acne and chlamydia. Alexander Fleming’s discovery of penicillin in 1928 marked the beginning of the antibiotic era and changed the medical landscape forever.\n\nAccording to Stephen Whitehead, chief executive of the Association of British Pharmaceutical Industry, 'without antibiotics, modern medicine as we know it would be unrecognizable.' The discovery of penicillin also changed the process of drug discovery and transformed the pharmaceutical industry. The so-called ‘golden era’ of antibiotics lasted until the late 1950s, during which most of the antibiotic classes we use today were discovered and introduced to the market.","5de8883f-6936-4478-913c-ed81b40ce2bf",[2692],{"id":2693,"data":2694,"type":68,"version":24,"maxContentLevel":35},"c5689335-165d-405c-9e55-471508cfeafc",{"type":68,"reviewType":35,"spacingBehaviour":24,"multiChoiceQuestion":2695,"multiChoiceCorrect":2697,"multiChoiceIncorrect":2699,"multiChoiceMultiSelect":6,"multiChoiceRevealAnswerOption":6},[2696],"Which of these is an example of a penicillin-derived antibiotic?",[2698],"Amoxicillin",[2700,2701,2702],"Erythromycin","Doxycycline","Lymecycline",{"id":2704,"data":2705,"type":25,"version":25,"maxContentLevel":35,"summaryPage":2707,"introPage":2715,"pages":2719},"bdfe4998-791b-4fb8-b222-d54ceb6034ac",{"type":25,"title":2706},"Antibiotics and the Human Body",{"id":2708,"data":2709,"type":35,"maxContentLevel":35,"version":24},"a10c52aa-bce6-4aff-b68e-a7d27f742fbc",{"type":35,"summary":2710},[2711,2712,2713,2714],"The human gut microbiome is a collection of microbes that protect us against disease","Antibiotics can cause gut dysbiosis, leading to infections and immune issues","Overuse of antibiotics has led to antibiotic resistance, making diseases harder to treat","The World Health Organization warns that new antibiotics are urgently needed, but overuse will make them ineffective too",{"id":2716,"data":2717,"type":54,"maxContentLevel":35,"version":24},"990a6726-db4b-4c35-a2d7-1ef9fb85026a",{"type":54,"intro":2718},[2652,2653],[2720,2736,2751],{"id":2721,"data":2722,"type":24,"maxContentLevel":35,"version":25,"reviews":2725},"d3ec7db1-badd-461e-8676-aab5f45307ed",{"type":24,"markdownContent":2723,"audioMediaId":2724},"The human gut microbiome is the collection of all microbes, such as bacteria, fungi and viruses that naturally live inside us. These microbes protect us against pathogens that cause disease and influence how our immune system develops. As a result, changes in the gut microbiome can affect how the body responds to disease.\n\nStudies have shown that antibiotics can cause a significant decrease in the bacterial diversity found in the gut and alter the microbiome causing gut dysbiosis, i.e. an imbalance of the bacteria and microbes in the gut. This can lead to a multitude of complications, from infections such as *Clostridioides difficile*, which causes diarrhea, to the dysregulation of immune responses and, thus, bringing on new conditions including asthma and food intolerances.","4c742424-8846-4045-bb74-c57fee1c44b3",[2726],{"id":2727,"data":2728,"type":68,"version":24,"maxContentLevel":35},"da58389a-4017-4d1b-9ae1-5a95757c3aea",{"type":68,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":2729,"activeRecallAnswers":2731},[2730],"What complications can gut dysbiosis lead to?",[2732,2733,2734,2735],"Infections","Immune dysregulation","Asthma","Food intolerances",{"id":2737,"data":2738,"type":24,"maxContentLevel":35,"version":25,"reviews":2741},"57ed49f7-5c87-4147-b0ae-256a8bc0442e",{"type":24,"markdownContent":2739,"audioMediaId":2740},"In 1940 Edward Abraham and Ernst Chain reported that an *E.coli* strain was able to inactivate penicillin by producing an active enzyme called *penicillinase*, while, in 1945, Alexander Fleming predicted that the high demand for antibiotics would introduce an 'era of abuse.' Once penicillin became available by prescription, the antibiotic started to be overused and Fleming’s prediction became a reality.\n\n![Graph](image://dacb19fd-947d-49be-8422-490950236139 \"E. coli bacteria. Image: Public domain via Wikimedia\")\n\nSince then, studies have proved the correlation between increased antibiotic use and the emergence of resistance, with each new generation of antibiotics following the same trend. To survive, germs that cause infections develop defense strategies against antibiotics called resistance mechanisms. These *resistance mechanisms* include changing or even destroying the antibiotic with enzymes that break down the drug. As a result, diseases are becoming harder or even impossible to treat.","27dde480-a061-4c4a-b393-4e74e66afa51",[2742],{"id":2743,"data":2744,"type":68,"version":24,"maxContentLevel":35},"da3ff568-d38f-4f6e-91f2-1687a018a4e7",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2745,"binaryCorrect":2747,"binaryIncorrect":2749},[2746],"What did Edward Abraham and Ernst Chain discover about E.coli in 1940?",[2748],"It could inactivate penicillin by producing penicillinase",[2750],"It could produce penicillin as a defense mechanism",{"id":2752,"data":2753,"type":24,"maxContentLevel":35,"version":25,"reviews":2756},"98fe399e-b354-4199-aaf1-f027208fba38",{"type":24,"markdownContent":2754,"audioMediaId":2755},"Antibiotic resistance is also known as *antimicrobial resistance* or *AMR*. The World Health Organization has declared that AMR is one of the top 10 global public health threats facing humanity today, with certain infections such as pneumonia and TB becoming increasingly harder to treat. According to The World Health Organization, new antibiotics are urgently needed but the clinical pipeline is limited; only 32 antibiotics addressing The World Health Organization’s list of priority pathogens were identified in clinical development in 2019, of which only 6 were classified as innovative.\n\nHowever, if current practices in how antibiotics are prescribed and used don’t improve, any new drugs developed will also eventually become ineffective. Research into the human gut microbiome – the community of helpful bacteria that reside within our digestive systems – has also begun to show the dangers of overuse of antibiotics. In particular, over prescription of ‘broad-spectrum’ antibiotics that indiscriminately eradicate both bad *and* good bacteria within us.","6c4fb148-6c31-49f8-a985-7834b7581263",[2757],{"id":2758,"data":2759,"type":68,"version":24,"maxContentLevel":35},"a9b29a9e-956f-4fde-b9c6-3d08ebaa1b3c",{"type":68,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":2760,"binaryCorrect":2762,"binaryIncorrect":2764},[2761],"Which of these is an accurate statement about antimicrobial resistance?",[2763],"One of the ten biggest public health threats according to WHO",[2765],"No longer considered a threat thanks to newer-generation antibiotics",{"left":4,"top":4,"width":2767,"height":2767,"rotate":4,"vFlip":6,"hFlip":6,"body":2768},24,"\u003Cpath fill=\"none\" stroke=\"currentColor\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\" d=\"m9 18l6-6l-6-6\"/>",{"left":4,"top":4,"width":2767,"height":2767,"rotate":4,"vFlip":6,"hFlip":6,"body":2770},"\u003Cg fill=\"none\" stroke=\"currentColor\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\">\u003Cpath d=\"M12.586 2.586A2 2 0 0 0 11.172 2H4a2 2 0 0 0-2 2v7.172a2 2 0 0 0 .586 1.414l8.704 8.704a2.426 2.426 0 0 0 3.42 0l6.58-6.58a2.426 2.426 0 0 0 0-3.42z\"/>\u003Ccircle cx=\"7.5\" cy=\"7.5\" r=\".5\" fill=\"currentColor\"/>\u003C/g>",1778228397234]