Melatonin has evolved from being considered merely the “sleep hormone” to a systemic modulator with significant effects on cardiovascular, metabolic, immune, and cognitive health. Recently, some controversy arose following the publication of preliminary observational data suggesting a possible association between long-term melatonin use and an increased risk of heart failure.

However, a critical review and detailed analysis of the information published by the American Heart Association (AHA) indicate that these types of studies do not establish a causal relationship and have important limitations. This is because they rely on large population databases and lack control over key factors such as dosage, duration of use, comorbidities, and participants’ sleep quality. These limitations reduce the clinical relevance of the findings, which should be interpreted as hypothesis-generating rather than definitive conclusions. For this reason, at Neolife we aim to share, with scientific rigor, the beneficial properties of melatonin beyond its role in regulating the circadian rhythm.

Dr. Sánchez – Neolife Medical Team

Beyond Sleep: A Key Molecule in Global Homeostasis

To date, no randomized clinical trials have confirmed any direct adverse effect of melatonin on the cardiovascular system. On the contrary, improving sleep quality—one of its main functions—helps reduce the risk of hypertension, diabetes, inflammation, and cardiovascular mortality.

What we do know about melatonin is that it shortens sleep latency and improves overall sleep quality, particularly in cases of sleep-onset insomnia. Moreover, it has a clear antioxidant effect and acts as an immune regulator with potential neuroprotective properties. And, importantly, it has a superior safety profile compared to benzodiazepines—melatonin does not cause dependence or cognitive impairment.

In recent years, melatonin has been found to play a fundamental role in maintaining the balance of the gut microbiome, opening up new therapeutic perspectives. It is now known that the gut contains concentrations of melatonin up to 400 times higher than those found in the brain. Melatonin is not only produced in the pineal gland but also in the gastrointestinal tract, where it acts locally on enteric receptors to modulate motility, immunity, and intestinal permeability.
This production occurs through intestinal bacteria, which can influence the conversion of tryptophan into serotonin—and subsequently into melatonin—directly affecting both its systemic production and function. This explains why patients with dysbiosis (an imbalance in the gut flora) often experience sleep disturbances, circadian rhythm alterations, and mood disorders.
Melatonin promotes the growth and maintenance of beneficial bacteria such as Lactobacillus and Bifidobacterium, while reducing pro-inflammatory species (LPS-producing bacteria), thus promoting a state of eubiosis (microbial balance). This activity helps reduce intestinal inflammation, improve mucosal integrity, and enhance immune response.

Melatonin is the only hormone with antioxidant properties, and its interaction with the microbiota reduces oxidative stress and inflammatory markers (TNF-alpha, IL-6), improving insulin sensitivity, lipid metabolism, and neuroendocrine regulation through the gut–brain axis.

Multiple studies suggest potential benefits of melatonin as an adjunct treatment in irritable bowel syndrome, stress- or antibiotic-induced dysbiosis, metabolic diseases (such as insulin resistance and obesity), and neurodegenerative disorders including Parkinson’s and Alzheimer’s.

Paradoxically, the same mechanisms that some observational studies have linked to cardiovascular harm are, in fact, those that protect the endothelium and reduce systemic inflammation, as supported by physiological evidence. Through its antioxidant action and its influence on the gut microbiome, melatonin reduces lipid peroxidation, enhances mitochondrial function (ATP production, i.e., energy), promotes a healthier lipid profile, regulates blood pressure and heart rate variability, and modulates the autonomic balance between the sympathetic and parasympathetic systems (vagal tone).

The bidirectional interaction between melatonin and the microbiome is emerging as an essential mechanism in the regulation of multiple physiological functions. Modulating this axis represents a promising therapeutic pathway in inflammatory, metabolic, and neurological disorders.

In this context, melatonin transcends its traditional role as a sleep regulator—it acts as a global modulator of the circadian–immune–microbial axis, with far-reaching effects on cardiovascular, metabolic, and neuroendocrine health.

Taken together, melatonin’s overall impact on the body is protective and homeostatic, especially when dosing and treatment are personalized by healthcare professionals.
At Neolife, the regulation of the circadian rhythm and quality sleep are considered fundamental pillars of treatment, with proven benefits for our patients’ well-being. We know that melatonin supplementation can help restore gut ecosystem balance (eubiosis) and serve as an adjunct therapy in conditions such as irritable bowel syndrome, stress-induced dysbiosis, and certain metabolic or neurodegenerative diseases.

The current clinical challenge lies in personalizing its use, adapting it to each individual’s age, chronotype, gut microbiome status, comorbidities, and clinical goals. While we await further research, current evidence supports a rational, safe, and medically supervised use of melatonin within a comprehensive, integrative approach to overall health and healthy longevity.

BIBLIOGRAPHY

(1) Iesanu, M. I., Zahiu, C. D. M., Dogaru, I.-A., Chitimus, D. M., Pircalabioru, G. G., Voiculescu, S. E., Isac, S., Galos, F., Pavel, B., O’Mahony, S. M., & Zagrean, A.-M. (2022). Melatonin–Microbiome Two-Sided Interaction in Dysbiosis-Associated Conditions. Antioxidants, 11(11), 2244. https://doi.org/10.3390/antiox11112244

(2) American Heart Association. Long-term use of melatonin supplements to support sleep may have negative health effects. News release, 3 Nov 2025.

La entrada Melatonin: from sleep to the gut-brain-heart axis se publicó primero en Neolife.

We live in mutualistic symbiosis with these microorganisms that inhabit our gut; we need each other.

Having a healthy microbiota is vital for our mental health, weight and appetite control, rest, lowering our cardiovascular risk, lowering our risk of developing diabetes, lowering our risk of developing cancer, having a proper immunity, preventing the development of autoimmune diseases, intolerances, allergies, migraine, diarrhea, constipation and abdominal pain, infertility, etc…

Dr. Alfonso Galán González – Neolife Medical Team

The microbiota is of utmost importance to our immune system.

You may know it as gut microbiota, microbiome, or gut flora in more colloquial terms. By now, we all know that we have healthy bacteria in our intestine that live with us and provide beneficial effects to our bodies. But do you really know how important they are? Did you know that changes in our microbiota are linked to pathologies? Did you know that we can study it…and repair it?

We also have microbiota in our skin and mucous membranes in physiological terms (except for the conjunctiva of the eye, which is sterile by definition). Approximately 80% of our immune system cells are in the gut and communicate via blood and lymph with the rest of the body.

Our gut microbiota accompanies us from the moment we are born (some studies now suggest that the amniotic fluid in which we swim before birth already carries bacteria that begin to populate our gut). As we pass through the birth canal, lay on our mother’s breast, receive kisses from family members, and suckle for the first time, we receive bacteria that colonize our gut. Our flora matures during the first 4-5 years of life, as we are exposed to different environments and foods.

Symbiosis and health

We live in mutualistic symbiosis with these microorganisms; we need each other. And we say microorganisms because they are not only bacteria, but also fungi and yeasts, viruses, protozoa, and archaea.

Some interesting facts:

• We have 100 trillion bacteria in our gut. This is 10 times more than the number of cells in the entire body!
• We have more than 1000 different species of bacteria.
• About 2 kg of our body weight is comprised of microbiota.
• They make up 48% of the weight of our stool.
• Our body is comprised of 21% protein, and we are not able to synthesize many amino acids (the components of proteins), but our microbiota can.
• More than 30% of the substances circulating in our blood are produced by the microbiota.

Our microbiota need multi-species communities to live and complete their metabolic capacity to degrade nutrients, obtain energy, and synthesize essential compounds for the community.

Having a healthy microbiota is vital for our mental health, weight and appetite control, rest, lowering our cardiovascular risk, lowering our risk of developing diabetes, lowering our risk of developing cancer, having a proper immunity, preventing the development of autoimmune diseases, intolerances, allergies, migraine, diarrhea, constipation and abdominal pain, infertility, etc…

I hope I got your attention with this last paragraph. Everything it says has been rigorously and scientifically proven, and, as always, we will get into it in greater detail.

The microbiota is of utmost importance to our immune system; 80% of our immune system cells are in the gut and communicate via blood and lymph with the rest of the body. It influences the maturation and correct functioning of our immune system by “training” it continuously and teaching it what to attack and what not to attack.

It constitutes a physical and biochemical barrier to prevent the entry of pathogens. If our microbiota is not in balance, we enter into what we call dysbiosis which leads to inflammation and disease.

It behaves like a real “second brain”. The enteric nervous system contains as many neurons as our medulla. Sixty percent of the information that reaches our brain comes from our gut, and it produces neurotransmitters in even greater quantities than the central nervous system (CNS). With our CNS, it is permanently in communication through these neurotransmitters, the hypothalamic-pituitary-adrenal axis (which we covered here), the bacterial metabolites, and cytokines secreted, etc… Who hasn’t felt nervousness, fear, hope, all kinds of emotions in “the gut”? They are closely related.

Functional groups

The most important and most studied group of gut microbiota are bacteria. As already mentioned, there are over 1000 species that are grouped into a number of functional groups, with similar functions. This facilitates their study and analysis.

We should make a distinction between the group of medium stabilizing bacteria and the group of facultative pathogens. Within the group of those that control the stability and homeostasis of the intestinal environment, we find bacteria that are protective, immunomodulatory, muconutritive, primary saccharolytic, and neuroactive. We’ll discuss their functions and the consequences of their alteration below.

Among the facultative pathogenic microorganisms, we find proteolytic bacteria, and fungi and yeasts.

The following depend on the functional stability of our microbiota:

• Food digestion
• The absorption of nutrients
• Normal immune, metabolic, and neuroactive performance

Immunoregulatory Microbiota

The most important bacteria in this group are apathogenic Escherichia coli and Enterococcus faecalis.

They locally regulate all the components involved in immune response, ensure a continuous training of the immune system, are able to induce non-specific immune responses, and collaborate with the immune system in the phenomena of immune identification or immunotolerance (identifying pathogens as pathogens and harmless molecules as non-pathogenic and therefore not susceptible in order initiate the correct immune reaction).

If we have a test result that shows a level that is below the normal range for these bacteria, the subject has an increased susceptibility to immune disorders such as autoimmune diseases, allergies, or immunodeficiencies.

Protective Microbiota

These are mainly bacteria like as Lactobacillus, Bifidobacterium and Bacteroides.

They stabilize the intestinal environment by maintaining the necessary acid pH in the intestine, and synthesize bacteriocins and hydrogen peroxide, protecting us from the growth and colonization of pathogenic microorganisms. Additionally, they strengthen and repair tight junctions, the junctions between the cells of the intestinal epithelium; when these fail, they lead to the very common symptoms of intestinal permeability.

If their number is low, we lose this barrier function against pathogens; the environment is destabilized, favoring dysbiosis, and nutrient absorption is compromised.

Muconutritive Microbiota

The most important bacteria in this group are Faecalibacteroium prausnitzii and Akkermansia muciniphila.

They stabilize the mucus layer that lines the intestinal epithelium, where our microbiota lives. They renew this mucus layer by degrading it and the intestinal fiber, producing oligosaccharides and SCFA (short-chain fatty acids) that serve as food for the intestinal cells and the rest of the microbiota. They modulate inflammation, and in a very important and characteristic way, they regulate neoglycogenesis, that is, the synthesis of glucose in the liver.

When these bacteria are low, we have an increased susceptibility to suffer from inflammatory pathologies such as Crohn’s disease and ulcerative colitis, and metabolic diseases such as type 2 diabetes, metabolic syndrome, obesity, or non-alcoholic fatty liver disease.

Primary saccharolytic Microbiota

The most important bacteria in this group are Bifidobacterium adolescentis and Ruminococcus Bromii

They support muconutritive microbiota in the digestion of long and complex carbohydrate chains. They stimulate other species to degrade dietary fiber normally. They are essential for the primary degradation of resistant starch and oligofructose, producing butyric and lactic acid that nourish intestinal cells and acidify the medium respectively.

A low count in this functional group, therefore, means that we cannot digest complex carbohydrates well and do not effectively produce the aforementioned SCFA.

Neuroactive Microbiota

Once again, Bifidobacterium adolescentis and lactobacillus plantarum are the most important bacteria in this group.

Neuroactive microbiota are able to synthesize GABA (Gamma amino butyric acid), which is an essential neurotransmitter especially in cases of anxiety. They also modulate neurotransmitter receptors and stabilize the gut-brain axis, the immune system, and visceral pain. Their ability to synthesize neurotransmitters like those in our brain means that our bacteria and our brain have a common language that functionally consolidates this gut-brain axis. We know that by administering Lactobacillus plantarum to stressed individuals, their stress and anxiety is reduced, with a correlation in the levels of neurotransmitters like GABA, serotonin, dopamine, and norepinephrine. Depressed patients show intestinal dysbiosis and alterations in neurotransmitter levels, affecting the gut-brain axis.

Proteolytic Microbiota

Proteolytic microbiota is composed of various bacteria that are facultative pathogens. That is, in the right balance and quantity, they do favorable work for the host, but if they get out of control, they can harm us.

They contribute to the digestion of proteins by generating good degradation products such as amino acids, and potentially harmful ones such as biogenic amines (some known as histamine and others with disturbing names like putrescine or cadaverine), ammonia, etc….

If we have an overgrowth of proteolytic bacteria, the pH of the intestine – which, remember, should be physiologically acidic – becomes more alkaline, favoring the development of pathogens. Our system tries to acidify the intestine again at the cost of overloading the liver and consuming our blood bicarbonate, leading to further acidification of the environment. These proteolytic bacteria injure the intestinal mucosa producing chronic inflammation and altering intestinal permeability.

Fungal Microbiota

Composed of fungi and yeasts, the most important of these is Candida.. If it grows above normal levels, it becomes pathogenic and releases toxic metabolites; it may also behave as a reservoir of fungi so that we may present infections in other areas such as the mouth (thrush), vagina (yeast infection), etc.

Well, I hope this has conveyed just how important it is to have a balanced microbiota, where we have the right amount of all the bacteria and microorganisms necessary, without an overgrowth of facultative pathogens or a weak protective microbiota.

Environmental and toxic factors

Unfortunately, the life we live may lead us to a real extinction of our intestinal bacteria, favoring cases of dysbiosis.

These are just a few of the external factors that may affect you:

• Diet; an excess of meat, sugar, or low fiber intake alter our flora.
• A sedentary lifestyle favors dysbiosis.
• Rest; circadian rhythm disorders and deregulation also favor dysbiosis.
• Chemicals; from additives to endocrine disruptors, these alter our gut bacteria.
• Drugs; especially antibiotics and proton pump inhibitors (the famous Omeprazole and drugs of that family).
• The very same aging process is related to a decrease in the population of protective bacteria and an increase in proteolytic bacteria.

It is more than likely that you have identified with one or more of these symptoms, which may be an indication of an imbalance in your microbiota.

At Neolife, we may now assess your intestinal microenvironment in the most scientific and advanced way with a simple stool sample. Our medical team will correlate your symptoms to the test findings and propose the best way to restore balance in your microbiota and correct the problem.

BIBLIOGRAFÍA

(1) Role of the normal gut microbiota. World J Gastroenterol 2015 August 7; 21(29): 8787-8803

(2) Enterococcus faecalis Inhibits Hyphal Morphogenesis and Virulence of Candida albicans Melissa R. Cruz, Carrie E. Graham, Bryce C. Gagliano, Michael C. Lorenz, Danielle A. Garsin Infection and Immunity January 2013 Volume 81 Number 1. 189-200

(3) Review Article: Association between Faecalibacterium prausnitzii Reduction and Inflammatory Bowel Disease: A Meta-Analysis and Systematic Review of the Literature Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2014, Article ID 872725, 7 pages

(4) Exploring the influence of the gut microbiota and probiotics on health: a symposium report Linda V. Thomas, Theo Ockhuizen and Kaori Suzuki. British Journal of Nutrition (2014), 112(S1), S1–S18

(5) Role of the Microbiota in Immunity and Inflammation Yasmine Belkaid and Timothy W. Hand Cell 157, March 27, 2014 ª2014 Elsevier Inc. 121-141

(6) Contribución de la microbiota intestinal y del género «Bifidobacterium» a los mecanismos de defensa del huésped frente a patógenos gastrointestinales Y. Sanz, M.C. Collado, J. Dalmau Acta Pediatr Esp. 2006; 64: 74-78

(7) Probiotics and prebiotics and health in ageing populations Sylvia H. Duncan∗, Harry J. Flint Maturitas 75 (2013) 44– 50

La entrada Gut Microbiota se publicó primero en Neolife.

Despite its fundamental role, the mitochondrion has not been getting the attention it deserves when it comes to COVID-19. In this blog post, we’ll explain the part it plays in this disease.

Patients with COVID-19 mainly present a lower respiratory tract infection. Unfortunately, a significant number of patients develop what is called a “cytokine storm”, a hyper-inflammatory state associated with oxidative stress, deregulation of iron homeostasis, hypercoagulability, and clot formation.

Dr. Alfonso Galán González – Neolife Medical Team

The fundamental role that mitochondria play in platelet function and survival

In this new blog post, we wish to present the latest research, which links mitochondrial dysfunction and alterations of the gut microbiota with the pathogenesis of coronavirus disease; in other words, they are intimately involved in the way COVID-19 affects us and causes us harm.

In another blog post, we discussed how mitochondria are involved in the aging process (here) and gut microbiota and the causes and consequences of dysbiosis.

Some evidence, which we have already discussed here, was already pointing to the mitochondria and their energy production mechanisms as something that was affected in one way or another in COVID-19 disease. In this blog post, and as simply as possible, we will break down what we know about mitochondrial involvement and our gut flora in coronavirus disease, and how mitochondrial dysfunction in the disease may also affect platelet survival and apoptosis, and potentially increase the risk of clot formation.

A brief introduction

It is common knowledge that SARS-CoV-2 is a betacoronavirus that emerged in Wuhan, China in December 2019. Since then, the pandemic has spread rapidly, causing over 2.7 million deaths worldwide at the time of writing.

Essentially, patients with COVID-19 present a lower respiratory tract infection. Unfortunately, a significant number of patients develop what is called a “cytokine storm”, a hyper-inflammatory state associated with oxidative stress, deregulation of iron homeostasis, hypercoagulability, and clot formation.

During this time, several biomarkers have been associated with a worse prognosis and mortality in critically ill patients, mainly lymphopenia, increased D-dimer, and IL-6. A prospective study of large numbers of ICU patients reported a higher risk of death for every 10% increase in IL-6 or D-dimer, pointing to the close link between COVID-19 disease and systemic inflammation and endothelial damage.

Higher levels of Ferritin are also a predictor of mortality, as is oxidative stress. A great deal of evidence links inflammation with oxidative stress.

Despite its fundamental role in controlling oxidation and the formation of reactive oxygen species (ROS), not much has been said about mitochondria as an important part of COVID-19.

Next, we will explain the theoretical role of inflammatory signals when it comes to aggravating oxidative mitochondrial damage and how this contributes to alterations in coagulation, ferroptosis (cell death dependent on iron), and dysbiosis. We will also see how extracellular mitochondria, in particular platelet mitochondria, affect coagulation and clot formation.

Mitochondria, oxidative stress, and inflammation

Normally, our tissues require a large number of functioning mitochondria to provide energy and regulate cellular functions based on our needs. If there is a higher demand, we create more mitochondria through a process called mitogenesis, while excess mitochondria are eliminated through a process called mitophagy. Mitochondrial defects have been implicated in many pathologies, like diabetes, cardiovascular disease, gastrointestinal diseases, cancer, and the aging process. Mitochondria are the biggest source of reactive oxygen species (ROS), which on the one hand leads to normal cellular functioning, but on the other hand, has been associated with an increase in intracellular oxidative stress.

Pro-inflammatory cytokines induce an increase in mitochondrial ROS. These inflammatory cytokines, like TNF-alpha and IL-6, are found in the blood of COVID patients, affecting mitochondrial oxidative phosphorylation, which leads to the production of ATP (our energy currency) and to the formation of ROS. This affects mitochondria in many ways leading to cell death (apoptosis) in the worst case scenario. Additionally, when these damaged mitochondria release their contents into the cell’s cytosol or extracellular space, this leads to the production of pro-inflammatory cytokines, like IL-1 or IL-6. Both are markers in severe cases of COVID-19.

Many studies have also shown the impact of mitochondrial dysfunction on immune response. For example, the production of pro-inflammatory cytokines is greatly increased in lung cells with dysfunctional mitochondria.

Iron and mitochondrial dysfunction

Studies of markers in COVID-19 have shown without any doubt that excess ferritin is associated with the severity of the disease and a worse prognosis. Ferritin, in addition to being a marker of inflammation, is released by the cells that die.

One of the iron-mediated oxidative stress targets is none other than the mitochondria. The function of the mitochondria depends on the right amount of iron, and an alteration in its iron levels will alter its function, leading to stress and cell death.

Moreover, we know that non-protein circulating iron catalyzes the formation of higher levels of ROS that cause damage to cellular and mitochondrial components, as well.

Ferroptosis is a recently discovered phenomenon of programmed cell death associated with iron accumulation. It has been shown in numerous infections by different microorganisms. Peculiarly, ferroptosis causes irreversible alterations in mitochondrial morphology

.
This data provides a solid basis for the idea that mitochondrial dysfunction plays a key role in COVID-19 disease.

Thrombopenia and hypercoagulability in COVID

It is clear at this point that coagulation abnormalities are closely associated with COVID mortality. The comparison of coagulation parameters between survivors and non-survivors indicates a higher D-dimer, higher fibrin degradation products, higher prothrombin time, and higher activated partial thromboplastin.

Also, a decrease in the number of platelets has been associated with an increase in mortality and is more common in more severe cases especially associated with disseminated intravascular coagulation (DIC)

Extracellular mitochondria and platelet mitochondria

We may curiously find mitochondria outside the cells; this is something that is not well known. Extracellular mitochondria may be found cell-free, enclosed by a membrane such as inside platelets, or in vesicles. Out-of-cell mitochondria may induce paracrine or endocrine responses and regulate cell-to-cell communication, regeneration, hazard detection, and cause immune responses. In addition to extracellular mitochondria, the release of mitochondrial DNA (MDNA) has been described during apoptosis.

The potential role of cell-free circulating mitochondria or their blood derivatives in patients with COVID-19 has not yet been determined, but it is something that may have therapeutic implications, especially with the use of plasma obtained from recovered patients to treat sick patients. But let’s delve a little deeper.

A platelet is a small anucleate blood cell with the primary physiological and pathological function of hemostasis and wound healing. In the absence of an all-controlling nucleus, platelet health is largely determined by the health of its mitochondria.

The role that mitochondria play in platelet function and survival is fundamental. Mitochondrial dysfunction in the disease may also affect platelet survival and apoptosis, and potentially increase the risk of clot formation. More importantly, it has recently been shown that apoptotic platelets may induce clotting e”50 times faster than normal platelets.

An increase in mitochondrial ROS production in platelets leads to severe oxidative stress that alters ATP production and mitochondrial membrane potential, leading to increased platelet activation.

This may explain the small number of platelets in COVID-19 disease despite the onset of thrombosis. Additionally, patients with COVID-19 are likely to suffer from impaired mitophagy due to the stress caused by hyper-inflammation. In a healthy context, mitophagy protects platelets from oxidative stress and mitochondrial destruction by eliminating damaged mitochondria to prevent platelet apoptosis; when platelet mitophagy, which is involved in COVID-19 pathogenesis, is altered, there is an increase in platelet apoptosis that contributes to an increase in thrombosis.

Therefore, preserving the mitochondrial function of platelets may be an additional means of decreasing the risk of potentially fatal thrombotic events in COVID-19.

On the other hand, by linking this to the previous point of iron overload in COVID, evidence suggests that iron overload is an agent of platelet dysfunction. Excess iron alters mitochondrial function and promotes oxidative stress. It is believed that there is a link between iron overload and elevated ROS.

Moreover, activated platelets may release mitochondria into microvesicles into the extracellular medium when exposed to oxidative stress. These mitochondria may be lysed by generating inflammatory mediators that promote endothelial inflammation.

Therefore, extracellular mitochondria and their “derivatives” may represent critical mediators in the progression of the inflammatory environment that leads to coagulopathy associated with inflammatory response pathways.

Cell-free mitochondria and mitochondria in microvesicles are a major subset of extracellular vesicles released by activated monocytes, and their pro-inflammatory activity in endothelial cells is determined by the activation status of their parent cells. Therefore, mitochondria may be critical intercellular mediators in cardiovascular disease and other inflammatory environments.

COVID and dysbiosis

It is very important to consider the link between mitochondria and microbiota in COVID-19 for several reasons:

• First, some patients have concurrent gastrointestinal symptoms, including diarrhea.
• The virus’ genetic material has been detected in the feces of patients with COVID-19.

These observations indicate the ability of SARS-CoV-2 to colonize the gastrointestinal tract, which would disrupt the gut microbiota. Interestingly, fecal metabolomic analysis suggested possible pathways linking gut microbiota to inflammation, which would explain the predisposition of certain individuals to develop severe COVID-19. Addressing the impact of the COVID-19 microbiota on mitochondrial function would provide new avenues for therapeutic strategies.

The interaction between the microbiota and the mitochondria appears to occur both ways through endocrine, immune, and humoral links

.

The gut microbiota influences mitochondrial functions related to energy production, mitochondrial biogenesis, redox balance, and inflammatory cascades. On the other hand, mitochondrial functions may alter the composition and activity of the gut microbiota. In fact, as described above, under stressful conditions such as bacterial or viral infections, mitochondria may modulate immune responses that lead to increased inflammation. This unbalanced immune response may result in dysbiosis.

Conclusions

Let’s try to sum this all up in a few words and present some takeaways:

• COVID-19 disease involves an inflammatory state.
• This inflammatory state involves the production of large numbers of inflammatory cytokines and is linked to the presence of hyperferritinemia (iron overload), leading to higher oxidative stress and cellular damage.
• The mitochondrion is the fundamental organelle in the generation of reactive oxygen species (ROS).
• Higher levels of ROS lead to intra and extracellular mitochondrial damage.
• This mitochondrial damage leads to microbiota dysbiosis.
• Additionally, platelet dysfunction plays a fundamental role in clot formation.
• Mitochondrial damage leads to the release of its contents, which aggravates the inflammatory state in a vicious cycle that leads to the progression of COVID-19.

This evidence of the involvement of mitochondrial, platelets and dysbiosis in inflammatory processes and COVID opens up new avenues in the search for new therapeutic and preventive strategies in this serious disease and others that involve severe systemic inflammation.

BIBLIOGRAFÍA

(1) Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020;54:1-7. doi:10.1016/j.mito.2020.06.008

(2) Zhang, D., Guo, R., Lei, L., Liu, H., Wang, Y., Wang, Y., Dai, T., Zhang, T., Lai, Y., Wang, J., Liu, Z., He, A.O., Dwyer, M., Hu, J., 2020a. COVID-19 infection induces readily detectable morphological and inflammation-related phenotypic changes in peripheral blood monocytes, the severity of which correlate with patient outcome. medRxiv 2020.03.24.20042655.

(3) Zhu, H., Santo, A., Jia, Z., Li, Y., 2019. GPx4 in bacterial infection and polymicrobial sepsis: involvement of ferroptosis and pyroptosis. React. Oxyg. Species 7, 154–160.

(4) Aguirre, J.D., Culotta, V.C., 2012. Battles with iron: manganese in oxidative stress pro- tection. J. Biol. Chem. 287, 13541–13548.

(5) Wang, L., Wu, Q., Fan, Z., Xie, R., Wang, Z., Lu, Y., 2017. Platelet mitochondrial dys- function and the correlation with human diseases. Biochem. Soc. Trans. 45, 1213–1223.

(6) Melchinger, H., Jain, K., Tyagi, T., Hwa, J., 2019. Role of platelet mitochondria: life in a nucleus-free zone. Front. Cardiovasc. Med. 6, 1–11.

(7) Gou, W., Fu, Y., Yue, L., Chen, G., Cai, X., Shuai, M., Xu, F., Yi, X., Chen, H., Zhu, Y., Xiao, M., Jiang, Z., Miao, Z., Xiao, C., Shen, B., Wu, X., Zhao, H., Ling, W., Wang, J., Chen, Y., et al., 2020. Gut microbiota may underlie the predisposition of healthy individuals to COVID-19. medRix 1–44.

(8) Green, D., Galluzzi, L., Kroemer, G., 2011. Mitochondria and the autophagy- inflammation-cell death axis in organismal aging. Science (80-.) 333, 1109–1112

(9) Lin S-J, et al. Calorie restriction extends yeast life span by lowering the level of NADH. Genes Dev. 2004;18:12–16.

(11) Imai S, Yoshino J. The importance of NAMPT/NAD/SIRT1 in the systemic regulation of metabolism and ageing. Diabetes Obes Metab. 2013;15(Suppl 3):26–33.

(12) Lin SJ, et al. Life span extension by calorie restriction in S. cerevisiae requires NAD and SIR2. Science. 2000;289:2126–2128.

La entrada Mitochondria and Dysbiosis at the Root of COVID-19 Disease se publicó primero en Neolife.

Neurological diseases have become one of the main health problems in developed countries due to their prevalence, clinical relevance, and impact. Evidence shows that nutrition is a promising approach to preventing age-related neurodegeneration.

With an increasingly aging population, there is evidence that points to how nutrition offers a promising approach to preventing neurodegeneration caused by aging and dementia. A new study published in the journal Ageing Research Reviews addresses new ways to explore the role of nutrition in healthy aging: the impact of nutrients, dietary manipulation, and microbiota.

Alejandro Monzó – Neolife Nutrition and Nursing Unit

The brain experiences neural development up to about 30 years of age

Nutrients play a fundamental role in the development and functioning of the human nervous system. Nutritional epidemiology has suggested a protective role for healthy diets and various nutrients, which affect brain aging outcomes. Older people who have a diet rich in fruits, vegetables, whole grains, and fish, like the Mediterranean diet, have larger brains than those with unhealthy diets (1, 2). The Mediterranean diet may be protective of cognitive impairment through various mechanisms (3):

• The intake of monounsaturated fatty acids would help preserve the cell membrane.
• The improvement of the metabolic pattern would lead to lower vascular deterioration,
• The intake of antioxidants would help decrease oxidative stress.

Therefore, the randomized clinical trial PREDIMED (PREvention with a MEDiterranean DIet) suggests that adherence to the Mediterranean diet decreases cardiovascular events including stroke, which directly and indirectly influences the development of dementia (3).

The bigger the size, the greater capacity

Additionally, it has been shown that people with bigger brains have better cognitive abilities, so any improvement in the quality of the diet may be a good strategy when it comes to maintaining elderly people’s cognitive abilities. There is evidence that shows that some nutrients or food ingredients, in particular vitamins and specific minerals, flavonoids, and omega-3 fatty acids are beneficial to cognitive function (Figure 1) (3, 4).

The importance of Omega3

In recent years, the role of omega-3 fatty acids has been studied in the development of cognitive decline and several mechanisms through which the risk of dementia may be diminished have been put forth. These polyunsaturated fatty acids exert their protective nature through their antithrombotic, vasodilator, anti-inflammatory, antiarrhythmic effects, and above all their effects on lipid metabolism. Since a direct link between cardiovascular disease and the onset of dementia, both Alzheimer’s and vascular, has been described, the reduction of cardiovascular risk may decrease the risk of dementia. These fatty acids, together with phospholipids, are part of cell membranes and may contribute to maintaining their integrity in neurons and their expression (2,3,4).

It is worth mentioning a paper published in the scientific journal Journal of Alzheimer’s Disease Reports, that shows that obesity may aggravate the effects of Alzheimer’s. This study revealed that obesity may contribute to the vulnerability of neural tissue, while maintaining a healthy weight in cases of mild dementia may help preserve brain structure (5). Therefore, overweight and obesity are additional burdens on brain health and may aggravate the disease,

Once again, the microbiota

Another new avenue of research regarding age is the study of human gut microbiome. This is the totality of the microorganisms that make up the gut microbiota, predominantly bacteria but also including fungi, viruses, and other organisms. The gut microbiome undergoes significant changes throughout life, presenting distinctive characteristics at different stages in life. The use of prebiotics and probiotics is presented as an interesting tool to address the microbiome-gut-brain axis and as an intervention to aid in the treatment of mental disorders. Prebiotics include dietary fibers that facilitate the growth of beneficial gut bacteria, and it has been suggested that they influence neurobiology, achieving good results in improving patients’ cognitive flexibility. However, the mechanisms through which the microbiota may influence brain function appear to be complex and multidirectional, and involve neural, endocrine, and immune pathways (4).

At Neolife, we develop a comprehensive health program, which includes the prevention of neurodegenerative diseases. And we have seen that nutrition plays an important role in both the cause of neurological disease and the treatment of many neurological processes. Therefore, an individualized dietary-nutritional plan is one of the keys in the prevention of disease in our patients, which also allows us to avoid premature brain aging and develop a state of optimal health.

BIBLIOGRAFÍA

(1) Otero. “La dieta mediterránea Evita que el cerebro se encoja con el envejecimiento”. Diario ABC. URL: https://www.abc.es/salud/habitos-vida-saludable/abci-dieta-mediterranea-evita-cerebro-encoja-envejecimiento-201805171223_noticia.html

(2) Redondo S., M.R. & González R., L.G. (2015). “Nutriguía: manual de nutrición clínica”. 2ªEdición. Editorial Médica Panamericana.

(3) De Luis Román, D.A. Bellido Guerrero, D. García Luna, P.P. Olivera Fuster, G. (2017). “Dietoterapia, nutrición clínica y metabolismo”. Tercera edición. Sociedad Española de Endocrinología y Nutrición. Grupo Aula Médica, S.L. Madrid, España.

(4) Flanagan E. y otros. (2020). “Nutrition and the ageing brain: moving towards clinical applications”. Ageing Res Rev. Vol. 62 URL: https://pubmed.ncbi.nlm.nih.gov/32461136/

(5) Dake, M.D. y otros. (2021). “Obesity and brain vulnerability in normal and abnormal aging: a multimodal MRI Study”. Journal of Alzheimer’s Disease Reports. Vol. 5, nº1, pp: 65-77. URL: https://content.iospress.com/articles/journal-of-alzheimers-disease-reports/adr200267

La entrada Nutrition and Brain Aging se publicó primero en Neolife.

The COVID-19 pandemic caused by SARS-CoV-2 continues to be an important problem for health, the economy, and the global society. Since its appearance in December of 2019, a great amount of data, evidence, diagnostics, and treatment options have arisen.

Christmas time will be atypical this year because of the coronavirus crisis. Recently, scientists have noted that measures even more restrictive will be adopted in December, events will be cancelled, home lockdowns will take place, and limits will be placed on family meetings and on social contact in general. These are measures that, without a doubt, will once again modify our nutritional and lifestyle habits.

Alejandro Monzó – Neolife Nutrition and Nursing Unit

Mortality rates are higher amongst those over 60 years old with prior conditions.

Currently, there are no registered medicines to prevent COVID-19 and there is also not a safe vaccine at the moment. Treatment is based mainly on support therapies and treating symptoms, as well as aiming to prevent respiratory insufficiency. As preventative measures, the use of face masks, hand washing, and respecting social distancing rules have all yielded results. Currently, a feasible, tried-and-true way to lower the rate of contagion seems to be the strict measure of a lockdown for the general population (1,2).

In Spain, the autonomous communities will have to try to be restrictive to control the pandemic’s curve at Christmas. This can be done by cancelling social events, limiting the number of people in family meetings, and avoiding closed spaces without ventilation. Home lockdowns have proven to be a good tool to combat the virus’s propagation (3). Nevertheless, this solution is a double edge sword that, unfortunately, can seriously compromise people’s health because of the habit and lifestyle changes that it implies.

It must be remembered that good health is the result of a set of different factors. Eating habits, physical activity and exercise, rest, the environment, the control of stress, our social relationships, our management of emotions, even our gut microbiota (amongst many other factors) play a key role for reaching optimal health.

Firstly, governments are applying lockdown, isolation, and social distancing measures that lead to a prolonged period of time at home. This has yielded reductions in physical activity and changes in dietary intake and is even more noticeable now in this Christmas season as foods rich in calories, sugars, and fat have a greater presence at home (4). In this context, the risk of sarcopenia increases, a deterioration of muscle mass and muscle functions (more prevalent in older populations), as well as increases in body fat. A new study published in the scientific journal GeroScience shows the health effects and consequences of home confinement restrictions due to COVID-19 (Figure 1), where these changes in body composition are associated with a number of chronic lifestyle diseases like cardiovascular diseases, diabetes, osteoporosis, frailty, cognitive impairment, and depression (5).

The generalized loss of skeletal muscle mass and strength is aggravated as a consequence of inactivity and a lack of exercise. The authors note, in addition, that the elderly population suffers from additional problems such as an increase in falls, fractures, reduction of mobility, greater deterioration, and a higher rate of mortality in general. Nevertheless, one of the most noteworthy points of the study is the risk of sarcopenic obesity (people who are losing muscle and gaining fatty tissue at the same time), an added risk factor for chronic diseases that does not only shorten life expectancy but also compromises quality of life (5).

Regarding diet, home confinement and the Christmas period can bring about changes in food choices and diet quality. These changes in eating habits, along with chances in appetite regulation, can increase the risk of weight gain (an average of 3 kilos of fat has been estimated) or, on the contrary, of weight loss (mainly because of the loss of muscle mass) (4,5). The authors even discuss the risk of the immune system working less effectively. In addition, a new Spanish study published in the journal Annals of Medicine has demonstrated that the level of blood sugar helps to predict the prognosis of patients in the hospital with COVID-19, even in those who are not diabetic (6). Therefore, specialists note that hyperglycemia is a risk factor and recommend controlling blood sugar levels. Also worthy of mention are other recent discoveries, like the connection between a deficiency in vitamin D and greater risk in the event coronavirus is contracted A recent study published in the journal Aging Clinical and Experimental Research shows that those countries with greater levels of vitamin D on average have a lesser number of deaths from the virus; therefore, healthy levels of vitamin D could contribute to reducing the risk of respiratory infections (7).

Likewise, the Christmas season along with social isolation could cause emotional and sleep problems. It has been shown that psychological factors, drowsiness, social isolation, and anxiety may play a considerable role in the loss of muscle during the pandemic (5). This could be due to the pandemic’s effects on healthy behaviors like irregular eating habits and physical exercise regimes coupled with stress, which, in turn, are associated with sleep alterations, less time sleeping, and insomnia, which are all affecting general health (4,5)

Another of the key health factors is the advancement and knowledge of gut microbiota. Scientists define microbiota as the set of microorganisms present in a set environment like the intestinal tract (8). It is important because it undertakes multiple defense tasks, as well as nutritional functions, and it influences mood and behavior. Researcher today consider it as if it were an “organ.” Recently, Spanish scientists have undertaken a research project to find the immunological mechanisms through which gut microbiota may protect the body from the coronavirus and reduce the seriousness of symptoms. It has been verified that SARS-CoV-2 can be detected in stool and its receptor is also expressed in the cells of the intestine and colon (9). Therefore, it is important to always consider ahealthy diet a priority, even more so during this Christmas season. What we eat nourishes us and the billions of microorganisms that live in our intestine.

Lastly, during Christmas, following the recommendations of the Spanish Academy of Nutrition and Dietetics against COVID-19 (10), it is important to increase the consumption of fruits and vegetables due to their richness in vitamins, minerals, fiber, and antioxidants and because of their role to combat oxidative stress brought on by a possible loss of muscle. Likewise, their consumption is important to keep the immune system working at its best. Include quality sources of protein, like legumes, meats, fish, and eggs to avoid sarcopenia. Also avoid the consumption of non-healthy fats contained in industrially processed and ultra-processed foods and go for a greater amount of healthy fats like olive oil, dried fruits, fish oils, and avocado (amongst others) due to their energizing and antioxidant properties. Other recommendations include keeping metabolically active; that is, avoiding a sedentary lifestyle and doing activities like walking, physical training at home, cleaning, etc. to guarantee body weight maintenance at Christmas time. Something no less important is to keep up social contact with our loved ones and family members despite the restrictions. This can be done thanks to the use of new technologies (Figure 2).

We are leaving behind 2020, a year marked by the coronavirus pandemic and in which the mechanisms of sarcopenia and its relationship with the effects of lockdowns on physical activity, eating habits, sleep, and stress are associated with a greater risk of coronavirus infection and more serious symptoms. Changes in body composition are frequent in Christmas; therefore, we must be aware and remember the current health context as well. At Neolife, we have become involved in the search for new medical treatments and approaches to prevention. Recently we have added the availability of new COVID-19 tests for the detection of the virus and antibodies in our clinics. There is even a new type of medical checkup know as the “Post-COVID-19 Checkup” which aims to undertake an exhaustive examination to those who have gone through the disease.

We at Neolife wish you happy holidays and a 2021 full of hope, health, and wellbeing!

BIBLIOGRAPHY

(1) Pascarella, G. et. al. (2020). “COVID-19 diagnosis and management: a comprehensive review”. J Intern Med. Vol. Vol. 288(2): 192-206.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267177/

(2) Cevik, M. et. al. (2020). “COVID-19 pandemic-a focused review for clinicians”. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases. Vol. 26(7): 842-847. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182753/

(3) Dhama, K. et. al. (2020). “Coronavirus Disease 2019 – COVID-19”. Clin Microbiol Rev. Vol. 33(4): e00028-20.

URL: https://cmr.asm.org/content/33/4/e00028-20#sec-25

(4) Ruiz-Roso, MB. et. al. (2020). “COVID-19 Lockdown and changes of the dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus”. Nutrients. Vol. 12(8): 2327.

URL: https://pubmed.ncbi.nlm.nih.gov/32759636/

(5) Kirwan, R. et. al. (2020). “Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss”. GeroScience.

URL: https://link.springer.com/article/10.1007/s11357-020-00272-3#citeas

(6) Carrasco-Sánchez, FJ. et. al. (2020). “Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry”. Annals of Medicine. Vol. 53(1): 103-116.

URL: https://www.tandfonline.com/doi/abs/10.1080/07853890.2020.1836566

(7) Ilie P.C., Stefanescu S. & Smith L. (2020). “The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality”. Aging Clinical and Experimental Research.

URL: https://link.springer.com/article/10.1007/s40520-020-01570-8

(8) Gut Microbiota for Health. (2020). “Gut microbiota info”.

URL: https://www.gutmicrobiotaforhealth.com/about-gut-microbiota-info/

(9) Hernández Bonilla, JM. (2020). “En busca de la relación entre las bacterias del estómago y el coronavirus”. El País Newspaper. Science.

URL:https://elpais.com/ciencia/2020-11-10/en-busca-de-la-relacion-entre-las-bacterias-del-estomago-y-el-coronavirus.html

(10) (2020). “Recomendaciones de alimentación y nutrición para la población española ante la crisis sanitaria del COVID-19”. Document stating the position of the Spanish Academy of Nutrition and Dietetics and the General Council of Official Associations of Dietitians-Nutritionists.

URL: https://www.academianutricionydietetica.org/noticia.php?id=113

La entrada Christmas in Times of a Pandemic se publicó primero en Neolife.

Overweight and obesity have been linked to an increased incidence of lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), or sleep apnea syndrome. Recent research links this pathology with severe forms of COVID-19, increasing the health risk of worsening the disease.

The natural history of chronic noncommunicable diseases, such as obesity, is the result of the combination of genetic factors, a sedentary life, and unhealthy eating. A new study published in the prestigious scientific journal The Lancet has called overweight and obesity the main risk and severity factor in the COVID-19 process.

Tania Mesa – Director of Neolife Nutrition and Nursing Unit

Excess fat is associated with an inflammatory state that may be increased by infection with the virus.

Obesity and all chronic noncommunicable diseases represent the true global pandemic. Cases of obesity have almost tripled between 1975 and 2016 worldwide. Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016 (1). The new SARS-CoV-2 coronavirus, which produces the disease known as COVID-19, continues to expand rapidly around the world. This is a respiratory virus that has been shown to be transmitted quite easily and puts this group of people at greater risk.

The Spanish Society for the Study of Obesity (SEEDO) states that almost half of the Spanish population, subjected to several weeks of lockdown, has experienced an increase in their average weight during this period of time (2). The results of his recently published survey indicate that 44% of the population claims to have gained weight during lockdown and, the majority, 73%, report a weight gain range of between 1 and 3 kilos. Half of the population surveyed in the SEEDO study was unaware that obesity worsens the prognosis of those who have COVID-19 (2).

Increasingly, we have data that point to overweight and obesity as factors linked to a poor prognosis in patients infected with COVID-19. Older age is the main indicator of mortality, but COVID-19 disease affects all ages. Recently, a clear inverse correlation between age and body mass index (BMI) has been shown, in which people admitted to the hospital were more likely to be obese and suffer acute forms of the novel coronavirus disease (3. 4). In a report by the UK’s Intensive Care National Audit and Research Centre (ICNARC), which includes 2,621 patients in intensive care units (ICUs) with COVID-19, 30.7% had a BMI of 30-40, and 7% was higher than 40. With regard to prognosis, the chance of survival was higher in patients with a BMI that was lower than 30 (5).

A new review published by the Mayo Foundation for Medical Education and Research shows that respiratory infections are more common in overweight patients. Obesity is associated with a decrease in respiratory reserve volume and functional capacity of the respiratory system. Generally, the obese patient has a higher number of pro-inflammatory cytokines (proteins responsible for intercellular communication) associated with excess fat tissue. Subjects with obesity therefore present a pro-inflammatory environment and COVID-19 is expected to further exacerbate inflammation by exposing them to higher levels of circulating inflammatory molecules compared to thin subjects (Figure 1). This situation results in metabolic dysfunction, which may lead to dyslipidemia, insulin resistance, cardiovascular disease, high blood pressure, and type 2 diabetes (6. 7).

Another common feature in obesity is vitamin D deficiency, which increases the risk of infections and impairs immune response. By contrast, vitamin D supplements may prevent respiratory infections through various immunoregulatory functions, including decreased production of pro-inflammatory cytokines, reducing the risk of pneumonia. Vitamin D deficiency may be involved in the link between obesity and increased susceptibility to complications and mortality due to COVID-19 (7, 8). It should be noted that alterations in the gut microbiota are common in obese subjects and some protocols for the treatment of COVID-19 include the use of probiotics to maintain the balance of bacterial populations and thus strengthen the immune system (8).

The Massachusetts General Hospital points out that obesity is not a risk factor for becoming infected with COVID-19. However, obese patients are more likely to require intensive care for COVID-19 (9). A characteristic complication of obesity is hypoventilation syndrome, where excess fatty tissue from the chest wall makes it difficult for obese patients to breathe deep and completely. They point out that this combination increases the severity of symptoms in those who develop COVID-19.

Obesity is a chronic disease that requires treatment. A new study published in The Lancet magazine reminds us of the importance of acquiring healthy lifestyle habits. They emphasize that this is a good time to start taking steps towards losing 5% to 10% of your body weight if you are obese (10). Regarding diet, a normal protein low-calorie diet that is low on carbohydrates and fats may be a promising strategy for losing weight and improving health; however, the patient’s profile and condition should always be considered.

In short, there are several biological mechanisms by which COVID-19 disease may affect people with obesity to a greater extent. The treatment of obesity requires a multidisciplinary vision, since it is a complex and multifactorial disease, in which an important component is the balance between energy intake and expenditure, but there are also other contributing factors, such as food availability, age, gender, genetics, metabolism, and physical activity. It is important to note that there are other environments to consider, such as home quarantines, isolation by areas or neighborhoods, isolation due to close contact with patients with COVID-19, etc., as we have recently witnessed. Therefore, it is important for us to be aware of all these factors and to remember the data and information on the increase in body weight during the lockdown suffered in March.

Performing a global assessment, interpreting information, establishing treatment strategies, identifying modifiable factors, and individualizing treatment is what we do here at Neolife, thanks to our team of healthcare professionals and the great success stories we’ve obtained. Treatment should be initiated with the recommendation of lifestyle changes, which requires nutritional intervention, cognitive behavioral therapy, and specific exercise prescription, associated with the pharmacological treatment of obesity and its complications.

BIBLIOGRAPHY

(1) (2020). “Obesity and overweight”. World Health Organization.

URL: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

(2) SEEDO. (2020). “Un 44% de los españoles aumentaron de peso durante el confinamiento” [44% of Spaniards gained weight during lockdown]. Spanish Society for the Study of Obesity.

URL:https://www.seedo.es/images/site/notasprensa/NP_Un_44_de_espan%C3%9Eoles_ha_au

mentado_de_peso_durante_el_confinamiento_Ok.pdf

(3) Simmonnet, A. et al. (2020). “High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation”. Obesity. Vol. 28(7):1195-1199.

URL: https://pubmed.ncbi.nlm.nih.gov/32271993/

(4) Bellido G., D. (2020). “Obesidad y Covid-19. La relación cada vez más consistente” [Obesity and COVID-19: An increasingly consistent relationship]. Hospital Universitario de Ferrol. Spain.

URL: https://www.foroactua.com/wp-content/uploads/2020/05/Qu%C3%A9-consecuencias-tiene-la-obesidad-cuando-aparece-el-Covid.pdf

(5) Fernández B., E. (2020). “Obesidad” [Obesity]. Píldora Científica. Revista Española de Salud Pública.

URL:https://www.mscbs.gob.es/biblioPublic/publicaciones/recursos_propios/resp/revista_cdrom/

Suplementos/Pildoras/pildora14_obesidad.pdf

(6) Sanchis-Gomar, F. et al. “Obesity and outcomes in COVID-19: when an epidemic and pandemic collide”. Mayo Clinic. Vol. 95(7): 1445-1454.

URL:https://www.sciencedirect.com/science/article/pii/S0025619620304778

(7) Chiappetta, S. et al. (2020). “COVID-19 and the role of chronic inflammation in patients with obesity”. International Journal of Obesity. Vol. 44, 1790-1792.

URL:https://www.nature.com/articles/s41366-020-0597-4

(8) Petrova, D. et al. (2020). “La obesidad como factor de riesgo en personas con COVID-19: posibles mecanismos e implicaciones” [Obesity as a risk factor in people with COVID-19: possible mechanisms and implications]. Atención Primaria. Vol. 52(7):496-500.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247450/pdf/main.pdf

(9) Fitch, A. & Hutter, M. (2020). “Understanding links between COVID-19 and obesity”. Massachusetts General Hospital.

URL: https://www.massgeneral.org/digestive/weight-center/understanding-links-between-covid-19-and-obesity

(10) Rubino, F. et al. (2020). “Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritization of access to surgery”.

URL:https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30157-1/fulltext

La entrada Obesity in the Crosshairs of COVID-19 se publicó primero en Neolife.

Due to the health crisis caused by COVID-19, the importance of physical exercise and, in turn, daily physical activity, is reassessed for its implication on our health.

It is important that we take care of our physical and mental health. Therefore, the World Health Organization (WHO) has provided five tips for dealing with this situation, namely: healthy eating, limiting alcohol consumption and sugary drinks, not smoking, maintaining social relations, and doing some form of physical exercise for at least 30 minutes a day. The aim of this newsletter is to present the benefits of physical activity and exercise in light of the current pandemic.

Tania Mesa – Director of Neolife Nutrition and Nursing Unit

Alejandro Monzó – Neolife Nutrition and Nursing Unit

The level of physical activity may condition immune function

From the moment we’re born, we are continuously exposed to infections, to which we would succumb if it were not for the fact that we have a physiological system that defends us from them: the immune system. Immune cells, or leukocytes, possess a broad functional capacity, as well as multiple and complex forms of communication (1).

Physical inactivity has been shown to be a real cause of over 35 chronic diseases and conditions (2). Some of these are serious chronic diseases, such as insulin resistance that leads to type II diabetes, premature aging that leads to Alzheimer’s disease, and a lower immune system response that causes infections, as well as other diseases or risk factors, which lead to cardiovascular disease, obesity, and metabolic syndrome. As a result, evidence supports that physical inactivity is a real cause of a shorter period of good health and early mortality (2,3).

For starters, it’s important to differentiate the concepts of “physical activity” and “physical exercise” (4). Physical activity is defined as any body movement produced by the skeletal muscles that requires the expenditure of energy. Regular and adequate levels of physical activity have been shown to reduce the risk of high blood pressure, coronary heart disease, stroke, diabetes, cancer, and depression, improve bone health, and are essential to weight management. Physical exercise is the type of physical activity that is planned, structured, repetitive, and chosen as a means to achieve a goal related to the improvement or maintenance of one or more fitness components. We may say that physical activity includes physical exercise, as well as other activities that involve body movements and are carried out as part of the working day, active transportation, household chores, and recreational activities.

During the current COVID-19 health crisis, our physical activity has been drastically reduced due to the confinement we’ve been practicing. This poses a risk, both physically and mentally, and everyone should be aware of it. For example, a review published by Frontiers in Public Health shows that a sedentary lifestyle and body weight gains (especially fat mass) are risk factors for our health (Figure 1), because they compromise the correct regulation of the immune system (5).

The immune system mediates numerous pathologies, so it’s important to know it’s structured and how it works. It is classified as innate and adaptive. The innate immune system provides an early and non-specific response against microorganisms (it is our first line of defense). On the other hand, the adaptive immune system provides us with a specific response to different molecules, possesses memory against antigens, and the diversity to react to a wide variety of antigens (6). There is growing evidence that physical exercise changes both systems.

Muscular work has been shown to directly trigger energy consumption and beneficial metabolic changes in relation to the immune system (7). A study published in Nutrition and Enhanced Sports Performance shows that moderate-intensity exercise improves immune function compared to inactivity, thus decreasing the incidence of respiratory infections, cancer, and inflammatory diseases (Figure 2). However, vigorous exercise temporarily suppresses immune function and may increase the risk of airway infection and muscle damage.

At the molecular level, regular exercise decreases the circulation of inflammatory cytokines and oxidative stress, also improves the function of resting immune cells. In this regard, thanks to an active life, molecules are produced that favorably regulate immune mechanisms, with anti-inflammatory actions, thus contributing to the maintenance of a strong immune system (6,7).

It is worth mentioning a recent study published in Exercise Immunology Review, which shows that an active lifestyle can be a modulator of the composition of the gut microbiota, leading to a greater biodiversity (8). The gut microbiota is the set of bacteria that live in the gut and perform key functions for survival, such as providing the body with nutrients and vitamins, digesting food, or educating the immune system so it may develop its function (9). That said, the aforementioned study combines the concepts of physical-microbiota-immune system activity (Figure 3), thus forming an axis with closely linked elements. The benefits of physical exercise may lead to healthy bacteria populations involved in good immune system regulation to combat chronic infections, diseases, and conditions (8,10).

Those who are most at risk of suffering complications from the COVID-19 respiratory virus are people over 65 years of age and people of all ages with certain conditions, such as immunosuppression, or chronic heart, lung, kidney, blood, or metabolic diseases (11). In general, physical exercise therapy seems to be promising, but we have yet to identify many of the mechanisms involved in it, as well as the type of exercise and the appropriate dose to achieve an adequate immune response (12).

• Physical activity may help remove bacteria from the lungs and airways. This may reduce the likelihood of catching a cold, flu, or other illnesses.
• Exercise causes changes in antibodies and white blood cells. These can circulate faster, so they can detect diseases faster than they would have done otherwise.
• Exercise decreases the secretion of stress hormones. A high level of stress increases the likelihood of a disease.
• The brief elevation of body temperature during and immediately after exercise may prevent bacterial growth, thus better combating infection.

Here at Neolife, we wish to convey how important it is for us to take care of our health during self-isolation. Now more than ever, it is essential for us to stay active at home because, as we have seen, physical activity influences how we manage stress, boost our immune system, and maintain a healthy body weight. Low levels of physical activity may have negative effects on our health, well-being, and quality of life, so here are some recommendations for steps you can implement during these weeks of self-isolation:

1. Use any household chore as an excuse to move around. Look for opportunities to move while you do your daily tasks; every small movement counts.
2. Exercise at home. You can do workouts with just your own body; you don’t need to use machines. Squats, planks, push-ups, sit-ups… even with the furniture in your house, they are very useful exercises. The Internet gives us the opportunity to search for videos, apps, and workout routines. Do them with your family; remember that doing sports with others is much more bearable and fun.
3. Use household objects as weights. There are many items at home that can be used as exercise weights, such as water bottles, milk containers, or detergent bottles. You can also hold them while doing squats.
4. Practice meditation exercises. Maintaining a good mental state is also very important. Yoga, meditation, listening to music, and drawing, as well as cleaning or reading are activities that make you focus on what you’re doing and provide good stress relief.
5. Do aerobic activities. Going up and down stairs can be a great option if you want to do cardiovascular activities. If you’re going up to a higher floor, take the opportunity to go up and down a couple more times. You can also jump rope if you have one at home, or even play active games that involve running or playing music and dancing.

One more day is one less day; let’s start appreciating what really matters most: our health!

BIBLIOGRAPHY

(1) Ishikawa T. (2014). “”. Sociedad Española de Inmunología. European Federation of Immunological Societies.

URL: https://www.inmunologia.org/pdf/LibroSEI.pdf

(2) Booth, F.W. et al. (2017). “Role of inactivity in chronic diseases: evolutionary insight and pathophysiological mechanisms”. Physiol Rev. Vol. 97(4): 1351-1402.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347102/

(3) Liliana P. Rodota and María Eugenia Castro. “Nutrición clínica y dietoterapia” [Clinical nutrition and diet therapy]. Editorial Médica Panamericana, 1st Edition, 2012.

(4) WHO. (2019). “Global Strategy on Diet, Physical Activity and Health”. World Health Organization. URL: https://www.who.int/dietphysicalactivity/pa/en/

(5) Pahani & Tremblay (2018). “Sedentariness and health: Is sedentary behavior more than just physical inactivity?”. Public Health 6:258.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139309/pdf/fpubh-06-00258.pdf

(6) Toche P. Paola. (2012). “Visión panorámica del sistema inmune” [Panoramic view of the immune system] . Revista Médica Clínica Las Condes. Vol. 23 (8): 446-457.

URL: https://www.elsevier.es/es-revista-revista-medica-clinica-las-condes-202-articulo-vision-panoramica-del-sistema-inmune-S0716864012703358

(7) Aoi W. & Naito Y. (2019). “Immune function, nutrition and exercise”. Nutrition and Enhanced Sports Performance (2º Ed.). Pages 83-95.

URL: https://www.sciencedirect.com/science/article/pii/B9780128139226000072

(8) Ticinesi A. et al. (2019). “Exercise and immune system as modulators of intestinal microbiome: implications for the gut-muscle axis hypothesis”. Exerc. Immunol Rev

URL: https://www.ncbi.nlm.nih.gov/pubmed/30753131

(9) De Luis Román, D.A. Bellido Guerrero, D. García Luna, P.P. Olivera Fuster, G. (2017). “Dietoterapia, nutrición clínica y metabolismo” [Diet therapy, clinical nutrition, and metabolism]. Third edition. Sociedad Española de Endocrinología y Nutrición. Grupo Aula Médica, S.L. Madrid, Spain.

(10) Lancaster, G.I. & Febbraio M.A. (2016). “Exercise and the immune system: implications for the elite athletes and the general population”. Immunol Cell Biol. Vol. 94(2): 155-6.

URL: https://www.ncbi.nlm.nih.gov/pubmed/26667594 (11) Portal Regional de la BVS. (2020). “Enfermedad por coronavirus (COVID-19)” [Coronavirus disease (COVID-19)]. URL: https://bvsalud.org/vitrinas/es/post_vitrines/nuevo_coronavirus/ (12) Castellanos Puerto, E. (2012). “Ejercicio físico e inmunidad en el anciano” [Physical exercise and immunity in the elderly]. Rev Cubana Med Gen Integr. Vol. 28(2): 72-78. URL: https://scielo.sld.cu/pdf/mgi/v28n2/mgi08212.pdf (13) MedlinePlus. (2018). “Exercise and immunity”. U.S. National Library of Medicine. URL: https://medlineplus.gov/ency/article/007165.htm

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Obesity and being overweight are related to genetic, biological, social, socioeconomic and environmental factors. In recent decades, several studies suggest that the gut microbiota is another factor associated with the development of this pathology.

It is widely accepted that metabolic disorders, such as obesity, are closely related to lifestyle and diet. Now, groups of researchers and new research such as the European MyNewGut project, are assessing how diet can influence gut microbiota and thus modify our metabolic and mental health.

Tania Mesa – Director of Neolife’s Nutrition and Nursing Unit

Alejandro Monzó- Neolife Nutrition and Nursing Unit

We are what we eat

The term microbiota denotes a set of microorganisms that reside in a given environment. Human beings have groups of bacteria in different parts of our body: in the skin, in the mouth, in the gastrointestinal tract and in the vagina, among others.

Our gut microbiota contains 100 billion microorganisms, including at least a thousand different species of bacteria that comprise more than 3 million genes, 150 times more than in the human genome. In fact, the gut microbiota can weigh up to 2 kilograms. One third of our microbiota is common to that of the majority, while the other two thirds are specific to each individual (1).

The gut microbiota provides essential functions for human beings. Three primary functions have been identified, which are, generally, functions of nutrition and metabolism, protection functions and trophic functions on the proliferation and differentiation of the intestinal epithelium, as well as the development and modulation of the immune system. Some of these functions are (1):

• Helping the body to digest certain foods that the stomach and small intestine are not able to digest.
• Contributing to the production of certain vitamins (B and K).
• Helping to combat the aggressions of other microorganisms, by maintaining the integrity of the intestinal mucosa.
• It plays an important role in the immune system, acting as a barrier effect.

The development of the gut microbiota begins at birth. Its composition evolves throughout our entire life, from birth until we get older, and at the same time is influenced by a host of environmental factors.

Environmental factors such as the increase in calorie intake and the decrease in the physical activity have been considered as causing the increase in the prevalence of obesity and Metabolic diseases. However, nutrition plays a key role in the development of healthy or, on the contrary, harmful microbial populations. This is confirmed by a review published by the magazine Genes & Nutrition. Growing evidence suggests that the gut microbiota is an important factor contributing to the individual’s response to nutrients (2).

The human gut microbiota can be considered as being an organ within another organ (the digestive system) that has evolved with humans to achieve a symbiotic relationship that leads to physiological balance, and has been called our second genome or second brain. Researchers point out that the human being provides an environment rich in nutrients, and the microbiota offers indispensable functions that humans can’t perform by themselves. That said, it has been shown that the gut microbiota regulates the energy metabolism and storage of fat, and researchers believe it is a driving force in the development of metabolic disorders associated with obesity (Figure 1) (2).

Therefore, the permanent interaction between gut microbiota and the human body opens a door to research into its relationship with diseases. The authors note that diet significantly influences the composition of the gut microbiota. Diet not only has the capacity to act on the immune system directly, but also indirectly, by modulating the gut microbiota, whose composition and metabolites may influence the individual’s health. Alterations of the gut microbiota and the adverse response of the individual to these changes is known as dysbiosis (Figure 2) (2,3).

On the other hand, a European project known as MyNewGut has conducted a five year study into the relationship between gut microbiota and its genome in the development of obesity and disorders linked to behavior with regard to our lifestyle. As conclusions, the researchers point to the following (4):

• The bacterial strains in our intestine could be the next generation of probiotics.
• The consumption of an excess of proteins generates certain toxic metabolites.
• Diets rich in fibers are associated with fewer symptoms of depression, help maintain body weight and reduce the risk of developing chronic metabolic diseases.
• A diet high in fat can have a negative impact on the gut microbiota and on the brain.
• The gut microbiota influences metabolic health.

At this point, the Western diet, characterized by being high in unhealthy fats, refined flours, sugars and salt, and low in dietary fiber, can contribute to a dysbiosis in the gut microbiota. This fact leads to an alteration in the bacterial populations, while in turn predisposing to obesity and chronic diseases (2,3). The MyNewGut project also demonstrates that certain microorganisms, such as Bacteroides Uniformis or Bifidobacterium Pseudocatenulatum have the capacity to reduce obesity, modify oral glucose tolerance and, most surprisingly, influence the mood of the individual, specifically the depression associated with obesity. The goal is clear, to develop other strategies, such as the identification of bacteria or bioactive metabolites, and use them as probiotics (4).

At Neolife, we consider our patients’ gut microbiota to be important, detecting those cases in which it is altered and working to keep it balanced and healthy.

BIBLIOGRAPHY

(1) Gut Microbiota for Health. 2019; 9:1–12. “Información sobre la microbiota intestinal”. URL: https://www.gutmicrobiotaforhealth.com/es/informacion-sobre-microbiota-intestinal/

(2) Duranti S. and others. (2017). “Obesity and microbiota: an example of an intricate relationship”. Genes & Nutrition. Italy. 1-15 URL: https://www.ncbi.nlm.nih.gov/pubmed/28638490

(3) Maslowski K.M. y Mackay C.R. (2011). “Diet, gut microbiota and immune responses”. Nature Immunology. Vol. 12, No1, pp: 1-5 URL: https://www.ncbi.nlm.nih.gov/pubmed/21169997

(4) (2019). “The Microbiome’s influence on energy balance, brain development, diet-related diseases and behavior”. European Union. URL: https://www.mynewgut.eu/sites/default/files/MyNewGut%20Leaflet_project_results%2B.pdf

La entrada The influence of gut microbiota on our weight se publicó primero en Neolife.

Changes in our microbiota have recently been linked to the onset of neurodegenerative, autoimmune and cardiovascular diseases.

Microbiota is the community of bacteria living as a host in our digestive tracts. Having adequate gut flora is key to ensuring the proper functioning of the digestive system, as well as other body systems. In a comprehensive Age Management programme, pre / probiotics play an important role in achieving a healthier flora that allows us to age better, facilitate the loss of visceral fat and reduce the onset of diseases.

Dr. Iván Moreno – Neolife Medical Team

We are beginning to understand the significant influence that gut microbiota has on our metabolism: on our weight, cholesterol… and even on our personality!

Recent scientific advances are leading us to better understand the significant role that gut flora plays in the maintenance of our overall health and in aging in particular. Cultivating good flora requires appropriate nutrition and, depending on the needs and condition of each individual, effective supplements.

For many years we have underestimated the role that our intestine, and our intestinal flora, has on our health.

Microbiota is the community of bacteria living as a host in our digestive tracts. There are thousands of different bacterial species, with some weighing up to 2 kg. A third of our flora is rather similar from one person to the next, however, the other two thirds are specific to each individual, almost like our fingerprints. The truth is that there are about 150 times more genomes in our body from these bacteria than from our very own cells.

It would appear that the significance of this complex ecosystem and its relationship with our health is one of the most important issues that medicine has overlooked until very recently. Only now are we beginning to understand just how important the role of our gut bacteria is on our metabolism… from influencing our weight, to the density of cholesterol deposits in our artery walls, and even in determining our personality.

70% of the neurons found outside of the brain are in the intestine, and their proper functioning is also influenced by our gut bacteria through the vagus nerve in a kind of brain-intestinal system. It has been proven that neural development, behavior, our stress response and even the onset of neurodegenerative diseases such as Alzheimer’s and Parkinson’s are related to the state of our microbiota.

Some of the functions of our gut flora are:

• Helping the body to digest certain foods.
• Helping the body to produce certain vitamins (B and K).
• Helping to fight against infections from other pathogenic bacteria.
• Maintaining the integrity of the intestinal mucosal barrier, preventing toxins and other germs from penetrating the intestinal wall membrane and preventing an immune reaction or from the liver overloading, helping to detox the body.
• Having an important role in the immune response and regulation in the intestine.

Adequate gut flora is key to ensuring the proper functioning of the digestive system, as well as other body systems. In fact, the importance of the functions it carries out is such that scientists and physicians are increasingly considering it as an additional organ of the body. Which is to say an acquired organ through the birth channel and through breastfeeding, since babies are born without microbiota, therefore representing the first step towards an inoculation of germs that will evolve as we grow.

It has also been discovered that the composition of our flora can be altered through changes in diet, with a less healthy diet being linked to imbalances in the composition of our gut flora in favor of less beneficial species, resulting in inflammation and the malabsorption of essential nutrients. Likewise, bad intestinal flora also flavors the onset of obesity and hinders efforts to lose weight. There are studies that show how pre / probiotic supplements help in losing weight and decrease visceral fat.

Needless to say, such a central organ – interconnected with different systems, the absorption of nutrients, immune response and the inflammation of the organism – is related to the way we age. Microbiota can influence the state of our skin, our immune system, cognitive functioning, and bone mineral density among others, which highlight the more or less early onset of frailty and deterioration in our body.

In this way, changes in our microbiota have been linked to the onset of neurodegenerative diseases, autoimmune diseases and cardiovascular diseases.

Once the significance of our microbiota is fully understood, it is easy to see the devastating effect that taking antibiotics has on the health of our microbiota. The loss of healthy bacterial species, the impoverishment of the intestinal ecosystem and the ease with which pathogenic species (intestinal dysbiosis) or parasites can then grow, is the price we must pay for taking antibiotics. Antibiotics are necessary on many occasions, and are one of the major turning points of modern medicine; however, we must avoid taking them unless absolutely necessary.

What are prebiotics?

Prebiotics are foods that promote the growth of healthy intestinal bacteria. They are like the substrate on which our intestinal ecosystem has to flourish.

This typically involves foods rich in insoluble fiber. These are naturally present in vegetables and fruits such as garlic, onions, leeks, asparagus, artichokes, tomatoes, bananas, plums and apples. Similarly, we can find them in grains and whole grains, as well as almonds. For this reason, fruit, vegetables and cereals must form part of a healthy diet, although this must be achieved in a balanced way, since an excess can also cause abdominal discomfort and swelling.

What are probiotics?

Probiotics are living microorganisms that, when consumed in sufficient quantity, promote a healthy microbiota and can help to rebalance it when it has been affected by a poor quality diet or other factors such as stress.

They can be found in fermented products like yogurt, cheese, sauerkraut, fermented tea, kefir, etc. It is important to take in a wide variety of healthy bacterial species (the more diversity the better) in good quantities, and make sure that these are living (sometimes food processing can kill them off). It is actually quite difficult to take in the right amount of these foods – in fact, we rarely do so in practice – therefore, to ensure these conditions are met (quantity, quality, and keeping the bacteria alive), gut flora supplements have been developed in recent years which ideally ought to then combine with the substrate in order to grow, therefore: a mixture of pre- and probiotics.

Should I take pre / pro biotics?

Although the ideal would be to have a varied and balanced diet, rich in micronutrients and prebiotic substances (fruit, vegetables, etc.) the fact of the matter is that this is not usually the case, either because food quality is not quite the same as in the past (especially in micronutrients), or because our eating habits leave lots of room for improvement. If, when we stop to think about it, we believe the quality of our diet could be improved, then our gut flora could definitely benefit from taking supplements.

In a comprehensive Age Management programme, pre / probiotics play an important role in achieving a healthier flora that allows us to age better, facilitate the loss of visceral fat and reduce the onset of diseases.

Similarly, after taking antibiotics it is important to promote a healthy rebalancing of our microbiota and avoid any colonization from less healthy bacteria.

Sometimes, our gut flora has already changed and we have symptoms of intestinal dysbiosis like flatulence, white tongue, constipation, skin irritations, allergic reactions, fatigue, and joint pains etc. In such cases, it is recommended to have a doctor who specializes in this field carry out an assessment, and if needed, conduct a study to asses any dysbiosis and outline a treatment.

It is always recommended that supplements are of a high quality and that we ensure there is a large number of microorganisms of various species of bacteria (as these work better than single bacteria supplements).

Just as important as choosing a good pre / probiotic, is taking it under the correct guidelines and for the proper duration, which will depend on each case in particular.

At Neolife we trust in the advanced prescription of supplements, with personalized doses for each case in particular, with the correct strength to be truly effective and achieve the desired results, monitoring the effects on the body in each patient individually.

We are discovering that the state of our microbiota is increasingly relevant on our current state of health and on the way we will age over the coming years. Are you ready to take care of your flora?

BIBLIOGRAPHY

(1) John G, Wang L, Nanavati J, Twose C, Singh R, Mullin G. Dietary Alteration of the Gut Microbiome and Its Impact on Weight and Fat Mass: A Systematic Review and Meta-Analysis. Genes 2018 Mar;9(3):167–19.

(2) Singh RK, Chang H-W, Yan D, Lee KM, Ucmak D, Wong K, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 4 ed. 2017 Apr 8;15(1):73.

(3) Calvani R, Picca A, Monaco Lo MR, Landi F, Bernabei R, Marzetti E. Of Microbes and Minds: A Narrative Review on the Second Brain Aging. Front Med. 2018 Mar 2;5:321–11. Image in open Access (PubMed Central) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840854/figure/F2/

(4) Kasselman LJ, Vernice NA, DeLeon J, Reiss AB. The gut microbiome and elevated cardiovascular risk in obesity and autoimmunity. Atherosclerosis. Elsevier Ltd; 2018 Apr 1;271:203–13.

(5) Candela M, Biagi E, Brigidi P, O’Toole PW, De Vos WM. Maintenance of a healthy trajectory of the intestinal microbiome during aging: A dietary approach. Mechanisms of Ageing and Development. Elsevier Ireland Ltd; 2013 Dec 30;136-137:1–6.

(6) Kundu P, Blacher E, Elinav E, Pettersson S. Our Gut Microbiome: The Evolving Inner Self. Cell. Elsevier Inc; 2017 Dec 14;171(7):1481–93.

(7) Open access image, courtesy of Rocky Mountain Laboratories, NIAID, NIH. https://commons.wikimedia.org/wiki/File:EscherichiaColi_NIAID.jpg#/media/File:EscherichiaColi_NIAID.jpg

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