Gut-Lung Axis involvement in COVID 19 patients and TCM effects on restoring gut microbiota
With a lot of data coming out of the COVID-19 pandemic scientists have a better understanding of the interconnectedness of gut microbiome and human health. Gut-Lung Axis (GLA) has emerged as a particular field of interest in the last couple of years further proving the importance and the need of the prevention health care model. Traditional Chinese Medicine (TCM) and its understanding of organ systems cross-talk plays a pivotal role in restoring and maintaining the richness of the host's gut microbiome. TCM is well positioned to address the chronic health manifestations post recovery. With advances in genome-centric precision medicine and it’s wide availability patients are empowered to take charge of their health journeys. Scientists and clinicians alike have long been aware of the importance of the healthy human microbiota. It plays a major role in modulating biological functions and preventing degenerative diseases. The human gut microbiota contains ten times as many cells and over 150 times as many genes as the human body. Our microbiome plays such a massive role in our overall health that many scientists consider it to be an additional organ.
The interest in the human gut microbiome has been around since the 1800s in Europe and a lot longer in Chinese medicine. Chinese physician Ge Hong was documented to be the first physician to prescribe fecal transplantation to treat acute food poisoning with “yellow soup” made from a healthy person’s stool around CE 350.
An American surgeon, Dr. Ben Eiseman, started treating his patients by fecal transplantation in 1958, about 1,600 years later after Ge Hong prescribed the fecal transplantation in China. Our digestive system as viewed through the lens of Traditional Chinese Medicine (TCM) is considered one of the most important organ system players to generate Qi or “vital energy” to support and nourish our entire body.
The gut microbiota imbalance also referred to as “dysbiosis” is strongly related to Qi (vital energy) deficiency. Chinese medicine physicians were well aware of the importance of the balanced digestive system thousands of years ago. They have observed the lack or impairment of our vital energy as a trigger for many physical and mental symptoms. In other words our resident bacteria help regulate our immune system, how we respond to infections and our cognitive function among others.
Gut microbiome research has faded away in Western medicine until the arrival of rapid and reasonably priced sequencing tools and the proof of effective outcomes of fecal microbiota transplants in the last two decades. Dr. Jeffrey I. Gordon played a pivotal role in bringing microbiota research into the mainstream awareness by establishing the link between human disease and altered microbiome in 2006.
As extensively as our gut microbiome has been studied, up until recently there has not been as much research dedicated to microbiotas of other organs such as lungs. Lungs microbiota are responsible for the homeostasis of the host. Although the current research available on Gut–Lung Axis (GLA) interaction is in its infancy it supports Chinese Medicine theory which views the human body as a network of interconnected organ systems. Chinese medicine physicians have long been aware of the symbiotic relationship between digestive organ system and the lung system. When digestion is impaired it adversely affects the healthy function of the respiratory system and overall innate immunity and nourishment of the host.
One of the studies focused on the outcomes of modification of a newborn's diet and its effect on their lung microbiota further proving an existing link between the composition of the gut and lung microbiota which suggests a host-wide network.
Gut–Lung Axis (GLA) and COVID-19
The recent pandemic provided a lot of perplexing data for the scientists. These data prompted investigations of microbial interactions within the Gut–Lung Axis (GLA). Scientists researching COVID-19 were intrigued by the wide variety of symptoms of infected patients. These symptoms extended outside the expected respiratory infections. They found it interesting that the most common nonrespiratory manifestation was gastrointestinal (GI) symptoms. Close to 50% of COVID patients reported abdominal pain, nausea and diarrhea. GI symptoms were the only symptoms in about 16% of infected patients. Patients with gastrointestinal issues took longer to clear the virus from their bodies compared with the patients without gastrointestinal symptoms.
Scientific research has shown that the virus that causes COVID-19 (SARS-CoV-2) directly attacks the GI tract’s epithelial cell lining. These epithelial cells are the same type of lining cells present in the lungs and are the primary site of infection. Since the start of the pandemic we have seen a number of small studies proving the link between microbial dysbiosis, increased illness severity during the acute phase and diminished lung function in the recovery stage in COVID 19 patients. Researchers found that the richness of gut microbiota was not restored back to its normal levels even six months after COVID-19 recovery.
Further more pre-existing gut dysbiosis might be implicated in ‘long COVID’ syndrome. Pulmonary functions were also worse in the patients who had lower microbial richness. The potential mechanisms of immune modulation include direct translocation of bacteria from gut to the lungs. These findings support the theory that by changing gut microbiota composition and its diversity we can help speed up recovery from COVID-19. And by maintaining stable microbial diversity of our gut microbiome we can support our overall immunity and increase resistance to opportunistic pathogens.
Empowering our patients
What are the lifestyle factors that predispose us towards the development of dysbiosis? There are multiple causes that can contribute to this imbalance such as chronic stress, frequent antibiotics use, over the counter pain medications or non-steroidal anti-inflammatory drugs use, diet high in calories, saturated fats and trans fatty acids, genetically modified and processed foods, preservatives in foods, trauma, infections that include viruses, bacteria, mold, parasites and heavy metal toxicity.
What can we do to support and restore our microbiome in everyday life holistically? First it is important to rule out any possible serious conditions that might be contributing to your symptoms such as cancer, organ failure (liver or kidneys), hypothyroidism, brain diseases and inflammatory bowel diseases. Once you are in the clear I suggest testing your microbiome with advanced functional tests.
These tests will give you and your practitioner a clear picture of what is going on inside and why. You will receive an analysis of what type of bacteria, viruses, fungi, phages, parasites and archaea are present in your gut. Based on these findings you will be suggested necessary targeted supplements specifically tailored to your needs. It is possible you will have to eliminate certain triggering foods out of your diet based on the results of your tests.
Regulating effects of Traditional Chinese Medicine (TCM) and lifestyle modification on gut microbiome
TCM is effective in treating dysbiosis, restoring the richness and homeostasis of the intestinal microbiome.
Chinese medicinal herbs are an important addition into daily meals and drinks throughout the process of recovery and maintenance. Studies of the medicinal herbs and their chemical constituents have proven to help alleviate symptoms of fatigue, anxiety, memory loss, propensity to feeling bloated, boost appetite and overall energy levels. These medicinal herbs are Astragalus root, Chinese yam, White atractylodes rhizome, Ginseng root, Siberian Soloman’s seal, Pseudostellaria root, American ginseng root, Licorice root, Codonopsis root, Chinese date and Reishi. These herbs have shown to have antibacterial, anti-inflammatory, antioxidant properties as well as to contain constituents such as amino acids, saponins, flavonoids, vitamins and minerals that help protect cells from damage.
Vitamin D deficiency is also indicated in playing a role in intestinal dysbiosis and is essential for maintaining a balanced intestinal flora.
Diet rich in fruits and vegetables contains acetate. A recent study of acetate showed the improvement of intestinal defense mediated by the epithelial cell lining and is believed to be protective against pathogens.
Low impact exercise such as walking, Qi Gong, yoga are all beneficial in restoring the gut microbiome. Managing stress with mindfulness tools like meditation, journaling and tapping have been proven to have beneficial effects in minimizing stress and inflammation.
As holistic medicine practitioners we understand well the importance of systems biology of a patient. With advances in TCM research and its effectiveness in treating complex health diseases that involve multiple organ systems, we are uniquely equipped to create effective and evidence based treatment protocols that address the very unique needs and microbial make up of each of our patients.