Dr. Christine Bishara is the founder of From Within Medical, a medical wellness practice that places emphasis on the mind-body and gut-brain axis to prevent and manage disease. With over 20 years of clinical experience, time and time again, Dr. Bishara has discovered that the connection between these systems plays a significant role in disease prevention and management, but it has not been adequately addressed.
Dr. Bishara is Board certified in Internal Medicine by the National Board of Physicians and Surgeons and is certified in Integrative Medical Weight Loss by the American Academy of Anti-Aging Medicine. She has previously served as Assistant Professor and Clinical Preceptor at New York Medical College. Her professional experience has spanned academically and clinically in both inpatient and outpatient settings. Haute Beauty sits down with Dr. Bishara to hear more about her recently published medical journal about gut health and its relation to COVID-19.
Photo Credit: Photo courtesy of Dr. Christine Bishara
Q: Dr. Bishara, you recently published an article in a biomedical journal related to gut health and covid-19, in particular why the majority of children seem to be protected from severe infection, while some individuals with certain conditions are at higher risk. Can you tell us a little bit about your findings?
Yes, my colleagues and I found some interesting data regarding gut health and SARS COV-2 infections. It is known that children for the most part have healthier guts than adults. Our initial hypothesis focused on what in particular afforded children this protection. We found significant data linking the gut microbiome to this Immuno-protection.
Q: What in particular did you find in your data?
Children’s gut microbiome differs slightly from adults. We all know the benefits of probiotics and many practitioners recommend that probiotics contain a particular species called Bifidobacterium. Well, it turns out that children have much higher levels of Bifidobacterium in their guts than adults do. This species actually constitutes the major gut microbe present in children under the age of 10. These levels begin to decrease as we age and are very low in the elderly and adults with certain conditions such as obesity and diabetes. A comparison of Bifidobacterium concentrations in the gut of children ranges from 60-80% compared to 20-40% in adults and less than 10% in the elderly with some high-risk groups as low as 1%. Bifidobacterium has been investigated extensively in previous studies and has been found to provide specific benefits to the immune system and in modulating immune cell mediators. We discovered that many of the immune signaling mediators and pathways were the same ones affected in severe SARS COV-2 infections. Interestingly enough, although Bifidobacterium levels decline with age, in one particular study, these levels were found to be higher in Italian and Japanese centenarians than in the younger elderly population.
Q: You mentioned specific conditions that put people at risk and how the gut plays a role in this. Can you elaborate on this?
Yes, as I mentioned, there are some conditions that put people at a higher risk of severe infection. Aside from the vulnerable elderly population, obesity is the most prevalent underlying condition in 18 to 64-year-olds hospitalized with COVID-19 infections. Many individuals that develop severe infections develop something called a “Cytokine Storm.” This Cytokine storm is modulated by certain inflammatory mediators called Interleukins. One particular Interleukin called Interleukin-6 ( IL-6) is a pro-inflammatory mediator. Its job is to alert the body of an infection or intruder. The problem with interleukin 6 is that sometimes it can pose as “ too much of a good thing.” Although it is meant to be protective in the body, and most of the time it is, it can sometimes lead to an exaggerated immune response by the body that causes the Cytokine Storm. The Cytokine Storm ends up causing more damage to cells in lung and other tissues than the actual infection. Here’s the other unfortunate thing we have found with Interleukin 6. The levels of IL-6 are found to be higher at baseline in high-risk individuals such as those with BMI’s over 30 and diabetics. This represents a subclinical inflammatory state. Think of it as a traffic light. If healthy individuals are at green subclinically, those with underlying conditions are at yellow and have higher than normal levels of IL-6 at baseline. When posed with an infection or perceived intruder to the body, these pro-inflammatory mediators lead to a hyper exaggerated immune response which leads to tissue damage. In these high-risk individuals, the immune system overreacts, leading to severe illness.
Bifidobacterium has been shown to down-regulate Interleukin-6 levels and actually increase certain anti-inflammatory markers.
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Q: With these findings, would you recommend that everyone take a probiotic containing Bifidobacterium for prevention and treatment?
Our review article was based on numerous research studies done on the protective role of Bifidobacterium in many medical conditions including Influenza.What we would love to do is conduct clinical trials where we could test the gut microbiome of infected individuals or those at high risk to correlate with the strong evidence we found. Bifidobacterium however represents a very viable and low-risk option for prevention and treatment, especially since there have been no reported cases of severe adverse reactions or sepsis with probiotic administration. In fact, preterm infants born with certain intestinal conditions have been safely given certain Bifidobacterial strains which led to a marked improvement in their conditions.
Q: Are there particular things to look for when buying a probiotic?
Our number one source of probiotics should be consuming prebiotics which are the foods like fruits and vegetables that help us build our good gut bacteria naturally. When supplementing with probiotics, an indicator of a good probiotic is to look at the CFU or colony-forming units written on the label. Since all probiotics have a certain shelf life, the CFU’s noted in the expiration are what matter most. You want them to be at least at least 50 billion, typically the refrigerated probiotics retain better viability of the organism.
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