Inspired by Wang et al 2021.[1]
Whilst I think EA is great in KOA, the most direct way of influencing the microbial diversity in the gut is through what we chose to put in it. All the data suggests that colourful vegetables are probably the most important component of diet – sorry Allyson!
EA – electroacupuncture
key to acronyms
IM – integrative medicine
ECIM – European Congress for Integrative Medicine
CoM – College of Medicine
KOA – knee osteoarthritis (OAK is also used on this blog)
NRS – numerical rating scale
WOMAC – Western Ontario and McMaster Universities osteoarthritis index
So, I have just finished attending a 4-day online conference on IM, and don’t really want to spend another day in front of my screens, but I am running late with the weekly blog, so needs must!
I spend most of my academic life deep in the acupuncture literature, so meetings with a broader scope, such as ECIM or the CoM Food Conference, bring up some topics that are less familiar to me. One such topic is the gut microbiome, which has been increasingly researched in recent years.
Gut Feelings
At ECIM we heard from Professor Alessio Fasano who is a paediatrician from Harvard, and co-author of the recent book ‘Gut Feelings: The Microbiome and Our Health’. He emphasised how important the first 1000 days of life are in the development of each of our own unique gut microbiota, and how important this is to our health and wellness.
It is a fascinating topic, and of course we all want to know how we can improve our situation if we end up with some form of dysbiosis – a reduction in microbial diversity with a loss of beneficial bacteria and a rise in less friendly varieties.
I am a big fan of eating a variety of colourful plants with lots of fibre of course, which is one way to promote microbial diversity in the gut. But it is not at all intuitive how we can influence the gut microbiome with treatments such as EA.
The paper that caught my eye this week measured the effect of EA versus superficial off-point sham EA (with no electrical stimulus) on the gut microbiome in patients with KOA. Eight points (mostly local) were used in a semi-standardised approach, and EA was applied at 2/100Hz in 24 sessions of 30 minutes over 8 weeks. It looks like this study was embedded within a larger RCT that I have discussed on here previously: Intensive EA/MA in OAK.[2]
This team from Beijing led by Liu Cun-Zhi, which has been responsible for most of the high quality large clinical studies in recent years, demonstrated that EA partially reverses the dysbiosis associated with KOA, and identified the key bacterial genera, the changes of which best correlated with the changes in difference outcome measures.
Bacteroides and Agathobacter
The 3 key genera were Bacteroides, Agathobacter and Streptococcus. In brief the first two are good and the last is bad, so EA reduced NRS and WOMAC score in KOA that correlated with an increase in Bacteroides and Agathobacter (negative correlation) and a decrease in Streptococcus (positive correlation).
Fascinating stuff, but I am no closer to trying to work out the link. I suspect that there the change in the microbiome is downstream of the mechanisms that mediate pain relief and a generally more ‘happy’ autonomic nervous system.
References
1 Wang T-Q, Li L-R, Tan C-X, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol 2021;11:597431. doi:10.3389/fcimb.2021.597431
2 Tu J-F, Yang J-W, Shi G-X, et al. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol 2021;73:448–58. doi:10.1002/art.41584
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