The gut microbiome as a contributor to the pandemic


Those of us at the forefront of the fight against COVID -19 have suspected since the beginning of the pandemic that "Long COVID" appeared to be linked to Imbalances of Gut bacteria. An impressive array of studies has now proven that the microbiome, which reflects the variety and volume of bacteria in the gut, is indeed implicated in the severity of COVID and immune system response to the infection. According to a study published online in the journal Gut, imbalances in the microbiome may contribute to persisting inflammatory symptoms, dubbed “long COVID.”


The gut, the second largest organ in the body (the skin is the first), and the bacteria in its microbiome have been proven to influence various immune responses. The Study, as mentioned above, aimed at determining how the gut microbiome affects the immune system response to COVID-19 infection, showed that the gastrointestinal (GI) tract is an essential organ influencing the propensity to and potential severity of COVID-19 infection. 


As it is the case in most diseases, the gut microbiome has been linked to various risk factors for COVID. Although our understanding of the role of the gut microbiome in COVID remains in its infancy and more studies are needed, the currently available data illustrate several routes of interaction between COVID, the gut microbiome, a protein called ACE-2 (ACE-2) found mainly in the small intestine and colon - and gut inflammation.

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The Study:

The Study aimed at characterizing the gut microbiome of individuals infected with COVID. Of those enrolled, 41 patients provided multiple stool samples while hospitalized, whereas 27 gave serial stool samples up to 30 days after clearance of COVID. 

All 274 stool samples showed that the microbiome significantly differed among those with and without COVID-19, independently of whether they had been treated with antibiotics or any other medication. 

COVID patients had higher numbers of Ruminococcus gnavusRuminococcus torques, and Bacteroides dorei species than people without the infection. They had far fewer species that can influence immune system response, such as Bifidobacterium adolescentisFaecalibacterium prausnitzii, and Eubacterium rectale. And the numbers of these bacteria remained low in the samples collected up to 30 days after infected patients had recovered from COVID-19.

We know that COVID prompts the immune system to produce inflammatory cytokines. In some cases, this response can be excessive, producing a "cytokine storm” that causes widespread tissue damage, septic shock, and multiorgan failure. 


Analysis of the blood samples of the study patients showed that the microbial imbalance found in COVID patients was also associated with raised levels of inflammatory cytokines and blood markers of tissue damage, including C-reactive protein and other enzymes. This suggests that the gut microbiome might influence the immune system response to COVID infection and potentially affect disease severity and outcome.

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"In light of reports that a subset of recovered patients with COVID-19 experience persistent symptoms, such as fatigue, dyspnea [breathlessness] and joint pains, some over 80 days after the initial onset of symptoms, we posit that the dysbiotic gut microbiome could contribute to immune-related health problems post-COVID-19", the authors concluded


Although the Study can't establish the cause, added to which the gut microbiome varies widely among different populations, the changes observed in this Study may not apply to other COVID patients elsewhere caution the researchers. But they point to mounting evidence showing that gut microbes are linked to inflammatory diseases within and beyond the gut.


Bolstering of beneficial gut species depleted in COVID-19 could serve as a novel avenue to mitigate severe disease, underscoring the importance of managing patients' gut microbiota during and after COVID-19.", the authors s concluded that


The Magic of Probiotics: The Gut's Arsenal Against COVID

Probiotics can reduce symptoms of COVID-19 when taken post-exposure. A recent randomized clinical trial showed how daily use of Lactobacillus rhamnosus GG (LGG) probiotic may protect against symptom development when used as post-exposure prophylaxis within seven days after exposure to severe COVID related acute respiratory syndrome.

Emerging evidence implies that general susceptibility to infectious agents may be diminished by probiotic interventions. More specifically, probiotics can manipulate intestinal microbiota and, in turn, modulate the human immune system and its inflammatory responses.

The evidence suggests that prophylaxis with bacterial Lactobacillus species (for example, Flora Plus by can significantly decrease, by at least half the development of upper and lower respiratory tract infections, improve outcomes in cases of ventilator-associated pneumonia, and even reduce sepsis burden in healthy infants

 Probiotics are likely to be helpful to mitigate the risk of COVID, most notably in areas with low vaccine availability or uptake. LGG is the most promising one, as it showed good results in different clinical trials and in vivo experiments. More specifically, probiotics may manipulate intestinal bacteria, which in turn help modulate the immune system - and its inflammatory responses. 

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More Proof in the Pudding; in the Microbiome, that is:


Another study published in MedRevix in January of 2022 enrolled 182 individuals older than one year of age who had household contact with a recent (i.e., less than seven days) diagnosis of COVID-19. These participants were randomized to receive daily LGG or a placebo for 28 days. Furthermore, their stool was collected to evaluate the  


The researchers found that participants taking LGG were less likely to develop symptoms by day 28 than those who took the placebo. Furthermore, participants taking LGG had a substantially prolonged time to symptom onset.


Microbiome analysis strongly showed how study participants who received LGG had a substantially greater abundance of Lactobacillus rhamnosus in their gut compared to those who received only placebo, in conjunction with a significant change in the overall structure of resident gut microorganisms.


In short, these findings again suggest that LGG probiotic may confer specific protection against the development of COVID-19 infection, but its value is also in halting symptom development when introduced as post-exposure prophylaxis within seven days after exposure.


While limited in sample size, our Study suggests that LGG is well-tolerated and is associated with prolonged time to develop COVID-19 infection, reduced symptomatic disease, and changes to gut microbiome structure", say the study authors.


These results support the notion that our symbiotic microorganisms, our own gut microflora, can be viewed as indispensable partners in the fight against COVID-19 but also against potentially other pandemic diseases in the future.

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Take home message:


The immune system is a complex, intertwined structure composed of white blood cells, antibodies, intrinsic proteins, networks, and organs. This impressive system act as a barrier to prevent viruses and bacteria from damaging organs like the brain while other parts of the system hunt and remove invaders from your body. 


It plays a crucial role in the fight against many disease-causing germs and viruses. To do so requires time to familiarize itself with the enemy, and it must recognize an illness-causing pathogen as a danger before it can be removed from the body. 


This is usually only possible once you've developed specific antibodies after being sick or receiving a vaccine. When an antibody recognizes the antigen of an invading pathogen, it binds itself to it tightly. Once attached it acts as a beacon, signalling other elements of the immune system to attack the invader.  


Developing a robust immune system helps the body “fight the fight against Covid or any other viral, bacterial or fungal disease.


Today, through an impressive body of research, we know that quality exercise and activity, nutrition, emotional and psychological wellbeing, and lifestyle choices can benefit your immune system.



We can HELP: 

About the Author:

Edison de Mello MD, Ph.D., has been on the front lines helping to fight COVID since the beginning of the pandemic. He is a board-certified integrative physician with over 25 years of experience in the field of Integrative Medicine. His recent book, BLOATED? Outlines Dr. de Mello's approach to medical care. 

With his signature approach, "I meet my patients before I meet their diseases," Dr de Mello has helped thousands of patients across the globe. 

Along with Dr. Maggie Ney, The Director of Akasha's Women Clinic, his most recent passion was to create an easy-to-follow, effective and comprehensive Integrative lifestyle program called Akasha Reset


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