Om tarmflora, immunforsvar og forekomsten af overvægt hos børn

Æble

 

Overvægt og fedme kan siges at være nogle af tidens mest belastende og meget komplekse tilstande, som det ikke er nemt at gøre noget ved. Overvægt er en multifaktoriel tilstand, hvor både arvelige faktorer og livsstil samt helbred og eventuel medicinering bidrager til den samlede ubalance i energistofskiftet og især til vanskelighederne med at ændre situationen permanent.

Af Eva Lydeking, ernæringsterapeut

Forandringer i tarmens mikrobiota, især i antallet af forskellige bakterier (diversiteten) og forholdet mellem de to største bakteriegrupper, der tilsammen udgør 80-90 pct. af tarmfloraen, er forbundet med en række helbredsproblemer, fra overvægt til diverse inflammationstilstande, adfærdsforstyrrelser og immun-dysfunktioner.
 

Tarmfloraens sammensætning

Tarmfloraen består af seks forskellige bakteriefamilier, lidt virus og svamp:

  • Firmicutes, som udgør ca. 35-45 pct. og består af Streptokokker, Lacnospirae, mange forskellige Clostridier, Eubacterium hallii, Faecalibacterium prausnitzi, mange Bacillus-arter og Lactobacillus-arter. Sidstnævnte er typisk fra 0 og op til 1-2 pct., så hvis man tilfører dem, er teorien, at de dæmper antallet af andre bakterier fra samme storfamilie.
  • Bacteriodeterne er en kæmpe storfamilie med ca. 7.000 forskellige medlemmer, overvejende Bacteroides og Alistipes, samt Prevotella, der kan virke som overvækstbakterie.
  • Actinobakterier er overvejende Actinomyces, mycobakterier, Nocardia og Bifido-familien (fra 0 til 2-4 pct.)
  • Proteobakterier er den mest variable og huser E.Coli-familien, hvoraf få er skadelige, samt proteobakterier og et bredt udvalg af enterokokker, hvor Salmonella, Citrobacter og Klebsiella hyppigt laver ravage i fordøjelsen.
  • Tenericuter er Mycoplasma og Ureaplasma.
  • Verruco-mikrober er bl.a. Akkermansia mucinophila, der er under hastig udforskning. Den kan være gavnlig som inflammationsdæmpende og relateret til ”slankhed”, men hvis den overvokser, er den ikke nem at håndtere, da den dræner slimhinden og medfører undervægt hos de (heldigvis få) klienter med det problem.

 

Tarmfloraens indflydelse på energistofskiftet

Tarmfloraen udvikler sig via den mad, vi spiser, eller rettere den del af maden, som den enzymatiske fordøjelse ikke kan nedbryde og optage. Overvægtsassocieret bakterieflora ændrer personens energiudnyttelse af maden, trigger insulinresistens, inflammation og deponering af fedt, såvel som appetitsignalering, og tendensen til at bruge mad som selvbelønning kan forstyrres. En del af denne signalvej løber via vagusnerven og en del via immun-hormonelle mekanismer.

Man har ”altid regnet med”, at fibre ikke bidrog ret meget i energistofskiftet, men nu viser det sig, at de enzymer, der kan nedbryde fibre (som mennesker ikke danner) – ja, dem kan vi få leveret af mikrobiotaen, så de ellers ufordøjelige fibre pludselig bliver til en energikilde, man må regne med, fordi der både kan dannes optagelige kulhydrater, kortkædede fedtsyrer og enzymer, der øger optagelsen af både kulhydrater og fedtsyrer. Det generelle billede (som endnu ikke er entydigt) er, at overvægtige har for mange Firmicuter i forhold til Bacteriodeter, men samtidig ved man, at adskillige Lactobacillus-probiotika (dog ikke L. Reuteri) kan dæmpe den samlede mængde af Firmicuter, formentlig fordi de mindsker andre fra samme familie, fx Lachnospira, Clostridier og Streptokokker.
 

Kostens indflydelse

En meget ny undersøgelse har via arbejde med komplekse analyser af både immunmekanismer og metabolomanalyser af markører klarlagt, at FIBRE og FERMENTERET MAD har forskellige virkninger på mikrobiotaen:

  • FIBERindtaget blev hos halvdelen af deltagerne fordoblet fra 22 gram dagligt til 43 gram ved at øge indtaget af frugt, fuldkorn, bælgfrugter, nødder, frø og grøntsager. Dette medførte en stigning i Lachnospira og et skift i mikrofloraens funktion, men ikke i diversiteten, så der blev mere effektiv kulhydratfordøjelse (dvs. mere energi udvundet fra kulhydrater). Immunresponset var personspecifikt.
  • Fermenteret-mad-gruppen øgede deres indtag af hytteost, kefir, kombucha, yoghurt, fermenterede grøntsagsdrikke som surkålssaft, fermenterede grøntsager (fx kimchi) fra ingenting til fem portioner dagligt, og det medførte en øget diversitet i tarmfloraen og nedsat inflammationsrespons i immunsystemet. Det er godt for alle mennesker, børn og voksne, unge og gamle med øget diversitet og mindre inflammation.

Forholdet mellem forskellige kosttyper og probiotika ses i figur 1.


Hvad med børnene?

Forskning med børn og mikrobiota i forhold til overvægt er ikke særlig omfattende, men her er lidt om, hvad man foreløbig har fundet ud af:

  • Hos ca. 7-årige børn i Finland fandt man, at børn, der blev overvægtige fra babyalderen til skolestart, har en ændret tarmflora i forhold til dem, der forblev slanke. Der var mere end dobbelt så mange Bifido-bakterier hos de slanke og mere end dobbelt så mange gule stafylokokker hos dem, der udviklede overvægt.

Brug Panda 2 regelmæssigt/systematisk til børn, der er genetisk disponerede for overvægt og gerne kollagentilskud til de hypermobile, fx Multicollagen Sport, som både øger bindevævets kvalitet og bidrager til bedre forbrænding af fedt, så der lettere bygges muskler.

  • Risikoen for overvægt øges, jo mere antibiotika barnet får i løbet af opvæksten og nok især før 6-måneders til 2-årsalderen. Antibiotika er det hyppigst ordinerede lægemiddel til børn, og tarmfloraen retter sig ikke nødvendigvis af sig selv efter ophør. En undersøgelse viser, at antibiotika før 2-årsalderen kan ses i mikrobiotaen i op til to år efter blot en enkelt kur.

I visse lande er det stadig tilladt at give produktionsdyr antibiotika under opvæksten for at opnå hurtigere vægtøgning.

Sørg for, at antibiotika kun bruges, når det er nødvendigt og ikke kritikløst. En række småinfektioner hos børn er nødvendige for immunsystemets sunde modning og kan klares på husapotekervis, når forældre sætter sig ind i området og altid sørger for optimal D-vitamin-status, god multivitamin med spormineraler og for at have et husapotek med fx NDS Olivenbladsekstrakt, UrtePensil, Immuforte, NDS Immunox og NDS Probiotic AAD samt hyldebærsaft/-suppe.

Gravide, især overvægtige gravide, kan med fordel forberede sig intensivt på en naturlig fødsel og sørge for en sund mikrobiota under graviditeten med fx NDS Classic eller Probiolax, hvis der er træg tarmfunktion. For at skabe optimale forhold for muskelfunktionerne under fødslen er det også vigtigt med korrekt mængde af D-vitamin og magnesium, fordi flere undersøgelser viser, at bliver et barn født ved kejsersnit (som kan ske, hvis der er muskulære problemer), er der en tre til fem gange større risiko for udvikling af overvægt hos barnet helt op til 7-årsalderen.

Figur 2 illustrerer samspillet mellem de to hovedgrupper af tarmbakterier, som er beskrevet som ”ude af balance” i forhold til vægtøgning/overvægt, sammen med de probiotikastammer og NDS-produkter, der er relevante at bruge i en samlet indsats.


Et overblik over et svært emne

Overvægt er en kompleks problematik, som påvirker alt for mange børn og voksne, og hvor der er voldsomt mange brikker i spil.

Uanset kan vi ikke komme uden om, at en afbalanceret tarmflora med både fermenterede madvarer og NDS probiotika, som har flere stammer, har vist sig gunstige til at skifte balancen mellem Firmicuter og Bacteriodeter i en retning, så madens energi ikke ”overudnyttes”.

Medtænk dog også stress (som medfører øget kortisol og fedtdeponering) og både søvnmængde og -kvalitet, som er stærkt relaterede til både vægt og mikrobiota. Probiotika, som hjælper i forhold til at normalisere tarmfloraen, kan også hjælpe på søvnproblemer, især sammen med magnesium, zink, D-vitamin.

NDS Multi Collagen Sport hjælper fedtforbrændingen og muskelopbygningen sammen med fysisk aktivitet, ligesom den giver næring til sener og led, så fysisk aktivitet føles rarere, og dermed hjælper den til at trække vægten i gunstig retning.


Kilder

Stojanov, S.; Berlec, A.; Štrukelj, B. The Influence of Probiotics on the Firmicutes/Bacteroidetes Ratio in the Treatment of Obesity and Inflammatory Bowel disease. Microorganisms 2020, 8, 1715. https://doi.org/10.3390/microorganisms8111715

Wastyk et al., Gut-microbiota-targeted diets modulate human immune status 2021, Cell 184, 4137–4153 August 5, 2021 ª 2021 Elsevier Inc. https://doi.org/10.1016/j.cell.2021.06.019

Kalliomäki, Marko; Carmen Collado, Maria Salminen, Seppo Isolauri, Erika Early differences in fecal microbiota composition in children may predict overweight The American Journal of Clinical Nutrition

JO Am J Clin Nutr 2008, VO 87, IS 3 p. 534- 538 https://doi.org/10.1093/ajcn/87.3.534

Ajslev, T., Andersen, C., Gamborg, M. et al. Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics. Int J Obes 35, 522–529 (2011). https://doi.org/10.1038/ijo.2011.27

Caroline L.J. Karlsson,Jenny Önnerfält,Jie Xu,Göran Molin,Siv Ahrné,Kristina Thorngren-Jerneck, The Microbiota of the Gut in Preschool Children With Normal and Excessive Body Weight

First published: 31 December 2012 https://doi.org/10.1038/oby.2012.110

Cláudia Maria dos Santos Pereira Indiani, Karina Ferreira Rizzardi, Paula Midori Castelo, Lúcio Fábio Caldas Ferraz, Michelle Darrieux,

Thaís Manzano Parisotto Childhood Obesity and Firmicutes/Bacteroidetes Ratio in the Gut Microbiota: A Systematic Review Childhood ObesityVol. 14, No. 8 Review Published Online:16 Nov 2018 https://doi.org/10.1089/chi.2018.0040

Alissa C. Nicolucci, Megan P. Hume, Inés Martínez, Shyamchand Mayengbam, Jens Walter, Raylene A. Reimer,

Prebiotics Reduce Body Fat and Alter Intestinal Microbiota in Children Who Are Overweight or With Obesity, Gastroenterology, Volume 153, Issue 3, 2017, Pages 711-722, https://doi.org/10.1053/j.gastro.2017.05.055.

(https://www.sciencedirect.com/science/article/pii/S0016508517356986)

Cristina Torres-Fuentes, Harriët Schellekens, Timothy G Dinan, John F Cryan,

The microbiota–gut–brain axis in obesity, The Lancet Gastroenterology & Hepatology, Volume 2, Issue 10, 2017, Pages 747-756, https://doi.org/10.1016/S2468-1253(17)30147-4.

Karvonen, A.M., Sordillo, J.E., Gold, D.R. et al. Gut microbiota and overweight in 3-year old children. Int J Obes 43, 713–723 (2019). https://doi.org/10.1038/s41366-018-0290-z

K Korpela, A Salonen, LJ Virta, RA Kekkonen, K Forslund, P Bork & WM de Vos (2016). Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children. Nature Communications 7:10410. doi: 10.1038/ncomms10410

Katri Korpela* and Willem M de Vos

Antibiotic use in childhood alters the gut microbiota and predisposes to overweight Microbial Cell | July 2016 | Vol. 3 No. 7, 296-298

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    Adaptability: Being adaptable and flexible helps in dealing with changes and challenges. It involves being open to new ideas, learning from experiences, and adjusting to di…
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