What Would You Like to Eat, Mr CKD Microbiota? A Mediterranean Diet, please!

Abstract

In this review we elucidate the role of gut microbiota as the plausible missing link between food and health, focusing on chronic kidney disease (CKD). Microbiota, the microbial community harboured in the large intestine, is considered a symbiotic “supplementary organ”. It contributes to digestion, mainly through two catabolic pathways: saccharolytic (fermentation) or proteolytic (putrefaction). It also interacts with host influencing immunity, metabolism, and health status. It is believed that a balanced healthy microbiota is primarily saccharolytic and diet has a deep effect on its composition. Mediterranean Diet, UNESCO “Intangible Cultural Heritage of Humanity”, prevents cardiovascular and metabolic systemic diseases, thanks to the high supply of fibres and antioxidants. Mediterranean Diet also favours the prevalence of saccharolytic species, while Western Diet promotes the shift towards a proteolytic profile (dysbiosis). Emerging evidences highlight the association between a wide range of diseases and dysbiosis. In CKD a vicious circle exists, in which proteolytic-derived microbial metabolites (p-cresol and indoxyl sulphate), represent the main circulating uremic toxins: their accumulation worsens dysbiosis and promotes CKD progression. Gut microbiota shaping through non-pharmacologic nutritional treatments, based on Mediterranean Diet, represents an innovative approach in CKD, potentially restoring microbiota balance, ameliorating CKD conditions and slowing down disease progression.

Effect of Whole-Grain Barley on the Human Fecal Microbiota and Metabolome

“…Saccharolytic and proteolytic fermentations are the major fermentation processes, which are carried out by metabolically active microbes at the colon level (14). Saccharolytic fermentation was associated with the synthesis of shortchain fatty acids (SCFA) (acetate, propionate, and butyrate), intermediate metabolites, such as succinate, acrylate, lactate, formate, and ethanol, and small final molecules (hydrogen, methane, and carbon dioxide) (15).…”

“…Saccharolytic fermentation was associated with the synthesis of shortchain fatty acids (SCFA) (acetate, propionate, and butyrate), intermediate metabolites, such as succinate, acrylate, lactate, formate, and ethanol, and small final molecules (hydrogen, methane, and carbon dioxide) (15). Proteolytic fermentation was associated with the synthesis of SCFA (acetate, propionate, and butyrate) and branched-chain fatty acids (BCFA) (isobutyric, isovaleric, and 2-methylbutyric acids), free amino acids (FAA), and some potentially toxic metabolites (phenols, indoles, ammonia, and amines) (14,16,17). The type of colonic fermentation mainly depends on the type of microbiota and fermentable substrate availability (17).…”

Alteraciones en el eje intestino-riñón durante la enfermedad renal crónica: causas, consecuencias y propuestas de tratamiento

“…Debido a ello, se ha propuesto la utilización del patrón dietético mediterráneo (DMED) en el paciente con ERC, confiriendo los beneficios al tipo de hidratos de carbono y las bajas cantidades de proteí-na de origen animal que conlleva dicho patrón alimentario. Se han propuesto algunos beneficios de la DMED en la composición de la microbiota intestinal, al favorecer el tránsito intestinal por las fuentes de fibra que incluye y disminuir con ello la producción de toxinas urémicas 52 , sin embargo su efectividad es controversial. En el estudio multicéntrico PREDIMED, Díaz-López y Cols.…”

Nutritional aspects and vitamin D supplementation in ankylosing spondylitis

“…Many of the anti-inflammatory effects of the Mediterranean diet are associated to the consumption of foods with low ratio omega-6/omega-3 PUFA and extra virgin olive oil which, with its high content of phenolic compounds and MUFAs, has been found to have antiinflammatory effects both in vivo and in vitro studies 13 . Due to the above, the Mediterranean diet helps in maintaining the good intestinal microflora, which is capable to favor the production of short chain fatty acids by promoting saccharolitic microbiota 39 . These metabolites seem to have a positive effect on the immune system, by promoting and maintaining the integrity of the intestinal epithelial barrier, by preventing intestinal inflammation and regulating the acetylation of lysine residues 40 .…”