December 7, 2019

New study demonstrates magnesium’s role in fracture prevention

According to a new study published in the European Journal of Epidemiology, researchers identified an association between low serum magnesium levels and an increased risk of fracture. Most patients with osteoporosis or osteopenia that want to optimize their bone health are told by their traditional doctor to take calcium and vitamin D, and most never recommend magnesium to their patients. All alternative and integrative practitioners know the essential role of magnesium in several cellular processes including it being a major component in bone (50%).

A magnesium insufficiency is seen in most patients, which can be crucial in addressing and preventing disability in middle-aged to elderly people resulting from fractures.

Bone fractures are one of the leading causes of disability especially among the elderly. It is well-known that calcium, vitamin D, vitamin K and trace minerals play an important role in bone health.

In this study, researchers followed 2,245 middle-aged men over a 20-year period. They found that men with lower serum magnesium levels had an increased risk of fractures, specifically fractures of the hip. The risk of having a fracture was reduced by 44% in men with higher blood levels of magnesium. None of the 22 men who had very high magnesium levels (> 2.3 mg/dl) had a fracture during the follow-up period.

Unfortunately, we do not have a great way to measure magnesium status. For example, serum magnesium which was used in this study only represents only 1% of magnesium stores, so if this is low, they have a severe deficiency. Magnesium is homeostatically controlled in the serum and measuring serum magnesium levels provides many false negatives. By the time your serum is low, you are very deficient as the body cannot maintain the serum magnesium levels. Red blood cell magnesium is definitely better and can be routinely assessed by most labs and it’s surprising to see how many patients are deficient.

As a result, these findings confirm the importance of assessing and addressing magnesium status in all patients but in this case those at an increased risk prevention of fractures.

RBC levels of magnesium do correlate with magnesium intake, however, this may not be the case for the elderly, those with specific GI condition, and those on certain medications. In these individuals increasing the intake of foods rich in magnesium may not increase their blood magnesium levels. It is important to address any underlying issues as well as providing magnesium supplementation.

Most individuals do not experience any symptoms or least associate their symptoms with low magnesium. Since blood magnesium is not routinely tested by traditional doctors and hospitals, it is often missed.

It is also important to consider collagen supplementation was well as to prevent fractures as it does make up a significant component many tissues such as bone.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Setor Kwadzo Kunutsor, Michael Richard Whitehouse, Ashley William Blom, Jari Antero Laukkanen. Low serum magnesium levels are associated with increased risk of fractures: a long-term prospective cohort study. European Journal of Epidemiology, 2017; DOI: 10.1007/s10654-017-0242-2


New study demonstrates bovine colostrum decreases intestinal permeability in athletes

There was an interesting study published 6 days ago in Nutrients on intestinal permeability and athletes. I shared a similar article last July in the American Journal of Clinical Nutrition on heavy exercise induced intestinal permeability in athletes.

When one thinks of nutritional supplements in athletes, they usually think of nutrients that increase enhance energy and sports performance. However, athletes commonly suffer from gut issues that are often not identifies or addressed. ‘Leaky gut’ occurs from dysfunction in the intestinal barrier.  This intestinal barrier in the gut is only one cell layer thick. It is essential for the absorption of nutrients and preventing large molecules and bacteria from getting into the blood stream.

This is a particular problem for those taking part in heavy exercise or any form of vigorous strength training, such as CrossFit athletes, strongman competitors, and powerlifters, which can lead to gut issues in athletes as well as more serious conditions like inflammatory bowel and autoimmune disorders.

Inthis study, researchers demonstrated that oral supplementation with colostrum decreased intestinal permeability which was seen with decreases of zonulin in stool samples.

This double-blind placebo-controlled study including 16 athletes during peak training of competition.  The study compared supplementation for 20 days with 500 mg of bovine colostrum or placebo. Gut permeability was assessed by a lactulose and mannitol absorption test and stool zonulin concentrations. Initial results identified that 6 of the 8 athletes in the colostrum group had increased intestinal permeability. After supplementation, the test results were within the normal range and were significantly lower than at baseline.

This is the first study to demonstrate that supplementation with bovine colostrum decreased and restored intestinal permeability in both urinary lactulose/mannitol ratio as well as fecal zonulin. Previous research demonstrated preventative colostrum supplementation on increased permeability associated with heavy exercise in athletes.

As a result, researchers demonstrated that colostrum supplementation decreased previously elevated intestinal permeability and was able to restore it within 3 weeks of supplementation.

These findings demonstrate the importance of colostrum in preventing leaky gut associated with heavy exercise but also as an important nutrients to consider for athletes. When working with athletes, there is often a disconnect between fitness and health. For those individuals that have a sensitivity to dairy, I would consider serum-derived bovine immunoglobulin/protein isolate (SBI) to normalize the gut microbiota and decrease gut permeability.The other advantage of this for athletes is the addition protein content with BCAAs levels superior to whey and provides high levels of IgG which reduces inflammation decreasing mucosal damage.

As a competitive powerlifter, I work with many of these athletes. Due to the stresses they put on their bodies and increased metabolic demands, many often have debilitating gut issues and inflammatory bowel diseases.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Halasa, M. et al. Oral Supplementation with Bovine Colostrum Decreases Intestinal Permeability and Stool Concentrations of Zonulin in Athletes. Nutrients. 2017 Apr 8;9(4). pii: E370. doi: 10.3390/nu9040370.

New study demonstrates enhanced cognition and cerebrovascular function from resveratrol

Alzheimer’s disease and related disorders (ADRD) are a group of conditions that cause mild cognitive impairment (MCI) or dementia. These conditions affect one’s ability to function socially, personally, and professionally. It’s important to recognize that Alzheimer’s disease begins long before symptoms start just like many other conditions. There is evidence that simple prevention strategies can reduce the risk of ADRD by as much as 50%.

The prevalence of dementia for those over 65 years of age is 14% in men and 32% in women. By the age of 80, sixty three percent of those with dementia are women.

Resveratrol has been widely publicized for its cardiovascular health benefits. However, researchers believe it also has positive effects on the hippocampus, an area of the brain that is critical to functions such as memory, learning and mood.

In a recent study published in Nutrients, researchers demonstrated oral supplementation with resveratrol enhanced both cerebrovascular function and cognition in post-menopausal women, which can potentially reduce the risk of cognitive decline.

Cognitive decline is associated with decreased cerebral blood flow and a reduced ability of cerebral arteries to dilate. There is evidence to suggest that the loss of estrogen may contribute to reduced cerebrovascular responsiveness. As a result, maintaining cerebrovascular function may help optimize mood and prevent cognitive decline.

Resveratrol can act through several mechanisms, including binding and activating estrogen receptors to increase nitric oxide bioavailability and facilitate the vasodilatation for adequate cerebral perfusion.

This study was a 14-week randomized, double-blind, placebo control trial consisting of 72 women. researchers demonstrated that a single 75 mg dose of resveratrol was most efficacious for enhancing global cerebral vasodilatation and cognitive performance.

These results support resveratrol supplementation as a potential strategy for mitigating premature cognitive decline in post-menopausal women. Researchers also observed marginal improvements in mood suggesting possible additional benefits to quality of life in the years following menopause.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Evans, HM et al. Effects of Resveratrol on Cognitive Performance, Mood and Cerebrovascular Function in Post-Menopausal Women; A 14-Week Randomised Placebo-Controlled Intervention Trial. Nutrients. 2017 Jan 3;9(1). pii: E27. doi: 10.3390/nu9010027.

New study investigates potential mechanisms of serum-derived bovine immunoglobulin in patients with IBS

Irritable bowel syndrome (IBS) can be debilitating condition consisting of cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS can affect and one’s work, sleep and relationships.

A variety of factors have been associated with IBS such as genetic susceptibility, infections, small bowel intestinal overgrowth, deficiencies in tight junction proteins, intestinal abnormalities with bile acid metabolism, changes in GI motility, visceral hypersensitivity, dysregulation of the interaction between the CNS and enteric nervous system, as well as psychosocial factors.

One may need a combination of botanicals, enzymes, and probiotics to optimize the gastrointestinal environment. Certain diagnostic tests may also be beneficial, including stool testing as well as food antibody testing.

Recent studies demonstrated the potential role of low-grade inflammation associated with alterations in the gut microbiome, which can contribute to intestinal barrier dysfunction affecting absorption of water and nutrients as well as an increase antigenic exposure with immune activation leading to further intestinal inflammation and gastrointestinal symptoms.

According to a study published 3 weeks ago in Physiological Reports, researchers evaluated the mechanisms of action and effectiveness of SBI in patients with IBS-D. A number of studies have suggested a potential role for serum-derived bovine immunoglobulin/protein isolate (SBI) as a potential therapy for IBS-D.

This study included fifteen patients with IBS-D base on Rome III criteria that were given SBI twice daily for 8 weeks. Researchers assessed GI symptoms and collected plasma and stool samples to evaluate tryptophan metabolism, intestinal permeability, intestinal microbiota, and expression of genes for tight junction proteins, secretory mechanisms, tissue repair proteins, and chemokines.

As a result, researchers demonstrated that GI symptoms improved over 8 weeks with SBI therapy. These findings are consistent with previous research shown with SBI improving GI symptoms in patients with IBS-D. In addition, the duodenal microbiome showed considerable structure changes with increases in the abundance of Proteobacteria Burkholderiales and Firmicutes Catonella to suggest that the small intestinal microbiome is altered after therapy with SBI and this may play a role in improving epithelial barrier function and modulating immune activation.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Valentin N. et al. Potential mechanisms of effects of serum-derived bovine immunoglobulin/protein isolate therapy in patients with diarrhea-predominant irritable bowel syndrome. Physiological Reports. 017 Mar;5(5). pii: e13170. doi: 10.14814/phy2.13170.

New study demonstrates sulforphane’s influence on genetics and prostate cancer

According to a recent study published in the Journal of Nutritional Biochemistry, researchers identified a pathway that sulforaphane may influence long, non-coding RNAs.

This research provides evidence on how these RNAs may play a critical role in triggering the proliferation of cells to become malignant and metastasize. Previous research has demonstrated that long, non-coding RNAs have an essential role in cellular development and an epigenetic influence by controlling what genes are expressed. Researchers believe that when these are dysregulated, they can contribute to chronic disease and cancer.

In this study, researchers demonstrated that one long, non-coding RNA was decreased four-fold with the treatment of sulforaphane and is upregulated in prostate cancer. As a result, treatment with sulforaphane could normalize these long, non-coding RNA levels which not only may help with cancer prevention but also slow cancer progression.

Prostate cancer is the 2nd most common cancer and the second leading cause of cancer-related deaths in the United States in men.
Earlier studies have demonstrated that cruciferous vegetables with a high concentration of sulforaphane help reduce the effects of environmental carcinogens. Sulforaphane targets several biological pathways that modulate Phase I enzymes and elevate Phase II enzymes that are present in all cells.

Once inside the cells, sulforaphane sends a signal to individual cellular enzymes that turns on the natural cellular defenses in these cells. Sulforaphane is capable of restoring the gene’s activity towards normal cell progression. Cells are naturally equipped with their own internal defense system. Much of the cell’s ability to defend itself is due to two main factors: sulforaphane’s ability to produce the antioxidants that quench harmful free radicals and detoxification enzymes to break down toxins.

This study reinforces the importance of diet and nutrition and their epigenetic influence on telling the DNA how to function by turning on and off genes. Other nutrients such as essential fatty acids, curcumin, EGCg, and vitamin D play an important role as well.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Laura M. Beaver, Rachael Kuintzle, Alex Buchanan, Michelle W. Wiley, Sarah T. Glasser, Carmen P. Wong, Gavin S. Johnson, Jeff H. Chang, Christiane V. Löhr, David E. Williams, Roderick H. Dashwood, David A. Hendrix, Emily Ho. Long noncoding RNAs and sulforaphane: a target for chemoprevention and suppression of prostate cancer. The Journal of Nutritional Biochemistry, 2017; 42: 72 DOI: 10.1016/j.jnutbio.2017.01.001

New study demonstrates b vitamins may reduce the negative effects from air pollution

According to a new study published in PNAS, researchers at Columbia University demonstrated that B vitamins may play an essential role in reducing the impact of air pollution. This is the first study to show possible interventions that prevent or minimize the adverse effects of air pollution.

This study shows how preventive measures with B vitamins can influence specific pathways that may mitigate the adverse effects of air pollution.

The World Health Organization (WHO) estimates that approximately 92% of the population lives in places where air quality levels exceed the limits of 10 μg/m3. Air pollutants can deposit in the respiratory tract which can result in lung and systemic inflammation. Although there has been substantial lowering of air pollution through large-scale emissions control policies over the past few decades, adverse health effects are still common.

The negative health effects of air pollution and its role in one’s health may contribute to many complex issues.
In this study, researchers gave participants a placebo or B-vitamin supplement containing folate, pyroxidine, and cobalamin. Plasma B vitamin levels were assessed before and after which demonstrated that B-vitamin supplementation prevented changes in the genes involved in mitochondrial oxidative energy from air pollution.

The truth is, we all live in an ever-increasing toxic environment. More than 80,000 chemicals are introduced into the world each year and our indoor environment is likely more toxic than our outdoor environment.

We are exposed to pesticides, herbicides, chemical solvents, xenobiotics, and industrial chemicals of all kinds that we get exposed through the food we eat, the water we drink and the air we breathe. These toxins accumulate in our body and contribute to the total toxic load that can cause a variety of health problems. Unfortunately, this exposure to chemicals are unavoidable in the environment,
What can we do? Support our detoxification pathways. There is significant evidence on the importance of diet and nutritional supplementation in maintaining detoxification pathways. This may consist of eating organic food, drinking clean, pure water, and supplementing with nutrients like B-vitmains, N-acetyl-cysteine and calcium d-glucurate or participating in a formal detoxification program.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: B vitamins attenuate the epigenetic effects of ambient fine particles in a pilot human intervention trial, Jia Zhong et al., PNAS, doi: 10.1073/pnas.1618545114, published online 13 March 2017

New study demonstrates blueberry supplementation improves brain function

Blueberries are rich in flavonoids, which contain powerful antioxidant and anti-inflammatory properties. High intake of flavonoids mitigate age-related cognitive decline, however, human studies are limited. Cognitive function declines with age as the body’s cells are more susceptible to damage and death. In addition, the body produces less energy due to slower metabolism and as a result, cells are less able to produce antioxidants and soak up free radicals.

According to a new study published last week, researchers demonstrated that drinking concentrated blueberry juice improves brain function in older individuals.

This study included 26 healthy individuals ranging from 65 to 77 years of age. Twelve people drank a concentrated blueberry juice every day providing 387 mg of anthocyanidins for 12 weeks that demonstrated improvements in cognitive function, working memory, blood perfusion to the brain as well as activation of the brain while performing cognitive tests.

Before and after the twelve week period, all 26 individuals took a variety of cognitive tests while an MRI scanner monitored their brain function and resting brain blood flow. As a result, those who consumed the blueberry supplement showed significant increases in brain activity in brain areas related to the tests.

There is evidence that simple prevention strategies can reduce the risk of dementia and preserved cognition with a diet rich in plant-based foods. Flavonoids are an essential component contributing to these effects.

Blueberry consumption also plays a role in the reduction of amyloid β protein (Aβ) aggregation, which can disrupt mitochondrial function and lead to neuronal cell death. Pathological levels of amyloid plaques are found in the brains of Alzheimer’s patients.1,2 Also, the cognitive improvement provided by blueberries is associated to higher brain antioxidant production of glutathione.3

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Soluble protein oligomers as emerging toxins in Alzheimer’s and other amyloid diseases. Ferreira ST, Vieira MN, De Felice FG. IUBMB Life. 2007 Apr-May;59(4-5):332-45.

Synaptic failure and adenosine triphosphate imbalance induced by amyloid-β aggregates are prevented by blueberry-enriched polyphenols extract. Fuentealba J, Dibarrart AJ, Fuentes-Fuentes MC, Saez-Orellana F, Quiñones K, Guzmán L, Perez C, Becerra J, Aguayo LG. J Neurosci Res. 2011 Sep;89(9):1499-508. doi: 10.1002/jnr.22679. Epub 2011 Jun 6

Effect of a polyphenol-rich wild blueberry extract on cognitive performance of mice, brain antioxidant markers and acetylcholinesterase activity. Papandreou MA, Dimakopoulou A, Linardaki ZI, Cordopatis P, Klimis-Zacas D, Margarity M, Lamari FN. Behav Brain Res. 2009 Mar 17;198(2):352-8. doi: 10.1016/j.bbr.2008.11.013. Epub 2008 Nov 17.

Source: Joanna L. Bowtell, Zainie Aboo-Bakkar, Myra Conway, Anna-Lynne R. Adlam, Jonathan Fulford. Enhanced task related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Applied Physiology, Nutrition, and Metabolism, 2017; DOI: 10.1139/apnm-2016-0550

New study identifies inflammatory trigger associated with inflammatory and autoimmune conditions

According to a new study published last month, researchers identified an inflammatory molecule associated with inflammatory disorders such as inflammatory bowel disease (IBD) and psoriasis.

This helps identify therapeutic targets for supporting and treating these types of conditions.
Researchers identified that dying cells release IL-1, an inflammatory signal, which is the cause of the inflammation and targeting this molecule may be an effective way of treating inflammatory diseases.

These findings suggest that targeting IL-1 could suppress inflammation associated with inflammatory diseases, multiple sclerosis, atherosclerosis, liver disease, pancreatitis, psoriasis, IBD, and infectious diseases.

Nutrients to consider

There are only a few natural products that have demonstrated the wide range of protective properties as curcumin. It provides anti-inflammatory properties and antioxidant effects that modulate cytokine and chemokine production and as a result balances the Th-1 and Th-2 T helper cells further downstream.

Glucosamine is a derivative of glucose which can be converted in cells to N-acetyl glucosamine (GlcNAc). This novel form of glucosamine has demonstrated that it acts as an immunosuppressive agent through a variety of mechanisms. Glucosamine can suppress the activation of T-cells and dendritic cells which are two crucial cells involved in the immune response. In one study when GlcNAc was used in children with chronic inflammatory bowel disease, biopsies revealed histological improvements as well as restoration of the epithelial barrier (i.e., repairing leaky-gut).

ParActin is a branded botanical that have very unique immune modulating properties. It is a standardized special extract of Andrographis, which activates the peroxisome proliferator activated receptor gamma (PPARγ) nuclear receptor. When activated, it not only stimulates the expression of genes involved in energy homeostasis, but also key regulators of the immune and inflammatory responses such as downstream inflammatory cytokines, tumor necrosis factor-α (TNF-α) and interleukin-1β.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Conos, al. Active MLKL triggers the NLRP3 inflammasome in a cell-intrinsic manner. Proceedings of the National Academy of Sciences of the United States, Feb. 7, 2017; volume 114 no. 6. doi: 10.1073/pnas.1613305114

Low vitamin D levels increase risk of relapse in patients with ulcerative colitis

According to a new study published this month in the journal Clinical Gastroenterology and Hepatology, researchers discovered lower levels of vitamin D were associated with an increased risk of a relapse in patients with Ulcerative Colitis (UC).

It is well known the role of vitamin D and autoimmunity and disease severity, however, it has been unknown if it contributes to disease relapses and unclear if the flare-up was lowering vitamin D levels or if low vitamin D levels were causing the flare-up.

In this study researchers investigated vitamin D levels when the disease was in remission and then followed patients moving forward to further determine this connection. The research team measured vitamin D levels of 70 patients with UC in remission as well as levels of inflammation. They then followed these patients for 1 year and compared the data from those that remained in remission and those who experienced relapses. As a result, those who had higher vitamin D levels greater than 35 ng/ml while in remission had a decreased risk of a relapse.

Autoimmune disorders occur when the body’s immune system is tricked into thinking that self is foreign and starts attacking itself. As a result, the immune system makes antibodies that attack various tissues in the body.

Vitamin D helps autoimmune disorders by regulating T cells in the immune system. This makes the body more tolerant of itself and less likely to mount autoimmune responses. The severity of Crohn’s disease is linked to the lowest vitamin D levels.

Vitamin D deficiency has been linked to many autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and Crohn’s disease, with studies finding a higher prevalence of these diseases in those who are deficient in vitamin D

There is plenty of evidence regarding the benefit of vitamin D supplementation on a multitude of health benefits not just with autoimmune disorders. Given the fact that supplementation of vitamin D in its natural form is harmless and inexpensive, many more people should get their vitamin D levels checked regularly and supplement according.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: John Gubatan, Shuji Mitsuhashi, Talia Zenlea, Laura Rosenberg, Simon Robson, Alan C. Moss. Low Serum Vitamin D During Remission Increases Risk of Clinical Relapse in Patients With Ulcerative Colitis. Clinical Gastroenterology and Hepatology, 2017; 15 (2): 240 DOI: 10.1016/j.cgh.2016.05.035

New study identifies dramatic shifting of the microbiome in inflammatory bowel disease

Inflammatory bowel disease is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

According to a study published four days ago in Nature Microbiology, individuals with IBD commonly have dramatic shifts in gut microbiome compared to that of healthy people.

Although it is well known that there are differences in the gut microbiome in IBD patients, this is one of the largest studies to follow the microbiome over a period of time. The most significant difference researchers saw was how the microbiome shifted, describing it as a “volatile dysbiosis.” These patients have a much less stable microbiome than healthy individuals.

Researchers have known that there are some differences in the microbiomes of patients with IBD patients compared to healthy individuals such as fewer beneficial microbes and many times high amounts of Enterobacteriaceae and E. coli.

It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.

In this study, researchers followed 137 individuals for 2 years, which included patients with ulcerative colitis, Crohn’s disease, and healthy individuals. They collected stool samples from patients every 3 months for up to 2 years and monitored patients’ symptoms.

The research team found that in healthy people, the gut microbiome was much more stable than those with IBD. The patients with IBD had dramatic shifts in their microbiomes with some bacteria disappearing almost completely at times. In addition, over 50% of their microbiome was displaced by other microbes in just a few months. The biggest swings were seen in patients with ileal Crohn’s disease who had had part of their intestine removed to improve their symptoms.

Also, researchers noted that changes in medication to treat IBD affected the microbiome. Individuals who had taken steroids for part of treatment had more fluctuations in their microbiome and those who were experiencing a flare-up in their symptoms were more likely to have dramatic fluctuations in their microbiome.

These results further support the integrative functional medicine approach to assess the microbiome regularly in these patients so one can take an individualized approach to manipulate the microbiome and keep these IBD patients in remission, especially if medications like corticosteroids can be shift the microbiome leading to an exacerbation of the disease.

I shared a study published last month in the Journal of Clinical Gastroenterology in which researchers demonstrated that a specific carbohydrate diet (SCD) can bring patients with active inflammatory bowel disease (IBD) into remission.

In addition, one must look into the other potential environmental triggers that can cause inflammation such as, food sensitivities, toxins, and molds. Also, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Jonas Halfvarson, Colin J. Brislawn, Regina Lamendella, Yoshiki Vázquez-Baeza, William A. Walters, Lisa M. Bramer, Mauro D’Amato, Ferdinando Bonfiglio, Daniel McDonald, Antonio Gonzalez, Erin E. McClure, Mitchell F. Dunklebarger, Rob Knight, Janet K. Jansson. Dynamics of the human gut microbiome in inflammatory bowel disease. Nature Microbiology, 2017; 2: 17004 DOI: 10.1038/nmicrobiol.2017.4