Bacteria, gases, metabolism, hairloss

Associations among hair loss, oral sulfur-containing gases, and gastrointestinal and metabolic linked diseases in Japanese elderly men: pilot study

Toshihiro Ansai1*, Shuji Awano1, Inho Soh1, Yutaka Takata2, Akihiro Yoshida1, Tomoko Hamasaki1 and Tadamichi Takehara1

* Corresponding author: Toshihiro Ansai ansai@kyu-dent.ac.jp

Author Affiliations

1 Division of Community Oral Health Science, Department of Health Promotion, Kyushu Dental College, Kitakyushu, Japan

2 Division of General Internal Medicine, Department of Health Promotion, Kyushu Dental College, Kitakyushu, Japan

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BMC Public Health 2009, 9:82 doi:10.1186/1471-2458-9-82

Male pattern baldness (MPB), an observable trait, has been reported to be associated with various diseases, such as prostate cancer and cardiovascular disease. Oral sulfur-containing gases have also been suggested to be useful as markers of systemic health condition. However, there are no known reports regarding the associations among MPB, and oral sulfur-containing gases, and systemic health conditions in males.
Methods

We studied 170 male subjects aged either 60 or 65 years old. The degree of MPB was assessed using the Norwood-Hamilton Baldness scale. Oral sulfur-containing gases were measured using a compact-designed device. All subjects completed physical and laboratory blood examinations, a face-to-face medical questionnaire, and an oral examination.
Results

There were significant differences between the levels of CH3SCH3 and baldness patterns, independent of age. When we analyzed whether the association was linked to systemic health condition, a strong significant association was observed between the level of CH3SCH3 and severe MPB in subjects with gastrointestinal diseases, hypertension, and hypercholesterolemia.
Conclusion

These results suggest that MPB is associated with the level of CH3SCH3, a sulfur-containing gas that causes oral malodor, in elderly Japanese males. Further, the association was intensified by the existence of gastrointestinal tract and metabolic disorders.
Background

It has been reported that for diagnosis of systemic diseases, male pattern baldness (MPB), a clearly observable trait, can be used [1,2]. It was also noted that MPB appeared to be a risk factor for some diseases, for example, clinical prostate cancer and cardiovascular disease, independent of other risk factors, including race and age [3-5]. The precise mechanisms leading to the development of MPB and such related diseases are largely unknown, however, they share some epidemiologic and biological risk factors, including age, heritable genetic factors, and androgenic metabolism [6,7].

On the other hand, oral malodor is reported to be primarily associated with dental caries and periodontal disease, though involvement of other factors including systemic health conditions and lifestyle have not been ruled out. It is generally known that volatile sulfur-containing gases, which mainly consist of the three compounds hydrogen sulfide (H2S), methanethiol (CH3SH), and dimethylsulfide (CH3SCH3), are responsible for oral malodor [8]. However, it has not been clarified whether these sulfur gases are derived from the mouth and/or other organs such as the gut, or how the contents of these gases are involved with systemic health conditions. Sulfur-containing molecules in the oral cavity have been used as markers of various systemic conditions. For example, these sulfur gases are also present in colonic gas, though colonic concentrations are orders of magnitude greater than those in breath. Since these gases are rapidly absorbed from the gut, it is possible that they could be transported to the lungs via the bloodstream and then cleared in expired air, as is well documented to be the case with H2 and methane [9]. Colonic H2S and CH3SH in breath could be explained by an extremely efficient metabolism of these gases by the colonic mucosa or liver [10]. Further, another study suggested that subjects with chronic liver diseases could be differentiated from those with normal liver function by comparing the levels of some sulfur-containing compounds [11]. In contrast, CH3SCH3 is not metabolized by the colonic mucosa or the liver, and colonic CH3SCH3 might be expected to appear in breath, and Suarez et al. (2000)[9] suggested that some CH3SCH3 is derived from the gastrointestinal tract. In addition, Hoshi et al. (2002) [12] compared sulfur-containing gases between Helicobacter pylori-positive and negative patients, and found that the levels of H2S and CH3SCH3 in mouth air were significantly higher in positive patients. Considering that various systemic conditions affects breath in the mouth, as described above, it is possible that MPB has an association with levels of oral malodor.

The purpose of the present study was to investigate the severity of MPB in correlation with these sulfur-containing gases. We also investigated whether systemic health disorders were linked to changes in the levels of those gases.
Methods
Recruitment and data collection

This cross-sectional investigation was part of a population-based study conducted to investigate the relationships between oral and systemic health. A total of 170 healthy community-dwelling male subjects aged either 60 or 65 years old residing in Fukuoka Prefecture were recruited in 2006, and all were provided an explanation of the nature of the research project and provided written informed consent. The study was also approved by the Ethics Committee of Kyushu Dental College (no.05022250).

Each subject completed a questionnaire regarding lifestyle, oral and systemic health conditions, and medical history, and also underwent physical, laboratory blood, and oral examinations. All current medication usage was recorded, including treatments for hypertension, diabetes, and hyperlipidemia. Blood samples were taken after the subjects had refrained from oral intake and smoking for at least 2 h before collection, then transported to a commercial laboratory on ice for measurements.

The degree of MPB was assessed in the male subjects using Norwood-Hamilton Baldness scale [1] by a trained doctor, with hair loss graded progressively from Type I (no loss) to Type VII (hair loss complete at the crown). For the purpose of our analyses, subjects with MPB were then classified to three groups; slight (Type I and II), moderate (Type III including Type III vertex to V), and severe (Type VI and VII).
Sampling of oral gases and the devise used

For sampling, subjects were asked to refrain from oral activity, including eating, drinking, tooth brushing, and mouthrinsing, before testing. Oral sulfur-containing gases were measured using an indium oxide (In2O3) semiconductor gas sensor (Oral Chroma, ABILIT, Tokyo, Japan), a compact-sized device that is popular in dental clinics in Japan, as described previously [13]. Briefly, subjects were instructed to keep their mouths closed and breathe through the nose for 30 s before analysis. A 1-mL disposable syringe was inserted into the oral cavity through the lips and teeth, and 1 mL of oral air was aspirated by the syringe. Immediately, 0.5 mL of the sample was injected into the device. In a previous hospital-based study that utilized the device (mean subject age, 32.1 years old), reference values for oral sulfur-containing gases were reported, as follows: H2S, 358.7 ppb (SE, 25.6); CH3SH, 143.0 ppb (SE, 14.6); CH3SCH3, 19.5 ppb (SE, 2.3) [14].
Statistical analysis

To assess differences between groups, a chi-square test was used for categorical variables and ANOVA for continuous variables, followed by adjustment for the effects of age if necessary. Linear trends for the associations were assessed by computing the P value for each trend with multiple regression analysis. All statistical analyses were performed using SPSS 14.0 for Windows (SPSS Japan, Tokyo, Japan). The level of statistical significance was set at 0.05 for all of the analyses.
Results

The prevalence and distribution of MPB in the 170 male subjects is shown in Table 1. We classified 67 subjects as slight (39.4%), 64 as moderate (37.6%), and 39 were severe (23.0%). As shown in Table 2, there were significant differences among the groups in regard to age, but not regarding systemic conditions, including blood pressure and laboratory blood test results, or lifestyle factors of alcohol use and smoking habit. Medical history for the subjects revealed 68 with hypertension (of whom 46 were receiving medication), 25 with diabetes, 10 with CVD, 24 with CHD, 39 with hepatic disease, 15 with respiratory disease, 79 with gastrointestinal disease, and 26 with hypercholesterolemia. There were no significant differences among the groups in regard to medical history. Table 3 shows the oral health status separated by MPB group. There was a significant difference only for the level of CH3SCH3. There were no significant differences between the ages groups regarding oral sulfur-containing gases. The mean values for H2S, CH3SH, and CH3SCH3 for all subjects were 4.64 ng/10 mL (= 346.6 ppb), 2.82 ng/10 mL (= 149.5 ppb), and 0.54 ng/10 mL (= 22.2 ppb), respectively. We also investigated the effects of systematic health on CH3SCH3 levels, as shown in Table 4. In the subjects with gastrointestinal diseases, hypertension (treated), and hypercholesterolemia, there were significant differences among the groups. In particular, CH3SCH3 in those with severe MPB showed significant associations with gastrointestinal disease, hypercholesterolemia, and hypertension (treated) (P for trend < 0.05 for each), with gastrointestinal disease and hypercholesterolemia occurrences shown to be approximately 2 to 5-fold higher than the level shown in Table 3. A total of 79 subjects had gastrointestinal diseases, which were gastritis in 24, gastric ulcers in 12, duodenal ulcers in 10, gastric cancer in 1, large intestine polyps in 11, and combinations of those gastrointestinal diseases in 21. In contrast, there were no significant differences among the groups in regard to subjects treated to eliminate H. pylori. In addition, in subjects with other systemic diseases such as hepatic and diabetic diseases, there were no significant differences among the groups regarding CH3SCH3 levels.

Bacterial Metabolism of Androgens and Estrogens
Sun, 20 May 2012 06:39:13 | Intestinal Microbiota

Estrone, estradiol, and estriol are the three major estrogens that are excreted into the bile. These estrogens are conjugated to glucuronic acid and/or sulfate. Upon excretion of these conjugated estrogens from the bile into the small intestine the conjugates are available substrates for bacterial metabolism. The bacteria of the lower small intestine and colon can hydrolyze the estrogen conjugate releasing free estrogens (45). The nonconjugated estrogens are then subject to additional bacterial action. A major reaction involves oxidoreduction of the C17 position. Bacteria can convert estrone to estradiol, and the fecal flora can also convert 16 alpha hydroxyestrone to estriol (46).

The intestinal bacteria can also modify androgens. The intestinal bacteria can reversibly oxidize and reduce the 3-hydroxy group, and reduce steroid nuclear double bonds at the one and four positions. The latter reactions can result in several interconversions of androgens (47).

Thyroid hormone and the gut.
Hays MT.
Source

Veterans Administration Medical Center, Palo Alto, California 94304.
Abstract

The gastrointestinal tract interacts actively with the thyroid hormones, T4 and T3. Both T4 and T3 are absorbed well but incompletely from the gut, and many factors affect this absorption. The mechanism of absorption is unknown. It is decreased in most malabsorption conditions, but is increased in the postgastrojejunotomy syndrome. It may involve conjugation to the glucuronide forms (T4G and T3G) in the mucosal cell with subsequent deconjugation prior to appearance in the portal vein blood. Absorption appears to be reduced in the presence of excess T4, and increased in hypothyroidism. The liver takes up a large fraction of the T4 and T3 from its circulation and returns a portion of the portal hormone back to the gut via the bile. There is also direct T4 and T3 secretion into the gut from the mesenteric circulation. Recent studies suggest that the gut plays a major role as a reservoir for the thyroid hormones, especially for T3, and that it may also play a role in the regulation of hormone activity.