CBD creams and other topical ointments are a great way to help treat pain naturally. If you've been in the market for a CBD topical but don't know where to begin, we've got you covered. Read on to see which brands are our top picks for the best CBD creams, salves, and lotions.
While oils, gummies, vapes, and other edible/inhalable options of CBD offer users a natural way to help manage various health conditions, a topical cream is the best way to target specific muscle and joint aches and pains.
Topical creams are a wonderful way to bring CBD directly to any area of the body that is having tension, aches, and pains. Many people who deal with chronic muscle aches, arthritis, fibromyalgia, and other conditions often turn to CBD cream because it offers fast, targeted, natural relief.
Our guide to the best CBD creams will not only inform you about CBD topicals and how they work, but we will also give you our top picks for the best CBD creams out on the market today so that you can get the very best natural relief possible.
Our Picks for Best CBD Creams and Topicals
Each product featured here has been independently selected by the writer. If you make a purchase using the links included, we may earn a commission.
- FAB CBD Topical Cream - Best Overall
- FAB CBD Body Salve - Best Full Spectrum Roll-On
- Spruce CBD Cream - Strongest CBD Cream
- cbdMD Freeze Roller - Best Broad Spectrum Roll-On
- Charlotte's Web Hemp-Infused Cream - Best Price
- CBDistillery CBD Balm - Best Post-Workout Cream
- Medterra Pain Cream - Best for Joint Pain
- Plant People CBD Balm - Best for Sprains and Bruises
How We Selected the Best CBD Creams
The CBD market is flooded with brands and products claiming to be the very best. But not all brands are the same, and not all products are created equally. We want to remove the frustration and confusion of finding the right CBD product so you can easily find the right CBD cream.
We evaluated each brand of CBD cream on the following six key categories.
- Value — How much does the CBD cream cost?
- Strength — How many milligrams of CBD does the cream contain?
- Source — Where does the hemp used for CBD come from?
- Scent — Is the cream scented at all, and does it use natural ingredients?
- Transparency — Does the brand use third-party lab testing to ensure quality?
- Customer Experience — Do customer reviews show a positive experience overall?
Learn more about each of the CBD creams on our list below.
Best CBD Creams & Salves
Every one of FAB's products contains the very best full spectrum extract that's been sourced from organically grown Colorado hemp. FAB's topical cream is made with 600mg of CBD from a full spectrum hemp extract. Not only is the cream smooth, silky, and non-greasy, it's also light as a feather and has a lovely subtle blood orange scent.
FAB CBD is also known for having a strong customer service department that makes ordering and shipping a breeze.
When you're looking for a CBD cream, you should be zeroing in on the following:
- Value — The price of FAB's topical cream is right in line with many of the other highly regarded brands. Not only is FAB's cream affordable, it's also highly effective, clean, and of the highest potency.
- Strength — 600mg full spectrum CBD per jar
- Hemp source — All of FAB's organic hemp is cultivated in Colorado.
- Scent — Blood orange
- Transparency — FAB believes in transparency, so it makes all of its third- party lab test results easy for customers to find on its website. Along with ensuring that all of the hemp is free from chemicals, herbicides, pesticides, and toxic unnatural fertilizers, FAB also uses state-of-the-art equipment to both clone and harvest the hemp. FAB uses an extremely safe and clean Co2 extraction process to ensure that there are no chemicals or impurities in the extracts.
- Customer experience — Many customers regularly use FAB's topical cream to help with tough health issues including arthritis, nerve pain, muscle aches, sleep issues, and many other difficult conditions. A host of verified positive customer reviews solidify the fact that FAB has one of the most effective and highly potent creams on the market today.
Why buy — We love FAB not only because the brand's products are top-notch, but also because the FAB team truly cares about their customers. FAB's products are not only affordable, they're also very potent and highly effective. We recommend FAB's CBD topical cream for its light feel, silky texture, and fresh citrus scent.
FAB CBD Body Salve
FAB CBD's newest topical product is its 1000mg and 3000mg full spectrum body salve. The salve has been lab tested for purity and contains essential oils, botanical terpenes, and both a heating and cooling element to help provide comfort and relief.
- Value — When it comes to the price of FAB's CBD Body Salve, we feel that it absolutely falls in line with the prices of other reputable CBD brands. It's made to be top-shelf quality, affordable, clean, and highly effective.
- Strength — 1000mg or 3000mg full spectrum CBD per container.
- Hemp source — Organic hemp that is grown and harvested in Colorado.
- Scent — None
- Transparency — FAB believes in transparency, so it makes all of its third- party lab test results easy for customers to find on its website.
- Customer experience — FAB's CBD Body Salve is perfect for those with active lifestyles like golfers, runners, gardeners, crossfitters, weight lifters, and even computer keyboard warriors who strain the joints in their fingers and wrists from typing all day long.
Why buy — The brand's newly crafted body salve is packed with all-natural, healing ingredients including organic golden jojoba oil, organic beeswax, menthol crystals for cooling, cinnamomum camphora oil for heating, distilled full-spectrum hemp flower extract, organic rosemary oil, ginger oil, lavender oil, eucalyptus oil, vitamin E, and so much more.
Spruce makes its salve from full spectrum CBD; this means that, in addition to CBD, there may be other plant parts and terpenes that can help bolster the product's therapeutic effectiveness. These ingredients combine with the full spectrum CBD for powerful pain relief. In fact, their CBD salve offers the highest concentration of CBD per ounce of any product on our list.
- Value — At $89 for 1000mg of CBD per 0.87oz. container, or $169 for 3000mg of CBD per 1.7oz. container, Spruce offers a very strong product at a reasonable price point.
- Strength — 1000mg or 3000mg full spectrum CBD per container.
- Hemp source — Kentucky and North Carolina
- Scent — None
- Transparency — Third-party lab tested with easily-accessible results online.
- Customer experience — Customer reviews offer plenty of success stories from patients who have used Spruce CBD salve to treat their arthritis symptoms and other chronic pains.
Why buy — We love the Spruce product line for a number of reasons, not least the fact that their product is made with natural ingredients and plant-derived scents. These ingredients combine with the full spectrum CBD for powerful pain relief.
cbdMD is one of the most popular CBD companies, and a quick look at their lineup of topical products shows you why. There are a lot of great options to choose from as you seek CBD-enhanced pain relief. For example, cbdMD offers basic creams, lip balms, hemp-infused roll-ons, and more.
The cbdMD Freeze roll-on is made with menthol, arnica montana, and aloe vera to support soothing and healing.
- Value — cbdMD's Freeze roller starts at $30 for the 300mg option and goes up to $150 for the 3000mg option, making it easy to select the right strength and price for you.
- Strength — 300mg, 750mg, 1500mg, or 3000mg broad spectrum CBD per 3oz. container.
- Hemp source — USA
- Scent — None
- Transparency — Third-party, ISO-certified lab tested to ensure purity and safety
- Customer experience — Customer reviews attest that this product works quickly to help relieve different types of pain. cbdMD also offers a 60-day money back guarantee which makes it easy to try this product for yourself.
Why buy — cbdMD's CBD roller uses a broad spectrum CBD that includes other cannabinoids (CBD, CBG, CBN) and terpenes without THC. It also includes menthol for a natural cooling sensation, and the non-greasy roller makes it easy to apply.
Charlotte's Web basic CBD cream offers a botanical formula that's designed to go on smoothly, and to provide comfort and relief even for those with sensitive skin. Best of all, the Charlotte's Web CBD cream is made without any parabens, artificial colors or dyes, GMOs, or synthetic fragrances.
- Value — This is the most affordable CBD cream on our list; the smaller of the two tubes costs less than $20.
- Strength — The 2.5-ounce tube includes 750mg of full spectrum CBD; the 1-ounce tube contains 300mg.
- Hemp source — Colorado
- Scent — None
- Transparency — Third-party lab test results available online for all products.
- Customer experience — Multiple customer reviews state this cream offers fast-acting and long-lasting relief.
Why buy — In addition to full spectrum CBD, some of the therapeutic ingredients used in Charlotte's Web CBD cream include aloe vera, coconut oil, and oat extract. It's also both gluten-free and vegan, and is made without any animal testing.
CBDistillery's CBD salve offers 500mg of CBD in a 1oz. tub. Made with a number of natural oils, it's designed to be quickly absorbed into the skin, offering prompt relief. This product is recommended for anyone who deals with chronic pain, or simply wants to revive their muscles after strenuous physical activity.
- Value — You can get 1oz. of this CBD cream for $50, which makes it very affordably priced for the concentration.
- Strength — 500mg of full spectrum CBD per 1oz. tub.
- Hemp source — Colorado
- Scent — None
- Transparency — All CBDistillery products are vetted by a third-party lab to ensure their quality.
- Customer experience — CBDistillery is one of the most trusted of all CBD brands, and not without reason. Customers say they love this product for its effectiveness and its affordable price.
Why buy — CBDistillery makes all of its products using natural, eco-friendly farming practices, and there are no GMOs in the hemp oil. Non-greasy balm formula makes it easy to apply and fast to absorb.
Medterra is another company that offers a range of salves, lotions, and creams. The basic Medterra CBD Pain cream is recommended for those who suffer from arthritic pain of any kind, as well as those afflicted by swollen joints, a stiff neck, or a tender back.
- Value — This cream comes in two different strengths, with the 500mg option starting at $35.
- Strength — 500mg of CBD, or 1000mg of CBD, per 1.7oz. container.
- Hemp source — Kentucky
- Scent — None
- Transparency — The CBD is carefully tested by independent labs and verified to be strong, pure, and efficacious.
- Customer experience — Medterra customers say that they enjoy this product because it works fast and has a soothing and pleasant fragrance from its natural ingredients.
Why buy — There's a lot to appreciate about this CBD cream, including the fact that it's made with U.S. hemp and it's grown organically, without any GMO use. Peppermint, jojoba oil, menthol, arnica, and aloe enhance the product's therapeutic effect.
Plant People makes an outstanding CBD balm, which is formulated with full spectrum CBD to soothe aches and pains. It's specifically cited for its effectiveness reviving sore knuckles, muscles, and knees. Indeed, Plant People boasts that its CBD balm is good for recovery as well as for addressing stiffness and swelling.
- Value — The price point is just under $50, but you can save on each order if you subscribe to regular deliveries.
- Strength — The Plant People CBD balm offers 450mg of CBD in its 2oz. package.
- Hemp source — Colorado
- Scent — None
- Transparency — All Plant People products are tested by independent third-party labs and the results are easy to access on each page of their site.
- Customer experience — Customers who have used this CBD balm claim that it works well to help relieve sore muscles and joints, and that they love the scent provided by its natural ingredients.
Why buy — Plant People's CBD balm is said to be highly effective at enhancing circulation, and can also be a good topical remedy for athletic sprains and bruises. It's non-GMO, USDA organic, and gluten-free.
Learn More About CBD Creams, Balms, and Salves
Why are CBD Topical Creams and Salves Popular?
Topical creams and salves are fast becoming the go-to method of CBD intake among people with an active lifestyle. Topical creams infused with CBD offer athletes, weekend warriors, pain-sufferers, and anyone and everyone a quick way to target tough muscle aches and pains. Moreover, along with muscle pain relief, topical cream may also help to increase relaxation.
Many individuals who suffer with chronic or acute pain are discovering that CBD is a safe, natural alternative treatment over prescription painkillers that can be both dangerous and addictive. Not only that, but unlike oils, capsules, edibles, and other forms of CBD, topical creams and salves go right to work when massaged into the affected area. Therefore, creams and salves are becoming the product of choice for those wanting quick relief from painful muscle strains, arthritis pain, fibromyalgia, nerve pain, and other conditions.
How Do CBD Creams Work?
Topical creams and salves work so well because, once massaged into the skin, the CBD goes to work with the body's endocannabinoid system. This system is a highly intricate cell-signaling system that was first discovered in the 1990s by researchers who were exploring the cannabis compound tetrahydrocannabinol, or THC.
While doctors and researchers are still trying to completely comprehend the endocannabinoid system, or ECS, they do know that it plays a pivotal role in regulating both functions and processes such as:
- Mood regulation
- Pain reduction and regulation
- Motor Control
- Inflammation and immune responses
- Skin and Nerve Functioning
- Bone Remodeling and Growth
- Liver Function
The body has two main endocannabinoid receptors: CB1 receptors that are located in the central nervous system, and CB2 receptors that are found in the peripheral nervous system. All of these functions help to keep the body in a state of homeostasis, or stability. Pain, chronic health conditions, or injury can throw these functions off, and that's when the ECS jumps in to help the body return to normal functioning or balance.
CBD Creams and Pain Management
When you use full-spectrum products like a full-spectrum CBD topical cream or salve, the trace amounts of tetrahydrocannabinol, or THC, and cannabidiol, or CBD, in the cream interact with the ECS. Researchers have found that THC helps to reduce pain and stimulate appetite by binding with CB1 and CB2 receptors, while CBD prevents the breakdown of endocannabinoids, which in turn allows them to have a stronger effect on the body. Researchers also believe that CBD helps to reduce pain, nausea, and other uncomfortable symptoms that are caused by various health/medical conditions.
When you rub CBD topical cream or salve into an area of discomfort, the CBD enters into the skin and sebaceous glands to synergistically work with the body to help reduce pain and inflammation while returning the body to a state of balance. Topical creams can directly help to relieve pain in the specific areas of the body where it's applied.
Targeting Various Conditions and Injuries
Yes, you can achieve relief by applying a CBD topical cream or salve onto your body. However, you can also add in other modalities to help get more relief. For example, if you're using topical cream for a sports-related injury, why not try adding ice or heat to further help calm down the swelling or inflammation.
Likewise, heat or ice on top of topical cream can also be a great way of calming arthritis pain and other chronic pain from conditions such as fibromyalgia, bursitis, Crohn's Disease, gout, knee injuries, and so many others.
CBD topical cream can be used to help treat:
- Chronic Pain
- Acute Pain
- Sore Joints
- Sore Muscles
- Skin Infections
How to Use CBD Creams
When you begin using CBD cream, you first need to apply the cream around the painful area to treat it locally. Actually, applying topical cream is very much the same as applying regular lotion. The main issue is that you have to use more care when using a CBD topical.
In order to make sure you're getting the correct dosage of CBD cream, you need to find out how many milligrams of CBD are in the topical. This way, you will know right off the bat whether there's enough CBD in the cream to give you therapeutic relief. Typically, topical creams with lower milligrams of CBD in them will be less effective than those with higher milligrams.
In general, you should use topical CBD creams as you would use CBD oil: start low and go slow. Begin with a low dose and then gradually increase the amount of the topical until you find the dose that gives you the most optimal therapeutic relief.
When it comes to deciding on a cream, there are a lot of varieties to choose from. Some topicals are lotions that help to moisturize the skin, while others are balms, salves, liniments, or ointments that contain CBD and extra natural ingredients to create hot or cold sensations for extra help with pain relief. Topical creams can contain a host of natural ingredients including citrus, mint, pepper, menthol, camphor, methyl salicylate, and triethanolamine salicylate. The type of topical you choose will purely be based on both preference and need. Regardless of the variety, the topical will still have the same function.
Generally, when you are applying cream to an area of pain, you would apply it exactly to where the pain is stemming from. However, if you are unsure as to where the pain is originating, then you should apply it close to the area that hurts.
Applying cream to various trigger points will also help alleviate pain in the general area. Some specific trigger point areas you an apply cream to are:
- Soles of the feet
- Any joint and the muscles surrounding it
Another great tip for applying cream is to always make sure the area you are massaging it into is clean and free from sweat, dirt, and dead skin cells. When your skin is clean, the CBD molecules will have a better chance of reaching the affected area. When you apply the cream to the area, make sure that you use a good sized dollop. The goal is to not just rub the cream onto the area, but to thoroughly and gently massage it into the skin. Deeply massaging the topical into the skin serves to both increase the blood flow to the area as well as help the cream penetrate deeper into the tissue and spread over a wider area of the body.
Lastly, always wash your hands after applying topical cream. Since some brands have cooling or heating ingredients added to them, it definitely would not feel good if you rubbed your eyes or touched your nose or mouth after an application. Likewise, you also might want to avoid applying creams with mint, pepper, camphor, or menthol to the insides of your elbows or the backs of your knees as the skin could be easily irritated.
How Long Does It Take for CBD Creams to Work?
While you will feel almost immediate relief from general aches and pains such as sunburns, sore, strained muscles, or minor skin irritations, chronic pain issues caused by arthritis, bursitis, or other medical conditions will take a little longer to manage. The key is to be patient and understand that some conditions require more time than others to get under control. If your pain worsens, or if you are dealing with chronic pain generally, you should consult with your primary care physician to fully treat the issue.
What are the Benefits of CBD?
CBD, a compound of the hemp and cannabis plants, has many health benefits associated with it including:
- Relief from chronic pain
- Nerve pain reduction
- Relief of muscle spasms and muscle tension
- Nausea relief
- Decreased anxiety and depression
- Reduced inflammation
- Improvement in sleep and relaxation
Not only can CBD topical cream help to alleviate these conditions, it can also help to improve the overall health and wellness of your skin. CBD has anti-inflammatory properties that can benefit the skin to help reduce oil production, relieve pain and itching, and help to moisturize. In fact, topical CBD cream can help to treat eczema, psoriasis, and other inflammatory skin conditions .
Many people falsely worry about purchasing full cspectrum products because they fear that they will get "high" from them. By law, all full spectrum CBD products must contain less than 0.3% THC; therefore, you can use full spectrum oils, creams, edibles, vapes, etc., without any fear of getting high. The good news is that when you use full spectrum topical creams, your body will be able to reap all of the benefits of the entourage effect.
During the entourage effect, CBD, THC, and other cannabis compounds and terpenes work together to decrease each other's negative effects while increasing their positive effects. For example, THC is known to cause nausea, paranoia, and anxiety in some people, however, when combined with CBD, these negative side effects are drastically reduced, therefore allowing for greater pain reduction and appetite stimulation.
Final Thoughts on Our CBD Creams and Salves List
Whether you suffer from sports injuries, muscle strains or sprains, or acute or chronic pain from conditions such as arthritis, Crohn's Disease, Fibromyalgia, bursitis, back pain, or others, a topical CBD cream might be a great option to help you treat specific localized areas of pain on your body. Even though oils, gummies, vapes, and capsules are also helpful and effective in their own way, a topical cream is the best option for painful areas on your body because it offers fast, targeted relief in a way that ingestible options cannot.
Topical creams can be used alone or with other modalities such as heat or ice to add further relief from tough muscle pain, sports injuries, and muscle tension issues.
Do Your Research
Regardless of how you use the cream and what you use along with it, it's always a good idea to first ensure that you've purchased the very best product for yourself. Because CBD continues to grow in popularity, so have the number of brands and products that are out on the market today. But before you spend your hard-earned money on a product that could potentially be inferior and ineffective, it's advised that you scour the brands' websites to locate third-party lab results. Remember, a brand that hires a reputable third-party lab not only cares about the quality, purity, and strength of its products, it also cares about what its customers are putting into their bodies.
After you've found those lab test results, take some time to pour through them and learn exactly what's in the topical cream that you intend on buying. If you're feeling overwhelmed or confused at any time during your research, you can always begin your journey by looking into the brands that our list. FAB CBD's Topical Cream is our number one choice not only because of the brand's stellar reputation and transparency, but also because FAB truly creates a potent, clean, and highly effective product.
When it comes to how pain sufferers are choosing to treat their tough chronic or acute pain, a great number of them are opting to forego the use of dangerous and potentially addictive prescription painkillers. Instead, many of them have successfully treated their health issues by using safe, natural, and non-addictive CBD topical creams.
Topical creams, as well as all other CBD products, contain a host of benefits which include nausea reduction, pain relief, reduction of muscle tension and spasms, increased relaxation, a reduction in sleep-related issues such as insomnia, reduced inflammation, nerve pain relief, and so much more. Rather than have to worry about the damage that a prescription medication is potentially doing to your body, you can have peace of mind knowing that your body is benefitting from the many benefits that CBD is giving it.
Consult With Your Doctor
Lastly, if you have any questions or concerns about using CBD, never hesitate to schedule a visit with your primary care provider or specialist. CBD is a wonderful, natural, safe way to help heal a great many health issues. So if you think it might be the best option for you but are still nervous, unsure, or have questions, then your healthcare provider can help you sort them out so that you can make the best decision possible for your health.
So many people are discovering first-hand the many benefits that CBD has to offer. If you've been wondering about what a topical CBD cream can do for you, then look no further than our top brands. The time to stop suffering with pain is now. Why not explore the many ways that CBD can both improve your health issues and enhance your life?
* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
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By Ana Maldonado-Contreras
- Your gut is home to trillions of bacteria that are vital for keeping you healthy.
- Some of these microbes help to regulate the immune system.
- New research, which has not yet been peer-reviewed, shows the presence of certain bacteria in the gut may reveal which people are more vulnerable to a more severe case of COVID-19.
You may not know it, but you have an army of microbes living inside of you that are essential for fighting off threats, including the virus that causes COVID-19.
How Do Resident Bacteria Keep You Healthy?<p>Our immune defense is part of a complex biological response against harmful pathogens, such as viruses or bacteria. However, because our bodies are inhabited by trillions of mostly beneficial bacteria, virus and fungi, activation of our immune response is tightly regulated to distinguish between harmful and helpful microbes.</p><p>Our bacteria are spectacular companions diligently helping prime our immune system defenses to combat infections. A seminal study found that mice treated with antibiotics that eliminate bacteria in the gut exhibited an impaired immune response. These animals had low counts of virus-fighting white blood cells, weak antibody responses and poor production of a protein that is vital for <a href="https://doi.org/10.1073/pnas.1019378108" target="_blank">combating viral infection and modulating the immune response</a>.</p><p><a href="https://doi.org/10.1371/journal.pone.0184976" target="_blank" rel="noopener noreferrer">In another study</a>, mice were fed <em>Lactobacillus</em> bacteria, commonly used as probiotic in fermented food. These microbes reduced the severity of influenza infection. The <em>Lactobacillus</em>-treated mice did not lose weight and had only mild lung damage compared with untreated mice. Similarly, others have found that treatment of mice with <em>Lactobacillus</em> protects against different <a href="https://doi.org/10.1038/srep04638" target="_blank" rel="noopener noreferrer">subtypes of</a> <a href="https://doi.org/10.1038/s41598-017-17487-8" target="_blank" rel="noopener noreferrer">influenza</a> <a href="https://doi.org/10.1371/journal.ppat.1008072" target="_blank" rel="noopener noreferrer">virus</a> and human respiratory syncytial virus – the <a href="https://doi.org/10.1038/s41598-019-39602-7" target="_blank" rel="noopener noreferrer">major cause of viral bronchiolitis and pneumonia in children</a>.</p>
Chronic Disease and Microbes<p>Patients with chronic illnesses including Type 2 diabetes, obesity and cardiovascular disease exhibit a hyperactive immune system that fails to recognize a harmless stimulus and is linked to an altered gut microbiome.</p><p>In these chronic diseases, the gut microbiome lacks bacteria that activate <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">immune cells</a> that block the response against harmless bacteria in our guts. Such alteration of the gut microbiome is also observed in <a href="https://doi.org/10.1073/pnas.1002601107" target="_blank" rel="noopener noreferrer">babies delivered by cesarean section</a>, individuals consuming a poor <a href="https://doi.org/10.1038/nature12820" target="_blank" rel="noopener noreferrer">diet</a> and the <a href="https://doi.org/10.1038/nature11053" target="_blank" rel="noopener noreferrer">elderly</a>.</p><p>In the U.S., 117 million individuals – about half the adult population – <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/" target="_blank" rel="noopener noreferrer">suffer from Type 2 diabetes, obesity, cardiovascular disease or a combination of them</a>. That suggests that half of American adults carry a faulty microbiome army.</p><p>Research in my laboratory focuses on identifying gut bacteria that are critical for creating a balanced immune system, which fights life-threatening bacterial and viral infections, while tolerating the beneficial bacteria in and on us.</p><p>Given that diet affects the diversity of bacteria in the gut, <a href="https://www.umassmed.edu/nutrition/melody-trial-info/" target="_blank" rel="noopener noreferrer">my lab studies show how diet can be used</a> as a therapy for chronic diseases. Using different foods, people can shift their gut microbiome to one that boosts a healthy immune response.</p><p>A fraction of patients infected with SARS-CoV-2, the virus that causes COVID-19 disease, develop severe complications that require hospitalization in intensive care units. What do many of those patients have in common? <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm" target="_blank" rel="noopener noreferrer">Old age</a> and chronic diet-related diseases like obesity, Type 2 diabetes and cardiovascular disease.</p><p><a href="http://doi.org/10.1016/j.jada.2008.12.019" target="_blank" rel="noopener noreferrer">Black and Latinx people are disproportionately affected by obesity, Type 2 diabetes and cardiovascular disease</a>, all of which are linked to poor nutrition. Thus, it is not a coincidence that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm" target="_blank" rel="noopener noreferrer">these groups have suffered more deaths from COVID-19</a> compared with whites. This is the case not only in the U.S. but also <a href="https://www.washingtonpost.com/world/europe/blacks-in-britain-are-four-times-as-likely-to-die-of-coronavirus-as-whites-data-show/2020/05/07/2dc76710-9067-11ea-9322-a29e75effc93_story.html" target="_blank" rel="noopener noreferrer">in Britain</a>.</p>
Discovering Microbes That Predict COVID-19 Severity<p>The COVID-19 pandemic has inspired me to shift my research and explore the role of the gut microbiome in the overly aggressive immune response against SARS-CoV-2 infection.</p><p>My colleagues and I have hypothesized that critically ill SARS-CoV-2 patients with conditions like obesity, Type 2 diabetes and cardiovascular disease exhibit an altered gut microbiome that aggravates <a href="https://theconversation.com/exercise-may-help-reduce-risk-of-deadly-covid-19-complication-ards-136922" target="_blank" rel="noopener noreferrer">acute respiratory distress syndrome</a>.</p><p>Acute respiratory distress syndrome, a life-threatening lung injury, in SARS-CoV-2 patients is thought to develop from a <a href="http://doi.org/10.1016/j.cytogfr.2020.05.003" target="_blank" rel="noopener noreferrer">fatal overreaction of the immune response</a> called a <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690" target="_blank" rel="noopener noreferrer">cytokine storm</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">that causes an uncontrolled flood</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">of immune cells into the lungs</a>. In these patients, their own uncontrolled inflammatory immune response, rather than the virus itself, causes the <a href="http://doi.org/10.1007/s00134-020-05991-x" target="_blank" rel="noopener noreferrer">severe lung injury and multiorgan failures</a> that lead to death.</p><p>Several studies <a href="https://doi.org/10.1016/j.trsl.2020.08.004" target="_blank" rel="noopener noreferrer">described in one recent review</a> have identified an altered gut microbiome in patients with COVID-19. However, identification of specific bacteria within the microbiome that could predict COVID-19 severity is lacking.</p><p>To address this question, my colleagues and I recruited COVID-19 hospitalized patients with severe and moderate symptoms. We collected stool and saliva samples to determine whether bacteria within the gut and oral microbiome could predict COVID-19 severity. The identification of microbiome markers that can predict the clinical outcomes of COVID-19 disease is key to help prioritize patients needing urgent treatment.</p><p><a href="https://doi.org/10.1101/2021.01.05.20249061" target="_blank" rel="noopener noreferrer">We demonstrated</a>, in a paper which has not yet been peer reviewed, that the composition of the gut microbiome is the strongest predictor of COVID-19 severity compared to patient's clinical characteristics commonly used to do so. Specifically, we identified that the presence of a bacterium in the stool – called <em>Enterococcus faecalis</em>– was a robust predictor of COVID-19 severity. Not surprisingly, <em>Enterococcus faecalis</em> has been associated with <a href="https://doi.org/10.1053/j.gastro.2011.05.035" target="_blank" rel="noopener noreferrer">chronic</a> <a href="https://doi.org/10.1016/S0002-9440(10)61172-8" target="_blank" rel="noopener noreferrer">inflammation</a>.</p><p><em>Enterococcus faecalis</em> collected from feces can be grown outside of the body in clinical laboratories. Thus, an <em>E. faecalis</em> test might be a cost-effective, rapid and relatively easy way to identify patients who are likely to require more supportive care and therapeutic interventions to improve their chances of survival.</p><p>But it is not yet clear from our research what is the contribution of the altered microbiome in the immune response to SARS-CoV-2 infection. A recent study has shown that <a href="https://doi.org/10.1101/2020.12.11.416180" target="_blank" rel="noopener noreferrer">SARS-CoV-2 infection triggers an imbalance in immune cells</a> called <a href="https://doi.org/10.1111/imr.12170" target="_blank" rel="noopener noreferrer">T regulatory cells that are critical to immune balance</a>.</p><p>Bacteria from the gut microbiome are responsible for the <a href="https://doi.org/10.7554/eLife.30916.001" target="_blank" rel="noopener noreferrer">proper activation</a> <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">of those T-regulatory</a> <a href="https://doi.org/10.1038/nri.2016.36" target="_blank" rel="noopener noreferrer">cells</a>. Thus, researchers like me need to take repeated patient stool, saliva and blood samples over a longer time frame to learn how the altered microbiome observed in COVID-19 patients can modulate COVID-19 disease severity, perhaps by altering the development of the T-regulatory cells.</p><p>As a Latina scientist investigating interactions between diet, microbiome and immunity, I must stress the importance of better policies to improve access to healthy foods, which lead to a healthier microbiome. It is also important to design culturally sensitive dietary interventions for Black and Latinx communities. While a good-quality diet might not prevent SARS-CoV-2 infection, it can treat the underlying conditions related to its severity.</p><p><em><a href="https://theconversation.com/profiles/ana-maldonado-contreras-1152969" target="_blank">Ana Maldonado-Contreras</a> is an assistant professor of Microbiology and Physiological Systems at the University of Massachusetts Medical School.</em></p><p><em>Disclosure statement: Ana Maldonado-Contreras receives funding from The Helmsley Charitable Trust and her work has been supported by the American Gastroenterological Association. She received The Charles A. King Trust Postdoctoral Research Fellowship. She is also member of the Diversity Committee of the American Gastroenterological Association.</em></p><p><em style="">Reposted with permission from <a href="https://theconversation.com/a-healthy-microbiome-builds-a-strong-immune-system-that-could-help-defeat-covid-19-145668" target="_blank" rel="noopener noreferrer" style="">The Conversation</a>. </em></p>
By Jeff Masters, Ph.D.
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