The increased tendency for anemia in traditional Chinese medicine deficient body constitution is associated with the gut microbiome

Constitution is a valuable part of traditional Chinese medicine theory; it is defined as the internal foundation for the occurrence, development, transformation and outcome of diseases, and has its characteristic gut microbiota. Previous study showed that deficiency constitution was related to lower Hb counts. However, no research has examined how alterations in the gut microbiome induced by deficiency constitution may increase the tendency for anemia. We used a multiomics strategy to identify and quantify taxonomies and compounds found under deficient constitution individuals and further explore the possible pathological factors that affect red blood cell indices. ① People with deficient constitution showed lower hemoglobin (Hb), more Firmicutes, less Bacteroidetes, and higher α diversity. ② We identified , , , and as potential biomarkers of deficient constitution. ③ , and were enriched in balanced-constitution individuals, and was the key bacterial marker of balanced constitution. ④ may be a protective factor against the tendency for anemia among deficient individuals. ⑤ may be the shared microbe base of deficiency constitution-related the tendency for anemia. ⑥ The microorganism abundance of the anaerobic phenotype was lower in deficient constitution group. ⑦ Alterations in the microbiome of deficient-constitution individuals were associated with worse health status and a greater risk of anemia, involving intestinal barrier function, metabolism and immune responses, regulated by short-chain fatty acids and bile acid production. The composition of the gut microbiome was altered in people with deficient constitution, which may explain their poor health status and tendency toward anemia.