Today, I searched PubMed for new articles relating to the gut microbiome and found 22,197 journal articles on the topic published in the past 5 years! Why so much research on the subject? Well, since "The Human Microbiome Project" was launched in 2007-08 (see https://www.hmpdacc.org for more info), there has been an explosion of interest in what dwells within the human gut (yes the whole body has a microbiome but the gut is where the action is!). Even more amazing is how much research is being done looking into the relationship between the gut microbiome and the development of health problems and disease. If you're interested, the article cited below is a good summary of much of the current research. Of course the gut microbiome is a major contributing factor in IBS, IBD, SIBO, diverticulitis, and other gut conditions, but loads of research is being published linking a messed up gut microbiome with a whole host of other disease including neurologic (e.g. Parkinson's and many others), cardiovascular (e.g. coronary artery disease and hypertension), as well as respiratory diseases like asthma, recurrent infections, and even cancer. Increasing piles of data are accumulating linking gut microbiota imbalances with obesity and type 2 diabetes. I could go on and on but for some of you, this may be the clincher: A messed up gut microbiome is a root cause, if not THE root cause of autoimmune disease. Type 1 diabetes, multiple sclerosis, rheumatoid arthritis, and Hashimoto's thyroiditis are just a few examples of the autoimmune diseases that are plaguing the western world. Overwhelming evidence points to the gut as the place where these all start. So now you know why there are over 22000 journal articles in the past 5 years.
What does this mean for your health now, today? Much of this is still in the research phases, but do you really want to wait the average of 17 years from research phase to common clinical practice? Many have poo-pooed the utility of stool tests (pun intended) that evaluate the general microbial balance in the gut because there's not much data backing up reliable ways to address the microbial imbalances on an individual basis. However there are a number of studies in that mix of 22000 that deal with this very topic, and these show improvements in disease when these variables are manipulated. No, we don't have it all worked out yet but in my opinion that fact shouldn't paralyze us from acting in safe and specific ways based on findings on stool tests. For example, there are a number of bacteria that can colonize the gut and have been associated with the development of autoimmune diseases. I routinely target these for treatment when identified on stool tests. Overgrowths of E. coli are common in inflammatory bowel disease and, in my opinion, should be suppressed when treating IBD. Hydrogen sulfide producing bacteria, methane producing bacteria, and others are disease-related culprits that I am looking for on stool tests and regularly addressing them with various treatment approaches.
As the article that I have cited suggests, there are opportunities for therapy when we look more closely at the gut microbiome. No, we don't have this perfected, and we may never have it perfected. If this lack of "perfection" paralyzes us, we will definitely miss out on preventing and treating the majority of chronic health problems.
Durack J, Lynch SV. The gut microbiome: Relationships with disease and opportunities for therapy.J Exp Med. 2019;216(1):20-40. doi:10.1084/jem.20180448
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