THE FLURRY of scientific papers recently published on the outcome of the National Institute of Health’s 5 year, $170-million Human Microbiome Project firmly marks a turning point in modern medicine. Taken together with the hundreds of other papers published on the bacteria living on and in the human body over the last decade, we have never been closer to understanding what makes us sick, and how our gut bacteria hold the potential to alleviate a modern disease burden that continues to drain government coffers the world over.
But the true promise of this new “micro” revolution, which is literally redefining the concept of self, may be lost if we allow pharmaceutical companies to hijack our gut bugs and start “drugging the microbiome.”
Every person on earth has two genomes. Our human genome is inherited from mom and dad, and we are more or less stuck with. Our second genome is initially acquired (seeded) from mom during childbirth and dynamically changing throughout life depending on our age, which people we hang out with, hygiene, what we eat, the medicines we take and general lifestyle choices. This second genome is our gut microbiome, made up of the trillions of bacteria (and their genomes) that reach their greatest numbers in our large bowel. These microbial cells outnumber our own 10 to 1 and at the gene level, 100 times more. Making us more microbe than mammal.
Spurred on by new genomic tools born out of the earlier Human Genome Project, an increasing number of studies show that the composition of a person’s microbiome is linked to disease. A steady flow of research is revealing a microbial connection between a leaky gut, subsequent inflammation and the onset of autoimmune diseases as diverse as type 1 diabetes, celiac disease, IBD, asthma, multiple sclerosis, and more. The microbial (and viral) connection with some cancers is no longer disputed, and the list of cancers associated with this microscopic world is sure to grow. The microbiome is seen as playing an important role in the mega killer, heart disease, and its part in metabolic syndrome diseases such as obesity and type 2 diabetes is hard to ignore.
But as the theoretical and computational power needed to unravel the mysteries between microbiome and disease advance, they continue to fueled by a not-so concealed agenda that the end game is likely the development of targeted drugs that manipulate the microbes and their genes along with host pathways. While drugging the microbiome is understandable at some level, given the funding realities and expectations, medical dogma of the day, and the perpetual seeking of magic bullets by some, it also might represent a lost opportunity for us to learn more about our own health.
Relegating the tweaking of the microbiome to pharmaceutical therapies may once again puts society at risk to repeat an era of handing ones health over to others because the subject matter was simply over our head. We are faced with a choice. Do we drug our microbiome into compliance or do we reinstate balance (symbiosis) through a better understanding of our ancient past and the nutritional landscape that selected for the immune system and nutrition-tuned symbiosis between “us and them?
The humbling reality that our microbiome makes us a super organism – part microbe, part mammal – provides a conceptual framework that we can all wrap our heads around. Linking together the lifestyle choices we make on a daily and societal basis with maintaining good health of our microbiome and thus us makes human health less mysterious. It starts at the cradle, ends at the coffin, and every point and decision in between. For example, since our initial seeding of bacteria come from mom, how we enter this world matters. Babies delivered via Caesarean section are populated during the critical first few days and weeks with a microbial community very different from that found in natural births. Add to this the lowest rates of breastfeeding in human history and over zealous use of antibiotics in youth, and we are setting up entire generations and society with crippling disease and associated costs.
With a better understanding of the birth-microbiome-nutrition-health connection, the public at large may decide to seriously address the out of control rates of Caesarean births, the predatory behavior of baby formula companies, and create policies that promote prolonged breast feeding – both at home and in the workplace. But if we choose to drug the infant microbiome, or do the admittedly less harmful administration of a probiotic species or species consortium (fecal transplants) shortly after birth, rather than address the real issues of tinkering with evolution, we will not get any closer to understanding our shared biology and what it takes to maintain good health.
While ones genes, age, and gender can play a significant role in microbiome composition, diet is emerging as the simplest and most immediate therapy for microbiome modulation. With a better understanding of what foods promote balance versus imbalance, which will require a better understanding of our biological past, consumers can begin to play an active role in their personal microbial balance and better health. This might best called future primitive. This play on words, suggests appreciating our primitive and coevolved past with our microbes is our best hope for a healthier future. Our guts are, after all, still in the Stone Age.