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From the December 11, 2013 National Geographic:

You Are What You Eat, All 100 Trillion Of You

By setting ten volunteers on either a vegetarian menu or a carnivorous one,Lawrence David from Duke University and Harvard University’s Peter Turnbaugh have shown that when our diet changes, our gut bacteria react very quickly. Within days, some species step into the limelight, while others fade into the background. They activate different genes, pull off different metabolic tricks, and secrete different substances. Our microbiome, it seems, can rapidly switch between plant-eating and meat-eating modes.

David’s team wanted to see what happens over days. If you flood your gut with different food, how long does it take for your microbiome to react?

They did this by recruiting ten volunteers who were willing to collect daily faecal samples. They each ate two different diets for five straight days —a plant-based one that was rich in grains, legumes, fruit and vegetables, and an animal-based one composed of meat, eggs and cheese.

In general, the animal diet led to more dramatic changes than the plant one. 

David and Turnbaugh’s team also found that the altered gut communities did different things. During the plant diet, they became better at breaking down carbohydrates; during the animal diet, protein digestion was their forte. On the meat-heavy days, they activated more genes for breaking down harmful chemicals found in charred meat, and for making vitamins.

And these changes happened very quickly. Some were obvious by day one. By day four, you could pick up a stool sample, list the active genes within it, and predict with total accuracy which diet the owners had been on.

Just two days after the volunteers stopped their diets, things were back to normal. The gut microbiome, it seems, is a fickle beast—easily changed, but not permanently so. The team also found that our food doesn’t just change the microbes that already exist in the gut—they also add some new ones. 

The point is that our gut microbiomes are more flexible than we previously thought. A recent study showed that most of the strains in our guts stay there for decades or more. But while the roster is clearly stable, their relative numbers fluctuate a lot, and food-borne newcomers can gain a foothold.

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According to a new report, exercise can be as effective as many frequently prescribed drugs in treating some of the leading causes of death. This is a major finding! From the Dec.11, 2013 NY Times:

Exercise as Potent Medicine

For the study, which was published in October in BMJ, researchers compared how well various drugs and exercise succeed in reducing deaths among people who have been diagnosed with several common and serious conditions, including heart disease and diabetes.

They ended up with data covering 305 past experiments that, collectively, involved almost 340,000 participants, which is an impressive total. But most of the volunteers had received drugs. Only 57 of the experiments, involving 14,716 volunteers, had examined the impact of exercise as a treatment.The researchers compared mortality risks for people following any of the treatment options.

The results consistently showed that drugs and exercise produced almost exactly the same results. People with heart disease, for instance, who exercised but did not use commonly prescribed medications, including statins, angiotensin-converting-enzyme inhibitors or antiplatelet drugs, had the same risk of dying from — or surviving — heart disease as patients taking those drugs. Similarly, people with diabetes who exercised had the same relative risk of dying from the condition as those taking the most commonly prescribed drugs.

On the other hand, people who once had suffered a stroke had significantly less risk of dying from that condition if they exercised than if they used medications — although the study authors note that stroke patients who can exercise may have been unusually healthy to start with.

Only in chronic heart failure were drugs noticeably more effective than exercise. Diuretics staved off mortality better than did exercise.

Over all, Dr. Ioannidis said, “our results suggest that exercise can be quite potent” in treating heart disease and the other conditions, equaling the lifesaving benefits available from most of the commonly prescribed drugs, including statins.  

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Some recent studies have explored the link between bacteria in the gut and colorectal cancer. The beneficial Prevotellaceae bacteria (mentioned in the Nov. 5 study below) have been discussed elsewhere as liking whole grain foods. So go feed your gut with some nice whole grain bread or cereal. And some fruits and veggies while you're at it. As mom used to say: "You are what you eat."

A study published December 6, 2013 found that decreased diversity of the gut microbiome and the presence of certain types of bacteria were associated with colorectal cancer in humans: Decreased Diversity of Bacteria Microbiome in Gut Associated Colorectal Cancer

From the November 5, 2013 Science Daily: Microbes in the Gut Help Determine Risk of Tumors

Transferring the gut microbes from a mouse with colon tumors to germ-free mice makes those mice prone to getting tumors as well, according to the results of a study published in mBio®, the online open-access journal of the American Society for Microbiology. The work has implications for human health because it indicates the risk of colorectal cancer may well have a microbial component.

Scientists have known for years that inflammation plays a role in the development of colorectal cancer, but this new information indicates that interactions between inflammation and subsequent changes in the gut microbiota create the conditions that result in colon tumors.

Known risk factors for developing colorectal cancer include consuming a diet rich in red meat, alcohol consumption, and chronic inflammation in the gastrointestinal tract (patients with inflammatory bowel diseases, such as ulcerative colitis, are at a greater risk of developing colorectal cancer, for instance).

The results were stark: mice given the microbiota of the tumor-bearing mice had more than two times as many colon tumors as the mice given a healthy microbiota. What's more, normal mice that were given antibiotics before and after inoculation had significantly fewer tumors than the mice that got no antibiotics, and tumors that were present in these antibiotic-treated mice were significantly smaller than tumors in untreated mice. This suggests that specific populations of microorganisms were essential for the formation of tumors...

Looking at the microorganisms, they found that tumor-bearing mice harbored greater numbers of bacteria within the Bacteroides, Odoribacter, and Akkermansia genera, and decreased numbers of bacteria affiliated with members of the Prevotellaceae and Porphyromonadaceae families. Three weeks after they were inoculated with the communities from the tumor-bearing mice, the germ-free mice had a gut microbiome that was very similar to the tumor-bearing mice, and they had a greater abundance of the same bacterial groups associated with tumor-formation. 

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This is the story of my family's successful Sinusitis Treatment using an all natural, easy home remedy. (UPDATE: The treatment worked so well that we all have been cured of chronic sinusitis, and we have been off all antibiotics for over 3 years.)

Ten months ago my family was struggling with chronic sinusitis that no longer responded well to antibiotics. My oldest son had just been told to get another CAT scan and to prepare for ENT surgery to "open up the sinuses more". We were desperate for something that would help us that didn't involve antibiotics or surgery.

Background: This story started many years ago when we (husband, myself, 2 sons) moved into a house with an incorrectly installed central air conditioning system. We all developed mold allergies and repeated bouts of acute sinusitis, which then led to chronic sinusitis. Eventually we discovered the problem, ripped out and replaced the air conditioning system and all ductwork, but by then the damage was done. Even though antibiotics helped acute sinusitis symptoms which occurred after every cold and sore throat, we always felt like we had chronic sinusitis. Over the years we tried everything we could think of, including antibiotics, decongestants, allergy pills, nasal sprays, daily sinus rinsing with salt water, vitamins, steam inhalation, etc. Both sons even had balloon sinuplasties, which had helped for a short while, but no longer. We had avoided sinus surgeries because we didn't know of anyone who had been "cured" going that route, even with repeat surgeries.

The research:  But then last winter I read with great interest all the latest research about bacteria and how all of us have hundreds of species of microorganisms (our microbiome), and how they may play a role in our health.  In fact we are more microbes than cells!

Especially exciting was a small study published in September 2012 which looked at 20 patients about to undergo nasal surgery - 10 healthy patients (the controls) and 10 chronic rhinosinusitis (sinusitis) patients. The researchers found that the chronic rhinosinusitis sufferers had reduced bacterial diversity in their sinuses, especially depletion of lactic acid bacteria (including Lactobacillus sakei) and an increase in Corynebacterium tuberculostearicum (which is normally considered a harmless skin bacteria). They then did a second study in mice which found that Lactobacillus sakei  bacteria protected against sinusitis, even in the presence of Corynebacterium tuberculostearicum. The researchers were going forward with more research in this area with the hope, that if all goes well, of developing a nasal spray with the beneficial bacteria, but that was a few years away. (Source: Nicole A. Abreu et al - Sinus Microbiome Diversity Depletion and Corynebacteriumt uberculostearicum Enrichment Mediates Rhinosinusitis. Science Translational Medicine, September 12, 2012. http://www.ncbi.nlm.nih.gov/pubmed/22972842 )

But we were desperate now and didn't want to wait. What to do? 

The Experiment: I thought that the answer lay with Lactobacillus sakei (or L.sakei) and I read everything I could find on it. I tried to find a natural and safe source for it, and eventually decided on kimchi. Kimchi is a Korean fermented vegetable product which can be made with varying ingredients, usually with cabbage. According to studies done in Korea, many (but not all) brands of traditionally made kimchi contain L. sakei  (as well as many other species of bacteria) after fermentation. It seemed to me that my best bet was to try an all natural kimchi made with cabbage, without any additives, preservatives, and no fish or seafood in it (this last was personal preference). The kimchi brands I bought had to be refrigerated before and after opening. They could not be pasteurized because it was bacteria that I wanted, lots of bacteria. Kimchi fermentation is carried out by the various microorganisms in the kimchi ingredients, and among the bacteria formed are the lactic acid bacteria, one of which can be L. sakei.

In February of 2013 I was off all antibiotics, but feeling sicker (with sinusitis) each day, when I decided to go ahead with the Sinusitis Experiment and purchased several brands of cabbage kimchi (all natural, vegan). Over the next  2 weeks I tried two brands, one after another. Not only did I eat a little bit every day , but I also smeared a little bit of the kimchi juice in my nose, going up about 1/2" in each nostril - as if I were an extremely messy eater. I did this once or twice a day initially. And yes, I was nervous about what I was doing for this was absolutely NOT medically approved. Obviously I did not discuss this with any doctor.

What if harmful bacteria got up in my sinuses and overwhelmed my system?  What if the microbes in the kimchi did harm, even permanent harm?  What really was in the kimchi? Even if the kimchi contained L. sakei, it also contained many other species of bacteria. The studies said that the bacteria in kimchi varied depending on kimchi ingredients (and each brand was different), length of fermentation, and temperature of fermentation.  L.sakei is found in meat (and used in preserving meat), seafood, and some vegetables, but I was nervous about other microbes found in sea food. This was a major reason I avoided any kimchi with seafood in it. After all, the labels on the kimchi I purchased said it was a "live product" (fermentation). When I opened the jars sometimes the liquid inside was bubbling and sometimes even overflowed down the sides of the jar. It takes a leap of faith to put a bubbling strong smelling liquid in the nose!

Results of the Sinusitis Experiment: By the end of the week I found that the one brand worked and it truly felt like a miracle!  Within 24 hours of first applying it I was feeling better, and day by day my sinusitis improved. All the problematic sinusitis symptoms (yellow mucus, constant sore throat from postnasal drip, aching teeth, etc.) slowly went away and within about 2 to 3 weeks I felt great - the sinusitis was gone. After a few weeks the rest of the family followed, one by one, in the Sinusitis Experiment. All improved to the point of feeling great (healthy) and have been off all antibiotics since then. All four of us feel we no longer have chronic sinusitis. We are very, very pleased with the results.

To continue reading the story...

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Last year a small study by Abreu et al raised the exciting possibility that the sinus microbiome (the microbial community in our sinuses) being seriously out of whack could be behind chronic sinusitis. Which some day could result in sinusitis treatment being the restoration of beneficial microorganisms that should be there, perhaps with a nasal spray. From Science Daily, September 12, 2012:

Sinusitis Linked to Microbial Diversity

A common bacteria ever-present on the human skin and previously considered harmless, may, in fact, be the culprit behind chronic sinusitis, a painful, recurring swelling of the sinuses that strikes more than one in ten Americans each year, according to a study by scientists at the University of California, San Francisco.

The team reports this week in the journal Science Translational Medicine that sinusitis may be linked to the loss of normal microbial diversity within the sinuses following an infection and the subsequent colonization of the sinuses by the culprit bacterium, which is called Corynebacterium tuberculostearicum.

In their study, the researchers compared the microbial communities in samples from the sinuses of 10 patients with sinusitis and from 10 healthy people, and showed that the sinusitis patients lacked a slew of bacteria that were present in the healthy individuals. The patients also had large increases in the amount of Corynebacterium tuberculostearicum in their sinuses, which are located in the forehead, cheeks and eyes.

The team also identified a common bacterium found within the sinuses of healthy people called Lactobacillus sakei that seems to help the body naturally ward off sinusitis. In laboratory experiments, inoculating mice with this one bacterium defended them against the condition. 

"Presumably these are sinus-protective species," said Susan Lynch, PhD, an associate professor of medicine and director of the Colitis and Crohn's Disease Microbiome Research Core at UCSF. What it all suggests, she added, is that the sinuses are home to a diverse "microbiome" that includes protective bacteria. These "microbial shields" are lost during chronic sinusitis, she said, and restoring the natural microbial ecology may be a way of mitigating this common condition.

Though the sinuses' underlying purpose is still unclear, they are all too familiar to American doctors and their patients because of what happens when the thin tissues lining them become inflamed, as occurs in chronic sinusitis -- one of the most common reasons why people go to the doctor in the United States. There are about 30 million cases each year, and the cost to the healthcare system is an estimated $2.4 billion dollars annually.

The pain of sinusitis can last for months. Doctors typically prescribe bacteria-killing antibiotics and, in more severe and long-lasting cases, conduct sinus surgeries. However, said Andrew Goldberg, MSCE, MD, the director of rhinology and sinus surgery at UCSF and a co-author on the paper, "the premise for our understanding of chronic sinusitis and therapeutic treatment appears to be wrong, and a different therapeutic strategy seems appropriate."

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There is a new procedure in which microbiota (the microbes) from a healthy individual are introduced into the gastrointestinal system of a diseased individual via a fecal transplant.  The purpose of the fecal transplant is to replace good bacteria which has been suppressed or killed (usually by antibiotics) , and which has caused bad bacteria, such as Clostridium difficile, to overpopulate the gut. This is having amazing success rates.  It has been used the most for Clostridium difficile (C. difficile) infections, which sickens about half a million Americans annually. This infection can be so debilitating and so resistant to all antibiotics that about 14,000 Americans die each year from it. Even though not that many have been done, fecal transplants are gaining in popularity (some even being done by do-it-yourselfers using fecal enemas at home) because fecal transplants can have a 95 to 98% success rate.                      

New research is starting to see if the fecal transplant can be made even easier (via a "poop pill"), and also if fecal transplants will work for Inflammatory Bowel Diseases (IBD). This would mean the future treatment possibility of transplanting microbiota from healthy individuals to individuals sick with IBD. From the October 4, 2013 Science Daily:  

 Fecal Transplant Pill Knocks out Recurrent C. Diff Infection

C. diff infection can occur after people take antibiotics, wiping out the good bacteria in the gastrointestinal (GI) system, allowing C. diff to flourish and leading to severe diarrhea. In some patients, infection continues to recur despite standard treatment with antibiotics. For patients trapped in that cycle, doctors have transplanted feces from healthy donors into their GI system to rebalance the bacteria and stop infections from recurring.

University of Calgary researchers reported a 100 percent success rate -- none of the 27 patients who took the tablet-sized pills had a recurrence of C. diff, even though all of them previously had had at least four bouts of the infection. Patients ingested between 24 and 34 capsules containing fecal bacteria, often donated by family members.

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There is even the site The Power of Poop  which calls itself a "patient information resource dedicated to promoting safe accessible Fecal Microbiota Transplant (FMT) and to raising awareness of the role of the human microbiome in digestive illness."    http://thepowerofpoop.com

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In case you missed it, Michael Pollan wrote an article about the human microbiome (the community of microbes that live within us) that was published May 15, 2013. Much of the article was about how the modern western diet may not be good for the human microbiome and how we can eat for better gut health. From the NY Times:

Some of My Best Friends Are Germs 

 As part of a new citizen-science initiative called the American Gut project, the lab sequenced my microbiome — that is, the genes not of “me,” exactly, but of the several hundred microbial species with whom I share this body. These bacteria, which number around 100 trillion, are living (and dying) right now on the surface of my skin, on my tongue and deep in the coils of my intestines, where the largest contingent of them will be found, a pound or two of microbes together forming a vast, largely uncharted interior wilderness that scientists are just beginning to map.

Few of the scientists I interviewed had much doubt that the Western diet was altering our gut microbiome in troubling ways. Some, like Blaser, are concerned about the antimicrobials we’re ingesting with our meals; others with the sterility of processed food. Most agreed that the lack of fiber in the Western diet was deleterious to the microbiome, and still others voiced concerns about the additives in processed foods, few of which have ever been studied for their specific effects on the microbiota.

So I gave up asking scientists for recommendations and began asking them instead how, in light of what they’ve learned about the microbiome, they have changed their own diets and lifestyles. Most of them have made changes. They were slower to take, or give their children, antibiotics. (I should emphasize that in no way is this an argument for the rejection of antibiotics when they are medically called for.) Some spoke of relaxing the sanitary regime in their homes, encouraging their children to play outside in the dirt and with animals — deliberately increasing their exposure to the great patina. Many researchers told me they had eliminated or cut back on processed foods, either because of its lack of fiber or out of concern about additives. In general they seemed to place less faith in probiotics (which few of them used) than in prebiotics — foods likely to encourage the growth of “good bacteria” already present. Several, including Justin Sonnenburg, said they had added fermented foods to their diet: yogurt, kimchi, sauerkraut. These foods can contain large numbers of probiotic bacteria, like L. plantarum and bifidobacteria, and while most probiotic bacteria don’t appear to take up permanent residence in the gut, there is evidence that they might leave their mark on the community, sometimes by changing the gene expression of the permanent residents — in effect turning on or off metabolic pathways within the cell — and sometimes by stimulating or calming the immune response.

...something a gastroenterologist at the University of Pittsburgh told me. “The big problem with the Western diet,” Stephen O’Keefe said, “is that it doesn’t feed the gut, only the upper G I. All the food has been processed to be readily absorbed, leaving nothing for the lower G I. But it turns out that one of the keys to health is fermentation in the large intestine.” And the key to feeding the fermentation in the large intestine is giving it lots of plants with their various types of fiber, including resistant starch (found in bananas, oats, beans); soluble fiber (in onions and other root vegetables, nuts); and insoluble fiber (in whole grains, especially bran, and avocados).

With our diet of swiftly absorbed sugars and fats, we’re eating for one and depriving the trillion of the food they like best: complex carbohydrates and fermentable plant fibers. The byproduct of fermentation is the short-chain fatty acids that nourish the gut barrier and help prevent inflammation. And there are studies suggesting that simply adding plants to a fast-food diet will mitigate its inflammatory effect.

...I began to see how you might begin to shop and cook with the microbiome in mind, the better to feed the fermentation in our guts. The less a food is processed, the more of it that gets safely through the gastrointestinal tract and into the eager clutches of the microbiota. Al dente pasta, for example, feeds the bugs better than soft pasta does; steel-cut oats better than rolled; raw or lightly cooked vegetables offer the bugs more to chomp on than overcooked, etc. This is at once a very old and a very new way of thinking about food: it suggests that all calories are not created equal and that the structure of a food and how it is prepared may matter as much as its nutrient composition.

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Within the past few years there has been an explosion in human microbiome research - looking at the community of microorganisms that live in and on human beings. Within the body of a healthy adult, microbial cells are estimated to outnumber human cells ten to one! This community of microorganisms remains largely unstudied, and so their influence on human development, diseases, immunity, and health are almost entirely unknown.  Some of the latest research looks at the microbiomes of healthy people and those with diseases, seeing how they differ, and from that looking at possible treatments using bacteria.  This is a whole different mind-set from the one we've had for decades that viewed all bacteria as bad (pathogens) and needing to be eliminated. 

An introduction to this emerging area of human microbiome research was written by Gina Kolata in the NY Times, June 13, 2013:  

In Good Health? Thank Your 100 Trillion Bacteria

For years, bacteria have had a bad name. They are the cause of infections, of diseases. They are something to be scrubbed away, things to be avoided. But now researchers have taken a detailed look at another set of bacteria that may play even bigger roles in health and disease: the 100 trillion good bacteria that live in or on the human body.

No one really knew much about them. They are essential for human life, needed to digest food, to synthesize certain vitamins, to form a barricade against disease-causing bacteria. But what do they look like in healthy people, and how much do they vary from person to person?

In a new five-year federal endeavor, the Human Microbiome Project, which has been compared to the Human Genome Project, 200 scientists at 80 institutions sequenced the genetic material of bacteria taken from nearly 250 healthy people. They discovered more strains than they had ever imagined — as many as a thousand bacterial strains on each person. And each person’s collection of microbes, the microbiome, was different from the next person’s. To the scientists’ surprise, they also found genetic signatures of disease-causing bacteria lurking in everyone’s microbiome. But instead of making people ill, or even infectious, these disease-causing microbes simply live peacefully among their neighbors.

"Until recently, Dr. Bassler added, the bacteria in the microbiome were thought to be just “passive riders.” They were barely studied, microbiologists explained, because it was hard to know much about them. 

The work also helps establish criteria for a healthy microbiome, which can help in studies of how antibiotics perturb a person’s microbiome and how long it takes the microbiome to recover.

In recent years, as investigators began to probe the microbiome in small studies, they began to appreciate its importance. Not only do the bacteria help keep people healthy, but they also are thought to help explain why individuals react differently to various drugs and why some are susceptible to certain infectious diseases while others are impervious. When they go awry they are thought to contribute to chronic diseases and conditions like irritable bowel syndrome, asthma, even, possibly, obesity.

"The microbiome starts to grow at birth, said Lita Proctor, program director for the Human Microbiome Project. As babies pass through the birth canal, they pick up bacteria from the mother’s vaginal microbiome.

Babies born by Caesarean section, Dr. Proctor added, start out with different microbiomes, but it is not yet known whether their microbiomes remain different after they mature.In adults, the body carries two to five pounds of bacteria, even though these cells are minuscule — one-tenth to one-hundredth the size of a human cell. The gut, in particular, is stuffed with them.

“The gut is not jam-packed with food; it is jam-packed with microbes,” Dr. Proctor said. “Half of your stool is not leftover food. It is microbial biomass.” But bacteria multiply so quickly that they replenish their numbers as fast as they are excreted.

Including the microbiome as part of an individual is, some researchers said, a new way to look at human beings. The next step, he said, is to better understand how the microbiome affects health and disease and to try to improve health by deliberately altering the microbiome. But, Dr. Relman said, “we are scratching at the surface now.”

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FOR THOSE WHO WOULD LIKE TO SEE A VIDEO ON THIS TOPIC, this TED talk given by Dr. Jonathan Eisen  is an excellent introduction to the human microbiome and how we should view ourselves as being covered in a microbial cloud.  And that this microbial community within and on us should be viewed as an organ, and thus should be treated carefully and with respect.

Who are “Me, Myself and Us?”

2012Jonathan Eisen

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 It seems like every day numerous new science and health articles are published. I have always enjoyed going to various sites and looking for articles that I actually think are significant and could help us understand the world around us, or what we should be concerned with, or even how to live a good and healthy life. For years I have been sending out articles to friends and family and finally decided to, what the heck, send them out to everybody else by posting them on a web-site.

I have always been interested in the interplay between our environment and health. There is still so very much that is unknown. And then there are new exciting areas of research using new technologies that make us rethink what we thought we knew, and how to treat diseases and live a healthy life.

I've decided to start by posting some articles that were published earlier this year because they lay out the groundwork for a lot of new exciting research. Stuff that we didn't know about or understand back when learning basic biology in school.