Microbiome, A Scientific Revolution in the Making?

Every day we hear more and more talk about probiotics, gut microflora and other little bugs that are living with us and on us, for their benefit, and for ours. But is it a real opportunity to improve our health and our lives, or just a fad of the media?

Gut microflora and probiotics
What we are really talking about is the microbiome. A bacterial mass totaling a couple of pounds of what we erroneously call our body weight. The microbiome comprises a thousand microscopic species dominated by four large groups of bacteria or phyla: Actinobacteria; Bacteroidetes; Firmicutes; Proteobacteria, and in number total 10x more than the cells we otherwise call our own. Although these numbers are approximate and still the subject of much discussion, the fact is we are home to a major population of ‘bugs’ that have taken a piggyback ride on us throughout our evolution. Well, not just on our backs…but everywhere!

The majority of these bugs are friendly and live in our gut. This is the gut microflora. Most of us by now are informed enough to know that they are here to stay, and some even know that probiotics are good bacteria.

Consumers do much of their own research through websites, blogs and forums and they read a lot of uncredited content. So much so that credible scientific research is lost among anecdotes and the commentary of profit seekers—the proliferation of “broscience” is the bane of scientists and medical professionals everywhere. However, we should never let ignorance get in the way of growth—ref. the predictions described in this article from 2004 claiming the consumer does not understand the benefits of healthy gut microflora, but that the category of probiotics will grow rapidly anyway. In fact, if these numbers are accurate then performance has massively outpaced projections in spite of continued high levels of ignorance on both probiotics and microflora.

The intuition that foods containing live cultures are beneficial to our health is not new in the mind of the consumer. My grandmother knew that eating yogurt when taking antibiotics helped with getting over diarrhea. Advertisements for yogurts, supplemental probiotics, and even deodorants have been quite effective in cultivating that knowledge in the mind of the consumer. A hundred years ago, prescribing a colonic purge for the treatment of psychosis was not uncommon, and like with my grandmother’s understanding of the role of yogurt, the reasons were unclear—it helped, and that was good enough.

Now there is a much wider understanding of the various functions and influences of the microflora, but scientists are still aggressively trying to understand the exact role of the gut microflora in conditions such as depression, obesity and high blood pressure. It seems impossible to read a scientific journal or website without finding at least one piece on the role of gut microbes on health. Below are just a few examples amongst thousands found with a Google search:

How much reality is in the hype, and is it a fad or part of how we function?
It is as real and obvious as the nose on your face (which incidentally probably has its own internal microbiological profile).

The microbiome is a very big player in dictating how we function and how we behave, how fit or sickly we are. It has become a hot topic, and the more we learn the hotter it seems to get. So much so that Baquero and Nombela[1] suggest that the few trillion microorganisms that live in symbiosis in and on our bodies should be regarded as a new organ, and that a new scientific discipline, microbiomology, should be created (there isn’t yet a wiki page though). You know you are a big shot subject when an entire scientific discipline is named after you!

In my relatively short career to date as a physiologist, I have seen several organs, mechanisms, or functions of the body elevated from “almost insignificant” to the “most important”—at least for a while and in terms of attracting research dollars. Take for example the fairly recent happening with white adipose tissue—fat—getting upgraded from a simple lipid storage compartment to a whole endocrine organ[2]. And it’s not just a question of semantics. If we consider that, just like any other organ, white fat can extend our metabolic capacities, it is not too farfetched an idea that controlling the health of our microbiome is a novel paradigm for developing new therapies for a range of acute and chronic pathologies.

A quick review of the recent scientific literature shows a huge and rapid increase in the volume of publications that link health to the microbiome. This interest in the nature of our little symbiotic friends has also fueled a large number of patents.

Unsurprisingly, big companies such as Nestlé, PepsiCo, General Mills and Monsanto are pursuing the opportunity to mine new innovations within this space. Nestlé was the sponsor for a special report on innovation in the microbiome that was published by the Scientific American and Nature in February 2015.

So if this is so big and important where is the innovation? Can I hold it in my hand or take it with my coffee? Is it in food products? In new pills and supplements? Yes, probably.

Probiotic supplements have been around for decades.

Probiotic supplements have been around for decades. Progress with technology is allowing the proper identification, isolation and encapsulation of specific strains of beneficial and useful bacteria. They now can be put almost anywhere and in anything, but controversy about efficacy abounds, and just like any other health-related product, hard claims are impossible to make without extreme scrutiny, but soft and vague claims are easy to concoct. There is only just enough clinical proof of efficacy in a few applications to constitute solid evidence that we can ‘manage’ the microbiome, yet scientists and consumers still strongly believe in the future of this approach.

The new hype? Fecal bacteriotherapy. Technically it works very well for a few conditions, notably recurrent C. Diff infections. Several biotech companies have started specializing in “harnessing the power of the microbiome”, we can find a comprehensive list on the pages of a very active advocate for the promotion of fecal therapy “The power of poop”.

For other conditions, there are too many unknown variables. For example, and in my mind this is a major obstacle, what are the bacteria to transplant. One can always use the services of sequencing companies such as μbiome to determine what your gut microbiota looks like and that is maybe half the battle already. Some investigators are taking an evolutionary anthropological approach and in the best traditions of experimentation are pushing the frontiers of the science in their own way. A sure sign that fecal bacteriotherapy is the new in-treatment is the recent interest being paid to it by the FDA.

And if you are in or adjacent to food and nutrition then you should be playing in the opportunity that is probiotics, or at least prebiotics.
Science can seem slow and sometimes is overly cautious in this world where people are anxious to find solutions and put them in the hands of consumers. The growing number of probiotics (and prebiotics/synbiotics) products that are invading the health market is proof, if needed, that consumers at least hope for some value in products that support the little bugs, and are willing to roll the dice on it. Global industry market research estimates a potential 6.8% growth for the probiotic markets in the next five years. This translates into a potential $45 billion market by the year 2018. When combined with the $1.4 billion consumer sales that the DI health supplement category has seen in 2011, this is most definitely an area that should be in the mind of every major player in the industry.

[1] Baquero, F., & Nombela, C. (2012). The microbiome as a human organ. Clinical Microbiology and Infection, 18(s4), 2-4.

[2] Scherer, P. E. (2006). Adipose tissue from lipid storage compartment to endocrine organ. Diabetes, 55(6), 1537-1545.