The Microbiome: Gut history, the history of conventional medicine, and why we need a reset
“Is it something I’m eating?”
I hear this question a lot from women who come to the clinic with obvious gastrointestinal-related symptoms. The answer is often "Yes...and what we eat is only part of the story." The other part of the story has to do with the community of organisms living in our gut, referred to as its “microbiome.” Other parts of the body have their own microbiomes — like the breast, for example. For the purpose of this discussion, when I refer to the microbiome, I am referring to the microbiome in the gut.
What we eat strongly influences the inner ecology of our gut, yet sometimes food alone is not enough to correct microbial imbalances that can occur. A lot of diagnoses we have — like psoriasis, depression, and autoimmune disease — may not seem as obviously related to the gut as well-known phenomena like gas and diarrhea, but such diseases are, nonetheless, integrally related to microbiome health.
Research about our guts has exploded, in the last few decades, largely because of the Human Microbiome Project, which launched in 2008. In addition to mapping the microbiota, this research project was designed to investigate their varied relationships to human health and disease. The findings discerned a correlation between microorganisms and many diseases, like autoimmune diseases and cancer, of which conventional medicine had limited understanding. When I started training at Women to Women in 2006, Digestive Wellness by Liz LIpski was one of the first books — if not the very first book — I read. I took off one pair of glasses and put on a completely different pair, permanently altering the way I understood and approached health, as I began to learn the central role of gut function.
The beginning stage or our microbiome is set at birth but continues to change, over the course of our lives. Whether we were born vaginally or by C-section, whether or not we were breastfed, our level of exposure to antibiotics and steroids, our diet, our exercise habits, and our degree of stress all influence the organisms in our gut — which, in turn, affect our overall health.
A vibrant digestive system is essential to our human existence. In fact, health is not attainable without it. I’m going to state that again because women’s minds are often blown by this idea as it takes hold: human health is not attainable in the absence of a fully functioning, balanced digestive system.About 100-trillion organisms, good and bad, live in our gut. When present in normal amounts, many of these bacteria, viruses, and fungi coexist without issue. When circumstances arise that promote the proliferation of an organism (one that's not problematic at normal levels) it can become wildly problematic at elevated levels. The infamous e.Coli bacteria is a great example of this — a common co-inhabitant of our gut microbiome. An overgrowth of e. Coli can cause us to pull over on the highway to relieve our bowels because there simply is no making it to the next rest stop.
We need adequate levels of protective bacteria, like lactobacillus and bifidobacterium, to maintain our microbial function and balance — hence the rise in popularity of probiotic-rich fermented foods, probiotic supplementation, and fecal transplants (yes, that's a thing). We also need healthcare practitioners who know how to protect, nurture and restore this essential ecosystem that exists inside our human core.
Here's a patient story that might be familiar to many of you who also have trod the halls of our healthcare system, seeking a working solution to gastrointestinal distress.
A woman in her forties who, by her own account, is “able to put up with a lot — too much, probably,” went through a GI nightmare in her early twenties. In college, she had a reputation for scouting out the bathroom at restaurants and clubs. As she graduated and entered the workaday world, this problem progressed beyond a running joke (so to speak) to the point that she began secretly rearranging her social life and work habits around an unstable response to the food she ate. “Public bathrooms — a nightmare. You have got to time that extra flush perfectly.” Sound familiar? Her chronic diarrhea became so debilitating that she was advised to take Immodium in order to travel. This resulted in a bad case of constipation and, eventually, an anal fissure. “For those of you who do not know what this is, just imagine trying to pass tiny but plentiful shards of broken glass.” Despite having asked every doctor what was causing such a chronic case of the trots, she had never been referred to a gastroenterologist until a fissure developed and blood appeared. She was given a few exams, which revealed nothing, a bowel prep agent, which resulted in hours of projectile vomiting, followed by a colonoscopy, which revealed nothing. The diagnosis was IBS — irritable bowel syndrome. Some spray foam was ordered up, for “inner itching,” which did not help. She continued to suffer with a fissure for months and chronic diarrhea for years.
Today, a woman diagnosed with IBS would be offered a variety of prescription medicines to lessen the symptoms. Twenty years ago, the offerings were, likewise, focused on symptoms, rather than the cause. A gastroenterologist who took a Functional Medicine approach might have asked some questions about her history with food and drugs. A crucial bit of her medical history — two years of an antibiotic, prescribed for teenage acne, immediately preceding her progressive GI distress — would have been revealed.
As it was, this tolerant and beleaguered young woman was met with a smile, when she asked if it could be something she was eating. Yes, she asked that crucial question. The answer, unfortunately, was no.
Eventually, after more than a decade of suffering, this woman found her own answers through “medical googling,” which turned up the phrase 'Celiac Disease' on a British veterinary website. She found a nearby research hospital where early research, of the human variety, was being done. She was tested and diagnosed with Celiac Disease and vitamin and mineral deficiency. When she eliminated gluten from her diet, she found immediate relief. By solving her chronic diarrhea and restoring her gut health with diet, probiotics and targeted supplements for her nutritional deficiencies, she experienced less fatigue and better mental health. In the whole of her body, she began healing. Her debilitating diarrhea has never returned.
In the fifteen years since her diagnosis, conventional gastroenterologists are only beginning to recognize the importance of the microbiome to overall health. Too many women come to the clinic with reports of diarrhea, having already been to the gastroenterologist and told their diarrhea has nothing to do with what they eat. Sometimes a probiotic is recommended, along with Immodium, but the “why” of a symptom is rarely addressed. Suffice it to say, multiple bouts of diarrhea a day is NOT normal, nor is it normal to only have a bowel movement every three days. We weren’t born with these symptoms so something in our physiology has changed to create them. Largely, the symptoms can be resolved by addressing our nutrition and restoring the balance of our gut microbiome.
Do not put up with a lot, my friends — not when a solution exists. And when seeking a solution to a health issue, be sure to follow your gut.
The next installment in the series will address injuries to the gut microbiome and the snowballing effects on our health that ensue.