The Microbiome, Our Health and Wellbeing
Dr Charlie Andrews talks to Dr James Kinross, PhD, FRCS
Dr. Kinross is a senior lecturer in surgery at Imperial College in London.
He is also a practicing colorectal surgeon in the NHS with a clinical interest in the prevention and treatment of colon cancer. He leads a team of amazing researchers working to better define how the microbiome causes cancer and other chronic diseases of the gut.
He is increasingly interested in how the gut microbiome develops in newborn babies and the implications on our long-term health.
He is the author of the well know book DARK MATTER.
Here are the key learnings for primary care on the microbiome from the attached transcript of the Ingest podcast with James Kinross:
Key Learnings for Primary Care on the Microbiome
1. What the Microbiome Is and Why It Matters
- Definition: The microbiome is the collection of all microscopic organisms (bacteria, viruses, fungi, etc.) and the environment they inhabit within a specific niche in the body, such as the gut, skin, or lungs.
- Symbiosis: The microbiome has a symbiotic relationship with the host, evolved over millennia. It is not static but dynamic and changes throughout life.
- Personalization: Each person’s microbiome is unique, impacting how individuals respond to treatments and develop diseases[1].
2. Microbiome Development and Early Life
- Early Colonization: The microbiome starts developing in utero, influenced by the mother’s microbiome, and is further shaped by birth route, breastfeeding, and early environmental exposures.
- Critical Window: Early life is a critical period for microbiome development. Disruption, especially through antibiotic use, can have long-term effects on immune system development and disease risk[1].
- Antibiotics Impact: Repeated or broad-spectrum antibiotic use in early life can lead to persistent changes in the microbiome, increasing the risk of immune-mediated diseases (e.g., allergies, asthma, eczema), obesity, and other non-communicable diseases[1].
3. Microbiome and the Immune System
- Immune Regulation: The microbiome plays a crucial role in shaping both the innate and adaptive immune systems. It influences how the body recognizes and responds to threats.
- Disease Risk: Early disruption of the microbiome can increase susceptibility to autoimmune diseases, allergies, and chronic conditions later in life.
- Gene-Environment-Microbiome Interaction: Disease risk is not just about genes and environment but also involves the microbiome (GEM interaction), which is highly personalized and dynamic[1].
4. Probiotics, Prebiotics, and Diet
- Probiotics: There is evidence supporting the use of probiotics, especially multi-strain, high-dose formulations, during and after antibiotic courses. However, probiotics must be taken consistently for weeks to have an effect.
- Prebiotics and Diet: Feeding the microbiome with a high-fiber, plant-based diet is crucial for maintaining a healthy gut ecosystem. Processed foods and sugary drinks should be minimized, especially during illness or antibiotic treatment[1].
- Practical Advice: Clinicians should recommend probiotics and dietary changes as part of a holistic approach to gut health, but the evidence for specific strains is still evolving[1].
5. Microbiome Testing
- Direct-to-Consumer Testing: Online microbiome tests are not currently recommended due to lack of standardization, robust interpretation, and actionable outcomes.
- Clinical Use: Microbiome analysis is best used in a targeted, clinical context, interpreted by specialists, and as part of a longitudinal assessment rather than a one-off snapshot[1].
6. Future Directions and Interventions
- Probiotic Formularies: The development of evidence-based probiotic formularies will help guide clinical use.
- Fecal Microbiota Transplantation (FMT): FMT is currently approved for recurrent Clostridium difficile infection but may have a broader role in the future for other conditions, with more targeted and capsule-based delivery methods.
- Postbiotics and Synthetic Biology: Emerging therapies include postbiotics (microbial metabolites) and engineered microbes for targeted treatments, though these are still in development[1].
7. Complexity and Clinical Action
- Superorganism Concept: Humans are superorganisms, with the vast majority of genetic material in our bodies being microbial.
- Clinical Translation: While the microbiome is complex and still being understood, it is increasingly relevant to clinical practice, particularly in managing non-communicable diseases and guiding personalized treatments[1].
Summary Table
| Topic | Key Points for Primary Care |
|---|---|
| Microbiome Basics | Dynamic, symbiotic, unique to each person, influences health and disease |
| Early Life & Antibiotics | Critical window for development, antibiotics can have long-term effects |
| Immune System | Shapes immune responses, affects disease risk, GEM interaction model |
| Probiotics & Diet | Multi-strain probiotics, high-fiber diet, avoid processed foods |
| Microbiome Testing | Not recommended direct-to-consumer, best used clinically and longitudinally |
| Future Interventions | Probiotic formularies, FMT, postbiotics, engineered microbes |
| Complexity | Humans are superorganisms, microbiome is a major part of health |
These insights highlight the importance of considering the microbiome in primary care decision-making, especially regarding antibiotic stewardship, diet, and personalized patient management[1].
Sources
[1] transcript-The-Microbiome-Our-Health-and-Wellbeing.pdf
