A focus on self-care is nothing new. Obviously, people have been doing it for centuries. Our ancestors did it, and we already do it each and every day. We practice self-care when we pick food for our meals, when we choose among lifestyle activities, when we select those we spend time with, and when we find the things that bring joy to our lives and pursue them on a regular basis. There is plenty of professional help when it comes to our health and well-being, but caring for oneself is ultimately a personal matter. We automatically become both the authority and the most relevant expert as overseer of our own bodies. Sometimes we may care for ourselves with lots of information available to support our decisions and choices of activities; sometimes we operate in a vacuum of information but have to make decisions anyway. That is the beauty of self-choice and self-care. When it comes to the outcomes of caring for ourselves, we are the ones who live with those outcomes.
You don’t have to change all the things you do or love, or change everything you eat or who you spend time with. These are simply new ideas and information about the array of options you have before you.
The word “makeover” itself is a fashionable new coinage, but things like having a spa day or a massage are really not that different from a visit to therapeutic hot springs of decades to centuries ago. They are all about figuring out what can refresh and renew our bodies and bring them into noticeably better balance. They are a reset button.
People have different preferred reset buttons. Maybe yours is a day at the gym, a swim in a pool or ocean, a walk, a hike, a jog, or a bike ride in nature, pursuing your favorite hobby, or maybe it is just being with friends or family or others with common interests. If you know what always allows your body to be relaxed, feel whole, and fully work for you, that is golden. It is also a frame of reference I would ask you to hold as you consider options for a superorganism makeover. Things you can do involving your microbial co-partners need to feel helpful and be useful for you—not something that is only theoretically helpful but, instead, something that you notice in your own body as useful.
I have my own frame of reference for this as well. For me it is swing dancing, a hobby I took up in middle age. After a good dance workout that is both physical and social since it involves dancing with other people, my entire body relaxes and I have a fully restored feeling. I sleep better, and that is a great personal benchmark for me. Consider what benchmarks you might use that will allow you to compare the helpfulness of specific superorganism makeovers. Which ones work for you, and which ones don’t? You know your own body. Let it be your guide.
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Let’s approach this question of self-care very gradually. Any reasonable person would have questions like these.
Yes. Just pick up any grocery store checkout magazine and look for articles. They tout things like . . . “Nutritional Breakthrough, Melt Fat with Probiotics.” I have one such article sitting in front of me as I write this. Of course, that is not necessarily the best way to gather health-related information.
Integrated medical therapies have been expanding on the health landscape, and certain parts of that are taking a systems-biology approach to health. That means not just focusing on a single specialty of the physiological system but looking across them for more holistic solutions. Yet even these integrated approaches still seem to be missing something. In a sense, it is only one small additional step to include the thousands of microbial species that are part of our makeup into an integrated approach in medicine and self-care. Beyond that, we do know what disease-connected microbiomes look like, and we do have tools for changing our microbiome.
Be that as it may, one of the things to keep in mind about the microbiome is that we are near the beginning of the learning curve. But that does not mean that we do nothing until we know all. If there is much we do not know about aspects of the microbiome, we do know what happens by doing nothing. That simply allows the NCD state to continue and more and more diseases to appear as we age. Most people would agree that is simply not good enough. They would prefer other options for improved well-being in their lives.
No. There are several very useful recipes for a better microbiome balance in any superorganism, including you. Many of these recipes are likely to be of some use for you. The very best for you will likely depend upon your ancestry/ethnicity, sex, age, previous and current diet, early-life experiences, food allergies and intolerances, health history, and current disease burdens. This is a little like planning the ideal vacation. One person’s perfect vacation would be another person’s worst nightmare, and ideal vacations involve many different personal factors. It is the same with ideal microbiomes. At present, there are thought to be three different fundamental types of healthy gut microbiomes. These are called the three enterotypes, meaning they are each a prototype of a useful mix of microbes dominated by one bacterial genus: Bacteroides, Prevotella, or Ruminococcus.
The enterotypes differ based on people’s ancestral origins and ancient lifestyles, including diet. For example, Bacteroides prefers to metabolize protein and animal fat, Prevotella is linked to mucin proteins and simple carbohydrates, and Ruminococcus prefers mucins and sugars. Mucin is a type of protein with lots of sugars (carbohydrates) attached to it. Because it carries lots of sugars, it is referred to as a heavily glycosylated protein. Mucins form gels that coat epithelial linings in our body, acting both as a barrier and as a lubricant. Some bacteria like to digest all or part of mucin; some don’t.
In Korea two different gut enterotypes have been identified. One is dominated by Bacteroides and the other by Prevotella. It is as if these ancestors and their co-partner microbes became a well-tuned completed self a long time ago using the diets that were locally available. Scientific debate abounds as to whether there are more than three enterotypes and whether they exist on a continuum instead of as discrete clusters of gut microbes. There is much more to say on this topic, but for now, suffice it to say that you should aim for the healthiest version of the nearest one of these enterotypes to you. People were healthy with them in the past, and we can be yet again.
Yes. Complete analysis of every possible body site is yet to come, but several companies, some university-connected, offer fecal, skin, and other site analyses of your microbial mix. That can give you a starting point for your personal makeover. However, most of the services offered, to date, are based on the types of microbes, mainly bacteria, in your samples and not on their gene composition or metabolic capabilities. Personal microbiome analyses are likely to become more widely available as they move quickly from the research lab to service companies.
Keep in mind that if you have a baseline analysis of your microbiome, that can be used as a starting point to monitor changes in the microbial mix as you pursue microbiome modifications. Obviously, how your own body feels and performs is the ultimate test of whether a specific rebiosis approach was useful for you. But the microbial analysis can tell you what changed along with your improving health.
Fecal microbiome analysis is the primary way that disease associations were established involving the microbiome, the immune system, the brain, and regulation of inflammation. We can see when there are major problems. We also can see when modifications have been made and evaluate those for their usefulness. But this kind of analysis doesn’t come close to telling us all we want to know. Besides the fact that it tells us little to nothing about the microbes in other body sites, such as the skin, reproductive tract, and lungs, it doesn’t even tell us about all of the microbes within the entire gastrointestinal tract.
In general, yes. To begin with, probiotics are microbes—sometimes individual bacteria, but often mixtures—that when administered correctly can improve health. There have been numerous studies with probiotics, but one of the most powerful in terms of numbers of humans evaluated was a collective analysis of all the published individual human trials that have been performed using probiotics examining gastrointestinal disease. Marina Ritchie and Tamara Romanuk of Dalhousie University in Halifax, Nova Scotia, Canada, conducted a meta-analysis using eighty-four trials involving some 10,351 patients with a focus on oral administration of probiotics. The findings were that probiotics are generally useful for both treating and preventing gastrointestinal diseases.
One of the best descriptions of the way this happens can be found in a consensus review article by a panel from the International Scientific Association of Probiotics and Prebiotics published in the journal Nature Reviews Gastroenterology & Hepatology. Colin Hill of the Alimentary Pharmabiotic Centre, University College Cork, Ireland, was the lead author on a collaborative paper with eleven researchers and clinicians located in Canada, England, Finland, France, Italy, Scotland, Spain, and the United States. The collaborators identified three types of situations in which probiotics can improve health:
No. There are at least three ways they can differ in outcomes. First, of course, the probiotic company’s production operation, especially whether it includes prebiotics, can affect what happens when you take the probiotics. Second, different source cultures of the same bacterial species (e.g., Lactobacillus species) might carry differences in some genes that affect the microbe’s metabolism and functions. Finally, there is some evidence that the probiotic bacteria’s host species of origin (say, human versus cow) might have different capabilities for signaling developing physiological systems such as the immune system. It is possible that for some types of help, human-sourced microbes are more effective in us than are microbes derived from other animals.
No. It is never too late to experience benefits. In fact, one of the exciting aspects of microbiome research is the potential for dramatic benefits on both ends of the life spectrum. There are many health issues of older age that are related to nutrient absorption and use as well as deterioration of multiple physiological systems, including the immune system and brain. Having a robust microbiome using more energy sources and producing metabolites that aid the immune system and brain is healthy.
No. Rebiosis reestablishes a healthy microbiome by seeding and nourishing useful microbiota after dysbiosis or a microbial imbalance has occurred. In theory, rebiosis would be unnecessary if you were seeded at birth with a healthy microbiome and had it fed well throughout infancy, childhood, and later in life. However, even under the best of circumstances, things can happen to anyone that disrupt the balance of one’s microbiota in the skin, airways, urogenital tract, or gut. Perhaps you had an incidence of food poisoning, a major stressor such as loss of a friend or family member, or an infection in one part of your body that took you out of your normal routine and forced you to change your diet. Travel on airplanes and visits to hotel rooms can bring you into contact with new microbes that can alter your personal balance. Exposure to chemicals and drugs can readily upset your microbiota. Additionally, a new NCD diagnosis—or even a flare-up of certain NCD symptoms (allergic rhinitis, asthma, Crohn’s, celiac, psoriasis) and the tissue inflammation associated with it—usually results in shifts in your microbes. Rebiosis is a sensible response.
Again, this may be the most important garden you ever tend because it constitutes 90 percent of you. You will harvest what you have seeded and nourished. If you do nothing, particularly early in the growing season, weeds will grow and thrive. Harvesting almost anything from a full bed of weeds might require starting over. But with preparation, careful seeding, and early attention to the seedlings, management of the garden becomes less onerous. Minor adjustments are in order to keep the balance among plants, and weed removal is needed to produce a bountiful harvest. There is also a synergy among the plants. A row of marigolds may not produce a food crop, but their presence helps to keep down pests. Understanding the positioning and interrelationships among your garden’s plants is useful. The same relationships exist among your microbiota.
Yes. It turns out that antibiotics are not the only medications that can alter your microbiome. Medications have not been routinely screened for safety of the microbiome, so for many, microbiome safety is likely an issue. One clue that might help sort out which drugs are most likely to cause microbiome problems would be if the medication has side effects that include GI tract symptoms. We now know that at least several of those affect the gut microbiome and can contribute to gut mucosal injury. The known list of antimicrobiome medications includes nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors. Additionally, some drugs such as statins only work in people who carry certain gut bacteria. Probiotic and prebiotic mixes (called synbiotics) can be helpful in protecting against these adverse drug effects.
Not necessarily. Changing the fecal microbial profile is only one way that probiotics can affect you. They can change metabolism while they are passing through your system even if they do not take up a long-term residency in your gut. But recently Rob Knight and colleagues at the University of Colorado Boulder discussed a different type of probiotic effect. Even when commercial probiotics were consumed by humans and their communities of gut microbes did not appear to change the mix of bacteria, there were still significant changes in gut microbe gene expression that affected food preferences.
Well, yes, but maybe not in the ways you might think. Many yogurts have a limited array of probiotic bacteria, and they are not necessarily at high doses. Live-culture yogurts often contain a limited array of Lactobacillus bacterial species. However, there are efforts to boost the number of species represented in some yogurts, and this may help their effectiveness considerably. Where are these bacteria most crucial? The vagina is where they are normally the predominant type of bacteria. There, they make lactic acid, which acidifies the vaginal environment and prevents the growth of microbes that cause bacterial vaginosis. So ironically, regular yogurt might help your health the very best when directly applied to the reproductive tract.
No. Certainly more has been done with the gut in terms of research and rebiosis strategies than for other body sites. However, they are all eligible for rebiosis when microbial imbalances arise. The vagina was just mentioned relative to Lactobacillus rebiosis and restoration of the acidic environment. There is evidence the skin microbiome can be altered through dietary ingestion of probiotics as well as topical application. In a recent screening of 896 oral bacterial isolates, the following bacteria—Lactobacillus crispatus YIT 12319, Lactobacillus fermentum YIT 12320, Lactobacillus gasseri YIT 12321, and Streptococcus mitis YIT 12322—emerged as good candidates for oral probiotics capable of inhibiting periodontal disease. For the airways and lungs, direct intervention with probiotics to modulate the lung microbiome has lagged behind efforts with other body sites. However, there is considerable interest in this area of prevention and therapeutics.
Probably not. Each individual is different, as are the circumstances. However, there is evidence suggesting that the most effective strategy is to adjust both your diet and your microbiome in a coordinated strategy. In some individuals, blunt-force changes in either diet or the microbiome have worked. But it is not easy nor is it universally effective. If it were, changing your diet would always lead to permanent weight loss and the correction of NCDs. It does not. It is very difficult for many people to lose weight and keep it off with only a change in diet. Neither does taking probiotics work well if your diet is working against supporting the microbes you are attempting to install. You need to consume a diet that allows the microbes you are installing in your gut to thrive, to have an ecological advantage in you, and to function fully. On the flip side you need microbes in place that allow you to benefit by consuming what is deemed to be a healthy diet. If you want to consume a Mediterranean-type diet but your microbes are calling for pizza and milk chocolate because they are incompatible with the healthier diet, you are in for a real internal struggle.
The use of dietary changes and probiotics went hand in hand in my own personal experience with correcting microbial dysbiosis.
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More than a year and a half ago, I pursued my own rebiosis path with very positive health outcomes that were verified by both my family and specialist physicians. The personal encounter with microbial dysbiosis began more than thirty years ago when, around age thirty and in the final stretches of my pursuit of academic tenure and promotion at Cornell, I developed what was diagnosed as irritable bowel syndrome (IBS). The prolonged stress of pushing hard to prepare for a competitive tenure package combined with a poor diet resulted in chronic gut issues that required antacid prescriptions (now available over the counter). It took close to two years of medical intervention and the granting of my promotion with tenure to resolve the issue.
But what I did not know then was that the GI issue, and the likely gut microbial dysbiosis that accompanies it, was not finished with my system. I soon developed a pattern of recurrent sinus infections that seemed to be promoted to some extent by respiratory allergies. The infections would not resolve and eventually required antibiotics. Soon I needed three to four rounds of antibiotics every year to function, and this pattern lasted for thirty years. Resistance would develop to the routine antibiotics, and I was requiring more specialized new-generation drugs, often with a longer and more serious list of adverse side effects. The cycle continued and continued, and I was losing hope as even ear, nose, and throat (ENT) specialists seemed at a loss for a longer-term solution. In reality, there were very few days during those thirty years when I felt really healthy and full of energy. Even when I was not on antibiotics, I was often developing infections that sapped my energy and impaired both my breathing and my sleep. One can only imagine what approximately one hundred rounds of antibiotics over this interval of my adult life did in terms of the inadvertent and almost constant attack on my microbiome. Of course prior to the 2000s we really did not know much about gut microbe dysbiosis and the connection to chronic diseases and conditions.
Things got bad enough with my health that my family doctor was telling me I needed to lose weight, and my ENT specialist was arming me with more allergy-related meds, trying to stave off any potential precipitating factors for the sinusitis. The immediate response was no weight loss and no significantly improved control of the recurrent sinusitis. Then a glimmer of useful information emerged. I was able to tell the ENT specialists that around the time each sinus issue began again, I had gastrointestinal issues, and this seemed to be consistent as a connected pattern. Their response was to quiz me about gastric reflux as a precipitating factor. But I had not noticed that. It was getting bad enough that even my esophagus was irritated along with my sinuses. The ENT clinicians again focused on the gastric reflux possibility, and finally, I was awakened one night by an intense episode of reflux confirming their suspicions. What we hadn’t known was that it had been happening at night during my sleep, and I had not been previously aware of it. It was what is called GERD, gastroesophageal reflux disease. That is one of those chronic NCDs.
Still, knowing that gastric reflux might be setting me up for the sinus infections was not enough to break the cycle. The gastric reflux was becoming more frequent and intense, and the soup of antibiotics continued to flow in the same pattern. In retrospect, it is no wonder that there was no significant improvement in the gastric-reflux-promoted respiratory issues. I had done nothing to correct my problematic microbiome. There was no seed-and-feed plan in place to help my much beleaguered gut microbes.
Then it happened, a totally offhand and unexpected observation showed me a way forward to address three decades of poor personal health. I traveled to Germany for a six-day, residential, scientific conference on the topic of metals and infectious diseases that I had helped to organize. At the end of the conference, we were supposed to have prepared most of a definitive monograph on the subject. During this time, we were sequestered together, working long hours, eating locally sourced, chef-prepared foods, and getting what was probably less than a normal amount of exercise. The food included local cuisine (e.g., German sausages and sauerkraut), but it also included more exotic Greek, Indian, and Chinese dishes. I ate some grains but in different forms than those I got in the United States. As usual on this type of trip, I was dreading the emergence of a sinus infection, which often cropped up connected with travel, time changes, and disrupted sleep. Just in case, I had an antibiotic refill with me from the ENT if needed.
To my astonishment, there was no sinus infection. But beyond that a remarkable thing happened. After four days of the six-day conference, my pants no longer fit me. Inexplicably, I had lost a pant size around the waist. How could this happen? I had been eating more than my fair share of what was exceptionally delicious food, three full meals a day, and getting little to no exercise. Yet my waist had shrunk! Plus, there was no gastric reflux, and I had more energy despite being jet-lagged. My loss of waist was all due to the disappearance of inflammation. Apparently, I had been experiencing constant inflammation in my body, and the change in environment in Germany had allowed that to lessen. Whatever helped to lock the inflammation in place was now absent or at least reduced.
I was convinced that something about the change in food was involved as I seriously doubted that sitting around all day and part of the night had helped my waist to shrink. I was not drinking my previously regular intake of diet soda, and that was a potential factor. Surprisingly, I ate a broader diversity of foods than normal in Germany, including some grains and some hard rolls. I immediately e-mailed my wife and let her know I had my own dietary experiment to run once I got home. I was determined to identify the factors in my US diet that kept me in a constant pro-inflammatory state. The German food had apparently aided my health, and something about my US diet had to be locking me into constant inflammation.
Of course, the conference itself provided some additional clues to my better health. It seemed that every discussion we had kept going back to the microbiome, even though that was not a specific agenda item or the topic of a background paper. We were beginning to realize that there was little point worrying about what the metal would do to the human immune system and resistance to disease if we first lacked information on what our microbes at the portals of entry (e.g., skin, gut, airways, and mouth) were doing with the metals. Every discussion session ended up being unintentionally rerouted toward the importance of learning, first and foremost, what our microbiome did with metals. For me, it seemed like the universe was repeatedly hammering me over the head with the microbiome until I got it.
Once I returned from Germany, I severely restricted my diet, added back one food at a time, and only kept what did not cause a big knot in my stomach (an early sign of future gastritis that I was now able to detect). At the same time, I started a rebiosis program using two different probiotic + prebiotic supplements. Diet soda was gone, as were lactose and gluten, with other grains severely restricted. That combination plus the probiotics did what nothing else could. In 2014, at age sixty-three, I experienced the healthiest year of my life since my twenties. Once I got a nice balance between the probiotics and foods, I was able to use the probiotics only when I detected that knot in my stomach or any other sign of gastric reflux. The probiotics resolved the knots even more effectively than combinations of antacids. The need for antibiotics was drastically cut, as was the number of days I spent either in distress or feeling ill. At the end of 2014 and beginning of 2015, I had my annual checkups with both my family doctor and my ENT specialist. They were both stunned. My family doctor kept mentioning how he tells lots of his patients to lose weight but only a few ever succeed in doing it. Furthermore, the weight loss is usually only temporary. When I told him it was all a result of my Germany observations, plus my microbiome seed-and-feed strategy, he asked for the microbiome papers as he wanted to help other patients.
The visit to the ENT clinician was even more memorable. His entrance began with the acknowledgment that something significant must have happened to me as his office never saw me anymore. It had been more than a year. When I told him that his theory about the gastric reflux combined with my Germany experience and knowledge of the microbiome had shown the way, he was stunned. But he also recounted how he suspected that other patients in his practice were experiencing similar gut-related, inflammation-driven respiratory problems. He could not get around how simple the solution had been. I still need some allergy meds, but the risk of sinusitis is now manageable, where before, it was totally out of control.
This is only one personal example. But given the knowledge that misregulated inflammation is at the heart of most NCDs and that the microbiome educates the immune system in matters that affect control of inflammation, it is likely to match many other cases. There are two take-home messages: (1) Since you have information about the microbiome that I lacked in 1980, don’t wait thirty years to do something useful about the 90 percent of you that is microbial. You can work with your health care providers to right the ship when it comes to your microbiome. (2) Changes in diet plus rebiosis are likely to be more effective than either dietary changes or rebiosis alone.
Yes. The reality is that there is some positive risk in almost every aspect of life, including getting out of bed in the morning, driving to work, entering your credit card number on a hotel’s Internet website, eating that yogurt, or undergoing FMT. So encountering something with more than zero risk is normal and may not be the critical factor in determining whether to pursue some level of rebiosis. The more useful question is whether the risk that exists is an acceptable risk. Is it acceptable to you? That is all that matters.
One of the more intriguing aspects of our society is how we deal with risk. There are several contributing factors to this, including our own personalities, the levels of actual risk, our perceptions of risk, and who controls the risk (i.e., us versus them). In this chapter, I will discuss risk in general and then as it involves the microbiome. Because the risk is not zero, there is always a possibility that something will happen. That possibility may be ridiculously low, but it is never zero. So a useful discussion of risk begins with the fact that we deal with different levels of risk that are more than zero. How much risk we undertake is based both on our level of tolerance and the likelihood and severity of the event itself. Our approach to risk can also change with age and life status.
Teenagers and young adults are often vested with an air of invulnerability. They are less likely to feel they need various forms of insurance and may be far more likely to ride the newest, most intimidating amusement park ride. Broken bones and falls happen, but healing happens as well. For the teenager’s great-grandmother, broken bones and the same fall can be a serious and justified fear. Middle-aged parents of those teens are likely to have a different view of risk and insurance as they view their invested stake in supporting their children’s emerging futures.
The big comparison to make is the risk of rebiosis (often low) against the alternative risk of doing nothing. In this case, doing nothing usually means dealing with one or more often-predictable NCDs, including what they mean in terms of shortened life span and reduced quality of life. No action has quite predictable consequences. Still, it is important that any action be recognized as having some risk greater than zero associated with it, and that amount of risk should be accepted before taking a bite of that yogurt, eating a fermented food (that topic is covered in a later chapter), or doing something more comprehensive in terms of rebiosis.
Yes. Of course much of the initial rebiosis research was performed in mice and rats, which are animals. But what you may not know is that the poultry industry has been using a quite successful rebiosis program for thirty to forty years. You probably have heard a lot about the sad tale of antibiotics in poultry feed, which I discussed in Chapter 9. But there is a much happier and remarkable story about the use of probiotics for decades in poultry. Not only do they work, they have transformed the livelihoods of some poultry farmers and provided a proof of biological principle for we humans who take probiotics.
Earlier in the book I introduced the famed Ukrainian immunologist and father of natural immunity, Elie Metchnikoff. But what I did not include in the prior mention is that Metchnikoff was an early proponent of and personal experimenter with probiotics. He regularly consumed his own probiotic-laden yogurt-like drink, which he was convinced would support a longer life. But if Metchnikoff was a personal pioneer in use of probiotics, it was chickens that first enabled the mass application of probiotics to minimize risk of disease. In 1973 Professor Esko Nurmi and Markus Rantala from the National Veterinary Institute, Helsinki, Finland, published an article in the scientific journal Nature demonstrating what came to be known as the Nurmi concept. These scientists were reacting to a devastating outbreak of Salmonella in poultry that occurred in 1971. Professor Nurmi was concerned with the fact that the modern agricultural practice was to raise newly hatched chicks apart from their mothers. These age-isolated newly hatched chicks were slow to develop their normal intestinal flora. This made them very susceptible to colonization by bacterial gut pathogens like Salmonella.
The comprehensive environmental management of the henhouse meant that you could feed prebiotics and probiotics at will and test out various combinations to find the ones best tailored for specific ages and functions (newly hatched chick, egg-laying adult hen, rapidly growing juvenile broiler, exceptional breeding stock, etc.) to boost health and productivity, ensuring profits for the farmer. The probiotic process used in animal agriculture such as poultry is known as competitive exclusion, where you seed and feed what you want in the chicken’s digestive tract and swamp out the capacity of bacterial pathogens to get a foothold.
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Following the Nurmi discovery there was a flood of lab research, field trials, and supplement development. By the mid-1990s a number of trials had been reported, and by 2003, there were already extensive reviews of prior work with Lactobacillus and Bifidobacterium supplementation along with specific prebiotic feeding. One of the driving goals was to reduce the risk for the spread of Salmonella both among poultry and to consumers from meat and eggs. But other benefits were also observed, including improved egg production, improved conversion of feed to muscle in broilers, improved overall growth rate, and increased resistance to disease (e.g., reduced mortality among production flocks). This is essentially the profit margin for chicken farmers.
To achieve effective competitive exclusion against pathogenic gut microbes, the probiotic formulations are usually administered to newly hatched chickens or turkeys as soon after hatching as possible. The probiotics can be given in a spray in the hatchery or administered in the drinking water of the chicks. However, the drinking-water route can produce more uneven benefits. Chicks may not drink water until after they’ve been shipped or even after they’ve begun eating. For this reason, spraying with probiotics even before the chicks are removed from the incubator/hatchers is a good option. There is interest in injecting probiotics directly into the egg as the embryo is developing, just before hatching. This has had mixed results as some probiotics given to the embryo can interfere with hatching itself. However, more recent efforts provide a glimmer of hope for late-embryo dosing. As with both chicks and children, the timing around hatching and birth are superb windows for action in support of a healthy microbiome.
Competitive exclusion is a bit analogous to a bar scene where someone yells “drinks are on the house,” and there is a mad dash toward the bar and bartender. In this case the bacteria that usually cause diseases are not as efficient at grabbing bar stools and they don’t get served. Put another way, competitive exclusion is like a promotional contest to log into a new advertising site. The first hundred log-ins win a free Caribbean cruise. In this competition, the probiotic bacteria are on high-speed connections, and the pathogens are using dial-up.
The process has been developed to the point where commercial probiotic products are administered with some containing as many as 200 different bacterial species. A retrospective look at the history of competitive exclusion in poultry concluded that it was highly successful not only for controlling gut pathogens in the birds but also with the added benefit of reducing mortality and enhancing growth. It has even been used in older birds that required antibiotic treatment as a means of restoring the birds’ microbiome. This form of rebiosis is particularly relevant to human health.
More than forty years of field experience with competitive exclusion in poultry has proven it to be a worthwhile health strategy. The poultry experience with probiotics has not gone unnoticed. What started as a poultry strategy has not stayed in poultry. Competitive exclusion has been used in pigs to reduce both E. coli and Salmonella problems in baby pigs. It seems to be an effective replacement for routine administration of antibiotics in feed within the pig industry. Probiotic mixtures have also been useful for calves, particularly those under management stress. What seems to be important is that the probiotic cultures for chickens, pigs, and dairy calves must be derived from the same animal species.
These successes using probiotics to shape the animal microbiome across decades, with massive numbers of animals constituting a significant percentage of the world’s animal protein food source, then raise the question, why have we been so slow to formally embrace a parallel strategy within westernized medicine? If a farmer’s profit margins and food safety rest on decades of proven strategies of using probiotics, what exactly are we waiting for?
Note that after thirty to forty years of successfully using a probiotic-management approach for poultry, farmers now have the optional approach of feeding microbial metabolites instead of whole live bacteria. The short-chain fatty acid butyrate can be fed to both chickens and pigs to discourage Salmonella from gaining a foothold. Of course that chemical, butyrate, still stinks, so it has taken some additional research to ensure that the chickens don’t smell as well.
Much as with humans, when your dog or cat has an NCD, the microbiomes of their gut and/or skin are skewed as well. Not surprisingly, probiotics work very well in dogs, and their microbiome management is an increasingly important component of their overall health given the high incidence of immune and gastrointestinal diseases in dogs. Probiotic microbes are now included in pet nutrition, therapy, and standard care.
For example, much like in chickens, oral probiotics are used to treat lower urinary tract infections in pets. One of the same probiotic mixes reviewed in terms of human health (VSL#3) is reported to be helpful in treating inflammatory bowel disease in dogs. Comparison of microbiological, histological, and immunomodulatory parameters in response to treatment with either combination therapy with prednisone and metronidazole or probiotic VSL#3 strains suggested a benefit of probiotic mixes for dogs with idiopathic inflammatory bowel disease. A wealth of US patents relating to probiotic bacteria for dogs have been filed for new product development and protection of intellectual property. This suggests that additional data, presently not in the open scientific literature, exists supporting the benefits of probiotic bacterial isolates in canine health.
In cats, dysbiosis of the gut microbiome has been associated with diarrheal disease with specific major differences in the prevalent bacterial species between healthy versus sick cats. Probiotics are used by numerous different groups within veterinary medicine as part of an integrated strategy to manage both GI tract and renal diseases. The Cornell Feline Health Center includes probiotics as a suggested part of newer treatments for inflammatory bowel disease in cats.
This is the big one. It’s the first question I am asked after my lectures and the one I dread the most. Why? First, the answer to that question lies solely between you and your professional health care providers. I can comment on what I see in the research literature and the personal approach I have taken, but that information is not intended as, nor should it be taken as, personal medical advice. What works wonderfully for one person might not work as well for someone else, and I hope the reasons why are now rather obvious.
Second, there are few standards for commercial probiotic products at the present time. It is much like selecting a hotel room in a city you are visiting for the first time. How do you go about that? Would you use online review sites such as Trip Advisor, go only with large hotel chains you trust for standards, or use word-of-mouth recommendations from your well-traveled friends?
Simply to provide you with one example, the approach used in our family has been to (1) first and foremost look at all the scientific evidence presented in a number of research and clinical trial papers suggesting which combinations of microbes are likely to be most useful, (2) use our own microbiome analysis results, and (3) look for any customer reviews about the specific commercial products we have identified as containing probiotic species we want to try. After that we let our own bodies, sometimes aided by relevant biological or microbiological analyses, tell us about the usefulness of the product.
Health Canada generated a list of probiotic strains for which there are sufficient studies to conclude that general benefits can be expected with sufficient doses. These include Bifidobacterium (adolescentis, animalis, bifidum, breve, and longum) and Lactobacillus (acidophilus, casei, fermentum, gasseri, johnsonii, paracasei, plantarum, rhamnosus, and salivarius). This does not mean that consuming other microbial strains has no benefit. It is only that these strains have substantial evidence as per benefits.
The bottom line is that even with some uncertainties, more information to come out, and risks greater than zero, there is little reason to simply live with NCDs and treat the end-process symptoms with heavy-duty pharmaceuticals while never addressing the root of the problem. It is time to consider treating yourself to a superorganism makeover.