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Wednesday, July 10, 2013

How the microbiome is (slowly) making its way into clinical practice

If you follow my Twitter feed (@bykriscampbell) or read this blog, it will be obvious to you that the microbiome impacts our day-to-day health. The research, granted, is in an early-ish phase where certainties are few and far between (as I mention in this podcast interview). But still, there are myriad studies that say things like "administer probiotics", "avoid prescribing antibiotics to kids", and "consider c-sections only in emergency situations".

What has me puzzled lately is this: if lots of good evidence is already out there, how come it's being incorporated so slowly into clinical practice?

Well, it's Good News Day on this blog. Because here are a few examples where health professionals are taking the information on the microbiome and using it to immediately help patients:

1) Fecal transplants are moving from the realm of weird voodoo cure, into a respectable treatment option. The most likely reason for this is that they work ridiculously well a lot of the time. In a recent NEJM study, for example, fecal transplants were used to treat recurrent C. difficile infection, and were so effective that the study had to be discontinued because it was unethical to withhold the treatment from the control group.

In the US, the FDA recently tried to put up a barrier for doctors wanting to use this treatment with their patients: requiring an Investigational New Drug application for fecal transplants. Recently, though, the requirement was thankfully overturned.

2) I was having another dinner-table conversation about feces the other day (wait, not all families do that??), when I heard from a Winnipeg doctor that the formulary in his hospital carries probiotics, and that he and his colleagues often administer probiotics when antibiotics are given to inpatients. Since then, I've heard that Quebec's Pierre-Le-Gardeur hospital does the same, as do several others in Quebec and Ontario. (And probably more that I haven't heard about.)

3) Should you be fortunate enough to have access to a clinic that does bacterial sequencing, the data can be used to personalize your treatment experience. As explained in the video below (with helpful hand gestures) by Nicholas Chia, Ph.D., at Mayo Clinic, a patient with refractory bacterial vaginosis could get a bacterial swab and have it sequenced. This would help the doctors know what antibiotics she is resistant to, and which bacterial takeovers she'd be susceptible to. Based on that, the doctor could find a treatment that would work better than the repeated rounds of antibiotics she might have had in the past. Here's the video with the full explanation:

Using "the firehose of information that comes down off of sequencers"

Those are three examples that make me happy. But the job is far from done. Anyone can do their part to advance "the cause" by bringing up the microbiome at their next doctor's appointment. Even if the doctor doesn't know much about it, she or he might go home and catch up on the topic by reading a few journal articles.

The microbiome is going to change healthcare, but it'll be one doc and one patient at a time.


  1. Wow! This is such well-explained facts about probiotics. Thank you for sharing this to everyone,
    We should be aware of what probiotics can do to our body.
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  2. I also have a blog about probiotics and microflora and you're absolutely right. There are tons of studies showing that probiotics have great results, but most of this isn't seen at the patient level. I think this will change soon. Hopefully, I can make you even happier by saying that at a research level, the microflora has never been hotter. Microflora and probiotics articles are making their way into the top scientific journals like Nature, PNAS and Gastroenterology. This should make a massive difference as many doctors know the impact of these journals.

    The biggest hurdle is still safety. While probiotics are generally considered safe, there was a study in patients with acute pancreatitis in the Netherlands. There was a higher death rate in those treated with probiotics. I'm sure this makes some doctors jittery.

  3. Wow! I'm so excited to have come across your blog! I developed an intolerance to wheat/gluten and various other food stuffs around three years ago.

    I became intolerant following a difficult end to my pregnancy(suspected HELLP syndrome induced birth),a course of antibiotics to deal with a breast infection and a tummy bug not long after. It was the tummy bug that I think dealt the final blow.

    My life feels blighted by my intolerances, but I'm sure there is an answer somewhere and I feel it has to do with my gut bacteria. I currently take a probiotic which keeps a yeast infection (which followed the antibiotics) at bay. If I stop the probiotics the yeast infection returns. Looking to the future, I'm particularly interested in whether fecal transplants may become a feasible option.

    I will be following your blog with interest!

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