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Rude health: so what does your gut say?

Doctors are still uncomfortable with the millions of bacteria that live inside our stomachs as they have very little idea of what these bacteria actually do

brunch Updated: Oct 13, 2013 10:15 IST
Vir Sanghvi

A decade or so ago, I went to see a trendy doctor in Harley Street, the traditional heart of British medicine. (Private British medicine, at any rate.) The doctor gave me a thorough examination, took blood samples and then proceeded to elucidate his own philosophy of medicine. "All diseases," he said forcefully, "begin in the gut. Cure the gut and you will cure everything."

I am an arts student who used to faint when we were asked to conduct dissections in biology class in middle school, so I make no claims to medical expertise. But even to my layman’s ears, this did not sound right. A brain tumour began in the gut? A lung infection was the consequence of a digestive dysfunction? Ingrown toenail could be cured by treating the gut? None of this sounded at all possible.

And indeed, as the doctor, who I will not name but will call Dr Quack Quack, went on, even I realised that he was a master of oversimplification. He tested my blood for proof of intolerances. ("Grapefruit, that’s what your system cannot take." Just as well because I never eat it.) He recommended colonic irrigation, made famous by Princess Diana. I was to take lots of enzymes. And how many probiotic tablets did I think I needed? I pointed out that I already took some. But he was clear that I needed many, many more. the years, I’ve grown increasingly sceptical of people like Dr Quack Quack who specialise in diagnoses that normal doctors do not recognise – just as they do not recognise the value of his so-called blood test for food intolerance. But, because I suffer from an annoying digestive condition, I’ve begun to follow advances in the field that Dr Quack Quack claimed to specialise in. It turns out that, as I suspected, much of what he said was sheer tosh. Some diseases do begin in the gut. But only an idiot or a faddist would claim that digestive relief is the answer to all our problems.

On the other hand, there is one aspect of gut medicine that normal doctors do not pay enough attention to. And that’s the subject of the veritable zoo that we carry around with us, everywhere we go. We were taught at school that the human body is composed of millions of tiny cells. This is true. But what they did not tell us is that our bodies contain many more bacteria than we have cells. The latest estimates say that for every cell in the human body, there are nine bacteria living in our system. In other words, we are not just people. We are also the host environments for billions of living organisms. Hence,the parallel with the zoo.

Medicine has always been unwilling to take bacteria seriously. For entire generations, the sum total of medical knowledge amounted to zero because doctors had not worked out that bacteria cause disease. Even when this became clear, it took a long time before medicine realised that good bacteria could fight bad bacteria: penicillin, antibiotics, etc. And even now, doctors are still uncomfortable with the millions of bacteria that live inside our stomachs. They know that the bacteria are a part of the digestive process, but your average GP has very little idea of what they actually do. The classic example is the case of ulcers which were thought to be caused only by stress or hot food (“curry, worry, and hurry” as doctors in the Punjab used to put it). It is only relatively recently that scientists have isolated the bacterium responsible for many ulcers and have prescribed the correct treatment for it. (This treatment consists of antibiotics, which is of course, a way of using one bacterium to fight another.)

One cause: Mary Roach points out in Gulp, that alimentary canal bacteria may be responsible for all kinds of things, including even, why we are fat or thin

Recent research suggests that medicine – even fad medicine of the sort that Dr Quack Quack practised – does not understand the importance of gut bacteria. Take, for instance, the idea that if you have the wrong sort of bacteria in your gut, all you need is a colonic wash of some kind to get rid of the bad guys. Then, you pop some probiotic pills full of good bacteria and – hey, Presto! – you will be cured. We know now that this is nonsense. Bacteria are like fingerprints. Once you are born with them, they never change. Around 80 per cent of the bacteria in your gut were transmitted from your mother during birth. The bacteria in your system today are roughly the same composition as the bacteria that lived there when you were an infant. Colonic irrigation makes no difference at all, even in the medium term.

As Mary Roach points out in Gulp, her bestselling book on the alimentary canal (from which all my new information on bacteria is derived), bacteria may be responsible for all kinds of things, including even, why we are fat or thin. Some of us have bacterial populations in the gut that make us eat different kinds of diet or store energy differently. We believe that we have some control over what we eat and where the food goes. But actually, it’s the bacteria that are making the decisions. (Perhaps the old ayurvedic classifications of rajsik, tamsik and sattvik came out of an understanding of bacteria!)

Roach explains that even the distinction between good and bad bacteria can be misleading. It is the circumstances that decide whether bacteria will have positive or negative effects or even, no effect at all. Take for instance, C. difficile (or C. dif), the bacteria that doctors warn you can cause diverticulitis. Thirty to 50 per cent of infants are colonised with C.dif and suffer no ill effects. But certain conditions in the adult colon may make it easier for C.dif to infect grown-ups. (Among these conditions is an overdose of antibiotics.) And then, the bad consequences kick in.

Fit for a princess: I was recommended colonic irrigation, made famous by Princess Diana

Or, take E. coli, the disease bacteria that doctors routinely blame for colitis. But most strains of E. coli cause no symptoms inside the colon and are easily handled by our immune systems. But, if the same strains get to the urethra or the bladder, they are perceived as invaders and our immune systems create the symptoms – inflammation, pain, etc. One theory is that many inflammatory bowel diseases (Crohn’s Disease, IBS, or ulcerative colitis) are merely inappropriate immune system responses to normal bacteria. Because the immune system misunderstands the nature of the threat, it responds with inflammations.

If bacteria are actually the key to understanding gut function then can we use them for our benefit? Over the last two decades, people like Dr Quack Quack have been telling us that good bacteria or probiotics are silver bullets. Flood your system with acidophilus or any of the probiotics available on the shelves of your local fad chemist and suddenly, the bad bacteria will be neutralised. Most people with digestive problems have fallen for this propaganda. Take my own example. Though probiotics have made little difference, I still take them occasionally on the grounds that, well, who knows?

According to Mary Roach, however, scientists are sceptical about the efficacy of probiotics. The bacterial content of most over-the-counter probiotics is disputed. And scientists say that culturing, processing and shipping bacteria in an oxygen-free environment is complex and expensive. One expert told Roach that 95 per cent of commercially available probiotics “have never been tested in a human and should not be called probiotic”. I am not sure if this applies to dahi which we regard as the ultimate Indian probiotic. But there is one approach that has been proven to work. Unfortunately, it is a very yucky one. Doctors have extracted bacteria from the colon of one living person and implanted it into the colon of another. These bacterial transplants nearly always seem to work. Patients with pain, diarrhoea, and other digestive complaints have reported immediate improvements.

The yuck factor comes from the methodology. The anaerobic bacteria that are transplanted have a limited lifespan. So, the only way that the process can work is if doctors perform a colonoscopy on a donor, harvest his good bacteria and then thrust them into the colon of the recipient. Hence, the rather unappetising name for the process: fecal transplant.

According to Roach, people will get over the yuck factor eventually because of the strongest argument in favour of the procedure: its efficacy. Success rates hover at around 93 per cent. And there is no other treatment that works. And indeed, last week’s papers carried news of product launches that depend on fecal bacteria. I am not sure that this approach could ever work for me. My yuck reaction is just too strong. But what these advances tell us is that medicine has ignored digestive bacteria for too long. Because real scientists have been too busy researching other illnesses, the field has been left clear for the likes of Dr Quack Quack and his fad remedies. But there is a real problem here. And medicine needs to find the solutions. Not just for each of us. But for the millions of other beings we carry around with us.

From HT Brunch, October 13

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