Imagine you and I go back in time to 1982, an age when we could play Pong on a Commodore 64 kilobyte computer with a square hockey puck being batted back and forth between rectangular “goalies” that could move up and down, not sideways. Code was rudimentary, graphics laughably crude, capabilities modest by today’s standards (though spectacular by 1980s standards).
Look at what we have in the 21st century: enormous computing power operating at lightning speed, streaming video, hackers implanting “viruses,” high-definition displays, smartphones more powerful than any computer of the 1980s that are GPS devices, movie cameras, as well as mobile communication devices. With the right plug-in hardware and/or software, your smartphone can become a mobile blood laboratory, weather tracking device, or toxic chemical detector. We’re just around the corner from smartphones becoming hand-held medical ultrasound devices and measurers/trackers of multiple simultaneous biomarkers. We’ve come a long way in 40 years.
In the world of the microbiome, i.e., the trillions of microbes—bacteria, fungi, archaea, and viruses—that we harbor in our mouths, skin, sinuses, airways, gastrointestinal tract, and genitourinary systems, we are at the equivalent of a 1982 game of Pong. We are capable of engaging in a number of strategies that help correct the enormous damage we’ve done to the modern microbiome, but the answers are incomplete, there are numerous gaps in our knowledge, and the prescriptive strategies we possess to achieve improvements are limited. But the science is unfolding rapidly, yielding new and often unexpected lessons quickly. While it’s been more than 40 years since the Commodore computer and Pong, I believe that critical insights into the microbiome will come to us in less time than that.
What might the future hold in the world of the human microbiome? I predict that:
- The probiotic of the future will contain mostly keystone species, i.e., species that support the survival and proliferation of other important species, just as plankton in the ocean keep populations of jellyfish and whales thriving. Bacterial strains will be specified so that we know precisely what we are getting, not the anonymous strains used in most commercial probiotics today. Several keystone species and strains have already been identified among the species of L. reuteri, L. gasseri, B. infantis, Faecalibacterium prausnitzii, and Akkermansia muciniphila. Many more will undoubtedly be identified in coming months and years.
- “Collaborative” effects among guilds or consortia of microbes will be identified. Dr. Raul Cano, for instance, designed the BiotiQuest Sugar Shift probiotic based on this concept: each microbe in isolation produces a limited amount of metabolites. Put the entire group together, combining Leuconostoc mesenteroides, Pediococcus acidilactici, Lactobacillus plantarum and several others, and the quantity of important metabolites increases dramatically—revealing bacterial “collaboration.” Dr. Cano believes that this specific combination has the potential to reduce blood sugar. (We are currently conducting an informal virtual trial of Sugar Shift in the Undoctored Inner Circle to get a preliminary look at the magnitude of the effect.)
- We will have what I call “third generation” probiotics that combine keystone and collaborative species with non-microbial components that further “shape” microbiome composition. The non-microbial components will consist of anthocyanidins, polyphenols, polysaccharides, prebiotic fibers, terpenes and terpenoids, and perhaps other factors. Some terpenes, for example, have the potential to bloom specific species of Clostridia that are “gatekeepers” of the intestinal mucus barrier.
- We will be able to detect evidence for the various forms of small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO), and colonic and small intestinal fungal overgrowth (SIFO) in the comfort of our own homes without need for doctors, labs, or hospitals. Dr. Aonghus Shortt, for instance, inventor of the AIRE device, tells me that the new device that detects H2S and methane in addition to hydrogen gas in the breath should be released in fall 2021. This is a game-changer for intestinal health. We will also test not with a single sugar like lactulose or a prebiotic fiber, but a mixture of sugars and prebiotic fibers so that we increase the likelihood of identifying all pathogenic overproliferated species that may have specific “preferences” for nutrients to convert to detectable breath gases.
- Sex-specific differences in microbiome composition will become more clearly mapped out. Right now, that knowledge is nearly non-existent but it may prove to be an important distinction to navigate.
- The overuse of C-section delivery and synthetic baby formulas will drop dramatically, as it becomes clearer and clearer that these practices impair health for a lifetime. Gynecologists will no longer express shock when a mom asks that a vaginal swab be dabbed on the baby’s mouth if C-section becomes unavoidable.
- “Stool banks” will become commonplace, a place where you can have a sample of your poop stored, obtained while you are healthy, to repopulate your gastrointestinal tract should you need to take antibiotics, undergo medical procedures that disrupt your microbiome, or develop health conditions associated with marked dysbiosis/SIBO/SIFO such as Clostridium difficile enterocolitis and inflammatory bowel diseases ulcerative colitis or Crohn’s. This allows the process called “autologous fecal transplant.”
- Gastroenterologists will come to realize that just screening people for polyps and colon cancer with colonoscopy is a practice of limited usefulness. They will come to understand that screening people for severe colonic dysbiosis and SIBO is a far more productive strategy if begun early in life that has far greater potential to preserve health and avert colon cancer and numerous other health conditions.
- The FDA will require drug companies (you know, that exploitative industry who has corrupted the practice of medicine and the economics of healthcare?) to characterize changes in the microbiome induced by their drug, as well as how the microbiome alters the metabolism and end-effects of drugs.
- And, the most far-flung of all: Doctors will counsel patients on how to manage their microbiomes. Imagine going to your primary care doctor who measures your weight, blood pressure, performs a basic physical exam, then proceeds to discuss your microbiome, perhaps perform an analysis of your stool microbes, then dispenses advice on how to, for instance, push back Proteobacteria contributing to rosacea, bloom Akkermansia to reduce your blood sugar, or cultivate Lactobacillus casei Shirota to improve your sleep. Sadly, this may be the vision of the future that is the most impractical and far away from the current status quo.
In short, knowledge and insight into the human microbiome is going to dramatically change notions of health, performance, disease, and aging. It is truly a wonderful time to be alive, especially since you are no longer resigned to only playing Pong nor to thinking that antibiotics are the key to health.