It’s not uncommon for medical groups like WholeHealth Chicago to have their patient charts audited by health insurance companies “for quality.” After all, insurers want to see how their money is being spent and since they’re for-profit businesses with egregiously overcompensated management teams, they do want doctors to keep costs as low as possible.
Some years ago, as medical director, I was summoned to discuss the results of an audit a well-known insurer had performed on WholeHealth Chicago. After a comprehensive review, they had just one complaint. We’d been ordering too frequently a test that evaluates the bacterial mix in stool specimens. The test results reflect the health of your microbiome, made up of the trillions of microbes living in your gut. The state of having an unhealthy microbiome is called intestinal dysbiosis.
The physician team reviewing our charts politely said there was no such condition as intestinal dysbiosis, a term they believed had been invented by chiropractors, naturopaths, and nutritionists. If I suspected an intestinal infection (like salmonella or amoebiasis) I could order a stool culture, but a general overview of intestinal bacteria was verboten and they simply would not pay for it.
At that precise moment I wanted to quote Hippocrates–who said all disease begins in the gut–but I didn’t want to seem like a wise guy. In truth, while many conditions are a reflection of gut health, not all disease starts there (genetic conditions being one example), but it never pays to argue with someone whose mind is permanently locked and loaded in their own reality tunnel.
Click here for a Blue Cross (Arizona) memo denying the existence of intestinal dysbiosis.
For an alternative point of view, here’s a nice article summarizing gut-related disease.
A few years pass
With the passage of time, of course, the microbiome gained more respect (except, apparently in Arizona, whose memo is dated 2018 ), though I suspect conventional gastroenterologists would rather clean colonoscopes with their dinnerware than admit chiropractic physicians and naturopaths were right about something they’d been clueless about.
Physicians, by the way, do a lot of damage to the human microbiome. A single course of antibiotics can be a veritable Rambo-mycin, killing trillions of good bacteria and throwing your intestines into turmoil.
Using a well-intentioned but misguided ultra-potent antibiotic like Levaquin to get rid of a minor bladder infection is definitely overkill. If there are any bacteria left behind, the same doc may prescribe yet another, like Augmentin, leaving you with Clostridium difficile (C-dif), a diarrhea-from-hell that requires even more antibiotics to clear.
If you’re curious, there are 450,000 cases of C-dif annually and nearly 30,000 deaths from it. A C-dif death is described as iatrogenic, which means while unintentional your doctor just killed your mom.
At last, mainstream medicine bows to the microbiome
Finally, even conventional physicians now acknowledge the power of the gut microbiome. The right bacterial balance can give you healthy immunity and clear skin, keep you from getting fat, reduce your chances of heart disease, limit (and sometimes cure) inflammatory conditions like rheumatoid arthritis, prevent cancer, and even treat depression.
Patients with familiar intestinal conditions such as irritable bowel syndrome, Crohn’s disease, and ulcerative colitis may benefit from a microbiome overhaul by undergoing a fecal transplant. This appetizing project involves getting an enema-full of someone else’s healthy stool or taking capsules filled with same.
The FDA is struggling with fecal transplants, but certain gastroenterologists are performing them for their ulcerative colitis and C-dif patients. Even Mayo clinic offers fecal transplants for C-dif—talk about mainstream. Considering the going rate is $11,000, you might respond the same way you did when you saw your first abstract expressionist painting–namely “Gee, anybody could do that!” Click here for one of the many YouTube DIY fecal transplant videos in case you want to try this at home. However, while the DIY route is tempting because of the cost savings, your donor needs to be in excellent health and definitely HIV negative. I suggest discussing all this with a gastroenterologist before moving forward.
Gut health goes mainstream
Regular Health Tip readers are pretty knowledgeable about the many chronic conditions associated with intestinal dysbiosis and leaky gut syndrome (also called intestinal hyperpermeability), small intestine bacterial overgrowth (SIBO), and the endless issues people have with parasites (such as Blastocystis hominis—click here for a Health Tip on parasites) once thought harmless, but now known to be involved in digestive conditions as common as irritable bowel.
What all this is leading up to is my delight at opening Medscape (the go-to website for physician news) this morning and discovering because it was Digestive Disease Week that right on the landing site there were three articles on the microbiome. They’re currently password-protected, but I’ll paste in the beginning of the most interesting one here:
An increasing body of experimental data strongly indicate that the gut microbiome, the trillions of microbes that colonize the gut of an individual, strongly influences both health and disease. Our microflora carry out essential functions; they facilitate digestion, generate needed nutrients via microbial metabolic activities, mediate brain-gut communication, modulate host immune responses, and harvest energy from food. Host-bacteria interactions not only influence normal physiology but also may induce susceptibility to disease; disruption of the symbiosis between microbiota and host (dysbiosis) may have profound untoward effects. Alterations in the balance between harmful bacteria and beneficial bacteria have been associated with such disorders as irritable bowel syndrome (IBS), inflammatory bowel disease, obesity, malnutrition, and liver diseases. An increasing understanding of the link between compositional and functional changes of the microbiota have led to innovative diagnostic techniques and development of novel therapies.
Just as intriguing, right below this piece were the headlines “More Evidence for a Gut-Brain Link in Alzheimer’s” and “Mom’s Microbiome and Inflammation Linked to Autism.” Sorry to say these are also password protected, but you get a sense of the future from the titles alone.
Lastly, although excellent microbiome testing is readily available, you really also need a practitioner trained in the interpretation of tests and the vagaries of treatment. Here’s a link to a sample interpretive report for the Genova Labs test GI Effects. It can be overwhelming (even to gastroenterologists), but WHC staff (Drs Caley Scott and Alaina Gemelas, and Nutritionists Marla Feingold and Olivia Wagner) are familiar with this test, can order it for you, and explain how to get your gut back into alignment.
David Edelberg, MD