Our bodies are not ours alone. We share them with trillions of bacteria, fungi and other microbes. Most of these live in our large intestine and are known collectively as the gut microbiome. The health of your gut can influence a surprising range of conditions, from obesity and diabetes to cancer.
Seth Rosen, M.D., a gastroenterologist affiliated with Baptist Health, illuminates the fascinating world of the gut microbiome with host Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute.
Our bodies are not ours alone. We share them with trillions of bacteria, fungi and other microbes. Most of these live in our large intestine and are known collectively as the gut microbiome. The health of your gut can influence a surprising range of conditions, from obesity and diabetes to cancer.
Seth Rosen, M.D., a gastroenterologist affiliated with Baptist Health, illuminates the fascinating world of the gut microbiome with host Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute.
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Dr. Fialkow:
Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
Many of you may not realize that we human beings live in a symbiotic relationship with other organisms. Each one of us has trillions of bacteria and other microbes living within our intestines. This is known as the gut microbiome. It may sound a little frightening, but it's actually a good thing and a necessary thing. Healthy bacteria help digest food and keep the number of unhealthy bacteria in check. And in recent years, numerous scientific studies have looked into the connection between the health of your gut and the microbiome and things like obesity, diabetes, and cancer. I'm happy to welcome Dr. Seth Rosen, back to the podcast. Seth's going to talk to us about the microbiome and the role of probiotics to keep our gut healthy. Dr. Rosen's a gastroenterologist at Baptist Health. He's the past chairman of the GI subsection. He's the past vice president of the medical staff, and currently chairman of the extremely important performance improvement steering committee. Welcome back, Seth.
Dr. Rosen:
Thank you, John.
Dr. Fialkow:
So Seth, let's get right into it. A couple of level-set concepts and definitions. First, tell us what is the microbiome. Just define... We use that term and it's being used more and more. What are we talking about?
Dr. Rosen:
The microbiome is the collection of bacteria that live in the GI tract. Predominantly in the colon, it is billions and billions if not trillions of bacteria that live there. They are necessary for healthy functioning. And it's a very normal situation to have all of these bacteria from the time shortly after you're born until you die. And when there's alterations in there it can lead to illness.
Dr. Fialkow:
And again, a couple of the illnesses that we throw out there, maybe you could elaborate, where do you see the more common medical conditions that we are now doing a lot of research and raising interest regarding the role of the microbiome?
Dr. Rosen:
Well, it's been talked about in a variety of situations. Most commonly in irritable bowel syndrome, where the balance of the organism seems to play a key role. It's also been implicated in Clostridium difficile or pseudomembranous colitis, which you get after you've taken antibiotics. That's well-known... Well-described-
Dr. Fialkow:
And those are really significant diarrheal illnesses, right?
Dr. Rosen:
It's a serious illness. There've been talk about the balance of Inflammatory Bowel Diseases, such as Crohn's disease and ulcerative colitis. And it's also seems to play a key role in the balance of the immune system in the body and generalized inflammation in the body and in your specialty it's been implicated... An imbalance has been implicated in possibly increasing inflammatory markers and leading to heart disease.
Dr. Fialkow:
Right. We think the bacteria protect us against and provide a barrier against certain substances, which otherwise can be absorbed and cause inflammation, and heart disease, and cancer, and even obesity. They're thinking that there might be a connection between why certain people can eat food and then bacteria digests in a certain way that increases the absorption of the food and may lead to obesity and various other things. So it's just fascinating.
Dr. Fialkow:
But taking it back to what we really know, which again is in the GI disorders. You did mention antibiotics and possible consequences. So, tie this together a little bit as one of our first points. The role of antibiotics, the risk of antibiotics, what we see with the microbiome, if someone... Well, what we see with the microbiome in relation to antibiotic use?
Dr. Rosen:
So, whenever you take antibiotics you're going to alter the bacteria balance in your GI tract. The antibiotics, especially the ones we use today, which tend to be very, what we call broad spectrum, broad acting against many different bacterial species will alter the balance of bacteria in the GI tract. And the result of that can create different conditions. Some people after they take antibiotics will have... Or during, or while they're taking antibiotics will have diarrhea. Some will have gas and bloating, some will have constipation. And this is all because you've altered that very critical balance of bacteria that exists in the GI tract.
Dr. Rosen:
Interestingly enough, a similar situation can occur when you've had a very severe gastroenteritis. And some of that bacteria just gets washed away from this diarrhea and it can take... There's a very well-described condition called post gastroenteritis irritable bowel syndrome.
Dr. Rosen:
The theory is that's because you've created... Or the illness has created a transient imbalance in the balance of bacteria. And just to get a little esoteric, for years people have wondered why do we have an appendix. Since it seems to be a vestigial organ that doesn't seem to have any purpose anymore. And one of the theories is, especially during evolution is the appendix was a reservoir to repopulate the bacteria in the GI track after an illness. Certainly in our ancestors there was much more frequent illness from poor... For hygiene, for water, et cetera. And the appendix may be a reservoir to repopulate healthy bacteria in the GI tract. And it's just a theory and it certainly hasn't been proven, but it's interesting.
Dr. Fialkow:
It's fascinating to connect these concepts. But as you say, anything that might eliminate the healthy bacteria in the antibiotics or other gastrointestinal illnesses are left with the consequences. So, let's talk a little bit about now probiotics and maybe dispel some myths, but also talk about some truths. When we talk about a probiotic and if you want to get into prebiotic as well, give us a little update and lecture on what a probiotic is.
Dr. Rosen:
So, probiotics are so-called healthy bacteria for the GI tract. There are literally dozens and dozens of probiotic products on the market. Many of them are proprietary. They're generic. They [inaudible 00:06:40] store brands. They come in brand names and they tell... So many different millions of colonies in the capsule. They will tell, "Oh, we have this specialized combination of bacteria in our capsule." The first thing people need to know is these are not treated as drugs by the FDA. The Food and Drug Administration classifies these as supplements or food supplements.
Dr. Rosen:
And so they don't go through the same rigorous testing that a drug will go through. The only requirements that a company has is to make sure that they're safe and won't harm people. But there is no requirement to show that there's truly a benefit to them. Now, some of the probiotics have done clinical studies and shown that there may be a benefit. And often these clinical studies are concentrating on a specific disease condition. Either diarrhea or irritable bowel syndrome, or perhaps even inflammatory bowel disease. But any of the probiotics that say "We will just improve your health," are probably lacking any solid scientific evidence.
Dr. Fialkow:
So that was actually a great concise review. FDA approval means that it's a medication that has a medical benefit that's been proven, has a safety profile that's been assessed, it's standardized and its delivery. And these are not FDA approved substances. They are supplements. You and I can in our backyard can concoct something called a supplement and sell it. And unless it's killing someone, we're allowed... Actually Stella, maybe we'll do another podcast on FDA and... After the safety of the FDA process. But to follow up on that. So you're talking about things that are sold and touted to be probiotic. And they may have an indication for certain conditions. What about natural probiotics? What about... Do you ever sit with people who have particular medical problems say, "Listen, if you eat more of this you can have this benefit." Or do you recommend any kind of dietary components that either are felt or shown to be a benefit?
Dr. Rosen:
Well, I'll answer that in two ways. First of all, when I recommend a probiotic... And again, many patients will say, "Should I be on a probiotic?" And I recommend probiotics when I want to treat a specific condition where I think the probiotic may be beneficial and then I'll try and select the probiotic. And there's only a handful that there's really been clinical studies on. I'll choose one where there's some data that supports treating that particular condition. So, that's the first part. But the people who say, "Oh, I don't have any problems." They may come in for colon cancer screening. And they'll say, "Should I be on a probiotic?" If they have no issues then there's no particular reason for them to spend their money on a probiotic. They tend to actually to be rather expensive, actually. As far as dietary issues, one of the questions will be, "Well, I eat yogurt and it says, it's got probiotics in it."
Dr. Rosen:
The problem is you can't eat enough yogurt that Really make a dent in your microbiome. There's not enough in the yogurts, the commercially produced yogurts. What has been shown are what are called prebiotics, which are certain healthy foods that act to stimulate the growth of the healthy bacteria in the GI track. Certain fibers are good for that. Somebody who's looked at dandelion extract, which is good for it. I met most of the... Cauliflower and broccoli have all been suggested to be healthy prebiotics. And you can buy supplements that are touted as being prebiotics. Which they do not have probiotics in them, but they will stimulate the healthy bacteria in the GI tract.
Dr. Fialkow:
So, my staple of my diet of eating purely yogurt, sauerkraut, and kimchi is not going to work if I have a diarrheal illness from an antibiotic [inaudible 00:11:17].
Dr. Rosen:
It's unlikely to. Actually there'll be played devil's advocate. There was a study that came out last year that questioned the efficacy of any probiotics. And that you take a probiotic and it's got a couple of million colonies of bacteria in it. And you're talking about billions and billions in the GI track or trillions. Does it make a difference if you take a pill every day with a couple of billion colonies of bacteria in it, and it has to make its way through your GI tract to get to the lower portion of your GI track? And some people have questioned whether it makes any difference whatsoever in scientific studies. The problem with the kimchi and the yogurt is that it has far less than what is in these little capsules. And so, no, you can't eat enough, although those are all healthy things-
Dr. Fialkow:
Right. Exactly.
Dr. Rosen:
... function particularly, the kimchi may function as a prebiotic.
Dr. Fialkow:
So, yeah. And again, I was going to get to that point is I think it's clear to the listeners that you and I are not advocating in any way taking any probiotic supplements. Unless maybe there's a particular medical condition, like you said. But certainly eating those foods that we just mentioned are not unhealthy. And turning around a different way. Is there any danger to the probiotic supplements in your mind? Obviously, we're assuming it's a company that's not... Doesn't contain something dangerous. I mean, is there anything particularly dangerous about probiotic?
Dr. Rosen:
There really is not. All the ones on the market even the ones without any real scientific data to support their use, they're not harmful. And as I said, one of the criteria is they can't be harmful. They're not put through the same rigorous testing as a drug agent or pharmaceutical agent. But they're not harmful other than to your wallet, because-
Dr. Fialkow:
I tell people they are very expensive stool.
Dr. Rosen:
They do because you're talking about 40, 50, 60, $70 a month. So it would be nice if you're really getting a benefit out of spending that money.
Dr. Fialkow:
Now, part of the concept and one of the other reasons why I think... Again, I really appreciate you coming on the podcast. And I thought it might be a value is we've had other podcasts regarding inappropriate antibiotic use and the risk of that. And interestingly to the viewers and... To the listeners, and you know this is actually a similar thought in chronic sinusitis. Which is from antibiotic use of various things. It's an overgrowth of unhealthy bacteria. So it might be some similary to the gut microbiome. But having said that, so we know not to take the antibiotics if we really don't absolutely need them. So let's say someone has to take a course of antibiotics and winds up with some diarrheal or GI type of issues. Number one, is that automatically C difficile, or if not, do you see that in your practice, and there are things you recommend to mitigate the consequences?
Dr. Rosen:
Yeah, there's a couple of points here. First of all, not all antibiotic associated diarrhea is C difficile. Very clearly, most of it is not. You can get diarrhea. It's not C difficile as a result of antibiotic use. To make a diagnosis of C difficile that needs to be specifically tested. And that's for a separate day conversation.
Dr. Rosen:
There are certain things that you may be able to do to decrease your risk. Number one, as you mentioned, only take antibiotics when they're absolutely necessary. We use way too many antibiotics in this country. And there's no question that it is detrimental to the health when they're overused. So that's the first thing.
Dr. Rosen:
Another thing is there are many, many people who are on proton Pump Inhibitors, that's Nexium, and pantoprazole, Protonix, Prilosec, omeprazole. Those are the Proton Pump Inhibitors. They shut down acid in the stomach, which was one of our early first defenses against bad bacteria. And there's been shown that people who are on this long-term may have more issues with their gut biome. And in the setting of using antibiotics may be more prone to certain illnesses, including C difficile. So I would say the same thing about Proton Pump Inhibitors as antibiotics. Don't use them unless they're absolutely indicated.
Dr. Rosen:
The third thing is there is one probiotic which has been suggested to help when you're on antibiotics or after you've been on antibiotics. When you're on antibiotics, most probiotics are not going to be effective because they're bacterial based and the antibiotics are going to kill off some of the many of the bacteria that you're paying to take in the probiotic. But there is one that is a yeast-based and that has been shown to maybe decrease the risk of C difficile in certain settings. And some of us think that it may help just decrease the risk of antibiotic associated diarrhea in general. And that one, because it's yeast-based is not a problem with taking the antibiotics and the probiotic at the same time.
Dr. Fialkow:
Seth, this is great information. I mean, we could take it in so many further directions regarding other types of organisms inside bacteria like you've mentioned. Various of the concepts of the gut microbiome. So stay tuned. We'll have you back and maybe just focus on some of those additional topics. Anything you want to just add that either I didn't... That we didn't touch on or anything just to reiterate?
Dr. Rosen:
I would encourage people to discuss this with their physician before they go out and spend a lot of money on something that maybe they don't need, maybe is not going to... Won't harm them, but maybe not give them any real benefit. But everyone should keep in mind the key role that the gut microbiome does play in healthy metabolism and good general health.
Dr. Fialkow:
Healthy well-balanced diet, natural ingredients. Don't use antibiotics unnecessarily.
Dr. Rosen:
That's good.
Dr. Fialkow:
Sound so great. Well, great to our listeners. Here's a programming note for you. In the coming weeks we're going to be having episodes on testosterone, cardio metabolic disease, the use of smart technology to monitor and care for patients remotely. Be sure to subscribe now so you don't miss an episode. If you have a comment or a suggestion for future topics, please email us at baptisthealthtalkatbaptisthealth.net that's baptisthealthtalk@baptisthealth.net. We'd love to hear from you. Thanks for listening and stay safe.
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