If I told you there's a new kind of medicine that could heal you, but it was made from germs, would you take it?
If you’re open to the idea – or maybe because it sounds gross – then hang with me and let’s start here. We see germs as a threat, and we've gotten really good at killing the ones that cause infections with things like hand sanitizers and antibiotics.
In fact, since 1950 the rate of infectious diseases, like measles, mumps and TB has plummeted. But during that same time, chronic diseases, including asthma, diabetes and Crohn’s disease have skyrocketed.
Is there a connection? Could it be, we're so obsessed with killing germs that we're making ourselves sick with other illnesses?
HOW BAD ARE GERMS, ANYWAY?
To find out what's going on, I went to Boston and the campus the Massachusetts Institute of Technology. That's where Dr. Eric Alm and his team work. They explore the relationship between us and germs.
“Are germs bad? People think they're bad. We try to get rid of them. Are they?” I ask Alm.
“It's a good question. My knee-jerk response is, of course, they're not bad. All of our bodies are completely filled with bacteria,” Alm says. “We don't usually call them germs,” he adds.
“Why would you not call them germs?” I ask.
“I think it has a connotation that you're talking about an infectious disease. Something that needs to be sterilized. Something that needs to killed. Something that you don't want to spread from person-to-person and the way to stay healthy is to avoid those things,” Alm answers.
Alm says your bacteria make up something called the microbiome. It's like a lush forest with a huge diversity of plants and trees.In that forest, there are a tiny number of bad bacteria, like weeds on the forest floor. They can cause disease. But in a healthy forest, they're held in check. There's no room for them to spread around.
“How do you think about bacteria?” I ask Alm.
“Bacteria are pretty exciting. They kind of make the world go round and in some pretty important ways,” he answers.
JACKING WITH OUR GERMS
Okay, so Alm’s saying most bacteria are good. But there's a growing body of research that shows our modern obsession with killing germs, can wipe out lots of innocent bacteria in the microbiome. That opens up space, giving bad bacteria the room to multiply and make you sick.
What’s jacking with our microbiome?
- Let's look at some of evidence, starting with hand sanitizer. A journal called BMC Pharmacology & Toxicology has a look at some emerging science focusing on mice. It found the key ingredient in hand sanitizer may cause changes to the balance of the microbiome.
- Three major science journals looked at very young kids and allergies. Taken together, The Lancet, The New England Journal of Medicine, Journal of American Medicine generally found kids without frequent exposure to farm animals or dogs had higher levels of allergies and asthma.
- And finally, there's the big one: antibiotics. Here's a major study from the Proceedings of the National Academy of Sciences. It found frequent antibiotics, given to small children, led to "a loss of diversity" in the microbiome and left it "altered from its initial state."
Dr. Rob Knight, at the University of California San Diego, is another leading voice on the connection between human health and the microbiome.
“People have their physiology and, in some cases, even their mood altered for years after an intensive course of antibiotics,” Knight said.
Dr. Alm says a lot of the research focuses on kids because, it’s believed, early childhood is when the microbiome develops.
“We may not be as exposed to bacterium as we used to be due to modern hygiene practices, which are good of course, we want the hygiene. But it might mean that we're not getting the right exposure to properly train our immune system,” Alm said.
RESTORING BALANCE TO THE GERM FORCE
This is where the story gets a little weird. Remember, I asked if you would take a lifesaving medicine if it were made from germs. Well, there’s no other way to say this, I’m talking about medicine made from the germs in poop.
I'm at a place called OpenBiome, in Cambridge, which spun out of Dr. Alm’s lab. And for demonstration, I've volunteered my own poop sample to see how they turn it from waste into medicine.
Yeah, the germs in poop can be a drug.
“Yes, it meets the technical specification of a drug,” said James Burgess, a Co-Founder of OpenBiome. “It’s a little bit of an unusual drug. You should think about that the next time you're going to the bathroom. That you're in the drug manufacturing business,” he said.
I’ve been invited to tour their production facility. It's super-sterile here, so I gown-up in several layers of protection.
“Basically, it's the perfect poop. Can't get much better than that,” says Biomanufacturing Manager, Delasie Dela-Seshie as we examine my sample.
First, it’s placed in a bag. Then, to preserve it, they add a saline and glycol solution. After that, it’s manipulated by a machine that helps filtered it into a liquid form. And finally, it's stored in a deep freeze until needed.
“The first time you see it, you get a little bit skittish but after the second time you really understand the reason that you're doing it,” Dela-Seshie says.
“You're making medicine out of it,” I say.
“You're making medicine. It's not weird anymore,” he adds.
The concept behind the poop transplant is very basic. A donor, who’s been through a rigorous screening process, provides a stool sample that’s loaded with his or her naturally healthy bacteria. It's then implanted into the patient who has a bacterial disease.
Currently, the process is only used to treat an ailment called C. difficile, a deadly gastro-intestinal infection where antibiotics don't always work. But when it comes to the fecal transplant, these studies show about 85% of the time it's a cure.
What’s happening now, is researchers are trying to isolate the individual bacteria that make the procedure work.
“Can we narrow it down to the specific bacteria that might have the therapeutic effects?” Burgess asks, rhetorically.
“Get away from poop and actually make a medicine that comes in a bottle?” I ask.
“Yeah, that's what we’re really excited about. In the meantime, there’s always poop,” he says.
So, are we so obsessed with being clean that we're making ourselves sick?
The science says yes. And here’s what we learned:
- Germs and bacteria are misunderstood.
- Some bacteria are bad, but most help us maintain a healthy balance in the microbiome.
- In our quest to kill germs, we have traded infectious diseases for chronic ones that are very hard to treat. And that’s why we’re turning to therapies like the fecal transplant.
Said another way, Dr. Knight says we need to make a shift away from thinking germs make us sick and they must be destroyed.
“Instead we want to think of ourselves much more like an ecosystem that we are managing and a large part of that is caring for and nurturing the beneficial microbes, so we can't just be colonized by the harmful ones,” he added.
In the meantime, both doctors Alm and Knight suggest very young children should be encouraged to play in the dirt and play with a family dog. Knight also suggests eating a wide variety of vegetables may play a role in developing a strong microbiome.
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American Gut Project: This is a crowd-sourced science project, run by Dr. Richard Knight. In exchange for a donation, this group will analyze a swab of your skin or even your poop and then send you a report on the bacteria you carry. So far, American Gut has collected 12,000 samples. They use the data to make connections between our bacteria and chronic illness.
Bristol Stool Chart: Doctors and researchers use 7 classifications to describe the quality of a person’s bowel movements. It may be helpful for you, in that it helps define what healthy poop should like.
Dirt Is Good: This book, by Dr. Knight and another leading researchers on the microbiome, is about the advantages of germs for your child’s developing immune system.
Missing Microbes: Dr. Martin Blaser explores how the overuse of antibiotics has led to an increase in chronic illnesses.
I Contain Multitudes: Science writer, Ed Yong, takes you on a journey to understand the role of bacteria in human life.