The professor of surgery explains how health emerges from a healthy microbiome.
When I ask Jack Gilbert about the future of medicine, he tells me what he recommends to his graduate students before they head into surgery, “When you go to cut someone open, you don’t just have one patient on the gurney. You have 40 trillion patients, and you have to think of how your actions are going to affect them.”
Those trillions of patients are microorganisms, communities of bacteria, viruses, fungi, and in some unhappy cases — pathogens. But they’re not all free riders. A growing body of research is making the case that the microscopic creatures in our gut, ears, mouth, and on our skin — together called our microbiome — play an essential role in our wellbeing. And Gilbert, faculty director of the Microbiome Center at the University of Chicago, and his team are at the cutting edge of this research.
Gilbert chatted with Nautilus from Chicago about the microbiome revolution, what a future trip to your doctor might look like, how our microbiome can make us fat (or thin), and the advice he presents to parents in his new book Dirt is Good.
What will a visit to the doctor be like in 10 years?
Imagine you have a routine mammogram and there’s a lump. They will refer you to an oncologist who will sequence the genome of your cancer and your microbiome. You’ll plug this information into our machine learning algorithms, and determine the most appropriate personalized strategy for you to respond to therapy. Maybe the doctor will find that you’re missing certain microbes, which would make a given therapy most effective. So we also give you a biological probiotic to enhance the activity of your therapeutic.
Also, we’ll continue to use the microbiome and develop therapeutic advances, which help to monitor our health in a continuous manner. I have interest in developing sensors that will be attached to toilets that allow us to continually monitor peoples microbiotin in their stool and use it as an early warning system for potential diseases. Or oral swabs or smart toothbrushes, which sense the microbial community in your mouth while you’re brushing your teeth.
We’ll enter into a phase when we know months in advance if someone is developing a complication. And then we will have the ability to tweak elements of their life and microbiome in order to treat them before it ever becomes a problem.
Which illnesses are correlated with our microbiome?
Everything from pet allergies to C. difficile colitis to anorexia. There’s polycystic ovary syndrome, sickle cell disease, renal disease, chronic pulmonary fibrosis. All of these are associated in some way with a dysregulation in the microbiota. Genetics still plays a role — it sets the stage upon which the microbial and immune system actors play. But there is always an associated link.
How is asthma linked to the microbiome?
We did work published last year in the New England Journal of Medicine, which demonstrated that the exposure children get on the farm is highly impactful to their health. We looked at the Amish and the Hutterites, two religious groups in the United States who came originally from agrarian societies in Eastern Europe. But today the Amish live on personal family farms where the kids are getting involved in the farming environment from birth, whereas the Hutterites live on communal farming environments where they actually embrace technology in quite a substantial way. For health and safety regulations, this means that the children aren’t allowed on the farm. So, the children on the Amish farm are exposed to all the animals, and the dirt. The children on the Hutterite farm are not.