Field Notes: Further Reading
There are already more than a dozen
consumer-focused books on the
microbiome. Here are two noteworthy books (acknowledging that there
are likely other good ones), and we
shall carefully avoid a discussion of
the, let’s just say, less-scientifically
salient options on the store shelves,
of which there are a few doozies.
Gut: The Inside Story of Our
Body’s Most Underrated Organ is
a fun read and does an admirable
job of explaining the many intricacies of our digestive systems in an
entertaining way. The author, Guilia
Enders, is a student in the PhD program in gastroenterology at Goethe
University in Frankfurt, Germany.
In 2012, she won the first prize at
the Science Slam in Berlin with her
talk “Darm mit Charme” or “Charming Bowels.” The talk went viral on
YouTube and Gut has sold well, both
in its native German and in English.
The writing in Gut is witty and
charming, even in translation, and
the jokes are tastefully scatological, which is not an easy feat. She
writes phrases like, “But back to our
kinky rectal closure mechanism…”
and proceeds to explain how leaning forward on the toilet allows for
more efficient evacuation. Even
the illustrations, done by her sister
Jill Enders, serve to lightheartedly
explain the structure and function of
our guts and how we might better
care for them.
The Good Gut is written by husband-wife team, Justin L. Sonnenburg, PhD, and Erica Sonnenburg,
PhD. Their Stanford microbiology
laboratory (led by Justin) is focused
on studying the intestinal microbiome and the effects of perturbations
in the intestinal environment. The
Sonnenburgs didn’t take lightly their
decision to write a book about microbiome research for consumers. The
science is still young. But they felt
there was enough there to warrant
raising public awareness since people hold so much power over their
microbiome in their personal choices
and since the potential numbers of
those suffering from microbiomerelated illness are astronomical.
Yet, the authors take pains to
not only explain what’s known about
the microbiome but also what is
not known. For example, The Good
ACC.org/CSWN
Gut is one of the few books on the
reading list for this subject that
made it clear that probiotics do not
repopulate the gut. Rather, the Sonnenburgs acknowledge probiotics
as only “transient members of our
microbiota.” During their temporary
stay, these bacteria appear to offer
support to resident gut bacteria but
“there is little consensus within the
medical community regarding who
can really benefit from probiotics.”
Both books clearly present
currently available research on the
makeup and development of the
human microbiome and its connection to an array of diseases and
conditions, as well as its contributions to immunity and inflammation.
The Good Gut, as would be expected
from a pair of microbiologists, is well
referenced. The information contained in both books is similar and
more or less matched the information from the scientific literature and
experts consulted for these articles.
At the end of the day, the authors
make similar recommendations and
conclusions: eat much more fiber
than you are now because it nourishes your resident bacteria, avoid
unnecessary antibiotic use, and stop
trying to make your private lives
as antiseptic as a surgical theater
because you’re probably killing more
good bacteria than bad.
One thing we learn from these
books: life with gut writers might not
always be so pleasant or private. The
Sonnenburgs have a young daughter
who has experienced more than her
fair share of gastrointestinal issues,
all of which are unsparingly shared
with readers. For her part, Ms.
Enders, who is single and without
children, appears to have some
pretty tolerant roommates, who don’t
seem to mind her singular obsession
with all things gut and fecal.
“My flatmates have learned to
recognize the familiar look on my
face when I rush into the kitchen,
bursting to tell them my latest gut
anecdote, like the one about the tiny
squat toilets and luminous poop,”
she writes. Indeed, both anecdotes
were fascinating.
From the scientific literature,
Judith Aron-Wisnewsky, MD, PhD,
and Karine Clement, MD, PhD,
from the Institute of Cardiometabo-
lism and Nutrition or ICAN in Paris
recently published a very comprehensive review on the microbiome as
it relates specifically to cardiometabolic disease. The review appeared
in Nature Reviews Nephrology in
March 2016 and clearly summarizes
the available data suggesting the
possible connections between the
gut and gut-derived metabolites,
dietary contributions, and metabolic
alterations and chronic cardiometabolic disease.1 ICAN also has
an annual conference on the topic in
December in Paris, with 2016 marking its fourth year.
Additionally, in July 2016, Dr.
Justin Sonnenburg published, in partnership with Fredrik Bäckhed, PhD,
an excellent review in Nature entitled
“Diet-microbiota interactions as moderators of human metabolism.”2
REFERENCES
1. Aron-Wisnewsky J, Clément K. Nat Rev
Nephrol. 2016;12:169-81.
2. Sonnenburg JL, Bäckhed F. Nature. 2016;
535:56-64.
feeding frenzy. But is the science advanced enough
to establish clinical guidelines, or even suggestions?
CSWN asked Drs. Hazen, Sonnenburg, and Libby
what clinical recommendations they feel can be
made based on the evidence we have today:
The Mediterranean diet is “the way to go,”
said Dr. Hazen, citing the PREDIMED trial.18
PREDIMED showed a 30% reduction in adverse
cardiovascular events with a Mediterranean dietary
pattern supplemented with extra virgin olive oil or
nuts compared to a low-fat, low-cholesterol diet. He
added that most people should probably not be taking probiotics for cardiovascular disease prevention
purposes.
“I would argue that we are way far away from
being able to say ‘Okay let’s absorb this set of microbes and it’s going to be healthy for your heart,’”
said Dr. Hazen. “The microbial community is so
complicated—I give the analogy of taking a probiotic and assumi