LUNCH IS KILLING ME

Perspectives on Microbiome Challenges

Let’s table for the purposes of brevity, the morbidity and mortality that comes from a poor diet, unbalanced nutrition, and the overwhelming burden of excessive sugar and processed food. Now, let’s focus on elements that are not yet in mainstream thinking but should be – the deadly infectious diseases caught from your food.

When we think of how we acquire infectious disease more often than not we consider the source to be from contaminated water or person-to-person contact whether it be touch or aerosolized pathogens. However, your food is also a source for dangerous infections. This is not a trivial issue, they can create a huge health burden on society. The magnitude of the problem is now amplified dramatically given that many of these pathogens are resistant to antibiotics.

How common are food-based infectious disease?

The CDC in the USA notes that 48 million people are affected annually with a food-borne illness. The cause may be one of 31 known pathogens accounting for 9.4 million cases. It may also be unknown pathogens leading to a further 38.4 million cases CDC, Food Infectious Disease.  These infections result in 128,000 hospitalizations and 3,000 deaths. With antibiotic resistance becoming more common, this burden will expand.

These numbers are for food-based infections. If one was to expand the survey to include water-borne, environmental, animal contact and person-to-person transmission, then the rate for the same 31 known pathogens is 37.2 million illnesses and 2612 fatalities, and for unknown pathogens 141.8 million illnesses and 3,574 deaths.

Food is a common source of infections and accounts for essentially half of the total fatalities.

The Primary Pathogens

Norovirus accounts for 58% of illnesses, 26% of hospitalizations and 11% of the fatalities. The remainder are dominated by bacteria.

In terms of hospitalizations the top microbial pathogens are:

·      Salmonella                              35%

·      Campylobacter ssp.                15%

·      Toxoplasma gondii                  8%

·      E. coli O157                             4%

In terms of fatalities for microbial pathogens the list includes:

·      Salmonella                              28%

·      Toxoplasma gondii                  24%

·      Listeria monocytogenes          19%

·      Campylobacter ssp.                6%

Even with this concerning trend, this data is dated, coming from a report from 2011 Report on Food Borne Illnesses. The problem has not been resolved despite significant publicity and food recalls when outbreaks arise.

Since 2006 there have been numerous investigations for multistate outbreaks

·      24 outbreaks of Listeria

·      45 E. coli outbreaks

·      92 outbreaks of Salmonella

Resistance to antibiotics needed to clear these infections is becoming more and more common. Nearly, 35,000 deaths are attributable to antimicrobial resistance, and that number increases to 48,000 when one includes Clostridium difficile infections usually arising from within hospitals (Death from antimicrobial resistant infections ).

Examples of Food Sources of Infectious Illness.

Salads

From  2014 -2018 the CDC notes that there were 51 outbreaks related to leafy green vegetables (salads). Most recently, in 2019–2021, CDC warned the public about nine multistate outbreaks linked to leafy greens. Among those outbreaks, six were linked to packaged salads, one was linked to romaine lettuce, one was linked to baby spinach. In 2022 a voluntary recall of Iceberg lettuce was issues because of contamination with Listeria monocytogenes (Iceberg lettuce and Listeria ). In the first week of April 2023 there are numerous recalls of salads contaminated with Listeria across multiple brands and states. (Listeria in Recalled Salads ).

Flour

One of the more recent outbreaks of concern is flour. Ongoing investigations have identified contamination with Salmonella in 12 states Salmonella in flour. These infectious disease cases are largely associated with the consumption of raw flour from cookies and cakes.

Infant Formula

In 2022 there was a recall of powdered infant formula from Abbott Labs for contamination with Cronobacter that led to the deaths of 2 infants.

Additional Sources

There are many of food sources linked to infectious diseases, details of noted on the CDC website (Outbreaks of Food Based Illness ). Cases noted in the last 2.5 years display a wide variety of product including:

·      Strawberries                            Hepatitis A

·      Alpha Sprouts                         Salmonella

·      Raw oysters                             Norovirus

·      Enoki Mushrooms                   Listeria

·      Deli Meat & Cheese                Listeria

·      Fish                                          Salmonella

·      Frozen Falafel                          E. coli O121

·      Brie & Camembert cheese      Listeria

·      Ground Beef                           E. coli O157:H7

·      Ice cream                                Listeria

·      Peanut Butter                          Salmonella

·      Packaged Salads                      Salmonella and E. Coli O157:H7

·      Spinach                                   E. coli O157:H7

·      Salami Sticks                           Salmonella

·      Seafood                                   Salmonella

·      Onions                                     Salmonella

·      Italian-style meats                  Salmonella

·      Cake Mix                                 E.coli O121

·      Fully cooked chicken               Listeria

·      Frozen shrimp                         Salmonella

·      Cashew Brie                            Salmonella

·      Ground Turkey                        Salmonella

·      Queso fresco                           Listeria

Are Solutions on the Horizon?

While this list seems daunting, one must leap to the critical question of how are we going to manage this? Beyond strict rules in the harvesting, cleaning and preparation of food items, which already exist, what can be done. In this article I would like to focus on two therapies that are not part of the routine therapeutic regimen ….. but are likely to be.

Antibiotics

Firstly, we cannot rely on antibiotics. Microbes are becoming more resistant and they also possess the ability to pass resistance between bacterial species. The problem is profound. Further, most pharmacological companies have stopped investing in antibiotic research. In essence, it is not cost-effective for them, and they have turned to more profitable areas of drug development.

Vaccines

We need to thank science for aggressively innovating the mRNA vaccines for COVID-19, a tool that was theoretical until then. While there is profound hope for expanding this technology to other viruses and even eluding to their potential to manage chronic diseases like cardiovascular disease and cancer. However, less is clear for bacterial infections and so we will table that area of innovation.

Phages

Phages are technically viruses that specifically attack bacteria. Their full name is bacteriophages. Why are they attractive in our pursuit of therapies for infectious disease? There are several key reasons:

·      They are remarkably specific in their targets. They never attack the host (human) cells nor the friendly bacteria that exist in our microbiome. Rather they specifically target the dangerous bacteria in question.

·      Their safety record is enviable.

·      Phages help restore the microbiome to a state balance.

·      Cocktails of phages that target the major food-borne pathogens have been developed and are becoming commercially available. In other words, they can be incorporated into our treatment regimens now, and they can also be used in a preventative manner.

·      Phages are part of a healthy microbiome. They along with healthy bacteria and fungi, are critical to our health and wellness.

In contrast to antibiotics who are indiscriminate in their microbial lethality, killing bad and friendly bacteria alike, phages are super targeted in their actions. They are specific “hunter seekers” to the problematic pathogens e.g., Listeria, Salmonella, E. coli. They have no impact on the good bacteria and human cells. Think of them as the “Smart Bombs” of the microbial world.

Phages have also shown promise outside the food-borne illnesses. Phages have shown to be effective in managing chronic gut disease like inflammatory bowel disease (IBD). In this case the target is Klebsiella Inflammatory Bowel Disease & Phages. It is enticing to speculate that perhaps the origins of an imbalanced microbiome that drives IBD is in part driven by a paucity of phages that target pathogens. Further, could the inclusion of phages help maintain gut health for at risk people and that may include those that eat salads as an example of food borne illness.

In other words, we are on the cusp of including phages as part of our pro-healthy microbiome strategies as a preventative strategy, not simply a therapeutic intervention.

FMT: Fecal Microbiome Transplants

The world of gastroenterology was placed on its head with the development of FMT as a treatment for Clostridium difficile infections. This infection leads to a sustained diarrheal state that is now largely fully resistant to antibiotics. This transformation arose in hospitals, and that is the primary source of infection.

FMT can be considered a total microbiome makeover. Simply put it takes feces from a loved one / cohabitant and generates a stool slushy that is then inserted into the recipients’ intestinal tract by endoscopy. A total makeover. While it can take patients off death’s door and restore health in a matter of days it does require care, staff and procedures that can be expensive. This is despite the fact that the therapeutic agent is a “biological waste product”. Some have sought a kinder gentler approach with feces in a capsule, but for various obvious reasons the marketing of this approach has not been easy.

Intuitive Predictions

It is easy to say the problem will get worse before it gets better. The abuse of antibiotics continues to this day, laying the foundation for societal burdens. In looking for solutions, I see the most advanced and fiscally reasonable solution to be the inclusion of phages as offering the best approach. This prediction is based on its safety, targeted approach and efficacy. Companies like Gnosis by Le Saffre are an example of a pioneer that is preparing and delivering phages for commercial use. I can also see a market where phages are combined with other microbiome friendly approaches – yeasts, probiotics, prebiotics, synbiotics and postbiotics.

Using the tools that exist in nature makes sense when the goal is to restore our microbiome to a state of health and balance. Phages, yeasts and bacteria do form the triad of health in our microbiome, and can help us overcome challenges, whether it be your salad, your appetizers or your hamburger.