MICROBIOME WARS

A Personal Tale & Perspectives of the USA Healthcare System

The Opponents in my Microbial War

Recently I had the misfortune to experience a clash of approaches in managing the diversity, functionality and health of my microbiome. For the 4^th time I had a bout of diverticulitis. For those that are unaware diverticuli are small pouches that expand out from the large intestine, like balloons. When they become infected and inflamed, these pouches swell and can burst. That is when true trouble starts as peritonitis and sepsis are life-threatening consequences.

The usual therapeutic approach is to substantially restrict food intake and form, whilst battling the infection with antibiotics. Metronidazole being one of the main pharmaceutical options. Conceptually, this combined approach is aimed at not feeding the microbiome to limit its proliferation, and then killing off bacteria in the diverticuli to arrest the wall degradation.

Given that this was my 4^th time I knew of the approach and embraced it. The swelling of the diverticuli is remarkably painful, so hospital-based therapeutics are often accompanied with a concurrent date with Mistress Opium. We all know the dangers of a long-standing relationship with her, even though she is quite the seductress.

End result: despite battling this at home, I needed assistance so into the hospital I go. The battle now involved additional therapeutics, i.e., more antibiotics and even greater dietary restriction. Broth and jello were my sole nutrient sources as I was culinary choices were reduced to a rank below toddler status.

This scorched earth approach to my microbiome can resolve the disease state, preventing rupture and its terrible sequelae. However, there is a cost. Clearing out one’s entire gut microbiome, in an attempt to get to the diverticuli, leaves a lot of anatomical real estate to be populated by antibiotic-resistant vagrants and squatters.

Enter into the story, C. difficile. This infection is resistant to many antibiotics, is largely only acquired in hospitals and in individuals that have cleared out their microbiome abundance and diversity. C. difficile is life threatening. My second GI infection that could kill me in a single week. With that kind of luck I should buy a lottery ticket.

So how do we fight both diverticulitis and C. difficile at once? In the current healthcare system the answer is to raise the ante in antibiotic therapy to include vancomycin (or related antibiotics that are good at targeting the vagrant that was driving my status). The end result is that the cure incorporates a strategy that was also causal.  Essentially expanding the approach that got me into this mess in the first place.

Symptom wise, diverticulitis feels like the movie ALIEN, where the baby alien bursts out the victim. I do not recommend it. On the other hand C. diff is like food poisoning with profuse diarrhea that is only matched by those experiencing the preparative phase of a colonoscopy, but added in toxicity, fever and a racing heart. Plus, you get to relive it every single day in a grotesque version of Groundhog Day (continuing with the movie references).

Protecting the Realm, the Castle is being Stormed

Option 1

Whilst C. diff is very challenging to clear, there have been breakthroughs in recent years or decades. Approaches that are quite different from the scorched earth approach of multiple antibiotics. A conceptually different mindset acknowledging how C. diff got there in the first place and correcting it. These alternative approaches focus on restoring the microbiome and letting your microbial colleagues kick out C. diff. Clearing the squatters from the building and re-gentrification of the microbiome is the goal.

When I enquired about including these approaches into my therapeutic strategy, I was met with the comment – Oh we do not do that here, but I can offer more potent antibiotic that are even more expensive and may not be covered by insurance.

Therein lies the disconnect. We know that the therapeutics for first GI Disease created the optimal conditions for the second, and the approach to clear the second was to raise the stakes and continue in the same manner. Not encouraging.

Option 2

What are these alternative approaches to managing the microbiome for these conditions? One is to take advantage of the power of yeasts, who are important and under-appreciated elements of the microbiome. Being yeasts they are not targeted by antibiotics who target bacteria, thereby bringing a powerful array of benefits to the defense of the realm. Saccharomyces boulardii was my suggestion knowing that here has been a plethora of excellent research in managing the symptoms of antibiotic-associated diarrhea (Managing Antibiotic Induced Diarrhea). I recommended that we incorporate that into my therapeutic battle, specifically the version called LynsideÒ strain CNCM I-3799.

The next therapeutic option in my microbiome wars was a bacterial probiotic, Lactobacillus rhamnosus LGG, given the scientific support for its therapeutic utility in managing a dysbiosis. Yes, bacterial in nature, but with solid support (L rhamnosus GG and C. diff). This approach was similarly rejected not because of poor science but the templates and hospital machinery drives actions in specific directions that preclude this mindset.

The 3^rd option, one that has been pioneered as a for well over a decade, is a transplantation of the microbiome from a donor. Abbreviated as FMT, fecal microbiome transplantation has been a life saver in resistant cases of C. diff (Rethinking approaches to C. diff, the value of FMT). The “stool slushy” involves the delivery of a donor, healthy fecal sample, usually from a cohabitant, to reclaim the gastrointestinal landscape, forcing C. diff to evacuate the premises. This suggestion was also rejected along the lines of “we do not do that here”. Not because the science is not compelling but because it lay outside the thinking of the hospital. My therapeutic options were being limited not because of a lack of credible science, but a resistant attitude.

That left me with a serious condition and an inability to fight off the infection by multiple fronts – use vancomycin to help eliminate the presence of C. diff and to restore the microbiome to force it out through Microbial Wars. My choice, despite being seriously ill, was to check out of the hospital and recover at home.

In my convalescence I ramped up my weapons in this vital microbial battle, by taking L. rhamnosus LGG, S. boulardii, and a host of probiotics. I maintained oral vancomycin. On that front the hospital pharmacy wanted to charge me $748 for an 8 day supply, CVS offered it for cash only (no insurance coverage) at $73 and GoodRx delivery for $38. Therein is a tale of how prescription costs are unexplainable in the US health care system. I went for the immediate route with CVS, as I was still desperately ill.

In addition to this approach, I included a botanical from the Amazon Rainforest, Sangre de Grado or Sangre de Drago. I had done a massive amount of research on this traditional Amazonian medicine when I was still a Professor in the Medical School system. It is an intensely proanthocyanidin rich tree sap, remarkable in its ability to block oxidative stress, calms sensory afferent nerves (Suppressing Neurogenic Inflammation) involved in nausea, itch, pain (Nausea, Itch & Pain) as well as demonstrated actions to heal intestinal ulcerations in a manner that was superior to multiple antibiotics (Healing Gastric Ulcers). My research also demonstrated an action of this traditional medicine on suppressing matrix metalloproteinases (MMPs) (Inhibition of matrix Degradation) that are involved in collagen and matrix degradation which is fundamental process in bursting the intestinal wall in diverticulitis (and matrix degradation elsewhere).

Being at home, my spouse played a huge role in providing me a functional and restorative diet. One that was not simply focused on macronutrients in the form of what looked like regurgitated dog food in the hospital, but fresh ingredients and fruit in easy to digest soups.

Winning the War

The bottom line is that within 36 hours at home with this alternative approach to GI health I was free of diarrhea (down from 19 bouts a day). I remain diarrhea-free since then along with a greatly reduced feeling of toxicity. I am not naïve to think that the battle is over, there are always stragglers willing to reclaim the real estate, but restoring my microbiome is the purest way to sustained health. As I have noted on many occasions if you nurture your microbiome it will nurture you.

Whilst this is also an obvious very personal tale, it is also a reflection of how we have a long way to go in terms of microbiome management within the USA medical system. My therapeutic discussions within the hospital and out, were not discounted as heresy as the science was well known. However, the machine could not take advantage of them. It only knew how to operate in a singular, pharmaceutical-supported direction.

Therein lies the dilemma and the challenge. Maybe, hopefully, with more direct conversations, we can achieve better, holistic approaches to health.