Probiosis

Bacteria, by and large, have received a bum rap (pardon the pun). Ever since they were discovered, there was a sense they were up to no good. Why were they always hanging around sick people, it was asked? And why did foul smelling things –the miasma (you gotta love these words)- always have bacteria skulking about in the background? There must have been some reason why -since the beginning of time, we have instinctively avoided rotting meat or putrescent items… Could it be the bacteria?

Of course, this eventually caused people –okay, Scientists– to wonder why our intestines are full of these malevolent creatures –and therefore why we weren’t all dead, or at least always ill on their account. The further paradox was when it became murkily clear that if this same intestinal effluvium were mixed with drinking water, we would be –very ill, that is.

So, how can you have your cake and eat it, too? Could it be that there was some sort of balance of good guys and bad guys in our guts that kind of neutralized each other in there? And maybe the balance wasn’t the same in the water near the sewage pipe?

And for that matter, because there were so many of them inside us, maybe it was for a reason? Even thinking like that seemed anathema to doctors –and companies- who had made their fortunes out of fighting them. And then, slowly, as the moon slipped quietly behind some clouds on the horizon, came the dawn. The paradigm shifted and it became acceptable to speculate that at least some bacteria might be on our side in Tennyson’s ‘Nature, red in tooth and claw’. Helpful bacteria living in secret bowel-caves, like traitors imbedded behind the enemy lines, were diligently hunted. And myriad uses were ascribed to their families. I even wrote about this a couple of years ago:

https://musingsonwomenshealth.wordpress.com/2014/05/15/the-human-microbiome/

So it was only a matter of time until those who had hitherto persecuted all microbes, were persuaded to alliances -marriages of mutual convenience. Helpers of helpers were proffered: probiotics.

Probiotic –even the word has come to inspire hope. And its etymology: pro –on behalf of- and bios –life, nails it, don’t you think? I’ve touched on the subject before in my essays, as well:

https://musingsonwomenshealth.wordpress.com/2015/09/27/miasmatics/

But I’m not trying to reinvent the wheel here, nor seduce you into re-reading my old essays. I am, however, still interested in the subject and was therefore somewhat disappointed in an article in the BBC News that seemed, at first, to denigrate the concept of probiosis: https://www.theguardian.com/science/2016/may/10/probiotic-goods-a-waste-of-money-for-healthy-adults-research-suggests There is a link in the article to the original meta-analysis paper in Genome Medicine.

I suppose it captured my attention the way any attack on my Confirmation Bias might: once I have been converted to a point of view, I take umbrage at any attempts to desecrate it… No, actually, that’s not true –I pay attention to the detail of the contention and see whether it could be refuted -what Carl Popper believed must be an essential component of all good Science.

This paper –a review of seven randomized, controlled trials (admittedly small numbers in each) of probiotics in healthy adults- concluded that there was ‘a lack of evidence for an impact of probiotics on fecal microbiota composition in healthy adults’. Fair enough, but contrary to the headline that might have attracted people to the article (Probiotic Goods a ‘waste of money’ for healthy adults, research suggests), buried near the end of the piece is the admission that ‘the real impact of the probiotics may have been masked by small sample sizes and the use of different strains of bacteria and variations in participants’ diets, among other factors’.

And the author of the Danish study, Oluf Pedersen, admitted: ‘“To explore the potential of probiotics to contribute to disease prevention in healthy people there is a major need for much larger, carefully designed and carefully conducted clinical trials.

“These should include ideal composition and dosage of known and newly developed probiotics combined with specified dietary advice, optimal trial duration and relevant monitoring of host health status.”’

So I think the final word on probiotics is still to come. It would make sense that one might not notice much of a change in fecal microbiota composition in those who are healthy and presumably already in possession of what Goldilocks described as ‘Just right baby bear’ stuff. But whether it could be further improved is the point at issue. There seems to be some evidence that it can be improved in those who need improvement –but at this stage, even that claim is contentious.

But it’s early yet, and as Robert Frost observed when he stopped by woods on a snowy evening: The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep… And so do we.

 

 

 

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The Colour of my Baby

What a great idea: a bandage that tells you when what it is hiding, is itself hiding something –an infection.  http://www.bbc.com/news/health-34808273

I suppose it was an idea looking for a platform. When bacteria are growing, they often invent ways to keep doing just that. Sometimes they overwhelm by sheer numbers to defeat the body’s defences, at other times it’s toxins that break down tissues and help them invade. The body, for it’s part, has its own bag of tricks. In the end, infections are often simply a kind of parry and thrust contest –a fencing match, if you will.

Most bodies are not unduly challenged by wounds, however –keep them clean and cover them with some sort of dressing, and they heal. Antibiotics are seldom required. The problem, of course, is that sometimes the foes are not evenly matched. People on immune suppressants (transplant patients), or those with already compromised immune systems –whether from disease or immaturity (babies, for example)- may not be able to mount a suitable response to bacteria in a wound and are at risk of severe infections. These are the ones in whom a timely and appropriate antibiotic would be prudent.

Sometimes, though, antibiotics are used like soap: if it looks dirty, or if it might turn out to be dirty, why not use an antibiotic? Just in case. Well, the simple answer is that the body is usually pretty good at dealing with bacteria. After all, we are all exposed to bacteria from day zero. It starts with the journey down the obviously non-sterile birth canal, and progresses to crawling along things, tasting things… none of which could be said to be free of bacteria of some sort or other. Bacteria are what we do, where we live… Bacteria live in our mouths, in our bowels, on our skin. There are more bacteria in our intestines than cells in our bodies; we simply cannot get rid of them all.

Nor should we. I’ve written before about the benefit of these usually commensal creatures and the benefits they provide both for continuing health and development: https://musingsonwomenshealth.wordpress.com/2014/05/15/the-human-microbiome/

But let’s not be naïve about bacteria –they don’t give a fig about us -they are amoral. A bacterium prefers to live with others –family. They grow and prosper with no regard for boundaries or house rules. Without suitable checks and balances they would take over. Like pouring water in a cup -too much and it merely overflows the constraints and moves on. That’s an infection. That’s when the body may need some help.

The trick is obviously intervening when it is necessary, but monitoring when it is not. Why? Well, treating every wound, say, with an antibiotic might get rid of the truly sensitive bacteria, but leave behind those that don’t respond quite as easily or quickly. The result of the treatment may therefore be to select for those bacteria that don’t mind the antibiotic –the resistant organisms. That’s how it happens.

So in those people who may not be able to deal with bacteria efficiently, it would be helpful to know when –or if– to intervene. That’s where the bandage that changes colour when bacteria in wounds begin to proliferate and infect would be helpful. There are other ways, of course: the old Latin aphorism I was taught in medical school, for example: Tumor, Dolor, Rubor, Calor – Swelling, Pain, Redness (inflammation), Warmth (infection). But sometimes it’s nice to have another tool in the kit that may detect a problem earlier -before these signs are present. Or, in the case of a body incapable of even producing the signs- when an infection would be catastrophic.

Clearly a lot of work needs to be done to detect the mischief of different types of bacteria –they don’t all produce toxins, and even if they did, there would likely be differences in their structures that would have to be accounted for in the detection mechanism. But this may be the bandage of the future –a Facebook band aid that is constantly posting. Almost like refrigerators that tell you what you need, or coffee pots that turn on when they hear the toilet flush in the morning. A brave new world.

It is ‘a hit’, as Osric, a courtier, says of Hamlet’s thrust as he is dueling with Laertes, ‘a very palpable hit.’ Let us hope so.