Every day, something new claims it is the easy and permanent excess weight removal solution, cure for depression, or whatever else ails you. Of course, they never are. Lately, the news has turned its attention to the microbiome, i.e., the bacteria we live in or out of harmony with in our gut.

Quick biology refresher lesson: 9/10ths of the cells in our bodies are bacteria cells that live in symbiosis with our human cells.[1] This bacteria and particularly the gut bacteria, affects our appetite, mood, food choices and many other health concerns.[2-4] Dietary changes easily influence the various bacteria populations living in our guts.[5] This is an evolutionary biological fitness-enhancing trait. Humans are hunters and gatherers. Controlling food consumption was not as easy for the ancients as it is for us. They ate fish when they caught a fish and berries when they found them, not when they were in the mood for them. Different gut bacteria affect digestion differently and different foods required different digestive strategies; thus, the capacity to change gut bacteria populations quickly in response to diet was an asset.[6-9]

Aside from dietary changes, and taking prebiotic and probiotic supplements, one can change his or her microbiome with Fecal Microbiotal Transplant (FMT). It may be new to you and I, but it has been around for a long time. Since the 4th century, Traditional Chinese Mecicine physicians used “yellow soup”  (feces in water that patients drank) to treat diarrhea and food poisoning. I know, you could have lived your entire life without that mental image—me too. Today, Western Medicine administers fecal matter a bit less disturbingly, i.e. mixed with saline or another solution via enemas, colonoscopies, endoscopies, or sigmoidoscopies. They do this to replace good bacteria that has been killed by antibiotics, allowing bad bacteria, specifically Clostridium difficile, or “C-diff” to over-populate the colon.[10] However, FMT proponents claim that physicians can use fecal transplants to treat many illnesses from obesity to depression.[11]

“In contrast to the dramatic therapeutic benefits of fecal microbial transplantation on patients with C. difficile infections, there is virtually no data from high quality clinical trials to support the use of FMT in any other human disease," says Professor Emeran Mayer MD, PhD, gastroenterologist, neuroscientist, and Director of the UCLA Center for Neurobiology of Stress.

Mayer is correct. However, I suspect the necessary clinical trials needed to convince Mayer and other such leading scientists will come. Why do I suspect this? Cedar-Sinai (Los Angeles), one of the best hospitals in the world, is building a huge FMT center. I do not think this is because they anticipate a C-diff epidemic. The David Geffen School of Medicine at UCLA is building a billion dollar center for microbiome-related research. Last, but not least, the FDA has started regulating it. I suspect this is because repopulating the microbiome is going to conceivably become the new penicillin, possibly replacing psychotropic medicines, and used to treat a myriad of diseases, especially obesity.[11-13]   

For example, statistically significant positive results from the first double blind, randomized clinical trial of NM504, a microbiome modulator for diabetes significantly improved glucose control in Type-2 and pre-diabetic patients.[14] Even more encouraging are the weight loss studies in rats. Scientist discovered that transplanting fecal material from skinny mice to fat mice, and vice versa made the fat mice skinny, and the skinny mice fat.[15] This happens because the gut microbes must influence the individual’s food choices by affecting our taste and food cravings to promote their nutrient needs. Regrettably, their nutrient needs are not always compatible with our weight loss goals.[13

Likewise, Claudia Sanmiguel, MD, also at UCLA CNS, says, “Bariatric surgery has had the most significant results for sustained weight loss, however, only in the patients that undergo certain functional brain changes. We are conducting studies to see if these changes are related to changes in the microbiome.” The implications of this are tremendous. Identifying the mechanism or mechanisms would be “OMG… totally huge dude,” as my Godson says. If that mechanism exists, and scientists articulate it, we could conceivably achieve the results of successful bariatric surgeries by changing the microbiome, and thereby obviating the need for bariatric surgery. More importantly, the medical community could spare the risk and disappointment for the thousands of people who undergo bariatric surgery that do not experience successful weight loss. Should scientists achieve this goal, FMT may be a very viable clinical option. 

We already know, thanks to research from Mayer and his team, that the microbiome affects mood and anxiety. Thanks to a preponderance of meticulous research, we understand that mood and anxiety affect disordered eating.[16-24] The brain-gut connection is real, and Dr. Mayer and his colleagues have led the way in proving that scientifically. [2, 25, 26]"It's almost unthinkable that the gut is not playing a critical role in mind states," says Dr. Mayer. Thus, it is just a matter of time until legitimate scientists connect the dots. When that happens FMT may be extremely useful.[27-34] However, although, the future is bright, remember, it is just that—the future. We live in a world of desperate people, who become charlatans and quacks. They prey on other desperate people, such as those of us fighting morbid obesity, spiritual, emotional or psychological illnesses. Thus, the latter must be cautious consumers of the research and the clinical wisdom or lack thereof. Most of all, we must always… remain fabulous and phenomenal.  

Sidebar:  Recently Psychology Today was named the Top Website for Psychology and I was named one of the “30 Most Influential Neuroscientists Alive.”  Thank you very much. I am truly honored, and very grateful to be included on that list with such great scientists.    

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1.         Rhee, S.H., C. Pothoulakis, and E.A. Mayer, Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol, 2009. 6(5): p. 306-14.

2.         Tillisch, K., The effects of gut microbiota on CNS function in humans. Gut Microbes, 2014. 5(3): p. 404-410.

3.         Moloney, R.D., et al., The microbiome: stress, health and disease. Mamm Genome, 2014. 25(1-2): p. 49-74.

4.         Forsythe, P., et al., Mood and gut feelings. Brain Behav Immun, 2010. 24(1): p. 9-16.

5.         Rothe, M. and M. Blaut, Evolution of the gut microbiota and the influence of diet. Benef Microbes, 2013. 4(1): p. 31-7.

6.         Wang, Y. and L.H. Kasper, The role of microbiome in central nervous system disorders. Brain Behav Immun, 2014. 38: p. 1-12.

7.         Turroni, F., et al., Human gut microbiota and bifidobacteria: from composition to functionality. Antonie Van Leeuwenhoek, 2008. 94(1): p. 35-50.

8.         Turroni, F., et al., Genome analysis of Bifidobacterium bifidum PRL2010 reveals metabolic pathways for host-derived glycan foraging. Proc Natl Acad Sci U S A, 2010. 107(45): p. 19514-9.

9.         Diaz Heijtz, R., et al., Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci U S A, 2011. 108(7): p. 3047-52.

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11.       Tilg, H. and A. Kaser, Gut microbiome, obesity, and metabolic dysfunction. J Clin Invest, 2011. 121(6): p. 2126-32.

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13.       Alcock, J., C.C. Maley, and C.A. Aktipis, Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays, 2014.

14.       Therapeutics™, M. Microbiome Therapeutics Reports Positive Top-Line Results from Clinical Trial of Microbiome Modulator NM504 in Type-2 Diabetes. 2014; Available from: http://thefecaltransplantfoundation.org/microbiome-therapeutics-reports-positive-top-line-results-clinical-trial-microbiome-modulator-nm504-type-2-diabetes/.

15.       Ji, Y., et al., Diet-induced alterations in gut microflora contribute to lethal pulmonary damage in TLR2/TLR4-deficient mice. Cell Rep, 2014. 8(1): p. 137-49.

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19.       Tobin, D.L., A.L. Molteni, and M.R. Elin, Early trauma, dissociation, and late onset in the eating disorders. Int J Eat Disord, 1995. 17(3): p. 305-8.

20.       Stunkard, A.J. and K.C. Allison, Two forms of disordered eating in obesity: binge eating and night eating. Int J Obes Relat Metab Disord, 2003. 27(1): p. 1-12.

21.       Schlundt, D.G., et al., A sequential behavioral analysis of craving sweets in obese women. Addict Behav, 1993. 18(1): p. 67-80.

22.       Perugi, G., et al., Bulimia nervosa in atypical depression: the mediating role of cyclothymic temperament. J Affect Disord, 2006. 92(1): p. 91-7.

23.       Parylak, S.L., G.F. Koob, and E.P. Zorrilla, The dark side of food addiction. Physiol Behav, 2011. 104(1): p. 149-56.

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25.       Tillisch, K., et al., Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology, 2013. 144(7): p. 1394-401, 1401 e1-4.

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27.       Zhang, F.M., et al., Fecal microbiota transplantation for severe enterocolonic fistulizing Crohn's disease. World J Gastroenterol, 2013. 19(41): p. 7213-6.

28.       Zainah, H. and A. Silverman, Fecal Bacteriotherapy: A Case Report in an Immunosuppressed Patient with Ulcerative Colitis and Recurrent Clostridium difficile Infection. Case Rep Infect Dis, 2012. 2012: p. 810943.

29.       Xie, Y., et al., Structural shifts of fecal microbial communities in rats with acute rejection after liver transplantation. Microb Ecol, 2012. 64(2): p. 546-54.

30.       Wu, Z.W., et al., Assessment of the fecal lactobacilli population in patients with hepatitis B virus-related decompensated cirrhosis and hepatitis B cirrhosis treated with liver transplant. Microb Ecol, 2012. 63(4): p. 929-37.

31.       Wu, G.D., Diet, the gut microbiome and the metabolome in IBD. Nestle Nutr Inst Workshop Ser, 2014. 79: p. 73-82.

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