Gut intelligence is the next step in personalized medicine that could help prevent certain illnesses.



Everything about the human body in terms of how we function, how we age, what chronic diseases we get, what chronic diseases we don’t get, all relate back to the composition and activity of the microbiome. There’s no other single thing in our universe that has that profound [an] effect on everything about our lives,” says Dr Stephen Barrie. The vice president of Viome, the gut intelligence home testing company, he has been researching the human microbiome for the past 30 years.



Understanding the microbiome – the entire collection of microbes living inside and on the body – is the next step in personalized medicine and it’s far more than ‘you are what you eat’ (although analysing your gut will tell you that too). Gut health has a complex and profound effect on human physiology, impacting aspects like brain health, hypertension, diabetes, obesity and autoimmune disease.



“Our human gut contains a large number of microorganisms that perform a variety of metabolic functions in our gut. Scientists are realizing that the metabolites produced by these microorganisms have a profound effect on our physiology – in other words, how the body works – and this has direct links to disease and health,” explains Dr Yvonne Holt, Next Bioscience’s chief medical officer. Next Biosciences, an African biotech company that conducts stem cell banking, carrier screening, and more, is the first to offer microbiome analysis locally.



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“So what scientists have surmised is that if we can manipulate our microbiome, we can hopefully treat certain diseases, improve our health and prevent certain illnesses from happening. For long-term health, it’s very important to manage the microbiome and revive it to its healthiest level.”



According to Holt, if the gut microbiome isn’t working – something called dysbiosis – it can cause numerous diseases and disorders. Inflammatory diseases, cancer, metabolic disease, liver disease and even neurological diseases can link to gut imbalance within the microbiome.



There is also direct interaction between the nervous system and the gut. This ‘gut-brain axes’ have been shown to modulate the development of neurodegenerative diseases such as Alzheimer’s, Autism Spectrum Disorder and Parkinson’s disease.



“When talking about Parkinson’s or Alzheimer’s, we now know that starts from what chemicals the microbiome is producing and which ones cross the blood-brain barrier,” says Barrie.



“We even know that the microbiome affects the effectiveness of a drug. Drug companies are working on how to modulate the microbiome so [drugs] are more effective and have fewer side effects. These are all incredible new arenas that are now emerging and will be a big part of our healthcare [the] next several years.”



Getting to better understand the microbiome is about understanding the role microorganisms play within the gut and how that in turn influences our health.



“The gut has truly emerged as a much more complex organ than once thought,” explains Lila Bruk, a registered dietician and nutritional consultant in Johannesburg. “There is definitely much more awareness of the microbiome. This has been building over the last few years with more awareness of the risks of antibiotic use, as well as the face of probiotics changing from something that is only used after antibiotics, to a supplement that has benefits in its own right. We now know that both autoimmune disease and allergies can be affected by gut health.”



The link between the microbiome and autoimmune disease, in particular, means that if we can manage our microbiome, then we can potentially manage the diseases that fall under it. While certain bacteria can be beneficial for most, in others, the same bacteria can trigger an autoimmune disease.



“People say ‘look after your gut’, but what does that mean? There are millions and millions of microorganisms and different groups and species. We have to define it better. We have to say ‘to prevent autoimmune disease, we need a higher quantity of this kind of microorganism and less of that kind of microorganism’,” says Holt.



Bruk brings up a 2015 study that found the microbiome of individuals with allergies differed from those that didn’t. “Generally, they had less diversity in their microbiome and this was especially the case for people with nut or seasonal allergies,” she explains, adding that by focusing on improving gut health, there has been improvement found in other relevant areas such as inflammation. Analysing the microbiome could finally give dietitians the results they need to assist patients and tweak their microbiotic balance to enhance their health.



“Scientists are working on it all the time. And the more tests people take, the more information we can get from it, and truly understand the human microbiome and how it affects disease,” adds Holt.



Understanding one’s microbiome takes personalized healthcare to the next level but according to Dr Dean Lutrin, a Johannesburg-based surgical gastroenterologist, while the microbiome is an interesting concept, it is unclear whether it is a fad or whether it is something truly meaningful.



“My opinion is that understanding the gut microbiome will have a meaningful role at some point. Patients with irritable bowel syndrome can be given appropriate dietary advice. We also believe that the microbiome might have a causative role in colorectal cancer, obesity, diabetes. Does changing the microbiome augment that risk? We don’t know – but it is worth taking seriously,” says Lutrin.



“I do think that less gastrointestinal surgery could be performed by deliberate strategies to augment the microbiome.”



Ultimately, people want to take control of their health and the introduction of gut-testing offers new and interesting insights into personalized healthcare that isn’t a one-size-fits-all approach.



“I think that this form of testing can prove valuable and can provide one with insights that we would otherwise not know. I believe that with time, there will be an increased focus on this sort of microbiome-testing due to the type of information it provides,” ends Bruk.&nbsp;



Understanding how genes work to identify disease causes



Recent Harvard Medical School research estimates that there are more genes in the human microbiome than stars in the universe – the total number of genes in the collective human microbiome is around 232 million. Viome is about understanding how these genes work.



Founded by Naveen Jain and Deepak Savadatti in California, Viome is different to other gut tests on the market because it is a meta-transcriptome sequencing test, which means it can identify all microorganisms living in the gut – bacteria and viruses to fungi, yeast, parasites and bacteriophages – as well as their function.



“Viome is not only about identifying the genes of the bacteria, the names, it also identifies its level of activity. Other tests only provide the DNA profile of the bacteria – this goes one step further in identifying the bacteria and this is what it&#8217;s currently doing,” explains Holt.



With this data, through an app, Viome recommends personalized foods and supplements to optimize microbial function.



“Gene expression is what drives Viome and allows us to understand the molecular behavior and what&#8217;s being produced by those trillions and trillions of microbiome bacteria… it enables us to identify the cause of a disease, and allows us to make health benefits and wellness benefits recommendations. You have to understand not only who&#8217;s there, and more importantly, what they&#8217;re doing,” says Barrie.



– By Tiana Cline

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How Trusting Your Gut Could Help You

Zola Brunner, the founder of BeyondLupus, says lupus patients have been directly affected by Covid-19 because there is a shortage of the drugs they require.



In April 2018, South African media entrepreneur Zola Brunner was only a month away from celebrating her 25th birthday when she received a life-changing phone call. Around noon, her rheumatologist informed her that her test results had returned positive for lupus. The nightmare she had dreaded all along, quickly turned into an earth-shattering reality.



“I was perplexed because it was not a straight diagnosis, I was told my symptoms also resembled that of lymphoma, a cancer of the lymphatic system,” she says.



Lupus is a chronic autoimmune disease causing inflammation and pain in any part of the body. The body’s immune system, which usually fights infections, attacks healthy tissue instead. Commonly affected are the joints, skin and internal organs such as the kidneys and heart.



While anyone can develop the disease, certain people are at a higher risk. This includes women between the ages of 15 to 44, as well as people from certain racial groups and ethnic backgrounds.



“A month later [after the diagnosis], I was sitting in hospital, and had no job,” Brunner says. All the trips to hospital meant she had to resign from a job she loved, as the producer of eNCA’s BackChat, a youth current affairs TV show.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="1024" height="693" src="https://www.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-1024x693.jpg" alt="" class="wp-image-46042" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-1024x693.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-300x203.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-600x406.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-768x520.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671.jpg 1116w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /><figcaption>Zola Brunner working from her hospital room. Photo supplied.</figcaption></figure>



She then made a decision to turn her pain into purpose.



In July that year, she started BeyondLupus, an advocacy page that has attracted a following of over 5,000 people around the world.



“I started it for two reasons. Firstly, I did not know anyone personally that had lupus and I wanted to relate to others. And secondly, I am a story-teller at heart and wanted to use this platform to give other lupus warriors the freedom to share and read each other&#8217;s experiences,” says Brunner.



Covid-19 impact on lupus patients



As Covid-19 turns the world on its head, those with low immunity need to be extra-vigilant as they are more susceptible to contracting the coronavirus.



For patients with autoimmune conditions such as lupus and rheumatoid arthritis, the pandemic has also brought with it another major problem: the reduced availability of the drugs used to treat them.



In March, US president Donald Trump was embroiled in controversy when he tweeted that “hydroxychloroquine and azithromycin, taken together, have a real chance to be one of the biggest game-changers in the history of medicine… hopefully, they will both be put in use immediately”.



Dr Joyce Ziki, a specialist rheumatologist in Johannesburg, says that plasmoquine/chloroquine, used for the treatment of lupus, is one of the drugs “that has been thought to prevent and or cure Covid-19 in conjunction with other drugs”.



“Plasmoquine/chloroquine was being used for prevention and treatment of patients with Covid-19 and hence it became unavailable in pharmacies in South Africa. Many patients with lupus or rheumatoid arthritis could not get the drug. The situation was worse in late March until May. Supplies are beginning to improve now,” she says, further adding that information regarding its efficacy in the management of patients with Covid-19 is currently controversial and inconclusive as studies are ongoing.



“Many members of the BeyondLupus community have come to me to tell me that they have been directly affected because there is a shortage of supply for [the drugs] and they are upset,” Brunner says.



As a result, BeyondLupus published a petition to put forward in collaboration with the Lupus Foundation of South Africa concerning the stockpiling of the drugs to the South African Health Products Regulatory Authority (SAHPRA).



Brunner says SAHPRA responded saying they would keep aside the plasmoquine/chloroquine medicine specifically for lupus patients.



“If you want to ensure that your medication supply is on track, you can message them or email them and they will make sure that they store it,” offers Brunner.



In a web statement, Dr Boitumelo Semete-Makokotlela, CEO of the South African Health Products Regulatory Authority (SAHPRA), urged pharmacies to effectively manage the access to chloroquine containing products and limit any possible stockpile as “it could have important negative public health consequences”. Semete-Makokotlela further stated that the benefits as well as the potential risks of the use of chloroquine as a treatment in patients with coronavirus, are still being investigated.

Tag: autoimmune disease

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How Trusting Your Gut Could Help You

How Lupus Patients Are Being Impacted By Covid-19