The transformative potential of the microbiome.

I’ve always considered the saying “trust your gut” to be a directive to respond to one’s innate instincts. However, as a gastroenterology clinical nurse specialist, I now recognize there can be a literal meaning to that phrase with the recent discovery of the microbiome and its implications for our health. The microbiome has yielded significant recent research discoveries for health promotion and has the potential to radically transform our diagnosis and management of disease and health disorders.

Microbiologists have actually suggested the microbiome be considered a human organ. Our CE article in AJN’s November issue, Current and Emerging Applications of Fecal Microbiota Transplantation, highlights how a disrupted microbiome, manifesting as Clostridium difficile (C. difficile) infection that is nonresponsive to first-line antibiotic treatment, can be effectively and quickly treated with transplantation of a diverse, microbiota-rich stool from a healthy donor.

But what is the microbiome?

The microbiome consists of the trillions of microorganisms that naturally live on and inside the body—specifically in the gut, skin, mucosa, mammary glands, and respiratory and urinary tracts. Think of the microbiome as a community of microorganisms similar to a social community made up of individuals. At birth, our social community is limited to our immediate family and friends; but over time, we introduce more people into our community, both directly and indirectly through social interactions, so that out community grows. Likewise, the microbiome community we are born with grows and is altered by our exposure to new microorganisms from the environment such as our diet or pharmaceuticals.

Some microorganisms can be beneficial (the true intent of the microbiome), while others can be pathogenic, causing disease or a disruption to the balance of our general health. Since a balanced gut microbiome is critical to protect the body from pathogens that promote disease, the goal is to ensure that beneficial microbiota exceed harmful microbiota.

Microbiota diversity and the intestinal barrier.

Our gut microbiota is considered to be well established by the age of 12. There is evidence that although the diversity of our gut microbiota changes over our lifetime, it generally remains stable in healthy individuals, with diet playing a major role in modulating the gut microbiome. Microbiota diversity contributes to a healthy gut microbiome by providing microbial strains that enhance intestinal barrier function and minimize pathogenic microbes.

The intestinal barrier is a primary line of defense against pathogenic microbial invasion in the body. If the intestinal barrier is compromised, pathogenic bacteria can enter the bloodstream and cause inflammation, tissue damage, and disease. Eating a diverse range of whole (non-processed) foods including vegetables, legumes, beans, fruit, fermented foods (i.e., yogurt, kefir, kombucha, kimchi, sauerkraut), foods rich in polyphenols (i.e., almonds, blueberries, broccoli, cocoa, onions, red wine) is important to provide nutrients to support those beneficial bacteria that promote intestinal barrier integrity.

What does the future hold?

In the past two decades, our knowledge and understanding of the critical contributions the microbiome makes to our health has rapidly increased. Precision medicine, for example, has the potential in the future to tailor disease prevention and treatment to an individual’s microbiome. Research into the associations between the microbiome of individuals with disease states, such as those involving the gastrointestinal, neurological, or immunological systems, are ongoing and reveal the potential for prevention, management, even cure.

In our CE article, you can explore more about how gut microbiota provided from healthy donors is being used to treat C. difficile infection and is a foundation for promising research in other diseases and health disorders.

Kathy A. Baker, PhD, APRN, ACNS-BC, FCNS, FAAN, is a professor at Texas Christian University, Harris College of Nursing & Health Sciences; a board-certified gastroenterology clinical nurse specialist; and editor-in-chief of Gastroenterology Nursing