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New research shows gut bacteria alter the effects of medication
Extensive research at Yale signals the future of personalized medicine
- New research from Yale confirms that gut bacteria alter the effects of medication.
- Researchers tested 271 oral drugs against 76 different types of bacteria in an extensive study.
- Such information could change how doctors prescribe medicine in the future.
One of the most frustrating aspects of medicine is the wild variations in efficacy. A pill that works wonders for one person is useless for someone else. A can't-fail remedy proves to be completely ineffective, causing you to wonder how it could have ever been pushed to market. It must be Big Pharma playing with consumer minds once again.
Not to let the pharmaceutical industry off the hook, but new research is evolving our understanding of how medicine operates inside of our bodies. The reason that pill worked for your friend but not you? It could be your gut.
New research from Yale confirms longstanding anecdotes regarding the role gut bacteria play in your body's ability to respond to medication. The researchers tested 271 oral drugs against 76 different types of bacteria in an attempt to mimic the complexity of the human microbiome. Roughly two-thirds of the medications were modified by at least one bacterial strain, while each of the 76 strains modified between 11 and 95 drugs. That essentially means every drug is affected in some way by your microbiome.
How the food you eat affects your gut - Shilpa Ravella
This is a huge breakthrough in treating patients. Recent evidence has emerged that the 10-100 trillion bacteria that comprise our microbiome are negatively impacted by a major class of drugs: antibiotics. The alteration of your microbiome isn't always bad — antibiotics could suppress a molecule that leads to heart disease, for example — but overall, tampering with gut bacteria in such a manner has not been proven to be beneficial, and the strength of antibiotics is apparently waning in part of the population.
Though our understanding of the microbiome is mired in complexity, emerging science is quickly educating us as to how our insides operate. Earlier this year, one study linked specific gut bacteria to depression; other research noted that one-third of those suffering from depression are also constipated. Given all of this data, it's not surprising that certain types of probiotics are showing efficacy in treating anxiety. How we treat our bellies matters for our overall health.
Like human communities, the microbiome is affected by lifestyle changes, diet, and environmental conditions. As science writer Ed Yong notes in his book, I Contain Multitudes: The Microbes Within Us and a Grander View of Life,
The microbiome is not a constant entity. It is a teeming collection of thousands of species, all constantly competing with one another, negotiating with their host, evolving, changing.
In fact, certain species of bacteria are more prominent at different hours of the day, meaning that even the time you take medication matters. Incredibly, a drug that works well in the morning hours might be less effective in the evening. And, of course, this opens an entire new line of questioning regarding diet.
Capsules of bacteria are pictured at Vedanta Biosciences. Vedanta is one of dozens of startups across the globe that hope to make medicines based on the latest insights about the trillions of bacteria, fungi, and other microbes that live inside and on our bodies.
Photo by Suzanne Kreiter/The Boston Globe via Getty Images
We need our microbiome to be healthy and, as Yong writes, diverse — antibiotics unfortunately destroy diversity. Again, like human communities, a varied population of gut bacteria creates the healthiest environment. That said, every drug has an effect on gut bacteria. Dialing in which drugs work for whom is an essential component of the future of medicine.
Then there's what happens after medications visit the gut. After testing the drugs in vials, the Yale researchers conducted another experiment with 28 volunteers. Using different medications, they monitored the microbial population through fecal samples, identifying drug-altering DNA snippets to understand how the bacterial population modified each drug. This study suggests genetically testing individuals could shed insight into what drugs will work in specific individuals, potentially informing doctors whether or not to include certain bacteria in fecal transplants.
The future of medicine is personalized, or so claim the growing list of smartphone apps designed to monitor health markers. While true, your phone won't get into your belly (yet). This is only the beginning of an exciting new chapter in medicine. Being able to provide exact doses at exact times will take the guesswork out of prescriptions. Many other factors play into gut health, but from a holistic point of view, this advance is certainly a game-changer.
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
A recent study tested how well the fungi species Cladosporium sphaerospermum blocked cosmic radiation aboard the International Space Station.
- Radiation is one of the biggest threats to astronauts' safety during long-term missions.
- C. sphaerospermum is known to thrive in high-radiation environments through a process called radiosynthesis.
- The results of the study suggest that a thin layer of the fungus could serve as an effective shield against cosmic radiation for astronauts.
Shunk et al.<p>Additionally, the fungus is self-replicating, meaning astronauts would potentially be able to "grow" new radiation shielding on deep-space missions, instead of having to rely on a costly and complicated interplanetary supply chain.</p><p>Still, the researchers weren't sure whether <em>C. sphaerospermum</em> would survive on the space station. Nils J.H. Averesch, a co-author of the <a href="https://www.biorxiv.org/content/10.1101/2020.07.16.205534v1.full.pdf" target="_blank">study published on the preprint server bioRxiv</a>, told <a href="https://www.syfy.com/syfywire/fungus-that-eats-radiation-could-be-cosmic-ray-shield" target="_blank">SYFY WIRE</a>:</p><p style="margin-left: 20px;">"While on Earth, most sources of radiation are gamma- and/or X-rays; radiation in space and on Mars (also known as GCR or galactic cosmic radiation) is of a completely different kind and involves highly energetic particles, mostly protons. This radiation is even more destructive than X- and gamma-rays, so not even survival of the fungus on the ISS was a given."</p>
International Space Station
NASA<p>To be sure, the researchers said more research is needed, and that <em>C. sphaerospermum</em> would likely be used in combination with other radiation-shielding technology aboard spacecraft. But the findings highlight how relatively simple biotechnologies may offer outsized benefits on upcoming space missions.</p><p style="margin-left: 20px;">"Often nature has already developed blindly obvious yet surprisingly effective solutions to engineering and design problems faced as humankind evolves – C. sphaerospermum and melanin could thus prove to be invaluable in providing adequate protection of explorers on future missions to the Moon, Mars and beyond," the researchers wrote.</p>
Shannon Lee shares lessons from her father in her new book, "Be Water, My Friend: The Teachings of Bruce Lee."
- Bruce Lee would have turned 80 years old on November 27, 2020. The legendary actor and martial artist's daughter, Shannon Lee, shares some of his wisdom and his philosophy on self help in a new book titled "Be Water, My Friend: The Teachings of Bruce Lee."
- In this video, Shannon shares a story of the fight that led to her father beginning a deeper philosophical journey, and how that informed his unique expression of martial arts called Jeet Kune Do.
- One lesson passed down from Bruce Lee was his use and placement of physical symbols as a way to help "cement for yourself this new way of being, or this new lesson you've learned." By working on ourselves (with the right tools), we can develop the skills necessary to rise and conquer new challenges.
How to deal with "epistemic exhaustion."