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Dr. David Relman on the Past, Present, and Future Potential of Microbiome in Medicine

C: Can You Discuss the Connection Between the Microbiome and Neurodegenerative Disease (as highlighted by Dr. David Perlmutter, MD (Private practice neurologist with over 20 years of experience, fellow of the American Academy of Nutrition, author of The Grain Brain and Brain Maker)?
R: I have followed Dr. Perlmutter’s work. It’s interesting and worthy of further exploration, but I am concerned with the links to a variety of clinical disorders. These are usually associations, not causation studies. Secondly, if there is a link to depression or Parkinson’s Disease for example, it seems likely to be a small contribution, since we already know other factors that are known to be connected. [However,] that doesn’t mean we should not be focusing on it, because it may be one of the things that we can do something about. We cannot typically do anything about a genetic problem, but changes in the microbiome are conceptually simple.
C: Are There Any Vitamins Besides B12 for Which Bacteria are Known to Play a Real Significant Role?
R: Bacteria can process vitamin K. If you take antibiotics, you cannot clot blood as well. It normally doesn’t matter, but if someone is on warfarin/coumadin, if they take an antibiotic, it can kill them. This is likely to be a bigger problem than we are aware. There is a lot of variation in adverse effects of drugs, and also, a lot of variation in people’s vitamin deficiencies.
C: Any There Other Anatomies That are Looked at in Microbiome Research Besides the Gut?
R: The first anatomy of microbiome research focus was the mouth. The most common infectious disease in the United States is, in fact, gum disease or oral cavities, but unfortunately that research community typically publishes in different journals and goes to different meetings. They have a long proud tradition. It is unfortunate that there is not more overlap in the research communities. Other non-gut anatomies of focus in microbiome research include the skin and vagina.
C: What Are the Next Steps for Your Research?
R: We are working on several things. We are generally interested in what makes the microbiome stable and what allows it to recover from a disturbance, like an antibiotic. So, we do a lot of longitudinal studies involving healthy people, where we observe what happens to the microbiome after a colonic clean out, antibiotic, drug, or diet shift. We look at many people and try to find the common features for remaining stable. We are also looking at pregnancy and how that affects gestational outcome. Most significantly we are finding out that there is a certain kind of microbiome that promotes premature labor. Hopefully one day we may help to prevent premature delivery, and instead promote full-term healthy in utero development.
W. Todd Penberthy, PhD is a medical writer with over 4 years of experience based in Orlando, Florida. Prior to that Todd was a professor directing biomedical research using zebrafish models of human disease with expertise in orthomolecular niacin-related science for 10 years. 
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