
Gut bacteria may change the way many drugs work in the body - idl3Y
https://www.sciencenews.org/article/gut-bacteria-may-change-way-many-drugs-work-body
======
tachyonbeam
Not to take away from these findings, but in general, individual genetics can
radically change the way many drugs work, and even doctors seem blissfully
unaware of this. Caffeine, for example, has a different elimination half-life
based on your genetics. There are also genetic polymorphisms in adenosine and
dopamine receptors that can change its effects:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242593/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242593/).
Another obvious example is how some people can't process alcohol.

If you think about this for a minute, it sheds some light into how primitive
medical research is. We generally assess the effectiveness of a drug based on
how it affects one metric _on average_ for a large group of people. It could
well be that a drug is helpful to some and detrimental to others based on
genetics, microbiome, etc. It follows that we are very likely to be giving
people drugs that are harmful to them, and rejecting drugs in medical studies
that could be helpful to some but are unhelpful to most.

~~~
Medicalidiot
These are all salient points and I would like to comment as someone who has
experience in medicine. We are truly on the precipice of so many breakthroughs
in the medical field. Cancer is going to be a chronic condition soon. HIV will
likely be gone in our lifetime. Congenital diseases will be eradicated very
soon.

What's going to also happen that mainstream media has failed to grasp the
gravity of is pharmacogenomics/pharmacogenetics. Essentially what we are going
to do the second you enter the ED/PCP/PreOP is sequence your DNA. Then we will
tailor your drug regime based on your phenotype (What traits/characteristics
you have expressed). This kind of thing was just imaginary, but last year I
listened to one of the world's leading pediatric pharmacogenomicists that had
a half dozens cases he shared; one of them was having a 16 y/o female that
presented with depression that was not ameliorated with first line SSRI. Upon
sequencing her genome they realized that her phenotype was incompatible with
this SSRI, switched her and upon 4 week followup her symptoms were
significantly reduced.

The 20th century was the century of physics, the 21st will be the century of
biology.

~~~
Thebroser
It truly is incredible! The cost of sequencing one's genome is only getting
lower (like this company that sequences it for $999 >>
[https://www.veritasgenetics.com/myGenome](https://www.veritasgenetics.com/myGenome))
and the possibilities that this brings to designing custom tailored
interventions is something we have never seen before.

I'm currently involved in some synthetic biology research and I still can't
believe that we are getting to the point where hijacking the very machinery of
cells and other living organisms to do things we want them to do like say act
as biological sensors for a disease or have them synthesize and deliver
compounds on their own could become as commonplace as taking a pill.

We are still a ways off, but we are getting there fast and like you say, it
seems that outside of academia/the medical field not many see the impact this
sort of tech is going to have.

~~~
mariushn
> I'm currently involved in some synthetic biology research

What is some open source software that I can contribute to in order to make
these easier? I'd prefer your recommendation for something actually
used/promising, instead of simply searching github. Thanks

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wpasc
I'm really glad to see the microbiome and the immune system finally getting
their due respect insofar as their contribution to literally every bodily
function. I suffer from an autoimmune disease (ankylosing spondylitis) and
I've anecdotally felt like the immune system has been neglected research-wise
because it is such a difficult, complex system to understand.

Three cheers for microbiome and immune system research :)

~~~
shdh
Lupus has been shown to have a correlation with gut biome balance as well. [1]

It makes sense though, certain bacteria's feed off of the sugars in our gut
and release harmful chemicals. Beneficial bacterium do the opposite.

[1]
[https://ard.bmj.com/content/early/2019/03/01/annrheumdis-201...](https://ard.bmj.com/content/early/2019/03/01/annrheumdis-2018-214856)

~~~
wpasc
IBD [1] as well but I guess that association is more obvious :)

My hope is that ankylosing spondylitis, which has a significant genetic
overlap with crohns and UC (combined referred to as IBD) and they have
significant incidence overlap, may also be treated or at least ameliorated
through the microbiome.

My larger hope is that all autoimmune diseases can be treated via the
microbiome. All the current autoimmune treatments we have are blunt objects
targeting major pieces of the immune system with very undesirable side
effects.

[1] [https://news.harvard.edu/gazette/story/2019/05/new-
findings-...](https://news.harvard.edu/gazette/story/2019/05/new-findings-
from-harvard-reveal-how-ibd-disrupts-gut-bacteria/)

~~~
will_brown
What kinds of things do you do personally to promote a healthy microbiome
and/or combat IBD?

I’ve really been experimenting with my diet in the past few years to improve
my running which I just started about 5 years ago. At one point when I was
really focused on my microbiome (to the best of my ability with limited
knowledge), i experienced changes that made me realize I’d kind of always
unknowingly had some symptoms of Chron’s, and I only realized it when they
went away. I have long since adapted my diet losing focus on promotion of a
healthy microbiome and these symptoms have returned. Coincidentally at the
time I was also taking creatine (not as part of my focus on the microbiome)
and I subsequently read some antecdotes (no formal studies) of people with
Chron’s who got benefits from creatine. But I feel I had similar benefits as
they described, only I haven’t previously got them with creatine when on
different diets.

Another anecdote I wanted to share, there’s a famous retired UFC fighter, GSP,
who got UC and has been very outspoken about it and his recovery (you can find
multiple interviews on youtube). He has really found success with intermittent
fasting and time restricted eating. I’m not sure if they have formally studied
it in humans but there have been formal studies on mice and the benefit of
fasting and their microbiome. One really cool study they did was they fasted
mice to promote more brown fat, they then transplanted the fasted mice
microbiomes into non fasted mice and they too began recruiting more brown fat,
that’s mice but it’s amazing to think you can possibly transfer some of the
benefits of fasting to nonfasted people through a microbiome transfer.

~~~
wpasc
I had no idea GSP had UC. Personally? I don't think I do enough, but when I'm
fully adhering to my own protocol, I:

-Don't drink alcohol

-Follow a paleo-autoimmune protocol (with the inclusion of white rice). I can't promise it works but I encourage self experimentation. There's been research around SCD (specific carbohydrate diet) and GAPS diet which you may want to look into because of its effects on crohn's (somewhat researched).

-I eat fermented foods (no affiliation to the company, but I eat from realpickles.com [seriously no affiliation, just sharing where I get from])

-Because my joints are in pain, I can't exercise much so I do pilates. Kinda funny, 26 year old male with a bunch of ladies in their 60's, they find it funny and so do I

-Try to sleep enough and meditate for stress levels.

-I intermittently fast, but not through much effort. I just skip breakfast which naturally leads to ~6-8 hr feeding window.

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octosphere
I made an effort to help my microbiome by eating/drinking various things. I
consume all the following:

\- Kimchi / Sauerkraut / Pickled red cabbage (or anything fermented)

\- Apple cider vinegar (Actually a 'pre-biotic' not a pro-biotic)

\- Kefir grains grown with organic milk and then separated (and drunk) each
night

\- Greek yogurt

\- Kefir water drinks (you can buy these at the health store)

\- Pro-biotic drinks (you can buy these at the health store. Note: avoid the
ones made with sugar)

~~~
lymeeducator
Fasting, water or dry, has been quite beneficial for me. Nothing longer than
48 hours yet.

~~~
wincy
I have terrible sweating problems even at comfortable temperatures. I’m just
always sweating. If I fast this problem ceases.

~~~
andy_ppp
I wonder if your body is desperately trying to get rid of something in your
diet (like organophosphates?) - have you also tried regular saunas?

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hangonhn
I was recently at a lecture given by a colleague of the Yale researcher.
Apparently the Yale cancer center is going to re-run most if not all of their
drug trials because of these findings. So drugs that didn’t do well during the
trials may actually have some efficacy if the protocol were changed to take
into account gut biomes. The work in gut biomes are having a huge impact on
medicine.

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rolltiide
I wish that nutritionists were able to do this level of research.

The general underpinning of their holistic approach is understandable, where
they need to treat an individual's body as an individual system. I understand
why it is therefore impossible to follow known practices of peer review and
repeatable results. But it is then used to rationalize extremely random
remedies or preventative dietary regimes that no two nutritionists would ever
independently come to.

There is seemingly no body of research or work toward any other method,
instead just a general rejection of the words "science", "drug" and "pharma",
to rationalize any procedurally generated remedy.

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inflatableDodo
The inverse is also true. I can actually digest things properly now since
quitting drinking.

~~~
stronglikedan
I was never affected by drinking per se, but IME, cutting out sugary drinks
did wonders for my digestion related issues. I wonder if that's related, since
most alcohols contain a good amount of sugar.

~~~
inflatableDodo
I think it was largely the quantity of spirits I was consuming. I loved things
like brandy, tequila, rum, vodka and whisky, but they all loved me back a bit
too much.

I also realised that there is no real need to play life at the hardest
difficulty setting all of the time.

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lpolovets
Here's an example of a YC startup that's exploring this area:
[https://persephonebiome.com/](https://persephonebiome.com/). They are
developing microbiome therapeutics that improve the effectiveness of certain
classes of cancer drugs. (We're a small investor.)

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joncrane
Not only that. Drugs often change your gut bacteria.

