understanding of the genetic influence on disease processes. This paved the way for an influx of life-changing therapies. The microbiome has similar potential, with the promise of microbial-based therapies being fuelled by both academic and financial |
micro-organisms that confer health benefits when administered in adequate amounts, exerting diverse effects on gut microbial composition, immune modulation, and barrier function. Prebiotics, on the other hand, are non-digestible dietary |
the low-FODMAP diet was never designed for long-term use and a planned rechallenge phase is important when implementing this approach. 12
It is not uncommon for patients to‘ inherit’ dietary restrictions without hav-
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recommendations on diet and supplements to‘ correct’ any anomalies seen. While these tests offer the allure of personalised health recommendations, caution must be exercised in interpreting their results and translating them into |
The gut microbiome is a complex ecosystem comprised of trillions of micro-organisms. |
interests. These types of therapies have the |
fibres that selectively‘ feed’ the beneficial |
ing any clinical benefit and often dietary |
actionable interventions. |
|
potential to be safer than traditional thera- |
bacteria in the gut. Postbiotics encompass |
restrictions themselves can have a bigger |
One of the primary concerns sur- |
|
pies, such as immunosuppression, and can |
a spectrum of microbial-derived metabo- |
impact on a patient’ s quality of life than |
rounding direct-to-consumer microbi- |
|
either work in place of, or complementary |
lites, cell components and fermentation |
any symptom they were designed to treat. |
ome analysis is the lack of standardised |
|
to, traditional treatment algorithms. |
products that exert bioactive effects on |
Like any other therapy, if a diet is not hav- |
methodologies and reporting of results |
|
There is still significant debate about where microbiome-based therapies sit |
the host. While these interventions hold promise, it is essential to critically eval- |
ing the desired effect, or is causing potential harm, then it needs to be reassessed. |
across different testing platforms. This limits the reliability and reproducibility |
|
within clinical practice. This means cli- |
uate the efficacy, safety and clinical rel- |
Finding a healthy diet that is achiev- |
of findings. Additionally, there is a lack |
|
nicians face a challenge in practice with |
evance of each individual product before |
able and sustainable is difficult. There is |
of evidence behind some of the interven- |
|
patients who request, or are already |
incorporating them into routine practice. |
increasing evidence that a Mediterrane- |
tions recommended. |
|
implementing these types of therapies, with or without guidance from a health professional.
Faecal microbiota transplantation( FMT) has gained particular attention for its potential to restore the entire gut microbial equilibrium and alleviate symptoms
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It is not uncommon for patients to‘ inherit’ dietary restrictions without having any clinical benefit. |
Recommendations
Rather than focusing solely on microbiome-targeted interventions, adopt a holistic approach to gut health, looking at overall dietary patterns, lifestyle factors and environmental influences. Encourage
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in various conditions. FMT involves the |
patients to consume a diverse, fibre-rich |
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transfer of faecal matter from a healthy |
It is also important to recognise that gov- |
an-style diet rich in fruits, vegetables, |
diet and to minimise intake of processed |
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donor to a recipient with the aim of repop- |
ernance of these products is currently |
whole grains and healthy fats is associated |
foods and artificial additives. An improved |
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ulating the recipient’ s gut microbiome to |
closer to that applied to foods rather than |
with a diverse and stable gut microbiome |
diet, along with regular physical activ- |
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either prevent or stop a disease process. |
medications, which means therapeutic |
profile, linked to improved health out- |
ity and stress management, can promote |
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This approach was thrust into the spotlight |
claims and marketing have to be inter- |
comes. Conversely, diets high in processed |
a favourable gut microbiome and mitigate |
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when it was shown to be highly effective |
preted with caution. |
foods, sugar and saturated fats have been |
the risk of chronic diseases. |
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for treatment of recurrent Clostridioides difficile( formerly known as Clostridium difficile) infection and since then, FMT has shown promising results in other gastrointestinal disorders including ulcerative colitis. 3, 8 In Australia, there are guidelines for clinical use, as well as TGA-approval ena- |
What about diet?
Diet plays a crucial role in shaping the
gut microbiome composition and function, and various diets have been shown to improve symptoms of a range of conditions. It is important to differentiate diets
|
shown to promote dysbiosis and increase
13, 14 the risk of chronic diseases.
Direct-to-consumer analysis
The proliferation of companies offering
direct-to-consumer microbiome analysis has fuelled public interest in personalised
|
If a specific intervention is being requested, ask your patient( and yourself),“ What are we trying to achieve with this?” and always have a plan to assess response and re-evaluate the need to continue.
As the evidence linking the gut microbiome to chronic illnesses continues to
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bling access to liquid FMT for C. difficile |
that target symptoms of a condition from |
health‘ insights’ based on an individu- |
accumulate, it is imperative for clinicians |
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infection. Central stool banks have also |
those that aim to improve microbial com- |
al’ s microbiome. These services typically |
to stay abreast of emerging research and |
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been developed, ensuring access for any |
position. An example of this is the low- |
involve the collection of stool samples, |
translate this knowledge into practical |
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hospital around the country. 9 |
FODMAP diet which is highly effective |
followed by superficial sequencing and |
strategies for promoting gut health in |
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In addition to FMT, the development |
in treating bloating and other symptoms |
analysis of microbial DNA to generate |
their patients. |
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of tailored probiotics, prebiotics and postbiotics offers exciting avenues for therapeutic intervention. 10 Probiotics are live |
of IBS. However, this diet has also been shown to reduce various components of a healthy gut microbiome. 11 Further to this, |
reports detailing the composition of commonly known bacterial, fungal and parasitic species followed by‘ personalised’ |
References on request from kate. kelso @ adg. com. au |
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