The Future of Medicine Revolves Around Our Gut: The Microbiome Revolution

Meet Our New Patients!

You cannot see them, but trillions — perhaps quadrillions — of organisms come and go from our offices every day. They are hungry, mysterious, community-oriented, and very, very small.

They are the microbes living in our current patients’ guts.

Soon, we will prescribe medicines not only for people but also for these microbes.

Dr. Stanley Hazen, co-chair of Preventive Cardiology & Rehabilitation at Cleveland Clinic and director of the Center for Microbiome & Human Health,says, “In the future, our medicine cabinets will contain not only drugs such as statins that treat us, but also pills that target an enzyme in our microbes and provide health benefits in a chronic disease.”

Microscopic Guests: The Role of the Gut Microbiome

The trillions of microbes living in our guts break down the food we eat to produce metabolites. These metabolites can affect our health positively or negatively.

Recent research, in particular, links the gut microbiome to

• diabetes,
• cardiovascular disease,
• liver disease,
• obesity,
• high blood pressure,
• neurological disorders,
• depression, and
• many serious diseases such as cancer.

A treatment developed in Dr. Stanley Hazen’s laboratory focuses particularly on a marker of cardiovascular disease and chronic kidney disease: the metabolite trimethylamine N-oxide (TMAO). This treatment aims to reduce the risk of these diseases by preventing TMAO formation, and clinical trials are approaching.

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The Health Effects of Gut Metabolites

Some of the thousands of metabolites produced by gut microbes play a critical role in our health. Here are some examples:

• Short-chain fatty acids (SCFA): Gut bacteria take fiber-containing foods and ferment them to produce short-chain fatty acids such as acetate, propionate, and butyrate. These metabolites protect against diseases such as obesity and diabetes by regulating appetite, energy expenditure, and fat oxidation. Butyrate, in particular, supports the integrity of the intestinal wall, reduces inflammation, and has anticancer effects.

• TMAO and phenylacetylglutamine: When animal proteins such as red meat, eggs, and dairy products are consumed, certain gut bacteria convert the choline and L-carnitine in these foods into TMAO. Research shows a strong association between TMAO and cardiovascular disease. Phenylacetylglutamine may increase the risk of cardiac events in patients with heart failure.

• Tryptophan metabolites: Gut bacteria can convert tryptophan into neurotransmitters such as serotonin and melatonin. By affecting the functioning of the gut–brain axis, these metabolites may cause mood disorders or contribute to the development of various neurological diseases.

• Bile acid byproducts: Gut microbes break down bile acids to produce compounds that affect inflammation and immune function. Microbes that break down corticosteroid hormones, in particular, are thought to influence the risk of postpartum depression.

The Medical Future of the Microbiome

Advances in microbiome research are ushering in a revolutionary era in understanding how these tiny organisms affect health. In the future, artificial intelligence (AI) models will be able to predict gut microbiome composition using information such as dietary habits and living conditions. Advances in metabolomics and bioinformatics will also allow physicians to personalize their treatment approaches.

For example, people lacking specific metabolites could receive dietary or probiotic-based treatments designed to increase their synthesis. Although butyrate supplements are already available, more research is needed. Some studies, however, suggest that fiber supplements that increase butyrate production may lower blood pressure according to their findings.

Personalized Microbiome Treatment

The simplest recommended step for improving gut health is to increase dietary variety. Foods such as fruit, vegetables, legumes, and hazelnuts increase the diversity of gut microbes and encourage the production of healthy metabolites. In addition, fermented foods may increase microbiome diversity and contain health-supporting postbiotics.

However, science has not yet reached a clear conclusion about probiotic supplements. Although certain probiotic bacteria may benefit some diseases, these supplements do not seem to affect everyone in the same way. Therefore, personalized microbiome-based treatments will be highly important in the future.

On the Threshold of a New Era

Gut microbiome research is opening a new era in modern medicine. In the future, not only a person’s genetic makeup but also their gut microbiome will play an important role in diagnosing and treating disease. Metabolites produced by the gut microbiome will be regarded, like insulin, as new hormones that regulate our bodily functions in their own right.

Developments in microbiome research will shape the future of modern medicine and deepen our understanding of the gut’s critical role in health.