Regina Saphier: TEDMED or Your Gut Feeling and Big Data

It is time I posted something about TEDMED, even if (unfortunately) I have no access to live TEDMED events. I however still watch those post production videos on TEDMED and I sometimes post them on my facebook wall with my comments. So, here are two of those posts, their slightly edited and extended blog versions, with added articles for deeper knowledge of the topic at the end of my blog post.

As a young doctor Peter Attia blamed an obese woman with diabetes for her terrible condition (while giving her the best possible medical care he was able to provide). Later he who is knowledgeable, fit and eats right, learned that he too was insulin resistant. In fact there are millions of lean people who are insulin resistant, while also millions who are obese but have no trace of insulin resistance. Peter says that he is very sorry that he let his patient down as a human being and one can see that he is truly ashamed of his mistake. Right now Peter is exploring the possibility that obesity is perhaps not the cause of insulin resistance but rather the result of an underlying, yet undiscovered mechanism that is behind the complex metabolic syndrome that is related to diabetes, insulin resistance and obesity.

I am glad someone finally noticed that. A healthy body does not get fat. A healthy person does not want to sit on the couch all day. If you feel like sitting all the time, and if your diet is healthy and you are still packing it on, something happened to you that should be fixed. The same is true if you are thin, have a slow thyroid, still, no matter how much you eat, you can not put on weight. I suspect one direction to explore is how our microbiome is related to these issues. I am sure that people with metabolic syndrome have a similarly screwed up gut flora, or some other consistent disharmony in their microbiome. Peter could work well with Larry Smarr‘s big data approach.

My kind of hero: Larry Smarr used big data (he compared his medical data to many other people’s medical information, like their lab results and the composition of their gut flora), a supercomputer, genetics, and science to precisely diagnose the dramatic changes in his microbiome that are making him ill. He now knows that his CRP (a marker for inflammation) is high because of a slowly developing intestinal illness (not yet visible with a colonoscopy!), due to a mass extinction of good bacteria and an overgrowth of harmful components. Quantified self at its best, but medicine is not there yet. His out of balance microbiome composition is consistent with one particular illness that shows the same imbalance in other similarly ill people. So, now he knows what is wrong, he also knows that this is a key to the future of medicine, but the knowledge and the methods to treat his illness based on his scientific and extremely precise diagnosis are not in place yet… But I am telling you to watch this field! And watch this video to look into the future of medicine. Below I am also providing relevant articles and citations for further reading.

Update (December 21, 2013):

A very important talk by Jessica Richman of uBiome @ TEDMED 2013 (Thank you Jessica for sending me the link during our AngelList discussion!)

Could a citizen scientist win a Nobel Prize?

Why our understanding of obesity and diabetes may be wrong: A Q&A with surgeon Peter Attia (ted.com) Clearly, many of us were thinking the same things after the talk:

“Scott McCollum asks:

What are your thoughts on the gut microbiome and obesity? Where’s the current research at and where is it headed?

Attia responds:

The current body of evidence certainly suggests that the gut biome plays a role not only in obesity, but more importantly insulin resistance and metabolic dysregulation. Perhaps one of the most amazing clinical observations is the amelioration of diabetes in patients undergoing gastric bypass prior to losing any weight post surgery. This at least suggests that the weight loss per se is not the issue in type two diabetes. Rather, something in the gastric bypass may be altering flora in the gut, which may in fact be altering the underlying insulin resistance. The most interesting question form my vantage point is this: Can the benefit of gastric bypass on the insulin resistant patient be achieved through a dietary intervention that also interrupts the gut biome? Stay tuned.”

I highly recommend this article: http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html

“We’ve known for a few years that obese mice transplanted with the intestinal community of lean mice lose weight and vice versa. (We don’t know why.) A similar experiment was performed recently on humans by researchers in the Netherlands: when the contents of a lean donor’s microbiota were transferred to the guts of male patients with metabolic syndrome, the researchers found striking improvements in the recipients’ sensitivity to insulin, an important marker for metabolic health. Somehow, the gut microbes were influencing the patients’ metabolisms.” (By MICHAEL POLLAN, Published: May 15, 2013)