MICROBIOME AND KIDNEY AND OTHER INFLAMMATORY DISEASES

I was requested to present an Introduction to Microbiome and its effect upon (or vice versa) on the Kidney diseases at a health fair being held at a tribal auditorium (one of the tribes to which I am a Consultant Endocrinologist)

My curiosity about the different metabolism of the indigenous people was aroused when I visited the San Blas Islands off the coast of the Republic of Panama, along with Dr M and Mrs G, while we were all at the University of Miami School of Medicine.

 
We noticed that the BP readings were in the 100-110/60-70 mm Hg. The doctor in residence at that time,I remember clearly was, Dr Enrique Chen of Panama City. He also told me that when the Kuna travelled to Panama City their Blood pressure would go up. Needless to say , there was no burden of Diabetes among the KUNA

 Many years later, I had a chance to visit the Tarahuamara or the Running People of the Canon del Cobre in Mexico in the company of my good friend Dr Ian Berger (olav ha shalom)

Not only the Raramuri as they called themselves, thin and muscular, the BP readings and Blood Sugar readings paralleled those of the Kuna.

Why are these traditionally living Indians free of the diseases of civilization? 

With the help of my friend Dr. Stuart we were able to measure the Insulin levels of the Tarahumara as well as the San people of Kalahari (Tsumkwe in Namibia to be precise), seen in the picture below.

 
By the time I reached the isolated villages of the Ticuna along the Colombian Amazon, I had compiled a long list of metabolic differences among the Indigenous peoples of the world.

 but differences in the MICROBIOMES in their guts was not among them, that knowledge was to come later 

 An Australian colleague, Dr Wendy Hoy, had been wondering, why do the native people of Australia suffer an inordinately higher rates of Kidney diseases?
In a series of elegant experiments and observations, she was able to confirm what leading nephrologists including Brenner or Brenner and Richter fame had suspected.

 Indigenous Australians (real ones and not the fake ones who have proliferated in the last two decades) have the same disease burden as the Native Americans.
(A Meskwaki elder said: when the white man has one drop of Indian blood, they claim to be Indian, but if they have lots of black blood, they try and hide it)

 My initial hypothesis was that the FATAL CONTACT of the indigenous people with the Immigrants/Conquistadores/Settlers led to an inflammation in their bodies which gave rise to 
OBESITY
DIABETES
and many other diseases of "civilization"

When I became aware of MICROBIOME and its presence at various levels in different populations, I began to understand the connection between indigenous people and the onslaught of diseases among them.
What are the Microbiome ? 

mi·cro·bi·ome

/ˌmīkrōˈbīōm/

noun

1. 
   

   the microorganisms in a particular environment (including the body or a part of the body).

   "we depend on a vast army of microbes to stay alive: a microbiome that protects us against germs, breaks down food to release energy, and produces vitamins"

   • 
     

     the combined genetic material of the microorganisms in a particular environment.

     "understanding the microbiome—human, animal, and environmental—is as important as the human genome"

 It came as no surprise that the least contacted people had the highest diversity of Microbiome. The greater the diversity lesser the chance of Metabolic Diseases...
In my limited experience on Microbiome among the Indians, most of them have lost their diversity by about 60-70 per cent and i wouldnt be surprised if in larger studies it shows that they have lost even higher percentage. In one patient who was going for Gastrectomy, the microbiome diversity had decreased to 16 per cent!

When I went to work for the Meskwakia as a newly minted Endocrinologist, I couldnt believe what they said.

It is the Food that have made us sick.

Now I do agree, it is the outsiders food that have made them sick.

Wise people, if only others listened to their wisdom!

 I remember telling a Nephrologist that Cholesterol is an indicator of the inflammation in our bodies and he laughed at me!  here is my proof  2018

 Many of the disease processes in the large gut or Colon are related to the imbalance of the Microbiome and these include"
Inflammatory Bowel Disease, Crohn's Disease.
If you look at the prevalence of Autism, there has been a dramatic increase in the incidence, now evidence is slowly coming in to say that it may be related to the lack of balance of Microbiome.

There is no one solution fits all. When I analysed my own microbiome, I realized that I cannot eat Kimchi, Tempeh, Miso or Pickles! 

But there were many other vegetables and fruits (not apple, nor tomato) that I could imbibe on. I was very sorry that couscous, millet, barley were a no no for me, sadly Pomegranate as well (the original fruit of Israel!)..but avacado is fine. I am also forbidden to eat Cane Sugar or Chili Powder.. 

So the prescription which has to come in the form of FOOD and not tablets are very individualized 

As I mentioned, my microbiomes do not like Kimchi but Lepaye and Natto are fine. I am happy about a Masala Dosa and few Idly (south indian rice cake) now and then.

Many of the Indigenous foods are beneficial to their Microbiomes and we dont have enough information about their original diet and microbiome to make concrete recommendations, not yet anyway. But Israeli scientists from Technion in Haifa have promised to help me resolve this question.. I trust them.

Eat more Phenol Rich Food (general advice)

 You really need to know your MICROBIOME before tailoring your recipes.. I analyzed my microbiome which forbids me to eat BlackBerries but BlueBerries are alright!

Future treatment of many of the metabolic diseases would include an analysis of your microbiome and recipes provided which include fruits and vegetables and meat, fish and spices that are beneficial to your gut and heal the disease process.

 The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of these, differences between old vs new frequencies were highly significant (p< 0.0001). Comparing various autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1 diabetes and myasthenia gravis frequencies increased the most in , and , respectively. Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and South, respectively.

Role of Microbiome in Kidney Disease

As Kidney disease progresses, the chemicals alter the microbiota, but changes in the microbiome can initiate kidney dysfunction .

 Israeli scientists at Technion in Haifa and Weizmann Institute in Tel Aviv, lead the world in Microbiome research and the treatment based on microbiome, 
One such treatment is already available to patients with Type 2 Diabetes in which nutritional recommendations and recipes would be provided. 
In the above graph, it shows that it is no longer correct to say: Bananas are better than Cookies for you. Now we have to say, in answer to the question, what is better to eat, Bananas or Cookies, you have to say, I better consult my Microbiome.

Video from Weizmann Institute in Israel.

Thank you all for your attention.

With a Khmer Child in Siem Reap, Cambodia  1.1.2019