LAUSR

We were very pleased to read the paper by Palliser and Spector on diet and the microbiome in the latest edition of JRSM. The concept of a damaged gut microbiome causing non-infectious disease, originally named ‘entero-metabolic disorder’, is now over 25 years old, but has only recently been receiving the attention it deserves. The identification of a damaged microbiome may, however, be hampered if workers concentrate efforts on formal characterisation of species in the gut flora. Many microbes cannot be cultured, and bacterial riboprobes are available only for species already recognised. Metabolomic analysis reflects the effects of both recognised and unrecognised organisms. We have found the use of metabolomic analysis to identify abnormal metabolites in either faeces or urine to be an effective and straightforward way of demonstrating microbial abnormality and hence to identify conditions worthy of further investigation. Palliser and Spector concentrate their attention on obesity and metabolic syndrome, but evidence has now been presented of the importance of the gut microbiome in a wide range of other diseases, originally irritable bowel syndrome, but now also Crohn’s and other autoimmune disorders such as immune thrombocytopaenic purpura. It further offers an improved screening technique for carcinoma of the colon. Whether the changes in the microbiome represent crucial underlying pathology or are merely epiphenomena remains finally to be resolved. It seems likely, however, that the development of techniques to correct a damaged gut flora will now prove an exciting and rewarding field of research.