Microbiome and Dysbiosis Video #4: My Most Nonlinear Discussion on Technological PseudoCertainty vs Effective Empiricism

While most of my written and presented work is intentionally linear, this particular conversation was more fluid—actually, during most of the time spent on this video, I was picturing lava lamps

Microbiome & Dysbiosis Video #4: Clinical Approach: Testing Microbes vs Treating Dysbiosis

While most of my written and presented work is intentionally linear, this particular conversation was a bit more fluid—actually, most of the time that I was preparing-recording-editing-reviewing this video, I was picturing lava lamps in the background.

Lava lamp photo by Dean Hochman,CC BY 2.0, commons.wikimedia.org/w/index.php?curid=79022567

In medicine and healthcare education, we are mostly taught to confirm each diagnosis before preceding to treatment, and generally this is appropriate. However, when dealing with complex and subtle multicomponent functional disorders, I argue that this approach is at least occasionally if not commonly impractical, myopic, and unsuccessful.

In post-graduate education such as conferences, most of the presenters who discuss “assessment” will focus on laboratory testing either by unconscious default, laziness or inability to tackle the problem abstractly, or because they are sponsored by laboratory companies that sell testing kits and results for assessment of microbiome and other components of dysbiosis. As such most conversations on treating dysbiosis include an excess of emphasis on laboratory testing.

Treating dysbiosis differs from treating an acute infection

1. Dysbiosis is chronic, whereas acute infections are characteristically short-lived.

2. Dysbiosis is nearly always polymicrobial, whereas acute infections are more commonly monomicrobial.

3. Dysbiosis always has numerous predispositions and perpetuating factors, whereas infections might have only one predisposing factor.

4. Dysbiosis nearly always has a component of systemic or metastatic inflammation, whereas with acute infections the inflammation is mostly local.

5. Acute infections are more easily and justifiably treated with drug antibiotics, whereas dysbiosis requires multicomponent treatment for long durations.

6. Dysbiosis nearly always has primary or secondary nutritional deficiencies, which may or may not occur with acute infections.

7. Acute infections are typically localized whereas dysbiosis can occur in multiple locations due to multiple microbes at the same time—I was the first to describe this as multifocal polydysbiosis.

8. The more complex the illness (eg, autoimmunity) the more likely is multifocal polydysbiosis.

9. Using laboratory assessment for each aspect of multifocal polydysbiosis is impractical or impossible; much of the data comes from research investigations that have used sophisticated laboratory/biopsy interventions that are impossible or impractical to replicate in clinical practice—we use that data to inform empirical treatment without being slaves to laboratory confirmation.

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Video #4 (1 hour and 18 minutes) Clinical Approach: Testing Microbes vs Treating Dysbiosis

This video is viewable only on the website at this page (use browser) for Dysbiosis video no4, even though the text is visible via email and in the app

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