In a recent study appearing in the New England Journal of Medicine it was shown that in some cases swallowing some poop can actually do you more good than taking a powerful antibiotic.

Els van Nood and colleagues were studying patients suffering gut infections caused by a nasty bacteria, Clostridium difficile. These bacteria release toxins that can cause severe abdominal pain, intestinal inflammation, bloating and diarrhea. They produce spores that are fairly widespread. Indeed many people catch the bug while in the hospital (how convenient!), resulting in an estimated 14 thousand deaths per year in the US (http://www.economist.com/news/science-and-technology/21565586-bacterial-medicine-starting-emerge-bugs-system).

Unfortunately, about 20 percent of people treated with powerful antibiotics respond poorly, suffering recurrent infections. So, someone came up with a brilliant idea. What if we treat them with poop instead of antibiotic??

At first glance this might not seem so smart. After all, they are already infected, and isn’t poop full of germs? How could that make them better?

Well, it can.

In fact our intestines are indeed normally full of bacteria. In fact they are so small and numerous that, in the end, our bodies actually have more bacterial cells in them than human cells. But these bacteria normally do no harm. Not all bacteria are bad. And the good bacteria in the gut actually compete with the bad ones, keeping down their population. So a proper intestinal flora mix, with a strong population of good bacteria is actually important for health.

It turns out that sometimes people with intestinal infections actually just need a good stool transplant. Perhaps their good bacteria have been killed off by a previous treatment with antibiotics, or such, leaving the bad guys free to ravage the gut unchallenged.

So in this study it was shown that stool infusion into the intestine, (probably better than drinking it), from a healthy donor, was actually far superior in treating patients than antibiotics. Indeed the results were so dramatic that they ethically had to stop the study midway. The control patients that had been receiving antibiotics were given stools instead, so they would have a better chance of recovery.

I’m wondering if those of us with especially good poop will now be able to patent it, turn it into pills, and make a fortune. Sounds like easy money to me.

Chronic inflammation is the modern day silent killer. It promotes the development of many deadly diseases, including cancer (http://www.scientificamerican.com/article.cfm?id=chronic-inflammation-cancer), heart disease, stroke, Alzheimer’s disease and diabetes (http://www.lef.org/protocols/health_concerns/chronic_inflammation_01.htm).

So, what is inflammation? Acute, or short term, inflammation is our normal response to an infection. The infected area becomes red, swollen and inflamed. We bring our innate immune system arms to bear, knocking holes in the bacterial cells, spewing out chemical poisons, and actually eating the enemy. A war against the infection is waged, and when it is won everything returns to normal.

Chronic, or long term, low level inflammation is, however, quite a different beast. The body is acting like it is constantly battling a low grade infection, even though generally none is present. And the effects can be lethal, as mentioned, promoting a host of diseases.

What causes chronic inflammation? There are several likely causes, including stress, obesity, diet, and in some cases actual chronic infection. But recent studies suggest a surprising correlation between an affluent lifestyle and chronic inflammation.

It has been known for some time that “being too clean can sometimes lead to disease.” (http://www.pbs.org/wgbh/rxforsurvival/series/diseases/polio.html). Polio, for example, existed for many centuries as a common virus, but rarely causing disease. Polio virus normally infects out intestinal tracts. It is transmitted by the “fecal-oral route”, when our poop contaminates our food. Before good sanitation procedures became common almost everyone carried the polio virus and infants would be infected at an early age. But the virus is quite benign when infecting infants, probably because of partial protection from the mother’s antibodies. So the severe form of the disease, where the nervous system is attacked resulting in paralysis, was uncommon. But in the 1900s, as the water supplies and sewage disposal systems became more sanitary, fewer people became infected with the virus, so sometimes the mother did not transmit protective antibodies, and infections at a much later age became more frequent. FDR was not infected until he was 39 years old. And at this age the paralytic form of polio is much more likely. So we paid a price for our improved hygiene.

A similar story might hold true for chronic inflammation. McDade et al (http://www.ncbi.nlm.nih.gov/pubmed/22639072) recently published a study in the American Journal of Human Biology where they examined chronic inflammation levels in the hinterlands of Ecuador, where very primitive living conditions prevailed. It is possible to quantitate chronic inflammation by measuring the blood levels of a protein, CRP, produced by the liver. They followed the CRP levels of the Ecuadorians for many weeks, finding that they have remarkably low levels of chronic inflammation. Of course their CRP levels went up when they had an infection, but their background CRP levels were about four times lower than what is seen in America. None of the Ecuadorians had CRP concentrations that would classify them as having chronic inflammation. This is in sharp contrast to America, where one third of adults have chronic inflammation, with CRP levels above 3 mg/l.

MacDade et al state that “infectious microbes have been part of the human ecology for millennia, and it is only recently that more hygienic environments in affluent industrialized settings have substantially reduced the level and diversity of exposure.” They suggest that natural exposure to microbes at an early age helps to fine tune our immune systems, “and in the absence of such inputs, poorly regulated or self-directed inflammatory activity may be more likely to emerge.”

So, when our immune systems aren’t presented with enough other things to attack, they might decide to attack us! It is probably not appropriate to start feeding our kids dirt, but it might be time to develop a safe soup of microbes, a kind of probiotic for infants, that could help them to mold their immune systems, and to reduce the levels of chronic inflammation in coming generations.

Genetic determinism, according to Wikipedia, is the belief that genes, along with environmental conditions, determine morphological and behavioral phenotypes. It does not mean that genes totally rule, and will decide your preferred political party, your religion, and your love of carrots. It just means that genes are really important in shaping who you are.

So how much is decided by genes, and how much by environment? How much nature and how much nurture? Studies of identical twins have helped us answer this question. Identical twins are the result of an early split of an embryo, thereby giving two people instead of one, but with exactly the same set of genes.

Below is a picture of my grandmother, Martha, and her identical twin Mary. In the small town where they grew up they were known as the Sin Twisters. No one could tell them apart. They’d often swap out for taking tests in high school, and even on dates. And no one was the wiser. Shades of the movie The Parent Trap, but they turned out better than Lindsey Lohan.

So, give two people the same set of genes and they’ll look pretty much identical. It is easy to conclude that genes are extremely important in determining appearance. But what about other things, like intelligence, athletic ability, and health? Twins can also help us figure out the genetic contribution for these features. The key is to study twins that were for some reason separated at birth and raised in different environments. If genes are really important in defining characteristics then one would predict that identical twins raised by different families would still show significant similarities, above and beyond their physical appearance.

Sir Francis Galton was the first to use twins to study the genetic contribution to traits. He was a cousin of Charles Darwin’s and was very much taken by the theory of evolution and interested in studying the inheritance of characteristics, including intelligence. He coined the term “nature versus nurture” and concluded from his work that nature was more important than nurture.

The modern day Minnesota Twins Study is one of the most comprehensive investigations of nature versus nurture. They have analyzed hundreds of identical and fraternal twins, raised in the same or different environments. It turns out that environment has relatively little effect on physical features. If you take identical twins and rear them apart they still look identical. And if you take fraternal twins and raise them together they still don’t look the same, although there will be similarities, in part because they do share half of their genes.

IQ also showed strong heritability, with the results indicating that about 70 to 80 percent of a person’s IQ is determined by genes. There were also some surprising results to come from the study, showing genetic contribution to unexpected psychological attributes. For example, there seem to be happy and sad genes. Identical twins, even when raised apart, scored more alike in measures of happiness than fraternal twins. And another surprise was the connection between genes and the level of religiosity. One might think that family environment in this case would be particularly important, with children exposed to religion on a weekly basis much more likely to become religious. But if one identical twin was religious, then the other was more likely to be as well, even when raised separately. Of course genes did not pick the faith. One twin might be a devout Protestant, while the other twin, raised by a different family, would be a devout Jew. And what about health? Genes are clearly important here as well, with hundreds of diseases now known to have a genetic component.

Of course genes are also important in defining our athletic ability. As an example of the relationship between genes and athleticism consider the dogs shown below. They are both female whippets of about the same age. But one has a mutation in the myostatin gene, and as a result her muscles have grown to rather enormous proportions. She is one very strong and very fast whippet. It turns out that some human body builders have natural occurring mutations in the same gene. They were born to body build.

So genes play an important role in defining both our physique and our psyche. But it is also important to note that they don’t completely define us. Identical twins are certainly similar, but they are not the same. Although our genes establish limits, within those limits there exist a wide range of possibilities, determined by chance and our environment.

Finally, there is the question of how much we currently understand about the relationship between genes and traits. Suppose that we could completely control the genetic makeup of our offspring. Perhaps shockingly, this possibility is not as far-fetched as you might think. Could me create children that are incredibly smart, healthy, good looking and athletic? The truth is that right now we understand very, very little about the genetic equations that define these traits. And it is clear that the answers are going to be, in general, extremely complicated.

But there is currently a revolution going on in the world of DNA sequencing. The price continues to plummet. We are now sequencing the DNAs of tens of thousands of people, and in the near future it will be millions. We will then be able to connect the dots, and relate the different orders of the G,A,T,C bases to the different traits of the people that carry them.

The future of our species could get very interesting.

About the Author: Eveloce was an undergraduate at UCLA, received his PhD from the University of North Carolina at Chapel Hill and was a postdoctoral research fellow at Harvard Medical School. He has published over one hundred research articles, co-authored the third edition of the medical school textbook Larsen’s Human Embryology, and serves on the editorial board of the science journal Developmental Biology. He wrote the book “Designer genes: A new era in the evolution of man” published by Random House and available at Amazon.

The 24 year old graduate student Aimee Copeland fell when a homemade zip line over the Little Tallapoosa River broke. She hit the rocks below, suffering deep cuts that became infected with flesh eating bacteria. And the horror began, with doctors forced to amputate both feet, both hands, all of one leg, and part of her body, in an effort to save her life. When told they would remove her hands she reportedly looked up and mouthed the words “Let’s do this”, appreciating that her purple hands would have to go.

So, what is flesh eating bacteria? The condition can be caused by many different kinds of bacteria, including Streptococcus pyogenes, Staphylococcus aureus and Clostridium perfringens. In the case of Aimee the culprit appears to be Aeromonas hydrophila, found in warm climates and fresh or brackish water. Like the antibiotic resistant strains of Staphylococcus aureus (MRSA), it is resistant to most antibiotics. It produces a toxin (poison) called Aerolysin Cytotoxic Enterotoxin that damages tissue.

How do you catch it? It can infect cuts, as was the case for Aimee, or you can even get it from a bruise (about one third of cases), and sometimes there is no evidence of an injury at all. You can also get it through foods, including seafood, meats and some vegetables.

The bacteria that cause it are fairly common, so the question is why do some people get it and others not? People with compromised immune systems are susceptible, as you might expect. But there is also increasing evidence that some people are genetically predisposed to get certain infections, even if their immune systems are otherwise perfectly fine. For some reason their immune systems are particularly prone to invasion by certain strains of bacteria. It also appears that the bacteria can make toxins that disable the immune system.

How do you treat it? The Aeromonas bacteria encode a protein called beta lactamase that degrades penicillin and the penicillin derivative antibiotics. Despite antibiotic resistance most strains will respond to so-called third generation agents. The other treatment is surgical removal of the most infected areas (surgical debridement).

What are the symptoms? The first symptom is usually pain at the site of a wound. Then the pain gets worse and the tissue around the wound swells and can change in color. As the infection spreads there are flu like symptoms with fever, nausea and diarrhea. It is important to get treatment early. Death can result within 24 hours, and even with high-dose antibiotic treatment about 25% of patients die.

The technical term for flesh eating bacteria is necrotizing fasciitis, which is a fancy way of saying dying tissue. It is generally relatively rare, with about 4 cases per 100,000 people (http://www.bioedonline.org/news/news.cfm?art=1234). So don’t panic, but be careful!

The day before a colonoscopy you stop eating solids and start pumping laxatives. Most people agree that this is the worst part of the procedure. You spend a lot of time sitting on the toilet, and feeling hungry. Many studies have shown that about one quarter of patients fail to properly prepare their colons, leaving a hazy cloud of debris that makes it hard for the gastroenterologist to see through.

Not surprisingly, a recent study by Reena Chokshi and colleagues, at the Washington University School of Medicine in Saint Louis, has shown that doctors can often miss pre-cancerous growths when the bowel is not cleaned out adequately. The data is from patients that had a follow up colonoscopy within a year, and growths that were almost certainly there before were found.

Indeed, the authors of the study suggest that if the doctor finds a murky milieu, which is often apparent within minutes of starting the procedure, then the colonoscopy should be terminated and re-scheduled rather than incur the slight risk of continuing, with questionable benefit.

So clean out that colon before your next colonoscopy! In the end it is for your own good.