Tim Spector MB MSc MD FRCP, Professor of Genetic Epidemiology and Director of the Twins UK Registry at Kings College London

We might like to think that we are all human with sovereignty over our own bodies. The reality is a little different. In fact, we’re made up of less than 1% human DNA. The rest is microbial. So while we may want to be in the driving seat of our bodily functions — we’re not. Our microbial partners number in their trillions and are made up of bacteria, viruses, fungi, protozoa, archaea and even some helminths from time to time. These tiny organisms — or most of them at least — are commensal, meaning that they live in relationship with us and are essential for our very survival, let alone our health and wellbeing. It’s incredible that we still know relatively little about our tiny microbial life partners and that’s mainly down to their size, the complexity of their functions and the fact they do their thing hidden deep within our bodies.

But all this is set to change over the next decade or so. We caught up with Tim Spector MB MSc MD FRCP, Professor of Genetic Epidemiology and Director of the Twins UK Registry at Kings College London, to talk about his newest research venture – Map My Gut (MMG). Tim Spector, as his biog on MMG indicates, “…has published over 800 research articles and is ranked as being in the top 1% of the world’s most cited scientists by Thomson-Reuters.”

Map My Gut (MMG) is a unique offering in the UK that uses the latest genetic sequencing technology to provide a personalised analysis of an individual’s gut bacteria, together with information on how these bacteria associate with health and disease. It promises to open a whole new door to personalised medicine by utilising simple, manageable diet and lifestyle interventions to transform health outcomes.

Our amazing gut microbiome

Research into the gut microbiome has ramped up over the past few years as its importance for our health has become more widely recognised and understood by the mainstream. Preceding Professor Spector’s MMG project were the Human Microbiome Project and the European MetaHIT project. Alongside a growing body of research, this research has revealed that an extensive diversity of species inhabit in our guts — our microbiome — and it’s fuelled an appetite for more knowledge and understanding of the unique role they play in our lives.

Some of the more mind-blowing facts revealed are that our gastrointestinal tract alone is inhabited with 10¹³–10¹⁴ microorganisms, around 10 times more than the number of human cells in our bodies and 150 times as many genes as found in our human genome. As an adult, we’re estimated to be carrying around more than 1,000 species, but possibly as many as 40,000, from more than 7000 different strains. Having said that, even more fascinating is that the communities of microbes we host vary from person to person and even twin to twin — the subject of one of the research areas in Professor Spector’s Twin’s UK project.

We are pulling off genomic feats in our bodies every day that allow life to occur as we know it. In his New York Times article, John Rinn describes this as, “…Genomic origami. In every cell, you have the same piece of paper. How you fold that paper determines if you get a paper airplane or a duck. It’s the shape that you fold it into that matters. This has to be the 3D code of biology”. If you understand that the piece of paper is our genetic inheritance, how the ‘paper is folded’ is dictated by our nutrition, lifestyle, environment — and our microbiome, made up of our gut bacteria and other symbiotic microorganisms.

Of particular note is that gut microorganisms use plant compounds (vegetables and fruit) that we eat to regulate a wide range of critical functions including our appetites, our immune systems, our brain function and the way we store and use energy. They also have a lot more to say about what drives our needs and desires i.e. what we eat, our relationships and our social interactions, than we typically give them credit for. Even our energy generating organelles within cells, the mitochondria, have evolved from bacteria and still contain genetic remnants.

This is where the rubber meets the road in terms of our health. Plant compounds refer to the probiotic and prebiotic foods and ingredients that support the health of our gut microbiome, yet – courtesy of the EU Nutrition and Health Claims Regulation (NHCR) – throughout the EU, these well understood terms are banned when linked to commercial products. The irony for consumers is that they’re still allowed to exist if used in a generic, educational or research context. Far from freeing the public from misinformation, consumers are faced with confusion. The probiotics they know are good for their gut bacteria are no longer mentioned on product labels. Instead they’re now confronted with ambiguous terms like bacteria and microorganisms which, frankly, could just have well been harvested from a toilet’s S-bend.

Health claims 101

The EU has one of the most draconian and restrictive legislative templates for natural health the world has seen. Far and away one of the greatest infringements to an individual’s health sovereignty and freedom of speech is the NHCR (Reg. No. 1924/2006). The NHCR requires any health benefit or nutrition claim to be ‘authorised’ by the European Food Safety Authority (EFSA) before it is allowed to exist on the list of allowable Article 13 claims for food and food ingredients, which also covers food supplements.

Since the full implementation of NHCR in July 2007, the terms ‘probiotic’ and ‘prebiotic’ in commercial presentations have been effectively banned in the EU. Regulators sometime like to say they’re not banned, they’re just ‘non-authorised’, meaning if you could authorise them they’d no longer be banned. In practice, there’s not much incentive to try to ‘unban’ them when no one has yet been successful with a single probiotic application. Note the use of the word commercial. NHCR only applies to the marketing of products for commercial sale/gain.

To labour the point over the absurdity of EU law, it’s fine for Professor Spector and others involved in research to shout the term probiotic and prebiotic from the roof tops when they’re talking about generic ingredients and foods they’re using to manipulate the microbiome. But if they were to come up with a commercial food or supplement – they’d no longer be able to use the term.

One of the key stated objectives of NHCR is to ensure that any claim made on a food label in the EU is clear and substantiated by scientific evidence. EFSA’s requirement for the latter requires that there be a demonstrable causal link established from the stated function to the claimed health benefit. Establishing causal links is a tall ask for food ingredients. Given that it took over 30-years for a causal link to be made between tobacco smoking and cancer, it’s no wonder that there are only 259 authorised claims to date. Many of those are for vitamins and minerals whose health benefits were unequivocally established by the pharmaceutical companies early in the 20th century. To put things in sharp perspective, there were over 44,000 health claims submitted from the European Member States back in 2006 when the NHCR process started. A shift in the goal posts 6 months after the submission date closed swept the majority off the table, leaving us in the current position with 2,050 rejected claims and only 259 authorised. Of the rejected claims, 129 are non-authorised health claims related to the term probiotic and 30 related to the term prebiotic. To date there is still not a single authorised health claim for either of these terms in Europe.

Mapping our guts

Professor Spector is a highly regarded scientist in the UK with a fascination for all things ‘omic’, including the working of our microbiome and the ‘superbugs’ (not the nasty MRSA and C dif type) that live there. Through his work with the Twins Registry and the British Gut Project (in conjunction with the American Gut Project), he’s mapped the gut ecology of thousands of twins and now knows a thing or two about the effect of individual dietary choices on the gut microbiome. Because this is such a modifiable area with extensive and powerful implications for health, he promotes the use of probiotic and prebiotic foods and supplements to alter the diversity of the gut microbiome and promote improved health. It’s a pity that EFSA don’t have him on their panel that has so far rejected 100% of health claim applications for probiotics (yes, all 129 of them). Although, if you live in the EU, you might find it harder to identify those probiotic and prebiotic products in the shops now the NHCR has forced the terms off the labels.

Professor Spector’s passion for this area of study is evident in the way he talks about the many unexpected discoveries along the way — all of which helps to further understand the variations and complexity of the gut microbiome. This, in turn, will help him and his team develop a better understanding of individual health concerns and the confidence to tailor dietary and lifestyle advice to change specific microbial colonies and therefore, change health status. In talking with us, Tim Spector was keen to stress that by changing what we eat and including probiotic and prebiotic foods, and supplements where appropriate, we can directly influence the microbes in our gut. Did you hear that EFSA?

Tim Spector and his team at Map My Gut will be looking at the gut microbiome of healthy (symptom-free) people by carrying out colonoscopies, which will take 18 different biopsies from different parts of the gut (upper intestine, upper and lower colon) on 200 pairs of healthy twins. The results of these investigations will be compared with people with a range of conditions (e.g. allergies, diabetes, depression and anxiety, autoimmune conditions, colitis, IBS, autism, obesity and fertility issues) to see what differences there are and to consider how the use of dietary changes including pre and probiotic foods and supplements can influence changes that improve health.

A bright microbial future

Spector’s mission is to create the world’s most complete database of microbial data with species-specific probiotic/prebiotic interventions delivered via the diet, coupled with targeted lifestyle choices, in order to change the microbiome and therefore, an individual’s health outcome.

Current testing of the gut microbiome focuses on pathogens and poor gut health, whereas the MMG tests, Metagenome in particular, map the whole microbiome and look at both beneficial and pathogenic microbes. The MMG team would like the test to become part of conventional medicine’s standard health tests and included as routine in annual health screening.

The Map My Gut website is currently in beta-testing, but if you are a member of the public that would like your gut microbiome mapped or a health professional interested in affiliating, then sign up to be kept informed.

Those of us in the UK, with the prospect of Brexit on the horizon, find ourselves uniquely poised to be able to undo some of the more restrictive and defunct EU laws (such as NHCR) to restore our right to health sovereignty and the freedom to choose the best healthcare.

Taking care of your gut

1. Familiarise yourself with the ANH-Intl Food4Health guidelines and compare your current diet. Healthy gut bacteria need plenty of fibre from vegetables and a small amount of fruit. They require both soluble (e.g. oats, nuts, apples, berries) and insoluble fibre (e.g. vegetable and fruit skins, vegetable stalks, rice, legumes, flax seed, root veggies). Avoid processed and chemically laden foods and stick to whole, unprocessed foods that don’t need a laundry list of ingredients on the label.

2. Include probiotic foods in your diet like properly fermented sauerkraut, kimchi, kombucha, kefir and yoghurt (unless you’re dairy intolerant). Olives are also a gut-loving food if you search out the traditionally fermented ones in brine.

3. Make sure you move frequently during the day. Exercise is not just about donning your lycra and hitting the gym, it’s important to keep active all day and avoid long periods of sitting. Keeping active can stimulate species diversity in gut flora, support digestion and reverse gut flora changes associated with obesity.

4. Rest is essential, not just to renew your cells, but for your gut flora too. Lack of sleep paired with a poor diet are strong contributory factors to obesity.

5. Be aware of the amount of alcohol you drink as excessive amounts can can contribute to gut inflammation and damage to the gut flora.

6. If you’re suffering with persistent gut distress visit a nutritional practitioner and/or register for a test from Map My Gut. Healthcare professionals can register as an affiliate by emailing the team at MMG ([email protected]).

7. If you’re in the UK, write to your MP to demand that he/she pushes for reform of the restrictive Nutrition and Health Claims Regulation before it is absorbed wholesale into UK law.