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I. Probiotics

Global Impact of Pre and Probiotics

Factors impacting the problem of antibiotic resistance

"We began the antibiotic era with a full-fledged attack on bacteria.

It was a battle misconceived and on in which we cannot be the winner.

We cannot destroy the microbial world in which we have evolved.

The best solution now is to take a broader view of the microbial world.

While focusing on the pathogens, our efforts should act in ways that impact fewer commensal flora.

We need to forget 'overcome and conquer' and substitute 'peace' when regarding the microbial world.

The commensal organisms are, in fact, our allies in reversing the resistance problem.

As they rebuild their constituencies, they will control the levels of resistance by out-competing resistant strains.

Then, when bacteria or other microbes cause infections, they will be drug susceptible, and we will have the armamentarium to treat them effectively and safely."

- SB Levy. J Antimicro Chemo. 2002;49:25-30.

Probiotics: Definition(WHO, 2002)

  • Living microorganisms
  • Provide a benefit when administered in adequate amounts
  • Non-toxic
  • Food Additive OR Medical Management / Intervention and position of the FDA

Probiotics: "What's in a Name" (John G Thomas PhD)

  • "Bacteriotherapy"
  • "Replacement Therapy"
  • "Competitive Exclusion"
  • "BioTherapeutics"
  • "Therapeutic Microbiology: Probiotics and Related Strategies."
    ASM Press 8/2008. James Versalovic and Michael Wilson.

We Live in a Microbial World (mostly Biofilm) John G Thomas PhD

  1. "We live in a microbial world" was visibly unmasked by the Dutch microscopist Van Leeuwenhoek in 1674, and later correlated with disease by Louis Pasteur in 1864 and Robert Koch's postulates in 1884, emphasizing "one bug one disease". These were the keys for antibiotic selection when penicillin was discovered by Fleming in 1928 and the world was a safer place for exogenous diseases. Unfortunately the panacea of 1960's has resulted in international mutli-drug resistance (MDRO's) in 2000.
  2. Simultaneously , the evolution of the ICU in the 1980's with increased HAI's often associated with IMD's, forced the recognition that microbes exist in two forms: free floating (planktonic) and attached (biofilms) and given the opportunity, 99% of microbes would chose the latter; "to attach is to survive, to free float is to die". Biofilms are a community of multiple species defined by "socio-microbiology" with physiochemical characteristics attributable to "a hydrated polymer" with unique visco-elasticity (elastic properties) and rheology (fluid mechanics ) (defined by the Greeks in 500 BC). In fact, 80% of ICU infections are associated with endogenous biofilms costing the healthcare community $92 billion per year.
  3. The explosion of non-culture techniques, first highlighted by PCR in 1988, has catalyzed a redefinition of our microbial co-ecosystem, invisible partner while highlighting limitations of present laboratory techniques. The human micro-biota has greater cells compared to humans (1012 vs. 1014) and greater gene pool (23,000 vs. 8,000,000) with a weight equal to our brain (4 lbs.). The utilization of Metagenomics (total gene function) has redefined our Normal Flora as "an unstructured organ system" where microbial members follow a microbial clock evolving early in life from commencal to disease association; this "clock" is best defined by "cluster analysis" utilizing phyla profiles rather than individual species.
  4. New understandings require new strategies, recognizing the collateral damage and limitations of antibiotics. Our new management themes recognize: 1) stewardship of the human microbiota while 2) exploiting the genomic strength of its corresponding members. Our goal is to harness the latter while maintaining the former focusing initially on two costly biofilm associated diseases (BAD): VAP/LRI (inpatient) and wounds (outpatient). The former enhances collaboration for dentistry and medicine in the oral-systemic connection while the latter addresses probiotics and a beneficial protective biofilm, a recent innovative concept. Both will be measured by ROI strategies.

II. Aging and Microbial Clock

The Human vs. Bacterial Genomic Libraries

Human Microbes

10^12 Eukaryotic Cells

Human Genomic library

One Book23,000 Genes

25 year generation time

10^14 Prokaryotic Cells

Bacterial Genomic library

many books8,000,000 Genes

20 second generation time


We live in a metagenomics microbial clock

Aged Care
Nursing Homes




Mother / Newborn

DayCare Center

Cognitive Skills


Microbiota / Mycobiota
Human Cells






Evidenced Based Medicine: F. nucleatum (An Example)

You are not what you eat, but what your bugs eat.

"You are what your bugs eat."
 0-6 Years
 7-18 Years
Not so GOOD
 19-55 Years
 57+ Years


III. Organ Systems: 6 + 1 (Normal Flora)