I love to start the New Year reading or watching information from someone whose ideas I trust and respect. One of those people is Michael Pollan. Lucky for me, his In Defense of Food manifesto was made into a documentary for PBS that aired on December 29. Lucky for you, you can still watch it on PBS.org. But you have to hurry because it will only be available until January 28.

One of the striking sections of Pollan’s documentary focused on the bacteria that live in our guts. It turns out the food we eat has a significant impact on the bacteria in our guts, which in turn have a significant impact on our health.

But let’s back things up a bit before we get into that.

Medical science has known for a long time that a healthy balance of bacteria in our guts – our microbiota - plays an important role in health. For example, Clostridium difficile infection results when the normal flora, or bacteria, in our intestines is severely disturbed by antibiotic use. Basically, many antibiotics don’t just target the bad guys, they target all bacteria. When the healthy bacteria are killed, it leaves an opening for bad actors like C. difficile to gain a foothold.

Doctors and nurses who care for hospitalized patients on antibiotics dread this complication. It is notoriously difficult to treat. It is resistant to many antibiotics aimed at treating it. It recurs often, is highly contagious and can be deadly.

Because of this, researchers are working hard and getting creative trying to treat C. difficile infection. One such creative treatment is a fecal microbiota transplant (FMT). The feces from a healthy individual is transplanted (often by way of colonoscopy) into the gut of the patient afflicted with C. difficile. I’m not kidding. The hope is that the healthy bacteria in the transplanted poop will grow and crowd out the C. difficile. The results have been promising, and we’ve learned some surprising things along the way.

One particular case study in Open Forum Infectious Diseases from 2014 described a patient who had C. difficile infection and received a FMT from her healthy but overweight teenage daughter. The patient recovered from the C. difficile infection, but she gained weight in a dramatic manner and remained obese at the time the case report was published. Previous studies on animals show this relationship between gut bacteria and weight.

I think we can all agree that, regardless of the ick factor, that’s pretty amazing.

But here’s where I become concerned. An editorial about this case report ended with this quote, “Ultimately, of course, it is hoped that FMT studies will lead to identification of defined mixtures of beneficial bacteria that can be cultured, manufactured, and administered to improve human health.”

What bothers me is that the quote doesn’t say, “Ultimately, of course, it is hoped that FMT studies will lead to the identification of the components of a healthy microbiota and how to prevent its disruption.” Not that there is anything wrong with using it for a treatment, but shouldn’t our first thought be, “A healthy gut is important, so how do we maintain it?”

Immediately I think of low T clinics – the freestanding clinics that dole out testosterone to men who want to maintain their youthful vigor. Since 50 percent of the population is men, who presumably age and become less vigorous over time, these clinics have become a highly profitable industry. Physicians in fields unrelated to endocrinology or sexual health are making the move to the testosterone clinics to join the cash party.

You see where I’m going, right? Fecal transplant clinics. Think about it. In a country with two thirds of the population classified as overweight, one-third as obese, and a 20 billion dollar weight loss industry, this is a serious cash cow.

Honestly, as much as the clinics are a bad idea, I hope to see a few pop up just so we can be entertained by the clever names they are sure to carry.

Of course, there is still a lot we don’t know about FMT. We don’t know if it works on a large scale. We don’t know if there are serious complications – one small study showed a significant number of autoimmune issues after the transplant, so it really could be dangerous. The FDA is requiring the FMT go through the approval process for the treatment of C. difficile, so we’ve got a long time to wait for it. But if it is approved for that, doctors can use it off label.

But what does that mean for you and me? We just want to lose a few pounds and fit into our favorite jeans. We don’t want a fecal transplant, and probably wouldn’t get one if we could.

Now let’s circle back to the Michael Pollan documentary. lt featured a study of African Americans who ate the typical western diet and Africans in Africa who continue to eat an ancestral diet based on high fiber plants. Taking these two groups and changing their diets also changed their gut flora…within two weeks. The Americans started showing substances in their feces that indicated healthier gut flora. The Africans started showing substances associated with chronic disease like Type 2 Diabetes.

It’s a short study. We don’t know the long-term implications. We don’t know if changes in the gut flora from diet will spur weight loss or help prevent long-term chronic diseases. But think about it from an evolutionary perspective. Humans didn’t evolve and then get colonized by bacteria. The bacteria were here first. We evolved around them. It makes sense that our health relies on the their health. So why wouldn’t we want to eat in a way that keeps that bacteria balanced and thriving?

And what is that way? Well, I really want you to go watch the show, but Pollan sums it up nicely with his mantra - Eat food. Not too much. Mostly plants. It really does always come back to common sense.

Amy Rogers MD is not a practicing physician and nothing written here should be taken as medical advice from either Amy or AssetBuilder. Medical decisions should be made with care in consultation with your health care provider.