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The Ultimate Guide to the Microbiome Why Gut Health is Essential

The Ultimate Guide to the Microbiome Why Gut Health is Essential

Contents

The human microbiome is a relatively new, rapidly growing field in medicine and biology

All the novel research findings are exciting, but the task of separating credible research from conjecture is often challenging.

Additionally, overzealous claims from commercial interests also muddy the waters.

Fortunately, many of the new findings are worth exploring, especially for people who are enthusiastic about their health, or who have gastrointestinal or immune health issues.

In this article, we’ll explore the significance of a healthy microbiome, ways to determine your gut health, simple steps to repair your microbiome (or maintain a healthy microbiome), and the best foods and supplements for a healthy gut.

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What is the Microbiome?

The word microbiome comes from prefix micro- meaning “very small” and the English word biome, meaning “ecological community.”

Originally, the word may have referred to the genetic makeup of microbes inhabiting a particular ecosystem or niche, while the word microbiota referred to the microorganisms themselves [1]

Today, though, scientists use the term microbiome to refer to “the microorganisms (bacteria, archaea, lower and higher eukaryotes, and viruses), their genomes (i.e., genes), and the surrounding environmental conditions” [1]

Humans and other animals are hosts to trillions of bacteria and other microorganisms, with most of them residing in the gut or gastrointestinal tract [2]

After the gut, the areas of the human body with the highest number of bacteria are the mouth, skin, genitals, airways, and urinary tract [3]

Your microbiome can contain a mix of helpful and harmful bacteria, but most of them are symbiotic, meaning their relationship with you is mutually beneficial [4]

The frontier of gut microbiome studies is one of the fastest-growing areas of human health research [5]

Keep reading to learn what the latest science says about how your gut bacteria influence your health and wellness.

How the Gut Microbiome Affects Your Overall Health

According to current research, your gut microbiome influences your health, wellness, and disease risk in the following important ways [6]

  1. Immune health and infectious disease risk: A healthy microbiome is essential for a functioning immune system, and disturbances in gut bacteria can increase the risk of infection [7]
  2. Autoimmune conditions: Recent research links problems with the gut microbiome to the development of autoimmune conditions including type 1 diabetes and multiple sclerosis [6] [8]
  3. Brain health and cognitive function: A network of neuroendocrine, neural, and neuroimmune signalling pathways exists by which the brain and gut communicate. [9] Although the mechanisms aren’t yet well-understood, research strongly suggests the microbiome regulates human cognition and behavior [] [9]
  4. Psychological wellbeing and depression risk: The microbiome can modulate (change) the production of neurotransmitters including dopamine and serotonin [10] . Evidence for microbiome involvement in neuropsychiatric disorders, especially depression, is growing [6]
  5. Metabolism, obesity, and type 2 diabetes: The effects of diet quality on the composition of the microbiome appear to account, at least partially, for the growing rates of obesity and type 2 diabetes [6]
  6. Inflammation, gout, and rheumatoid arthritis: Gut microbiome changes appear to precede chronic inflammatory diseases including rheumatoid arthritis and gout, and their prevention may be possible by addressing imbalances in gut bacteria [6]
  7. Cardiovascular health and hypertension: Gut microbiome composition is associated with markers of atherosclerosis and arterial stiffness, and early evidence suggests that microbiome changes could be the cause of sodium-sensitive hypertension [6]
  8. Cancer risk: According to some research, the composition of individuals’ microbiomes may account for upwards of 20% of cancers worldwide [6]
  9. Infant health and early development: Microbiome composition influences infants’ and children’s health including allergies, asthma, inflammatory skin conditions, cognitive development, and more [6]
  10. Aging, longevity, and lifespan: During aging, intestinal microbes shift in composition and function [11] . Chronic inflammation due to gut bacteria imbalances appears to be one cause of age-related degenerative diseases and unhealthy aging [12] . New research reveals that gut microbes can affect the aging process via multiple pathways, and anti-aging microbiome technologies may follow [13]

Keep in mind that the field of microbiome studies is relatively new, and has only become well-established in the past decade [14]

The effects your microbiome has on your overall health are only beginning to be understood, and it is certain that scientists will uncover additional details in the coming decades.

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Understanding a Healthy Gut Microbiome

A healthy microbiome goes beyond what can simplistically be termed as “good” or “bad” bacteria.

As you’re about to discover, some bacteria can be both depending on their circumstances, which is one reason why researchers have established other ways to gauge the health and integrity of an individual’s microbiome.

The latest research suggests bacterial cells in your body outnumber human cells by a ratio of 1.3 to 1, and other microbes like viruses could be ten times more abundant still [15]

The bacteria and other microbes of the gut are extremely diverse. Based on an estimated 1,000 bacterial species in your gut, containing an average of 2,000 genes per species, the 2,000,000 genes in your gut bacteria alone would outnumber your human genes by a factor of 100 [15]

Instead of focusing solely on the presence of particular, individual species of interest, researchers also assess microbiome health in terms of diversity and abundance.

In other words, the number of different species and the total number of members of beneficial species in your gut are also relevant to your health and wellness.

A loss of diversity and abundance relates to many modern diseases including Crohn’s disease, ulcerative colitis, type 1 and type 2 diabetes, multiple sclerosis, celiac disease, allergies, obesity, and cancer [16]

Poor diet quality, Western or “standard American diet,” preservatives in processed foods, the use of antibiotics, and disrupted circadian rhythms are documented factors that can cause the loss of diversity and abundance in your microbiome [16] [17]

The importance of the microbiome for general health is undeniable, but the role of specific species and strains is often much less clear. In the next section, you’ll learn what the best research says about different types of microbes.

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Good Bacteria vs. Bad Bacteria In Your Gut

Researchers refer to an imbalance of gut bacteria or other organisms--resulting from the loss of beneficial species or the gain of harmful species--as dysbiosis, literally meaning “bad or difficult life or way of living” in contrast to symbiosis (a mutually beneficial relationship) [18]

And as we discussed in the previous section, the shifting composition of the microbiome in modern humans appears to be associated with the onset of chronic, inflammatory diseases [18]

But with around a thousand estimated different species of bacteria in your gut, cataloging the pros and cons and specific effects of each species is a monumental task.

The majority of published analyses so far rely on statistical modeling to draw correlations from case-control studies, which compare the microbiome of people with a specific disease to those without it [19]

Some scientists have criticized current perspectives on gut bacteria and health as being circular and observational, rather than borne out in experimental studies [19] . And up to two-thirds of bacterial species remain uncultured [20]

To make matters even more complicated, current research shows that the microbiome varies geographically and seasonally among hunter-gatherers, which makes the concept of a “healthy” microbiome even harder to define in modern humans [19]

Nonetheless, the following phyla, genera, and individual species are the ones with the strongest evidence for being beneficial or harmful for modern people living in industrialized societies.

And as you’ll see, in some cases a particular species of bacteria or archaea may be beneficial in certain situations, yet appear to be harmful in others.

Bacteroidetes

Bacteroidetes is a diverse phylum of bacteria found in every type of habitat on earth.

This phylum is Gram-negative, meaning their cell walls consist of a very thin layer of peptidoglycan (a polymer substance made of sugars and amino acids) and an outer membrane with a polysaccharide component (large molecules consisting of a lipid and a polysaccharide bound together).

They are a major component of animals’ gastrointestinal microbiome, and appear to function as specialists in breaking down proteins and polysaccharide carbohydrates [21]

Species from Bacteroidetes living in the large intestine ferment complex carbohydrates that are resistant to digestive enzymes and would otherwise reach the colon intact.

The end-products of Bacteroidetes fermentation are short-chain fatty acids (SCFAs) including butyrate, propionate, and acetate.

SCFAs represent an additional 7-10% of daily energy available to humans, and some of them have antiinflammatory effects and help support gut health [22]

Studies have reported a decrease in Bacteroides species abundance in irritable bowel syndrome (IBS), ulcerative colitis, rheumatoid arthritis, and depression [20] [23] [24]

On the other hand, elevated Bacteroidetes levels are linked to weight gain in obesity and during pregnancy [25] [26]

And elevated levels of Prevotella sp., a genus belonging to the Bacteroidetes phylum, have been found in inflammatory bowel disease (IBD) and type 2 diabetes [27] [28]

Firmicutes

Alongside the Bacteroidetes phylum, the Gram-positive Firmicutes phylum represents the vast majority of the bacterial population in the gut microbiome [22]

Compared to Gram-negative bacteria, Gram-positive bacteria like Firmicutes have a thicker cell wall structur made of peptidoglycan.

Similar to Bacteroidetes, some members of the Firmicutes phylum play a role in the fermentation of otherwise indigestible carbohydrates in the gut, resulting in production of short-chain fatty acids like butyrate [22]

Animal experiments and observation of human subjects suggest that Firmicutes abundance has a relationship to obesity, and that higher abundance increases fatty acid absorption, energy efficiency, and harvesting [29]

Some microbes from the Firmicutes phylum may modify lipolysis and other physiological activities of hosts, resulting in a reduced rate of fatty acid oxidation (fat-burning) [30]

Butyrivibro crossotus, a member of Firmicutes, does not appear to correlate with any disorders, and its abundance may help protect against weight gain and obesity [31]

Lactobacillus spp. are well-known symbiotic species with a decades-long history of use in probiotic treatments. They aid digestion and vitamin absorption and help prevent diarrhea, IBS, and overgrowth of pathogens [32]

Conversely, Clostridium difficile infection results in diarrhea. Research points to a link between antibiotic overuse in humans and animals and a resulting overabundance of C. difficile [33]

Proteobacteria

Proteobacteria is a phylum of gram-negative bacteria that includes pathogens, symbiotic bacteria, and freeliving organisms.

Many species from Proteobacteria play a critical environmental role in nitrogen fixing, which makes nitrogen from the atmosphere available to plants.

The presence of Proteobacteria appears necessary for normal function of a healthy gut microbiome, but some species are associated with inflammatory conditions [34]

For example, Desulfovibrio piger and Escherichia coli both exist as symbiotic strains, but increased abundance or an imbalance of either is associated with increased risk of IBD and IBS [27] [35] [36] [37]

Heliobacter pylori, another member of Proteobacteria, is what is known as an amphibians--an organism that can have either a pathogenic or symbiotic relationship with the host depending on context.

The presence of H. pylori is associated with various diseases: peptic ulcer disease, gastric mucosa-associated lymphoid tissue tumors, and gastric adenocarcinoma [38] [39]

However, it’s also associated with decreased incidence of reflux esophagitis and childhood-onset asthma [40]

Fusobacteria

Like Proteobacteria, members of Fusobacteria are Gram-negative bacteria that appear to act in pathogenic as well as symbiotic roles.

Unlike Proteobacteria, Fusobactera are exclusively anaerobic.

Although they are commonly found in the human gastrointestinal tract, some species like F. nucleatum are linked with IBD, chronic gut inflammation, and increased cancer activity [41]

F. nucleatum is also linked with periodontitis and appendicitis [42]

Cyanobacteria and Melainabacteria

Cyanobacteria are a phylum of Gram-negative bacteria that produces energy via photosynthesis. They are the only photosynthetic prokaryotic organisms that can produce oxygen [43]

While many members of Cyanobacteria produce toxins, other members play key ecological roles in producing fatty acids, amino acids, antioxidants, vitamins, and minerals [44]

Organisms from the phylum Melainabacteria, which evolved from Cyanobacteria, are found in the human gut alongside Cyanobacteria species and synthesize K and B vitamins including B2, B3, B7, and B9 [45]

Verrucomicrobia

Verrucomicrobia are a phylum of tiny, wart-shaped Gram-negative bacteria commonly found in freshwater and soil.

To date, one member of Verrucomicrobia, Akkermansia muciniphila, has been identified and isolated and identified in the human gut.

Some researchers consider A. muciniphila to be a marker species of a healthy gut due to its anti-inflammatory and immunostimulant properties, as well as its ability to improve gut barrier function and protect against obesity, insulin resistance, and colon cancer [46]

Euryarchaeota

Archaea are a domain of single-celled prokaryotic (lacking nucleo) organisms that resemble bacteria, but possess distinguishing characteristics like different cell wall structures and methane production.

Three distinct species of Euryarchaeota have been detected in the human body to date: Methanobrevibacter smithii, M. stadtmanae, and M. oralis [47]

These methane-producing bacteria use hydrogen (H2) to reduce Carbon Dioxide (CO2) and methane for their metabolism.

As part of the normal human diet, proteins and carbohydrates enter the gut. During the metabolism and fermentation of these macronutrients, abundant amounts of H2 gas are created.

Under normal conditions, elevated levels of H2 inhibit bacterial fermentation, but archaea like M. smithii consume H2 and support the fermentation activity of other microbes [48] [49] [50]

However, elevated levels of methanogenic archaea are linked with increased levels of mono-, di-, and trimethylamine, which may increase the risk of cardiovascular disease [51]

Other potential disease states linked with high levels of methanogenic organisms and methane production include colorectal cancer, obesity, anorexia, IBD, and IBS [52]

About Microbiome Testing or Sequencing (And When to Get It)

Until a few years ago, having your microbiome tested was only possible if you participated in a study or your doctor requested a stool sample analysis looking for specific pathogenic microbes.

But personal microbiome sequencing and testing using the same technology found in studies and medical labs is now available commercially.

Microbiome testing requires a stool sample, which is then sequenced using microbial DNA and analyzed for its bacterial content, diversity, abundance and metabolites.

The most common sequencing method relies on characterization of the 16S rRNA gene, which is present in all bacteria . 16S refers to Svedberg units, a measure of sedimentation rate (how rapidly the ribosomal subunits sink when passed through a centrifuge, which relates to their size [1] )

You can think of 16S rRNA genes as a “DNA barcode.” Mutations and other variations in bacterial 16S rRNA genes allow for efficient identification of species, as well as establishing taxonomic diversity.

Another less common but more accurate technique, whole genome sequencing, has been shown to detect and amplify more genera of bacteria, archaea, viruses, and eukaryota compared to 16S sequencing [54]

Once either type of test analysis is complete, buyers receive a customized report, usually with recommendations included.

Companies like Viome, BIOHM, Psomagen, and others claim their personalized diet plans and other advice can help users lose weight, improve gut health, and more--all based on the unique contents of each individual’s microbiome.

Unfortunately, there is no peer-reviewed evidence in support of individualized diet or supplement recommendations based on microbiome at this time.

And as you probably noticed in the preceding section, the line between “good” and “bad” species of bacteria is blurry at best. Oftentimes, an individual species can have desirable or undesirable associations depending on other factors.

That’s not to say the idea has no merit, but rather that the insights of microbiome sequencing are in their very early stages, and it would be premature to draw conclusions about current personalized recommendations, especially without high-quality evidence.

It also doesn’t mean that microbiome testing is a waste of money. Individuals who enjoy trying out new technologies may find it worthwhile, and it could potentially provide valuable information for people with severe gut issues who have exhausted other treatment options.

But commercial microbiome testing or sequencing is not a requirement to improve your gut health or ensure you maintain a healthy microbiome.

You should speak to your doctor if you have severe health problems that you think may be linked to gut health.

He or she can help rule out other, unrelated causes, and may order specific tests based on your medical history (such as use of antibiotics or other drugs).

As we’ll cover in a moment, even if you’re dealing with gastrointestinal problems, you can take steps today to repair your microbiome without paying for a commercial test.

5 Steps to Repair Your Microbiome and Gut

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The basic, foundational steps for improving or maintaining your gut health are the same regardless of whether your gut health is excellent, fair, or poor.

That said, your current health status can help determine the best approach.

For instance, if you’re free of diseases and symptoms, you might prefer to make gradual changes to realize the best results possible as conveniently as possible over time.

Or if you’ve got Crohn’s disease, IBD, antibiotic-associated diarrhea, or another condition, you might be desperate, and could dive into a gut health protocol geared towards the fastest possible relief.

It’s also possible that you’ve been dealing with a gut condition for a long time, in which case your best bet could be to troubleshoot each possible factor one at a time.

In any case, here are the steps you’ll need to take for better gut health.

1. Eliminate These Causes of Poor Gut Health

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For most people, eliminating causes of poor gut health is the best place to start.

Taking probiotics and other supplements for gut health is less likely to be effective if you’re still consuming harmful foods and being exposed to other influences that detract from gut health.

According to research, these are the most common and significant causes of poor gut health to avoid:

  • Packaged, processed foods with a poor nutritional profile and long shelf-life, including soft drinks and sweet and savory snacks [55]
  • Acellular nutrients, which are nutrients that are freed by processing or added to food and not found in their natural form (inside of cells as part of whole food) and can contribute to growth ofharmful gut bacteria [55]
  • Other unnatural food additives, including preservatives, emulsifiers, and artificial sweeteners [55]
  • Antibiotics and other drugs shown to alter microbiome composition, which according to one recent survey include proton pump inhibitors, laxatives, and metformin [56] . (Another analysis of 1,000 prescription drugs found that 24% of drugs, including psychotropic medication, can affect microbiome composition [57] ).

Once you’re avoiding causes of poor gut health to the greatest extent possible, the next step is to focus on a diet and lifestyle that support a healthy microbiome.

2. Eat a Healthy, Microbiome-Friendly Diet

As is the case with microbiome studies as a whole, research into the influence of specific foods and diets on microbiome health is relatively new [58]

Along with eliminating food additives and other artificial ingredients, the foundation of a microbiome-friendly diet seems to be eating as many fresh, whole foods as possible [58]

Carbohydrates, fiber and prebiotics, high-quality protein, and healthy fats are all essential for a healthy microbiome [58]

Micronutrients, phytonutrients from plants, and antioxidants also play a role in shaping the microbiome and regulating health through related mechanisms [58]

The best sources of the above nutrients are minimally-processed whole foods. For the most part, dietary supplements that provide acellular nutrients in non-naturally-occurring forms have the potential to disrupt the microbiome balance by feeding pathogenic bacteria [55]

Probiotic and fermented foods, especially homemade and traditional varieties, are also helpful in supporting gut health [59] . You’ll learn more about those in the next section, “The 9 Best Foods for a Healthy Microbiome.”

So far, no particular eating pattern has been proven to be more effective than other healthy diet types for gut health or microbiome support.

Vegetarian, vegan, ketogenic, gluten-free diet, low-FODMAP, and the Mediterranean diet all show distinct, unique effects on microbiome composition [58]

If you’re troubleshooting a chronic gut health issue, you should definitely experiment with different ways of eating to see which one provides the most relief from symptoms.

Otherwise, you can choose any healthy diet that fits your preferences, as long as it primarily consists of fresh, unprocessed or minimally-processed whole foods.

Last but not least, food quality also matters. Organic produce appears to have greater microbial diversity compared to non-organic, and similarly, wild-caught, pastured, or grass-fed animal products are less likely to contain pesticides and other toxins and may be more nutrient-dense [60] [61]

3. Live a Lifestyle That Supports a Healthy Microbiome

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Beyond your dietary choices, your living environment and lifestyle have significant effects on the composition and balance of your microbiome.

Here are the factors that current research suggests can make a positive difference:

  • Effective stress management may help prevent microbiome disruption [62]
  • Minimizing exposure to man-made chemicals and toxins at home and at work supports a healthy microbiome. Chemicals to avoid include heavy metals, pesticides and other pollutants, and antimicrobial cleaning agents [63]
  • Skincare and cosmetics are another area to consider chemical exposure, with the average person being exposed to about 126 unique chemicals with unknown microbiome effects from personal care products each day according to a 2004 study from the Environmental Working Group (EWG) [64]
  • Breathing fresh, unpolluted air may result in a healthier microbiome [65]
  • Increasing direct exposure to natural environments like soil or forests, and spending more overall time in nature, can increase microbiome health and diversity [66]
  • Maximizing exposure to daytime natural light, minimizing exposure to artificial lights (especially at night), and minimizing exposure to electromagnetic fields (EMFs) from home electricity and cell phones could support a healthy microbiome [67] [68] [69]
  • Getting plenty of sleep and maintaining a healthy, consistent twenty-four-hour schedule (circadian rhythm) may benefit microbiome composition and function [68] [70] [71]

As you can see, lifestyle factors can be a major factor in achieving or maintaining a healthy gut and a balanced, properly-functioning microbiome.

4. Use Targeted Supplements to Rebalance Your Microbiome and Repair Your Gut

Not everyone needs to use supplements for microbiome repair and gut health. For people who don’t have existing gut issues or symptoms, they probably aren’t worth the cost.

If you do decide to use them, make sure you understand the purpose and function of each one, and don’t assume that the statements from the manufacturer are correct. In most countries, dietary supplement makers can make health-related claims with little or no evidence

The basic categories of gut health supplements you may want to consider are digestive aids and enzymes, supplements that support a healthy epithelium or gut barrier, prebiotics to feed “good” bacteria, probiotics to augment your microbiome and reduce inflammation, and supplements that safely aid the elimination of gastrointestinal parasites and opportunistic bacteria.

We’ll cover more supplement details in an upcoming section.

5. Consider Fecal Microbiota Transplantation, Bacteriotherapy, and Other Measures

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If nothing else works, you can consider cutting-edge therapies for your microbiome.

One such therapy that is backed by clinical evidence is fecal microbiota transplantation, which uses fecal matter with intact microbes from a healthy donor to repopulate and restore a healthy microbiome to the recipient [72] . The method of delivery is either through an upper gastrointestinal delivery route (such as a feeding tube) or rectally.

Other forms of bacteriotherapy and fecal transplantation involve treating an active infection with antibiotics prior to restoring the microbiome balance with donor microbes.

However, you should approach fecal transplantation with caution, and avoid attempting it without professional supervision.

In at least one case documented in the New England Journal of Medicine, a mistake resulted in the death o the recipient due to pathogenic E. coli bacteria [73]

Other fatalities have occurred from problems like complications during sedation or possibly-unrelated infections [74]

The 9 Best Foods for a Healthy Microbiome

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In many ways, the best foods for a healthy microbiome resemble those found in a primal or Paleo-style diet

Here’s what to eat to support a healthy microbiome:

  1. Probiotic fermented foods, especially homemade fermented foods or traditional probiotic foods like kefir, yoghurt, kombucha, and water kefir. Some evidence suggests that eating fermented foods is a more effective route of administration for beneficial bacteria than probiotic supplements [59]
  2. Berries and other fruits high in prebiotic soluble fiber and polyphenol antioxidants and relatively low in fructose [75]
  3. Colorful yellow, orange, and red fruits and vegetables, which are high in the antioxidant vitamins called carotenoids that support a balanced microbiome [58]
  4. Leafy greens and other vegetables that are nutrient-dense and high in prebiotic soluble fiber [76]
  5. Extra virgin olive oil, which is an excellent source of the monounsaturated fatty acid oleic acid and is high in anti-inflammatory phenolic antioxidant compounds [58]
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  1. Fatty fish and shellfish high in anti-inflammatory omega-3 polyunsaturated fatty acids, which may be able to restore the Firmicutes/Bacteroidetes ratio and increase production of short-chain fatty acids [58]
  2. Food sources of conjugated linoleic acid (CLA, a polyunsaturated fatty acid), which include grass-fed ruminant animal products such as beef, lamb, butter, and other full-fat dairy products [58]
  3. Beef, calf, chicken, duck, or goose liver and other organ meats for their incredibly high content of fat-soluble vitamins in the natural, cellular form [77]
  4. Complete vegan or vegetarian proteins such as pea protein or whey protein, as well as highquality grass-fed or pastured animal proteins [58]

As we already discussed, you should avoid highly-processed foods altogether

And even some natural foods, such as wheat or other grains, contain irritants and antinutrients that may impai gut barrier function or affect digestion [78]

The Top 13 Supplements for Restoring Gut Health

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As mentioned in the previous section entitled “5 Steps to Repair Your Microbiome and Gut,” most people don’t require supplements for a healthy microbiome.

If you think you may benefit from supplementation, these are the best supplements to consider for restorin your gut health:

  1. An ultra-high-quality freeze-dried cold storage probiotic like VSL #3 for short-term usage
  2. Prebiotics like MegaPreBiotic, Biome Bliss, or Ultimate Fibre taken together with probiotics
  3. Grass-fed hydrolyzed collagen and vitamin C to restore tight junctions in the gut [79] [80]
  4. Curcumin or turmeric powder to decrease inflammation [] [81]
  5. High-quality L-glutamine to aid in immune function and cellular repair [82]
  6. Sodium butyrate or calcium magnesium butyrate to reduce inflammation and support an abundant population of healthy bacteria [83]
  7. Ginger powder or ginger extract for easier digestion and relief of symptoms like nausea and possible increase of bile release [84] [85]
  8. Digestive enzymes (protease, lipase, amylase, and others) to assist with food digestion if necessary
  9. An immunoglobulin-based supplement designed to neutralize environmental toxins and rebuild protective intestinal barriers [86] [87]
  10. Salts of D-glucaric acid to decrease viability of pathogenic bacteria and assist the excretion of toxic compounds [88] [89]
  11. Colostrum or lactoferrin if required to combat opportunistic bacteria and as an anti-biofilm agent [90]
  12. Peppermint oil or oil of oregano if needed as a broad spectrum antimicrobial, taken separately from probiotics [91]
  13. Low doses of activated charcoal to bind endotoxins if you experience a severe Herxheimer or “detox” reaction [92] . Consult the label recommendations, limit your doses, and take away from meals.

Remember that supplements are secondary to the core practices of eliminating causes of poor gut health, eating a diet that supports a healthy microbiome, and living a lifestyle that’s conducive to a healthy population of microbiota.

Conclusion: The Importance of a Thriving Microbiome

Microbiome research is exciting, but still very new. As you pay attention to what the latest research reveals, keep in mind that most findings are inconclusive and experimental evidence is currently lacking.

And still, even the best research paints a picture that can be confusing, with all phyla and even some species playing “good” and “bad” roles for gut health in different contexts.

Fortunately, the science behind establishing or maintaining a healthy microbiome is relatively clear

Microbiome testing may be interesting or useful in some cases, but it’s by no means a requirement to achieve a healthy gut.

Instead, begin by removing causes of poor gut health from your life, then prioritize a healthy, whole-foodsbased diet with plenty of nutrient dense and probiotic foods.

A healthy lifestyle is another important yet easily overlooked requirement for a balanced microbiome.

Finally, if you have severe, pervasive symptoms of a disrupted microbiome that do not respond to basic measures, you may wish to resort to supplements or advanced procedures like a medically-supervised fecal microbiota transplant

Microbiome Guide References 1. Marchesi JR, Ravel J. The vocabulary of microbiome research: a proposal. Microbiome. 2015;3:31. Published 2015 Jul 30. doi:10.1186/s40168-015-0094-5

2. Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the human microbiome. Nutr Rev. 2012;70 Suppl 1(Suppl 1):S38-S44. doi:10.1111/j.1753-4887.2012.00493.x

3. Ma Zhanshan, Li Lianwei, Li Wendy, Assessing and Interpreting the Within-Body Biogeography of Human Microbiome Diversity, Frontiers in Microbiology, 2018 , DOI=10.3389/fmicb.2018.0161

4. Chow J, Lee SM, Shen Y, Khosravi A, Mazmanian SK. Host-bacterial symbiosis in health and disease. Adv Immunol. 2010;107:243-274. doi:10.1016/B978-0-12-381300-8.00008-3

5. NIH Human Microbiome Portfolio Analysis Team., Proctor, L., LoTempio, J. et al. A review of 10 years of human microbiome research activities at the US National Institutes of Health, Fiscal Years 2007- 2016. Microbiome 7, 31 (2019). https://doi.org/10.1186/s40168-019-0620-y

6. Rui-xue Ding, Wei-Rui Goh, Ri-na Wu, Xi-qing Yue, Xue Luo, Wei Wei Thwe Khine, Jun-rui Wu, Yuan- Kun Lee, Revisit gut microbiota and its impact on human health and disease, Journal of Food and Drug Analysis, Volume 27, Issue 3, 2019, https://doi.org/10.1016/j.jfda.2018.12.012.

7. Harris VC, Haak BW, Boele van Hensbroek M, Wiersinga WJ. The Intestinal Microbiome in Infectious Diseases: The Clinical Relevance of a Rapidly Emerging Field. Open Forum Infect Dis. 2017;4(3):ofx144. Published 2017 Jul 8. doi:10.1093/ofid/ofx144

8. Rui-xue Ding, Wei-Rui Goh, Ri-na Wu, Xi-qing Yue, Xue Luo, Wei Wei Thwe Khine, Jun-rui Wu, Yuan- Kun Lee, Revisit gut microbiota and its impact on human health and disease, Journal of Food and Drug Analysis, 2019, https://doi.org/10.1016/j.jfda.2018.12.012.

9. Kirby TO, Ochoa-Repáraz J. The Gut Microbiome in Multiple Sclerosis: A Potential Therapeutic Avenue. Med Sci (Basel). 2018;6(3):69. Published 2018 Aug 24. doi:10.3390/medsci6030069

10. Strandwitz P. Neurotransmitter modulation by the gut microbiota. Brain Res. 2018;1693(Pt B):128-133. doi:10.1016/j.brainres.2018.03.015

11. Seidel J, Valenzano DR. The role of the gut microbiome during host ageing. F1000Res. 2018;7:F1000 Faculty Rev-1086. Published 2018 Jul 16. doi:10.12688/f1000research.15121.1

12. Kim S, Jazwinski S, M: The Gut Microbiota and Healthy Aging: A Mini-Review. Gerontology 2018;64:513-520. doi: 10.1159/000490615

13. Seidel J, Valenzano DR. The role of the gut microbiome during host ageing. F1000Res. 2018;7:F1000 Faculty Rev-1086. Published 2018 Jul 16. doi:10.12688/f1000research.15121.1

14. https://pubmed.ncbi.nlm.nih.gov/?term=microbiome

15. Gilbert JA, Blaser MJ, Caporaso JG, Jansson JK, Lynch SV, Knight R. Current understanding of the human microbiome. Nat Med. 2018;24(4):392-400. doi:10.1038/nm.4517

16. Mosca A, Leclerc M, Hugot JP. Gut Microbiota Diversity and Human Diseases: Should We Reintroduce Key Predators in Our Ecosystem?. Front Microbiol. 2016;7:455. Published 2016 Mar 31. doi:10.3389/ fmicb.2016.00455

17. https://asm.org/Articles/2019/November/Disappearance-of-the-Gut-Microbiota-How-We-May-Be

18. Wilkins, L.J., Monga, M. & Miller, A.W. Defining Dysbiosis for a Cluster of Chronic Diseases. Sci Rep 9, 12918 (2019). https://doi.org/10.1038/s41598-019-49452-y

19. Wilkins, L.J., Monga, M. & Miller, A.W. Defining Dysbiosis for a Cluster of Chronic Diseases. Sci Rep 9, 12918 (2019). https://doi.org/10.1038/s41598-019-49452-y

20. Brüssow, Harald, Problems with the concept of gut microbiota dysbiosis, Microbial Biotechnology, 2020, https://doi.org/10.1111/1751-7915.13479

21. Thomas François, Hehemann Jan-Hendrik, Rebuffet Etienne, Czjzek Mirjam, Michel Gurvan, Environmental and Gut Bacteroidetes: The Food Connection, 2011, 10.3389/fmicb.2011.00093

22. Marx, Tennille, Chapter 35. Immunoprotective Effects of Probiotics in the Elderly DO - 10.1016/B978-0- 12-418680-4.00035-X

23. Noor SO, Ridgway K, Scovell L, Kemsley EK, Lund EK, Jamieson C, Johnson IT, Narbad A. Ulcerative colitis and irritable bowel patients exhibit distinct abnormalities of the gut microbiota. BMC Gastroenterol. 2010 Nov 12;10:134. doi: 10.1186/1471-230X-10-134. PMID: 21073731; PMCID: PMC3002299.

24. Vaahtovuo J, Munukka E, Korkeamäki M, Luukkainen R, Toivanen P. Fecal microbiota in early rheumatoid arthritis. J Rheumatol. 2008 Aug;35(8):1500-5. Epub 2008 Jun 1. PMID: 18528968.

25. Collado MC, Isolauri E, Laitinen K, Salminen S. Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women. Am J Clin Nutr. 2008 Oct;88(4):894-9. doi: 10.1093/ ajcn/88.4.894. PMID: 18842773.

26. Schwiertz A, Taras D, Schäfer K, Beijer S, Bos NA, Donus C, Hardt PD. Microbiota and SCFA in lean and overweight healthy subjects. Obesity (Silver Spring). 2010 Jan;18(1):190-5. doi: 10.1038/ oby.2009.167. Epub 2009 Jun 4. PMID: 19498350.

27. Swidsinski A, Weber J, Loening-Baucke V, Hale LP, Lochs H. Spatial organization and composition of the mucosal flora in patients with inflammatory bowel disease. J Clin Microbiol. 2005;43(7):3380- 3389. doi:10.1128/JCM.43.7.3380-3389.2005

28. Zhang X, Shen D, Fang Z, Jie Z, Qiu X, Zhang C, Chen Y, Ji L. Human gut microbiota changes reveal the progression of glucose intolerance. PLoS One. 2013 Aug 27;8(8):e71108. doi: 10.1371/ journal.pone.0071108. PMID: 24013136; PMCID: PMC3754967.

29. The gut microbiota as an environmental factor that regulates fat storage

30. Fredrik Bäckhed, Hao Ding, Ting Wang, Lora V. Hooper, Gou Young Koh, Andras Nagy, Clay F. Semenkovich, Jeffrey I. Gordon, Proceedings of the National Academy of Sciences Nov 2004, 101 (44) 15718-15723; DOI: 10.1073/pnas.0407076101

31. Rajilić-Stojanović M, Biagi E, Heilig HG, Kajander K, Kekkonen RA, Tims S, de Vos WM. Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology. 2011 Nov;141(5):1792-801. doi: 10.1053/j.gastro.2011.07.043. Epub 2011 Aug 5. PMID: 21820992.

32. Malinen E, Krogius-Kurikka L, Lyra A, et al. Association of symptoms with gastrointestinal microbiota in irritable bowel syndrome. World J Gastroenterol. 2010;16(36):4532-4540. doi:10.3748/wjg.v16.i36.4532

33. Squire MM, Riley TV. Clostridium difficile infection in humans and piglets: a ‘One Health’ opportunity. Curr Top Microbiol Immunol. 2013;365:299-314. doi: 10.1007/82_2012_237. PMID: 22695920.

34. Bennett, JE, Dolin, R & Blaser, MJ 2014, Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. vol. 1-2, Elsevier Inc.

35. Fava F, Danese S. Intestinal microbiota in inflammatory bowel disease: friend of foe? World J Gastroenterol. 2011 Feb 7;17(5):557-66. doi: 10.3748/wjg.v17.i5.557. PMID: 21350704; PMCID: PMC3040327.

36. Chassard C, Dapoigny M, Scott KP, Crouzet L, Del’homme C, Marquet P, Martin JC, Pickering G, Ardid D, Eschalier A, Dubray C, Flint HJ, Bernalier-Donadille A. Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome. Aliment Pharmacol Ther. 2012 Apr;35(7):828-38. doi: 10.1111/j.1365-2036.2012.05007.x. Epub 2012 Feb 8. PMID: 22315951.

37. Duboc H, Rainteau D, Rajca S, Humbert L, Farabos D, Maubert M, Grondin V, Jouet P, Bouhassira D, Seksik P, Sokol H, Coffin B, Sabaté JM. Increase in fecal primary bile acids and dysbiosis in patients with diarrhea-predominant irritable bowel syndrome. Neurogastroenterol Motil. 2012 Jun;24(6):513-20, e246-7. doi: 10.1111/j.1365-2982.2012.01893.x. Epub 2012 Feb 22. PMID: 22356587.

38. Atherton JC, Blaser MJ. Coadaptation of Helicobacter pylori and humans: ancient history, modern implications. J Clin Invest. 2009;119(9):2475-2487. doi:10.1172/JCI38605

39. McColl KE. Clinical practice. Helicobacter pylori infection. N Engl J Med. 2010 Apr 29;362(17):1597- 604. doi: 10.1056/NEJMcp1001110. PMID: 20427808.

40. el-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut. 1998 Sep;43(3):327-33. doi: 10.1136/gut.43.3.327. PMID: 9863476; PMCID: PMC1727258.

41. Bashir A, Miskeen AY, Hazari YM, Asrafuzzaman S, Fazili KM. Fusobacterium nucleatum, inflammation, and immunity: the fire within human gut. Tumour Biol. 2016 Mar;37(3):2805-10. doi: 10.1007/s13277- 015-4724-0. Epub 2015 Dec 30. PMID: 26718210.

42. McCoy AN, Araújo-Pérez F, Azcárate-Peril A, Yeh JJ, Sandler RS, Keku TO. Fusobacterium is associated with colorectal adenomas. PLoS One. 2013;8(1):e53653. doi: 10.1371/journal. pone.0053653. Epub 2013 Jan 15. PMID: 23335968; PMCID: PMC3546075.

43. Hamilton TL, Bryant DA, Macalady JL. The role of biology in planetary evolution: cyanobacterial primary production in low-oxygen Proterozoic oceans. Environ Microbiol. 2016 Feb;18(2):325-40. doi: 10.1111/1462-2920.13118. Epub 2015 Dec 21. PMID: 26549614; PMCID: PMC5019231.

44. Christaki E, Florou-Paneri P, Bonos E. Microalgae: a novel ingredient in nutrition. Int J Food Sci Nutr. 2011 Dec;62(8):794-9. doi: 10.3109/09637486.2011.582460. Epub 2011 May 16. PMID: 21574818.

45. Sara C Di Rienzi et. Al, The human gut and groundwater harbor non-photosynthetic bacteria belonging to a new candidate phylum sibling to Cyanobacteria, Microbiology and Infectious Diseases, 2013

46. Fujio-Vejar Sayaka, Vasquez Yessenia, Morales Pamela, Magne Fabien, Vera-Wolf Patricia, Ugalde Juan A., Navarrete Paola, Gotteland Martin, The Gut Microbiota of Healthy Chilean Subjects Reveals a High Abundance of the Phylum Verrucomicrobia , Frontiers in Microbiology,2017, DOI=10.3389/fmicb.2017.01221

47. https://www.hindawi.com/journals/archaea/2010/967271/

48. Conway de Macario E, Macario AJ. Methanogenic archaea in health and disease: a novel paradigm of microbial pathogenesis. Int J Med Microbiol. 2009 Feb;299(2):99-108. doi: 10.1016/j.ijmm.2008.06.011. Epub 2008 Aug 30. PMID: 18757236.

49. Eckburg PB, Lepp PW, Relman DA. Archaea and their potential role in human disease. Infect Immun. 2003 Feb;71(2):591-6. doi: 10.1128/iai.71.2.591-596.2003. PMID: 12540534; PMCID: PMC145348.

50. Liu Y, Whitman WB. Metabolic, phylogenetic, and ecological diversity of the methanogenic archaea. Ann N Y Acad Sci. 2008 Mar;1125:171-89. doi: 10.1196/annals.1419.019. PMID: 18378594.

51. Koeth RA, Wang Z, Levison BS, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013;19(5):576-585. doi:10.1038/nm.3145

52. Gaci N, Borrel G, Tottey W, O’Toole PW, Brugère JF. Archaea and the human gut: new beginning of an old story. World J Gastroenterol. 2014 Nov 21;20(43):16062-78. doi: 10.3748/wjg.v20.i43.16062. PMID: 25473158; PMCID: PMC4239492.

53. NA

54. Brumfield KD, Huq A, Colwell RR, Olds JL, Leddy MB (2020) Microbial resolution of whole genome shotgun and 16S amplicon metagenomic sequencing using publicly available NEON data. PLOS ONE 15(2): e0228899. https://doi.org/10.1371/journal.pone.0228899

55. Shi Z. Gut Microbiota: An Important Link between Western Diet and Chronic Diseases. Nutrients. 2019;11(10):2287. Published 2019 Sep 24. doi:10.3390/nu11102287

56. Vich Vila, A., Collij, V., Sanna, S. et al. Impact of commonly used drugs on the composition and metabolic function of the gut microbiota. Nat Commun 11, 362 (2020). https://doi.org/10.1038/s41467- 019-14177-z

57. Maier L, Pruteanu M, Kuhn M, et al. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature. 2018;555(7698):623-628. doi:10.1038/nature25979

58. Rinninella E, Cintoni M, Raoul P, et al. Food Components and Dietary Habits: Keys for a Healthy Gut Microbiota Composition. Nutrients. 2019;11(10):2393. Published 2019 Oct 7. doi:10.3390/nu11102393

59. Homayoni Rad A, Vaghef Mehrabany E, Alipoor B, Vaghef Mehrabany L. The Comparison of Food and Supplement as Probiotic Delivery Vehicles. Crit Rev Food Sci Nutr. 2016;56(6):896-909. doi: 10.1080/10408398.2012.733894. PMID: 25117939.

60. Wassermann Birgit, Müller Henry, Berg Gabriele, An Apple a Day: Which Bacteria Do We Eat With Organic and Conventional Apples?, Frontiers in Microbiology, 2019, DOI=10.3389/fmicb.2019.01629

61. Mie A, Andersen HR, Gunnarsson S, et al. Human health implications of organic food and organic agriculture: a comprehensive review. Environ Health. 2017;16(1):111. Published 2017 Oct 27. doi:10.1186/s12940-017-0315-4

62. Karl JP, Hatch AM, Arcidiacono SM, et al. Effects of Psychological, Environmental and Physical Stressors on the Gut Microbiota. Front Microbiol. 2018;9:2013. Published 2018 Sep 11. doi:10.3389/ fmicb.2018.02013

63. Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/ toxics8010019

64. Farnaz Fouladi, Maximilian J. Bailey, William B. Patterson, Michael Sioda, Ivory C. Blakley, Anthony A. Fodor, Roshonda B. Jones, Zhanghua Chen, Jeniffer S. Kim, Frederick Lurmann, Cameron Martino, Rob Knight, Frank D. Gilliland, Tanya L. Alderete,

65. Air pollution exposure is associated with the gut microbiome as revealed by shotgun metagenomic sequencing, Environment International, 2020 https://doi.org/10.1016/j.envint.2020.105604

66. Blum WEH, Zechmeister-Boltenstern S, Keiblinger KM. Does Soil Contribute to the Human Gut Microbiome?. Microorganisms. 2019;7(9):287. Published 2019 Aug 23. doi:10.3390/ microorganisms7090287

67. Liliane Costa Conteville & Ana Carolina P Vicente (2020) Skin exposure to sunlight: a factor modulating the human gut microbiome composition, Gut Microbes, 11:5, 1135-1138, DOI: 10.1080/19490976.2020.1745044

68. Liebert A, Bicknell B, Johnstone DM, Gordon LC, Kiat H, Hamblin MR. “Photobiomics”: Can Light, Including Photobiomodulation, Alter the Microbiome?. Photobiomodul Photomed Laser Surg. 2019;37(11):681-693. doi:10.1089/photob.2019.4628

69. Crabtree DPE, Herrera BJ, Kang S. The response of human bacteria to static magnetic field and radiofrequency electromagnetic field. J Microbiol. 2017 Oct;55(10):809-815. doi: 10.1007/s12275-017- 7208-7. Epub 2017 Sep 28. PMID: 28956351.

70. Smith RP, Easson C, Lyle SM, et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14(10):e0222394. Published 2019 Oct 7. doi:10.1371/journal.pone.0222394

71. https://www.cell.com/trends/endocrinology-metabolism/fulltext/S1043-2760(19)30180-8

72. Kim KO, Gluck M. Fecal Microbiota Transplantation: An Update on Clinical Practice. Clin Endosc. 2019;52(2):137-143. doi:10.5946/ce.2019.009

73. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1910437

74. Wang S, Xu M, Wang W, et al. Systematic Review: Adverse Events of Fecal Microbiota Transplantation. PLoS One. 2016;11(8):e0161174. Published 2016 Aug 16. doi:10.1371/journal.pone.0161174

75. https://pubs.rsc.org/en/content/articlelanding/2020/fo/c9fo01634a#!divAbstract

76. https://n.neurology.org/content/nutrients-and-bioactives-green-leafy-vegetables-and-cognitive-decline- prospective-study

77. https://fdc.nal.usda.gov/fdc-app.html#/food-details/169451/nutrients

78. de Punder K, Pruimboom L. The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients. 2013;5(3):771-787. Published 2013 Mar 12. doi:10.3390/nu5030771

79. Chen Q, Chen O, Martins IM, Hou H, Zhao X, Blumberg JB, Li B. Collagen peptides ameliorate intestinal epithelial barrier dysfunction in immunostimulatory Caco-2 cell monolayers via enhancing tight junctions. Food Funct. 2017 Mar 22;8(3):1144-1151. doi: 10.1039/c6fo01347c. PMID: 28174772.

80. Traber MG, Buettner GR, Bruno RS. The relationship between vitamin C status, the gut-liver axis, and metabolic syndrome. Redox Biol. 2019;21:101091. doi:10.1016/j.redox.2018.101091

81. Burge K, Gunasekaran A, Eckert J, Chaaban H. Curcumin and Intestinal Inflammatory Diseases: Molecular Mechanisms of Protection. Int J Mol Sci. 2019;20(8):1912. Published 2019 Apr 18. doi:10.3390/ijms20081912

82. Cruzat V, Macedo Rogero M, Noel Keane K, Curi R, Newsholme P. Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients. 2018 Oct 23;10(11):1564. doi: 10.3390/nu10111564. PMID: 30360490; PMCID: PMC6266414.

83. Säemann MD, Böhmig GA, Osterreicher CH, Burtscher H, Parolini O, Diakos C, Stöckl J, Hörl WH, Zlabinger GJ. Anti-inflammatory effects of sodium butyrate on human monocytes: potent inhibition of IL- 12 and up-regulation of IL-10 production. FASEB J. 2000 Dec;14(15):2380-2. doi: 10.1096/fj.00- 0359fje. PMID: 11024006.

84. Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr. 2018;7(1):96-108. Published 2018 Nov 5. doi:10.1002/fsn3.807

85. Chuah SK, Wu KL, Tai WC, Changchien CS. The effects of ginger on gallbladder motility in healthy male humans. J Neurogastroenterol Motil. 2011;17(4):411-415. doi:10.5056/jnm.2011.17.4.411

86. https://www.gastrojournal.org/article/0016-5085(78)93779-4/pdf

87. Utay NS, Somasunderam A, Hinkle JE, et al. Serum Bovine Immunoglobulins Improve Inflammation and Gut Barrier Function in Persons with HIV and Enteropathy on Suppressive ART. Pathog Immun. 2019;4(1):124-146. Published 2019 May 3. doi:10.20411/pai.v4i1.276

88. Dwivedi C, Heck WJ, Downie AA, Larroya S, Webb TE. Effect of calcium glucarate on beta- glucuronidase activity and glucarate content of certain vegetables and fruits. Biochem Med Metab Biol. 1990 Apr;43(2):83-92. doi: 10.1016/0885-4505(90)90012-p. PMID: 2346674.

89. Lamichhane-Khadka R, Benoit SL, Maier SE, Maier RJ. A link between gut community metabolism and pathogenesis: molecular hydrogen-stimulated glucarate catabolism aids Salmonella virulence. Open Biol. 2013;3(12):130146. Published 2013 Dec 4. doi:10.1098/rsob.130146

90. Ammons MC, Copié V. Mini-review: Lactoferrin: a bioinspired, anti-biofilm therapeutic. Biofouling. 2013;29(4):443-455. doi:10.1080/08927014.2013.773317

91. Swamy MK, Akhtar MS, Sinniah UR. Antimicrobial Properties of Plant Essential Oils against Human Pathogens and Their Mode of Action: An Updated Review. Evid Based Complement Alternat Med. 2016;2016:3012462. doi:10.1155/2016/3012462

92. Pegues AS, Sofer SS, McCallum RE, Hinshaw LB. The removal of 14C labeled endotoxin by activated charcoal. Int J Artif Organs. 1979 May;2(3):153-8. PMID: 381215.