Sunday 8 December 2019

The dangers of an ultra-clean lifestyle: Coeliac disease, asthma, and obesity may be on the rise

Our highly sanitised way of modern life is limiting our exposure to important natural bacteria, with disastrous consequences for our health, writes microbiologist Dr Maria Gloria Dominguez-Bello

Our highly sanitised way of modern life is limiting our exposure to important natural bacteria. Stock Image
Our highly sanitised way of modern life is limiting our exposure to important natural bacteria. Stock Image

In today's urban societies, we've become very good at keeping things clean and holding any dirt at bay. We use antibacterial sprays in our homes, and too often keep windows and doors firmly closed against whatever might blow in from outside.

In New York there are even some apartments where the windows can't be opened at all. We move from air-conditioned cars to air-conditioned offices and sanitise our skin with hand gels.

Our built environment is also a highly artificial one. We overuse plastic and other synthetic materials and exclude natural elements from our surroundings.

But all this cleaning and protection we've built up against the natural world doesn't come without consequence. What we're doing, without fully understanding the implications, is minimising the variety of natural microbes with which we come into contact. In my work as a microbiologist at Rutgers University, New Jersey, I've observed that the more urbanised the environment we live in becomes, the fewer bacteria from soil and plants we are exposed to. And in the most humanised environments, the only source of microbes ends up being humans themselves, who shed them mostly from their skin and mouths.

Please log in or register with Independent.ie for free access to this article.

Log In

What these ultra-clean, indoor modern lifestyles result in, then, is a change in the human microbiome - that is, the genetic material of all the microbes (bacteria, fungi, protozoa, and viruses) that live on and inside the human body. Essentially the human microbiome loses diversity as we urbanise. We haven't proved that urbanisation causes this, but it certainly correlates with it.

In a new documentary for the Smithsonian Channel called Aliens Inside Us, I explore just how big a role microorganisms play in our lives, and how the disappearance of microbes may be responsible for everything from asthma and allergies to diabetes and obesity.

Threat: Antibiotic resistance is becoming a real concern
Threat: Antibiotic resistance is becoming a real concern

Cleaning is not the only culprit. An article in The Lancet medical journal last year reported that the number of babies born through caesarean section globally had almost doubled between 2000 and 2015, from 12pc to 21pc of all births. While in many cases this surgery will be life-saving for women and babies, it might also bring less desirable effects, because a c-section is a birth without microbes.

During a natural birth, microbes colonise the body of the baby just before it is pushed out. This process starts when the mother's waters break, and as the baby passes through the birth canal, its body is heavily colonised by certain bacteria, which research has suggested may help boost a baby's response against allergies and asthma. Babies delivered by c-section miss out on exposure to these microbes.

We also overuse antibiotics, which brings collateral damage of its own. The drugs are often prescribed to treat common childhood viruses, despite being ineffective against them. In other cases, they can, of course, save lives. But one effect of their widespread over-prescription is certain strains of bacteria (which are a type of microbe) change in response to their use, becoming resistant to the drugs. When these bacteria then infect patients, we find they are harder to treat.

Scientists like me are currently trying to understand which of our internal functions are disappearing as a result of the way modern life has changed the variety and nature of microbes to which we are exposed, and those which live on or in us. What we have learned so far is extremely concerning, and the problems start right from birth. By performing more c-sections, limiting skin-to-skin contact with the mother at the start of a child's life, formula feeding instead of breastfeeding and leaving babies to sleep in cots in clean rooms instead of by the side of their mother, we are impairing the transmission of the mother's bacteria to the baby, which has implications for the healthy development of the baby's immune system.

The baby then develops within a built environment, not a natural one: an environment composed of artificial materials layered with synthetic paints. We are still learning about the toxins these materials, including plastic, contain. But we do know they often feature compounds that impact our physiology.

Plastics, for instance, contain compounds that interact with the metabolism of steroids, and steroids are the basis of our hormones. We see effects on the endocrine system as a result - a system that plays a key role in whether you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and many other hormone-related disorders.

We also have evidence that fungal diversity increases as bacteria decreases. What this means is we are trading the infectious diseases that used to kill us for new ones: immune and metabolic diseases such as type 1 diabetes, an autoimmune disease that destroys the pancreas. This used to be rare and its onset was not until patients were in their teens. It's no longer rare and arises in very young children.

Coeliac disease, asthma, and obesity may also be on the rise as a result of our more limited microbial exposure. Some people think even Alzheimer's and autism are related to this. There's enough evidence to suggest that modern autoimmune diseases have a probable underlying cause related to microbes and the education of the immune system.

In combating, or preventing, some of these ill effects, scientists like me must establish which microbes children need to develop the healthiest immune systems. We also need to know how we can restore the microbiome after its been impacted by medicines.

In the meantime, what can we do to alleviate some of the potentially damaging effects on our microbiome of the sanitised modern lifestyles we've embraced? Reverting to living in the jungle is obviously not an option. But we can learn from those who live in greater harmony with nature about what is missing from our own microbiome. To this end, we visit in the documentary a Peruvian village called Checherta and its isolated rural Amazonian community, whose lifestyle is more similar to that of our ancestors in terms of its impact on the microbiome.

They live in open huts and mostly eat what they gather from their natural environment every day. They typically go fishing daily and regularly eat soup made with fish or roots, once or twice a fortnight going hunting. There's no electricity in the huts, so families go to bed early and rise early. They tend to nap in the middle of the afternoon, something we rarely have time for in urban societies, and they tend to eat frequently, throughout the day, with very high amounts of fibre and low amounts of fat in their diets.

The Chercherta community lacks modern medicines, so mortality is extremely high. But its members do have much greater diversity in their microbiome, and we can learn a lot from them about what we have lost from our own, and what functions in the body this affects - something we are working on currently.

We can also include some of their healthy practices in our own lifestyles, not only by switching to a high fibre diet to improve the microbiome, but by exposing ourselves to nature far more, and to soils and plants, we might otherwise tend to exclude. We still don't understand exactly why, or what are the mechanisms involved, but there's now a scientific consensus that eating plants and fibres and being exposed to the environment are generally healthy behaviours. All of us can live better lives by bringing nature back in.

As told to Rosa Silverman

Aliens Inside Us airs on the Smithsonian Channel at 9pm on Thursday

Irish Independent

Editors Choice

Also in Life