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A look at the issues, research and history surrounding this controversial topic.
By: Nava Dayan
February 1, 2017
Study of the human-hosted microbiome led to the realization that the human body is a physical ecosystem, an entire universe of organisms, arrangements and processes working in harmony. Since we are at the tip of the iceberg in this area of research, this knowledge may be associated with unrealistic fear to the effect of these organisms on the human body. The tools currently used may not fully capture this universe; in fact, we are currently facing challenging limitations in detection, mapping and, most importantly, understanding the relationships between these systems, their purpose and role in life health and disease. Simply put, when comes to relationships between the human microbiome and the human innate biology, we have yet to connect the dots. Questions to be answered include: what is the complete map of the human microbiome? Where and how pathogens emerge? Why is the microbiome so diverse between individuals? How and how often is it changing over the course of our life and between generations? How does the environment affect it? What are the relationships between the host (human body) and the inhabitants (collection of microbiome)? These are basic questions. How can we attempt at controlling these complicated systems before we understand the baseline? Epidemics of Choice The hygiene theory, also termed “biome depletion theory” or “lost friends theory” is a theory in medicine related to physiological development and adaptation. It stems from the idea that, in developed countries, parents raise their children in an overly clean environment preventing interaction with bacteria, viruses and parasites that should be educating the immune system at an early stage of life and equipping it with means of protection from physiological challenge. The parallel between emotional and physical strength is clear. The diminished exposure to infectious agents and symbiotic microorganisms is suspected to cause immune intolerance and allergic diseases. In their paper “Fifty years of allergy: 1965-2015,” Campbell and Mehr note: “the last 50 years of allergy could almost be considered the first 50 years, calling it the “allergic epidemic.” Since the original suggestion of the “hygiene theory” in the late 1980s, science expanded its research to the implications of lower incidence of infection in early childhood to diseases other than “the atopic march” that includes asthma, atopic dermatitis and rhinitis to a variety of other chronic diseases such as type 1 diabetes, multiple sclerosis and even specific types of depression and cancer. Some researchers claim that although limited biota exposure may contribute to deprived immunity, this reason alone cannot explain the increased prevalence of asthma. In their 2005 paper, Platts-Mills TA et al. note that in North American inner cities, asthma is increasing among children who live in very poor houses which they assume are less clean. They offer a broader view of a Western lifestyle such as diet and exposure to allergens in foods and decreased physical activity. A more recent paper by Platts-Mills, from 2015, reviews the allergy epidemics from 1870 to 2010. The authors elucidate that the best explanation for the appearance and increase in allergy is the combination of hygiene and increased pollen secondary to changes in agriculture. Asthma did not start to increase in children until 1960, and by 1990 it had clearly grown to epidemic numbers in all countries where children adopted an indoor lifestyle. Atopic dermatitis, also termed “asthma of the skin” had grown parallel to asthma and is considered a non-treatable skin disease of babies and toddlers. Interestingly, a suggested cause for the rise in atopic dermatitis is linked to reduced exposure to UVB radiation. In their publication from late 2015, Thyssen and co-authors suggest that, in addition to decreased exposure to pathogens in early life, lack of sufficient UVB exposure could be contributing to the rapid increase in the incidence of atopic dermatitis in developed countries. Recent generations who are trained to use sunscreens extensively may be deprived of such exposure. The reportedly overly clean environment in Western society stems from the importance and public awareness of refraining from spreading infections. In his presentation to the Institute of Medicine Forum (IOM) of the National Academies in 2008, Prof. Stephen Mores from Columbia University points toward important aspects of the current status of human infectious disease. He notes the following:
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