In this March 2020 presentation, Dr. David Perlmutter argues that the gut microbiome plays a central role in the inflammatory and immune pathways that influence COVID‑19 severity. He begins by outlining established high‑risk factors for severe disease—age, cardiovascular disease, diabetes, obesity, chronic organ disease, chemotherapy, radiation, and neurodegenerative conditions—and notes that these share a common thread of heightened inflammation. Drawing on prior research, he explains how a diverse, fiber‑rich gut microbiota supports low‑grade inflammation and balanced immunity, whereas dysbiosis (caused by antibiotics, NSAIDs, acid‑blocking drugs, processed diets, excessive hygiene, chlorine‑treated water, and C‑section birth) predisposes to inflammation, autoimmunity, and possibly worse COVID‑19 outcomes. He cites comparative studies of African (Burkina Faso) versus European children that show diet‑driven microbiome differences, and references the hygiene hypothesis—higher parasite loads in low‑hygiene regions correlate with lower rates of inflammatory diseases such as Alzheimer’s and, intriguingly, lower COVID‑19 prevalence in many sub‑Saharan African nations. Anecdotal observations from a post‑earthquake humanitarian mission in Haiti suggest robust immunity in low‑hygiene settings. Recent data linking ibuprofen and other NSAIDs to increased COVID‑19 severity are highlighted, reinforcing concerns about medications that disrupt gut flora. Perlmutter concludes with a call for systematic sequencing of COVID‑19 patients’ gut microbiomes to identify protective or harmful signatures, and offers practical advice: increase prebiotic fiber (garlic, onions, leeks, kale, broccoli), limit processed sugars, and use antibiotics, NSAIDs, and proton‑pump inhibitors judiciously. The overall message is a cautious optimism that microbiome‑targeted strategies could mitigate risk and improve outcomes.
Chapters
Hello everyone, I'm Dr. David Perlmutter. You know, everybody's been trying to figure the coronavirus out. We have wonderful researchers around the world who are dedicating themselves to try and trying to learn why this is happening, how it is happening, and most importantly, what can we do about it. One area that I've not seen much research in is the area of the microbiome, and You know, when you recognize that the microbiome, the gut bacteria, and its metabolic products and genetics play such an important role in 2 things, inflammation and immunity, one would think that this might be an area that we should explore. You know, when we see data now indicating that here in the United States, there seems to be more hospitalizations of younger people, when we see that there may be an increased risk for complications in people chronically taking the nonsteroidal anti-inflammatory drugs, when we note, for example, significantly lower cases or prevalence in places like sub-Saharan Africa and even Haiti, one would wonder again if there may be some connection To the microbiome. So I decided to create this presentation for you to explore these thoughts and reveal what the science has told us in the past, and maybe this is then a call to action to explore a new area as it relates to this coronavirus. Coronavirus, COVID-19, and the microbiome. First, I'd like to explain Let's explore what we know are some of the powerful risk factors for having bad outcome as it relates to this infection. Certainly cardiovascular disease ranks amongst the very highest, along with things like diabetes and obesity. Certainly being elderly can't really change that. Chronic pulmonary disease, chronic liver, chronic kidney disease as well. Recent chemotherapy and even recent radiation therapy are related to increased risk for having more complications, more severe illness, and even chronic neurological diseases like Parkinson's are related. And, you know, this discussion, I think, takes me back to some of the work that we've done previously and really lets us recognize that what is going on here That seems to be so similar or shared is that by and large what you are looking at are situations in which there is increased inflammation. I've been talking about that inflammation as it relates to the brain for quite some time, looking at things like Alzheimer's disease and Parkinson's, autism, multiple sclerosis, stroke, depression, coronary artery disease as well, not a brain disorder, diabetes, and obesity. So We recognize that these conditions, many of which are now described as being associated with increased risk for more severe disease as it relates to coronavirus, are at their core inflammatory. And we have been discussing for quite some time the important role of the gut bacteria in regulating inflammation, in regulating the immune system. So let's have a look at that. Let's look at some of the science. This takes us back to 2011, looking at the commensal flora, the gut bacteria, and the regulation of inflammatory and autoimmune responses. Remember that the regulation of inflammation is key as it relates to coronavirus. When we have a good situation, a high-fiber diet, natural birth, breastfeeding, exposure to microbes, meaning playing in the dirt when you're young, etc., this tends to stabilize the gut bacteria and leads to good resolution of inflammation, gives us good integrity of the gut lining that is so important for maintaining inflammation at a low level, and balances our immunity. When, however, we are exposed to medications like antibiotics, obesity, the standard Western diet, overly involved with hygiene or stress— something we can certainly get involved with or control these days— and certain pathogenic bacteria, that causes what's called dysbiosis, or disturbance of the gut bacteria, and that ultimately It predisposes us to inflammation, cancer, and autoimmune— autoimmunity. What we're really focused on right now is the inflammation part of that story. Well, this is an interesting study, and it looks at the impact of diet in terms of shaping the gut bacteria, and it's a comparison study, and you're gonna, I think, really appreciate where this goes as it relates to the current data of coronavirus, which we're going to look at. And it looks at the gut bacteria in a couple of areas of the world. Age-matched children either living in Burkina Faso, which is a rural African area— we're going to look at that in a moment— versus European children and looking at their gut bacteria. Burkina Faso in western sub-Saharan Africa, and we know that it is a An underdeveloped area. This is one of the villages in Burkina Faso. This is what the typical dwelling looks like. This is making— grinding millet and sorghum out on a wall out where, you know, it certainly could be not as sterile as our food might be. And then these things are ground into the typical— Flour. PO, or TO, rather, that is what they— this is called. But in comparing the array of bacteria in the African children's gut bacteria versus the European, dramatic, dramatic differences. And even in some major categories like Firmicutes and Bacteroidetes, children have, in Africa, have a far different array of bacteria. And as we will see in a moment, this has huge effects in terms of things like immunity. And the authors of this study concluded that our results suggest that diet has a dominant role in shaping the gut bacteria, gut microbiota, and we can hypothesize that the reduction in richness that we observed in the European Union compared to Burkina Faso children could indicate how the consumption of things like sugar, animal fat, calorie-dense foods in industrial countries is rapidly limiting the adaptive potential of the microbiota. We'll explore what that means in a moment. I, in thinking this through, had thought back to an interview I did with a Dr. Molly Fox. And Dr. Molly Fox approached something called the hygiene hypothesis, which was originally proposed— we'll look at that in a moment— 1989, But she wanted to look at it in reference to Alzheimer's disease. And she studied people across the world and wanted to determine, is there a relationship between Alzheimer's, an inflammatory disease, and hygiene as measured by something called the parasite load? And I'm not going to challenge you to look at this chart. I know that it's very challenging. But she uses parasite load as a marker of hygiene. Obviously, higher levels of parasites— these are different countries, 100 countries— higher levels of parasites in areas with lower levels of hygiene. And here's what she found. I made it simpler. That increasing parasitic stress, like in Sudan, Kenya, Ethiopia, Nigeria, Chad, etc., was associated with lower risk of an inflammatory condition That we call Alzheimer's. Now, this is a very, very important finding because we are now noticing that the areas on the right side of your screen are some of the areas in the world that are having the lowest infection rate of coronavirus. Now, I will absolutely accept the argument that these are areas where there is less international travel. But I'm not sure that necessarily holds true for India, for example. If you look at the top, you'll see places like the United States and Italy and Germany and even Iceland, where 1% as of today— today is March the 19th, 2020— even in Iceland, 1% of the entire population is now infected with coronavirus. Population, I guess, around 340,000 people. And again, one could argue that that's an area of travel, but when we think of the millions and millions of people and the population density in some of these African nations, it does beg the question. I mentioned the hygiene hypothesis. I copied this from Wikipedia. The hygiene hypothesis in medicine states that early childhood exposure to particular microorganisms such as The gut flora and helminth parasites, meaning the bacteria that are found in the gut, as well as worms, protects against allergic diseases by contributing to the development of the immune system. Strengthening the immune system, balancing the immune system by being exposed to a non-hygienic environment. Again, I think we should consider northern countries in Europe versus sub-Saharan Africa, as an example. It is intriguing— well, I'll get there in just a moment. Here is a headline from 2010. A magnitude 7 earthquake hit Haiti. Well, when this happened, I jumped on a plane, flew to Haiti, and realized that, you know, there weren't a lot of Yeah. There were not great medical facilities at that point. Things were very stressed. And this is the UNICEF tent where we were treating patients. This is inside that tent. And these are not necessarily, you know, the typical sterile, hygienic kinds of environments where we would hope to treat patients with devastating injuries. But what we noticed that was really quite profound is that these people had really aggressive injuries. And what we noticed in treating them was that there were very few infections. And again, I think it's a testament to the robust immunity— was my conclusion as I left— the robust immunity from the fact that they don't live in such a hygienic environment, strengthening their immune systems probably through what it does to the microbiome, or perhaps what it doesn't do to the microbiome with respect to the way we treat our gut bacteria with medications, antibiotics, Chlorinated water, you name it. So think about that when we look— this is from today, and I know that this map will definitely change. This is looking at coronavirus activity, but look at the disparity between Africa and Europe. It dates back, in my mind, to the original study I showed at the beginning of this presentation of the differences in The gut bacteria in comparison to Burkina Faso children, sub-Saharan Africa, west side, to those in Europe. The gut bacteria play a fundamental role in regulating our immune systems. And again, another image taken today, and I know this will be out of date soon. India is a very dense population with lots of travel. Compare that— to other areas of Asia where the rates of this virus are absolutely exploding. Well, today we learned this interesting fact published— actually, it was published yesterday, but I learned it today— that CDC is telling us that about 40% of patients, that 40% of patients sick enough to be hospitalized are between the ages of 20 to, I believe it is, 54. The point is that there are younger patients being hospitalized. And that is something that we didn't see until this sort of spread to the United States, because one wonders then, what is it about our kids that's making them at a higher risk? And I would submit it's because of the modern Western diet that they are consuming. We also found this study that was published 2 days ago. Ibuprofen should not be used in managing symptoms, say doctors and scientists. Why? This was published 2 days ago in BMJ. Well, we know that ibuprofen changes the gut bacteria and can do so quite aggressively. We've known that for quite some time. We've been blogging about that for many, many years. That drugs like the nonsteroidal anti-inflammatories, as well as acid-blocking drugs, have a significant effect upon the diversity and array of gut bacteria. And this can affect immunity and may actually lead to increased inflammation. We know there is an association with nonsteroidal anti-inflammatory drugs and, for example, risk for stroke and Alzheimer's disease. So what threatens our microbial diversity? Antibiotics. Not saying we shouldn't use them, of course we should use them, but I think it's quite clear that in developed countries, especially the United States, we overuse antibiotics, with 70% of the antibiotics used in America actually going into poultry and cattle. Method of delivery affects the gut bacteria of the newborn and infant. Being born either vaginally or via cesarean section. Medications I mentioned, like nonsteroidal anti-inflammatory drugs and acid-blocking drugs. If our water contains residual chlorine, that could be a threat. The diet is such an important factor. A highly processed diet with high levels of sugar, for example, threatens the gut bacteria. I don't know that there's any data that suggests specifically that GMO foods threaten the gut bacteria. But we do know that one of the things that is increased in our diets when we're eating a lot of genetically modified foods is the chemical glyphosate. The work of Dr. Stephanie Seneff clearly indicates that has an effect on the microbiome. And finally, as we've learned based upon Dr. Strachan's work in 1989, this hygiene hypothesis whereby excessive efforts to increase hygiene may have an effect on the array diversity of the gut bacteria. Ultimately, this can lead to increased gut permeability, and that is a direct pathway to the process of inflammation. So then, as we look at these issues that we know are associated with increased risk for complications, bad outcome, we should look at these things through the eye of, or the lens of, the gut bacteria. So I believe that the gut bacteria is very, very important in terms of our understanding of the pathogenesis of the COVID-19 situation. I'm hopeful that Some of my colleagues in this field will do their best to sequence what is going on in the gut of those individuals who have good outcome versus those who have bad outcome, so we can begin to look at that data and try to make some sense out of it, and hopefully thereafter begin to create novel ideas for interventions to— Perhaps help individuals not only with the ongoing disease, but even perhaps as a way to reduce risk. That said, I think it makes sense to keep your gut bacteria in as good a shape as you possibly can, and that means doing your best to reduce your consumption of highly processed foods, of simple sugars, making sure you're getting a lot of dietary fiber. Things like, especially prebiotic fiber, garlic, onions, leeks, kale, broccoli. You can find the list certainly online. You can go to drpermutter.com. You know I've been interested in this for quite some time. You can buy any over-the-counter brand of prebiotic fiber, and that would be helpful in my opinion as well. I can't imagine it's going to hurt. Certainly be very considerate about your usage of medications like Proton pump inhibitors, acid-blocking drugs, nonsteroidal anti-inflammatory drugs, and certainly antibiotics. Again, as I mentioned earlier, there are times when medications are necessary. Infections that are caused by bacteria need antibiotics. I'm certainly saying not to do that, but we should consider the possible overusage of antibiotics in Western countries and how that might have an effect on the microbiome, and perhaps how that might be relevant in our understanding of COVID-19. Thank you for listening. I'm Dr. David Perlmutter.
