Microbiome’s role in disease unclear

Dear Dr. Roach: I have struggled with IBS and GERD since I was a small child.

Recently, a friend of mine suggested having my gut flora screened by a private company for analysis. This company takes your results and suggests a prebiotic regimen for you to help improve your gut’s microbiome. However, these tests are expensive, and I’m leery about spending $200 or more on a test kit that might not be as valuable as these companies claim.

What is your opinion on at-home private gut flora screening? Is it worth doing?

NE

Answer: There is great excitement about the microbiome, but still a great deal of uncertainty. There is not a consensus about what makes a “healthy” microbiome. It’s also not clear that an “unhealthy” result from your microbiome testing is the cause of, or the result of, intestinal disease. It is also very unclear that trying to manipulate a specific microbiome result through diet or probiotics leads to better outcomes than general healthy diet advice.

The evidence that your $200 on testing will lead you to better health is not strong enough for me to recommend them at this time.

Dear Dr. Roach: My recent DEXA scan said I had a 19% chance of a major fracture within the next 10 years. Does that mean that I have an 81% chance of not having a major fracture?

MEH

Answer: Yes, that’s exactly what it means, but you should realize that after the 10 years, your risk will continue to go up. If you are one of the lucky 81% who does not get a hip fracture, you have a substantially higher chance in the following years to get a major fracture.

Most authorities recommend treatment when the risk of major osteoporotic fracture exceeds 20%. The higher the risk, the more benefit a person will get from treatment.

All medicines have downsides, and bisphosphonate drugs (Fosamax is one) increase the risk of several problems, including osteonecrosis of the jaw. These medicines should only be used when there is a clear benefit outweighing the risk, and the 20% threshold is one commonly used guideline.