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The spores act as orchestrators of that system to be That’s where all of the action takes place, and most of the
able to repair the damage that leads to intestinal microbes that live in your body live in the mucosal surface.
permeability. We can absolutely repair that. Probiotics will That’s an important thing, but lets put it aside for a
play a very important role. But, of course, we’ve got lots of moment.
things around us that continuously drives gut damage. Now, when you look at the population of microbes in
Poor diets, consumption of processed foods and fast foods that mucosal surface, you’ve got somewhere around
and things that have been cooked in rancid oil, foods that 40 trillion microbes in that mucosal surface, 40 trillion!
are covered in Roundup and glyphosate, which is a really That’s an insane number to wrap your head around. Now,
potent antibiotic, but kills off lots of good bacteria, all when you look at immune cells that are responsible for
cause inflammation. monitoring that entire 4,000 square foot system that has
We’ve got lots of preservatives and additives in our 40 trillion microbial cells, you’ve got somewhere around
food supply. We’ve got dead soil everywhere. The 200 million of those immune cells. So you have 200 000
nutritional value of our food is really poor. We’ve got times more microbes in the system than you have immune
chlorine and fluoride in our drinking water. We, of course, cells that are responsible for monitoring the system.
over use antibiotics, both in the medical community and The question becomes, “How in the world is it
in agriculture. We’ve designed our society to be around possible for the immune cells to monitor that entire sea of
killing bacteria and killing microbes, when those are the microbes to understand when a pathogenic or
things that we need in our corner to help us with our dysfunctional microbe or virus enters the system?”
vulnerabilities. The analogy I give people is imagine you’re at a music
Leaky gut and the presence of circulating LPS and the festival and this music festival is in a huge field and there
resulting chronic low-grade inflammation makes us way are 200 000 people there. Among those 200 000, that there
more susceptible to something like a COVID infection, are maybe 40 or 50 people that are really problematic.
but another thing to think about is the role of the They’re out there distributing all kinds of drugs and
microbiome in immune response, and its critical. What potentially causing harm. They might have weapons. They
you start to understand when you really dig into the may be really problematic to the crowd. You are the sole
research in this space is you start to understand that the security guard in that sea of people. Imagine you are one
microbiome is the neighborhood watch for the immune security guard among 200 000 attendees where 40 to 50 of
system. them may be problematic. How would you ever be able to
That is a really important point for clinicians, identify and find those problematic music goers?
especially to understand and get across to their patients You wouldn’t. The only way you could is if the other
because the immune system could not function at all 199,950 or so music goers are also helping you, acting as a
without the presence of the microbiome. And the more neighborhood watch. They would alert you and radio to
diverse and healthy your microbiome is, the better your you if they saw something suspicious. That’s the only way
immune system functions. Let me give you some numbers you could do it. And that’s exactly what happens with the
that will help illustrate this problem that we have in our immune system and the microbiome. The microbiome is
bodies. the neighborhood watch for the immune system.
Inside our system, we are covered by a mucosal layer. When a virus enters any part of the mucosa, let’s say
We use to think our skin, the outer barrier, is the largest the respiratory tract, the respiratory microbiome actually
surface area in the body, the largest barrier in the body. sends signals to the gut microbiome that there’s a new
We’ve heard of the skin being called the largest organ in virus in town. The gut microbiome then alerts and
the body, and that’s not actually true. The skin, if you amplifies the immune system to get it to go to the lungs.
unfold it all, is about two square meters in surface area. That’s how intimate the connection is between the
Inside the body is the mucosal layer. That covers the entire microbiome and the immune system, and this has been
digestive track, every orifice in your body, your upper demonstrated beautifully in the case of influenza. We’ve
respiratory tract, urogenital tract, even through the skin. If had influenza among us for hundreds if not thousands of
you penetrate through the skin, you end up in a mucosal years. So we’ve had a lot of time to study it. We understand
layer. that the moment that the influenza virus enters the body,
That mucosal layer is almost 400 square meters the microbes will detect that the influenza virus is there
compared to two square meters of the skin. And for and it’s starting to infect the intestinal epithelial cells. The
Americans who are not used to the metric system, 400 microbes will then send signals to the gut microbiome.
square meters is actually almost 4000 square feet. If you The gut microbiome will then turn on an
think about that surface area, any one of us would be inflammasome response. That inflammasome response
happy with a house that was 4000 square feet. That’s a big actually targets or recruits immune cells to go to that site
living space. Imagine that whole area is folded up as a of action. And, in fact, the microbiome can turn on
mucosal surface inside your body, and every pathogen that interferon response as well, the antiviral response. So if we
enters your body will enter through the mucosal surface. don’t have an effective functioning neighborhood watch,

70 Integrative Medicine • Vol. 19, No. S1 Krishnan—Viewpoints