Benjamin Click, MD: Treating the Gut and the Brain

The link from the gut to the brain—and really, other critical systems involved in overall health—is becoming better understood. But the exact definitions of gut microbiota and gut health are not yet detailed.

In an interview with MD Magazine®, Benjamin Click, MD, a staff gastroenterologist with the Cleveland Clinic, described the excitement surrounding advances in gut microbiota research, and what’s currently understood about the gut-brain dynamic.

MD Mag: What is the current understanding of gut microbiota’s overall effect on a person’s health?

Click: What we know about the gut microbiota and human health is that they are intricately related. We're just starting to scrape the surface of fully understanding what all of the interactions are and the true impact. And so I think there's still a lot more to discover in that realm.

What we do know about the microbiota is that it's certainly associated with many different disease states, and it seems like every week we read about a new association with a new disease. Our challenge now is to try and figure out what is truly causative and what is purely associated with the microbiome and gut in overall health.

And so I think we've seen that we see certain profiles of the microbiome that are associated with certain disease states, but we haven't quite truly teased apart what's the chicken and what's the egg. So we know that there are certain profiles of “bad bacteria” that are associated with inflammatory bowel disease for instance, but we're just starting to figure out what's the insulting event that goes to lead to that profile. Is it the profile itself, or is the profile a result of the inflammation and disease process or the medications? And we're still teasing that apart.

So I think it's an exciting avenue and area of research, but we're just starting to scrape the surface and truly understand that impact.

MD Mag: What is the significance of treating for quality of life and psychiatric measures in patients presenting with gastroenterological diseases?

Click: I think the brain and the gut are intricately related and intimately tied. We speak about the brain-gut axis, because there's a huge back-and-forth network of communication both neurologically via chemokines and hormones, between the gut and the brain.

And what we've come to understand and truly appreciate is that certain disease states can have a vast impact on a person's quality of life. Similarly what we've noticed is that certain mental states can have a conversant gastrointestinal health.

So for example, patients who experience high levels of anxiety or depression are more likely to report gastrointestinal symptoms, and similarly, patients with inflammatory bowel disease have higher rates of depression and anxiety.

And so we're trying to understand what that mechanism and what that axis truly is and how do we intervene on that as a therapeutic option, and what it means for an individual's risk of developing certain processes or diseases as they age and develop. So it's an exciting area of research and therapeutic opportunity, and there's a lot more to discover. But the 2 are intimately related.