Far From Elementary: Medical Students, Mysteries, and the Microbiome
Medicine has a funny way of keeping us humble. A common misconception is that we know exactly how the body works. Spoiler alert: we’re still working on it. Take Tylenol, for example—we know it helps with pain, but we don’t fully understand how. Or hiccups—science still hasn’t explained them. Even sleep, something we spend a third of our lives doing, remains partly a mystery.
It’s this endless curiosity, paired with a healthy dose of humility, that drives discovery forward. Medicine isn’t a destination; it’s an ongoing journey led by breakthrough after breakthrough. In 1928, penicillin launched the antibiotic era, revolutionizing infection treatment. By 1975, ivermectin was saving millions worldwide from parasitic diseases.
Each breakthrough didn’t just add to our toolkit; it fundamentally changed medicine.
Medical Students: Medicine’s New Detectives
With medicine advancing rapidly, who’s on the front lines of discovery? While countless teams contribute to breakthroughs, medical students often play a critical role. We might even think of them as the detectives of medicine. In their journey to learn and understand, students bring fresh eyes and curiosity, questioning everything and innovating, solving mysteries that might otherwise be overlooked.
So, what’s the next mystery waiting to be solved?
The Mystery of the Microbiome
Each person’s microbiome is unique, like a fingerprint. The microbiome is a vast collection of trillions of microbes, primarily in our gut, that work together to help digest food, break down complex molecules, and produce essential vitamins like B and K. It also plays a crucial role in regulating our immune system, helping distinguish between harmful invaders and our own cells. Beyond digestion and immunity, the microbiome even communicates with our brain, influencing mood and behavior—a connection often called the “gut-brain axis” (perhaps the origin of feeling “hangry” when hungry!).
When the microbiome becomes imbalanced, known as dysbiosis, it’s linked to health issues like obesity, diabetes, autoimmune diseases, and even mental health disorders. Despite these insights, much of the microbiome’s complexity remains a mystery. As we strive to protect this microscopic ecosystem, we must ask what can cause dysbiosis? This is the question Dr. Andrew Kirkpatrick and I at the University of Calgary are investigating, channeling our inner Sherlock and Watson as we use our detective skills to unravel this mystery.
Under Pressure: IAH and the Microbiome
What do medical students, and the microbiome have in common? They both hate being under pressure. Unfortunately, for both, pressure is often unavoidable.
Enter intraabdominal hypertension (IAH)—a fancy way of saying there’s too much pressure inside the abdomen. IAH is a cornerstone concept in trauma and critical care medicine, as anything from surgery to pregnancy can increase this pressure. IAH is no small matter; it can lead to a severe complication called Abdominal Compartment Syndrome, where dangerously high pressure impacts organ function and can be life-threatening. Could the microbiome also be affected by this pressure?
The Forrester-Kirkpatrick Hypothesis: The Microbiome as an Uncharted Organ
Our hypothesis in a nutshell: elevated abdominal pressure from IAH leads to reduced blood flow to the gut (gut ischemia), disrupting the microbiome’s balance. This dysbiosis involves bacterial translocation, where harmful bacteria move from the gut into the bloodstream, sparking widespread inflammation and further destabilizing the microbiome. Evidence from animal models supports this, suggesting that high abdominal pressures can indeed lead to dysbiosis.
Taking it further, we argue that the microbiome itself functions as an organ. Like the liver or heart, it performs essential tasks, from digestion to immune support. When the microbiome falls into dysbiosis, we could view this as organ dysfunction. The Forrester-Kirkpatrick Hypothesis suggests that IAH doesn’t just disrupt the microbiome—it triggers dysbiosis, resulting in organ dysfunction. The very definition of the abdominal compartment syndrome is new organ dysfunction resulting from a sustained increased of intra-abdominal pressure greater than 20 mmHg. Thus if dysbiosis results from IAH it should be considered to constitute the abdominal compartment syndrome, it would warrants intervention and ideally prevention.
The New Frontier
Our understanding of the microbiome and its role in conditions like IAH is just beginning. Although current evidence comes from animal models, the next step is clear: we need studies in people to establish links between IAH and microbiome shifts. This could pave the way for therapies to correct and prevent dysbiosis. In ICU settings, long-term microbiome monitoring could offer early clues of imbalance, guiding treatments to protect patient health and potentially saving patients from critical illness driven by microbiome dysfunction. With a deeper understanding of these microbial interactions, medical education itself will evolve, equipping future doctors with new tools to address conditions once thought unrelated to gut health.
For medical students, this field is a thrilling case waiting to be solved. As the “detectives” of medicine, students bring fresh questions and perspectives that drive discovery. Ten years from now, today’s textbooks may look entirely different, shaped by the puzzles we tackle today. As Dr. Kirkpatrick and I delve deeper into the microbiome, each clue reveals new layers of complexity—proving that this mystery, unlike Sherlock’s cases, is far from elementary.
