I’ve been recommending Peter Attia for a while. In my list of integrative medicine books, I recommend Attia’s Outlive. And just recently I recommended that people listen to his podcast, The Drive. I’ve even shown up on a list of “doctors like Peter Attia,” which is kind of funny.
That’s not to say Attia and I think alike on all issues though. For example, I admire Attia’s dedication to rigorous scientific research—but when it comes to a holistic approach to treating individuals, I think integrative medicine doctors need to take on the role of explorers, alongside our patients.
Holistic approaches, by the nature of the word whole, attempt to combine various interventions simultaneously in conjunction with an individual’s unique situation and genetics. This means we are sometimes going places where the science is still evolving, and where there may not be definitive, double-blinded randomized control trials to defend every potential intervention—for example, the microbiome.
As a recent piece in The Atlantic points out, there is no one clear definition of what makes a healthy microbiome:
The makeup and balance of people’s microbiomes vary based on numerous factors, including genes, diet, environment, and even pets. This means that a treatment that works to rebalance one gut might not work for another.
This kind of complexity makes it hard to have a randomized controlled trial, known as the “gold standard” of research. This is the kind of science that Attia really values, and I’ve noticed in the past that if it’s not there, he tends to not have so much interest in talking about it. This skepticism is not uncommon in scientific communities, especially when confronted with a field that is as dynamic and rapidly developing as microbiome research.
That’s why I was heartened to listen to his recent episode with Colleen Cutcliffe, an expert in molecular biology and co-founder of Pendulum Therapeutics. Pendulum has been working on manufacturing specific strains of probiotics to help improve gut health—specifically, one called Akkermansia.
Attia readily admits his opinion has changed about some things, to his credit. The importance of gut health and the microbiome is one of them. That’s because there is new science that links certain strains of probiotics to the management of chronic diseases, such as diabetes.
Cutcliffe notes a 2020 study that investigated a novel probiotic formulation's impact on blood sugar control in individuals with Type 2 Diabetes. The trial found that the probiotic blend significantly improved post-meal blood sugar levels and glycated hemoglobin (A1c), a marker of long-term blood sugar control, without safety or tolerability issues.
The study shows that specific probiotics might play a role in managing Type 2 Diabetes alongside diet and other treatments. “To our knowledge, this is the first randomized controlled trial to administer four of the five strains to human subjects with [Type 2 Diabetes],” the authors wrote.
It’s great to see studies like this, and a good scientist and skeptical mind like Attia will modify their prior assertions accordingly when new, rigorous studies like this one are released.
At the same time, one of the cornerstones of both functional and integrative medicine is that each individual is different. Integrative and functional medicine physicians take a holistic approach to investigating the root causes of chronic disease. The early stages of each investigation can and should be informed by the existing science.
After this, we must necessarily experiment. The Atlantic is right that a treatment that works to rebalance one gut for one person might not work for another. But the holistic investigation of gut health can profoundly influence patient outcomes and offer insights into a wide range of health issues, from metabolic disorders to mental health.
Meanwhile, despite the hesitancy to fully embrace microbiome science, there's an increasing recognition of its significance, including among mainstream influential doctors like Peter Attia. Still, the microbiome's complexity and its interplay with diet, lifestyle, and overall health make it a challenging area of study.
Cutcliffe is doing groundbreaking work at Pendulum and has contributed significantly to our understanding of gut microbiota. Their research presents tangible evidence of the microbiome's impact on health. This in turn paves the way for targeted probiotic therapies. These therapies, rooted in the deep understanding of specific bacterial roles, represent a significant leap in personalized medicine.
Even Peter Attia is coming around to that—because the science is as well.