April 29, 2026
Gut Microbiome Part 1: Inflammation
In Flames
In med school, we learned the Latin names of the outward signs of inflammation:
Calor (warmth),
Dolor (pain),
Rubor (redness), &
Tumor (swelling)
Inflammation is the body’s response to something bad like infection, toxins (from metabolism or medications or drugs), or injury, whether on the macro level like swelling after a hip fracture or micro level through immune system byproducts that harm cells over the long term. Inflammation is a double edged sword. If persistent over time, it becomes death by a thousand paper cuts. Just like with chemotherapy or antibiotics, inflammation fights off the bad, but there’s collateral damage involved.
In short bursts, inflammation helps heal that sprained ankle or fight off the common cold. Persistent inflammation is another beast altogether, causing diseases that touch every organ system, as we’ll see below.
Organs Affected by Inflammation & Diseases Caused
That’s pretty much every organ system. From outside to in, from skin to our cells, inflammation either causes or contributes to disease. As we’ve advanced, we’ve found new ways to poison ourselves. Pollution, microplastics, fast food, ultraprocessed food, and endless other environmental toxins overwhelm immune systems and condition them to be in a state of constant hypervigilance, collateral damage be damned. In fact, we’ve learned an incredible amount about heart disease through studies focused on autoimmune conditions such as rheumatoid arthritis. It turns out having an autoimmune condition, defined by persistent and inappropriate inflammation, confers significantly higher risk of heart disease than a carbon copy without the autoimmune condition.
In the gut, a spectrum of diseases ranging from Irritable Bowel Syndrome (IBS) to Inflammatory Bowel Disease (IBD, including Ulcerative Colitis & Crohn’s Disease) can be traced to inflammation, if inflammatory bowel disease wasn’t enough of a clue. In arteries, including the arteries feeding your heart muscle, blockages were once seen as plumbing issues. Landmark trials have shown over and over again that the driver of clogged pipes is inflammation. It turns out you need a system reset (and a plumber too). In fact, next time someone spews nonsense about statins, popular cholesterol-lowering medications demonized in pseudoscientific literature, tell them about the JUPITER trial.
In 2008, the JUPITER trial was published, showing that healthy adults with normal cholesterol but high levels of inflammation (as determined by a blood test for an inflammatory marker, C-reactive protein or CRP) when started on a statin had less heart attacks and strokes (and less death from heart disease) than similar people not on a statin. What that told us was the benefit of these wonder drugs wasn’t just the cholesterol lowering effect. It was anti-inflammatory, and that seemed to be the key. Now plumbers like me had to know about inflammation too, and that’s good for society.
In cardiology, there’s a concept of “residual risk.” In basic terms, if we plug and chug every risk factor into a calculator to predict cardiac disease, or “events,” a sanitary way to say “heart attack,” we still miss a chunk of people. As evidence has accumulated since the JUPITER trial, that driver of residual risk is convincingly somewhere on the inflammatory pathway. I certainly believe that, and I would bet a lot that the majority of my colleagues do also.
So, where do we look?
Join me on a brief tangent. On call last weekend, a father, husband, and son in his early 60s showed up to the ER with a heart attack. The cath lab team and I were setting up the table, ready to receive him when the ER called. He had lost a pulse. 25 minutes later, he was back with us and on the table in front of me. I take one picture of his arteries and he loses a pulse again. It was clear he needed more than medications to keep his heart going while I opened the artery. I put in a temporary heart pump, called an Impella, but to no avail. He lost his pulse roughly 9 more times, despite a stent in the left main to open the blockage (the artery responsible for ~75% of the heart’s blood flow). Ultimately, I had no choice but to place him on ECMO, or heart-lung bypass.
He’s still alive, but his story and that of countless others is of little consolation to me. A 25 year old who looked just like me, skin tone and all, suffering a massive heart attack and passing away despite being on ECMO, his mother midway over the Atlantic on a flight from India, is not okay. If we could just find an off switch for the driver of inflammation, the root cause of what I treat and what so many of my colleagues across medical specialties treat, we can stop playing catch up. We can prevent rather than react.
Tangent over. Again, where do we look?
Imagine you’re hosting a party. Maybe it’s a tailgate, maybe it’s a fancy sit down affair. It’s you and 50 friends. It’s a great time, but the next morning, you find your toilet clogged, your freezer wide open and full of spoiled food, your TV cracked, and a line of ants following a trail of crumbs and soda residue through the wide open front door. Do you blame the toilet? TV? Freezer? If it were me, I’d call each of those 50 friends another word that starts with “F” and demand answers.
You and I are the hosts, and those 50 friends are countless microorganisms living it up in our bodies. This is your gut microbiome. Microorganisms, bacteria being the best defined, outnumber you, more bacterial cells than human in your own body. They’re amazing friends when things go right, but when your lock doesn’t work and you’re out of town for the weekend, they’ll trash your place & turn from friends to another “F” word. The lock in modern society is as broken as it’s ever been. Ultraprocessed foods, microplastics, and a host of other toxins have permanently rusted the lock.
The gut microbiome is responsible for immune system training, ensuring the cells lining your gut don’t “leak” and absorb harmful substances because the lock ain’t working, and countless other vital functions that can make the difference between a clean house and one that just (barely) survived a literal or metaphoric hurricane.
This is where we look.
As my loving wife says, I’m not long story short, I’m “short story long” (thanks Tooba Anwer). At the risk of being short story long, I’ll pause this Odyssey. Next time, I’ll dive into what the gut microbiome is, what specific functions it serves, and how things can go wrong.
Until next time.
