Tuesday, September 29, 2015

What are Biofilms and Why Should You Care?

I have been getting a lot of questions about biofilms lately.  So what is a biofilm, and should it be an issue in a functional medicine practice?

A biofilm is any group of microorganisms in which cells stick to each other on a surface.  Microbes form a biofilm in response to many factors, not the least of which is nutritional cues.  The questions I have been getting are usually in regard to the pathogenic kind and their impact on the gut microbiota, because biofilms, like any microorganism, can be both beneficial to human health or harmful, depending on the nature of the microorganism.  

Here's some basic facts about biofilms:
  • ALL bacteria live in a biofilm.
  • Good bacteria themselves – regardless of strain – produce a healthy biofilm.
  • All good bacteria produce various bacteriocins – such as the strains used in Ultra Flora Women's and Ultra Flora Integrity and Ultra Flora Acute Care, etc – to aid in restoring microbial balance.
  • Bad biofilms are due to the bad bacteria themselves. To reduce pathogenic biofilm focus less on specific probiotic strains and more on overall good biosis (i.e. 5R Gastrointestinal restoration program).

Since biofilms are colonies of organisms, most all intestinal organisms, including good flora, reside in a biofilm. These biofilms also allow organisms to attach to the intestinal wall. Enzyme type oral ‘biofilm’ disruptors are often suggested as a counter to pathogenic biofilm formation. Along these lines, Spectrazyme Complete is a broad spectrum enzyme formula that could be useful as a pathogenic biofilm disrupter. Of course, Spectrazyme Complete is not labeled for biofilms, but the effectiveness of this type of ‘biofilm buster’ is a strong possibility, albeit a bit more theoretical (Petri dish). 

Petri dishes are often like Las Vegas. At times what happens in a Petri dish stays in a Petri dish and is not necessarily applicable in the complex human digestive tract.  That being said, there may be merit nevertheless in using enzymes for helping to support healthy GI microbiota.  

If desiring a comprehensive approach, consider that a biofilm is more driven by dysbiosis itself (is produced by the dysbiotic organisms themselves). A 5R program utilizing GI-active herbals such as the berberine complex in CandiBactin BR or bacteriocin production products like Ultra Flora Restore or Ultra Flora Women's, and/or prescriptive antimicrobials followed by the remainder of the program seems applicable. Colostrum-like support (whey immunoglobulins and prebiotics -- think Probioplex Intensive Care) can further support proper biosis by decreasing the adherence of these pathogenic organisms to the GI wall (lactoferrin, lactoperoxidase). Also, part of 5R includes the use of enzymes mainly to support proper digestion.

Of particular interest is the evidence showing that those more susceptible to pathogenic biofilm colonization had reduced numbers of probiotic strains in the gut.   

“...Biofilms are communities of [established] microorganisms residing within a self-produced matrix of exopolymers. Microbes prefer living within biofilms, which protect them from dislodgement, predation, host immune responses, and antimicrobial agents...Macfarlane noted that microbes inhabiting biofilm are more efficient at fermenting long-chain polysaccharides than are free-living luminal bacteria, which appear to chiefly ferment oligosaccharides. Microorganisms within biofilms in the mucus layer overlying the intestinal mucosa are more likely to interact with the host's immune system, and these interactions may be healthful or harmful depending on the organisms involved. She noted data showing that microbial gastrointestinal biofilm communities in patients with ulcerative colitis contain significantly fewer bifidobacteria and higher numbers of anaerobic gram-positive cocci, peptostreptococci, enterococci, and enterobacteria. Macfarlane reviewed both in vivo and in vitro evidence that the prebiotic inulin [FOS] can significantly increase intestinal biofilm bifidobacterial populations while simultaneously decreasing biofilm populations of Clostridium, Bacteroides, Fusobacterium, and Enterobacteraceae species, and at the same time inhibit pathogen activity and reduce C. difficile toxin concentrations...” http://www.townsendletter.com/FebMarch2009/probiotic0209.htm

While the use of the term "biofilm" seems novel and cutting edge, actually, it is simply another way of describing dysbiosis.  The approaches that experienced functional medicine and nutritionally-based holistic practitioners have been using for healthy GI microbiota all along are effective in establishing a GI environment that is antagonistic to unhealthy biofilms and encouraging of the healthy biofilms, because at the end of the day it's still about good bugs vs. bad bugs.