Meet the squatters within you

You wouldn't be able to digest food properly without the microbiome bacteria 'squatting' in your gut. Antibiotics wipe them out, leaving you with the trots. Pic/ Getty Images

Hello, Mike, you're looking better than I've ever seen you," I said to my old friend. "Have you found a magic cure?"

"I'm feeling better than I have in years," said Mike (not his real name of course). "Got some treatment out in Phnom Penh."

Mike is a genial, extremely clever computer scientist suffering from a rare and incurable autoimmune disorder called sarcoidosis, which affects multiple organs but most commonly the lungs and the lymph glands. Symptoms vary according to the organ affected, but a common cause of death is congestive heart failure.

Today Mike was definitely glowing. His cheeks shone, his eyes were clear and he radiated good energy. Because of treatment in - Cambodia? Really?

"I thought sarcoidosis had no treatment," I said.

"It was slightly unusual," he grinned. "They gave me hookworm."

You've had hookworm, right? When you were small? From playing barefoot in the dirt? Then your father gave you an anti-helminthic to purge the worms out of you?
Mike went all the way to Cambodia to get infected with hookworms. And now he felt a whole lot better.

Let's rewind. Your body, like Mike's, has an immune system, made to quickly detect and demolish outsiders. Problems start when the immune system gets paranoid and begins imagining that its friends are actually enemies. It goes trigger-happy, attacking parts of your own body such as skin, eyes and liver, believing them to be lethal. When your immune system starts shooting at shadows, you have an autoimmune disorder.

Asthma is a common autoimmune disorder. Your airways become narrow, swell up and produce extra mucus. Breathing becomes difficult, you wheeze. Sometimes you die from asphyxiation.

According to Mike, most Cambodian doctors don't recognise asthma when they see it - because they see so little of it. Cambodian immune systems apparently behave themselves pretty well as far as asthma goes. The reason: childhood hookworm infections are common, a result of just playing barefoot in the dirt like we all once did.
The hookworm is a clever parasite - in order to be allowed to live in your body as a 'squatter', feasting off your feasts, it releases chemicals that dial down the immune system, the bodily equivalent of a white truce flag. Persuaded that the hookworm is not such a bad fellow after all, your immune system calms down. The result: no asthma, fewer allergies, fewer auto-immune disorders.

A scientific study confirmed this: introducing hookworm into people with asthma improved their symptoms measurably.

The Cambodian doctor placed hookworm larvae into small incisions on Mike's arms. A few days later, he had a full-blown hookworm infection. And by gum, he'd never felt better!

We are walking on the wild side of medicine here. After 10 years of looking the other way, the United States Food and Drug Administration recently allowed - poop transplants. You heard right , I said poop. This unorthodox cure has been working amazingly - to cure irritable bowel syndrome, Crohn's disease and C. Diff (Clostridium difficile), all autoimmune disorders. In a fecal transplant, the diluted poop of a healthy donor is pumped up your lower intestine. In short order, entire populations of healthy gut bacteria from the poop grow and re-colonise your gut. Soon you feel dramatically better.

What on earth is going on?

You won't like this: scientists are learning that most of you is not you. Of the mega-trillions of cells in your body, barely 10 per cent are originally yours. The rest are literally 'squatters' who establish residence in your gut, skin, eyes, hair, feet, wherever they can. They make up a rich and thriving 'microbiome'. Like all squatters, they come to improve their own lives but first they need to strike win-win deals with your body so that they don't get attacked and purged - and they're very good at this.

You wouldn't be able to digest your food properly without the microbiome bacteria 'squatting' in your gut. Antibiotics wipe them out, leaving you with the trots.
A baby emerges from the mother's womb glistening with her mother's protective microbiome. Realising that a C-section baby would have missed this microbiome wash, progressive midwives manually anoint the child with the mother's uterine effluents.

I learn two things. One, there's much to be said for not being a hygiene fanatic. And barefoot in the park occasionally may not be such a bad thing.

Two: It's humbling to know that I'm mostly made up of visiting 90 per cent long-term squatters who take care of 10 per cent of me.

I think of Mumbai's giant populations of squatters in their fragile slums, all hopefully arrived from the hinterland in search of glittering futures - and who are treated as ruinous outgrowths to be evicted as often and as far as possible. But these squatters, Mumbai's own microbiome, give us our maids and chowkidars, our cooks and gardeners, our plastic scavengers and entrepreneurs. And the occasional 'slumdog millionaire' too.

In a sentence: we are nothing without our squatters.

Here, viewed from there. C Y Gopinath, in Bangkok, throws unique light and shadows on Mumbai, the city that raised him. You can reach him at cygopi@gmail.com

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