Tuesday, December 22, 2015

2015: A year in travels

Ben (In like Flint, MI) – Senior year

San Francisco (multiple to see Theresa)

Residency interviews
East Lansing
Ann Arbor

Foreign travel
Vancouver, Canada – engaged
Uganda – Mbale, Bududa, Jinja, Sipi Falls, Murchison Falls, Kampala
Vietnam – Sapa, Hanoi, Phong Nha, Hoi An, Saigon, Vung Tau

Los Angeles
Las Vegas
Zion Nat’l Park
Bruce Canyon
Arches Nat’l Park
Canyonlands Nat’l Park
Antelope Canyon
Grand Canyon

Tally:  34+ cities and sites

B (places where I stayed in 2015 in chronological order)

Denver – U. Colorado (3 talks)
Vancouver, Canada – tai chi
Beijing, China
Vietnam – Hanoi, Phong Nha, Hoi An, Saigon
Chicago – American Academy of Pediatrics
Madison – U. Wisconsin (talk)
Mendham – grandkids
Baltimore – Mt. Sinai (2 talks) during Baltimore riots
East Lansing – Ben’s graduation
Lawrence – Dad’s memorial celebration
Madison – wedding
Toronto, Canada – Canadian Pediatric Society (talk), Toronto Sick Kids (group mentoring)
Mendham – grandkids
Vancouver, Canada – tai chi
Hong Kong, China – Dad’s estate
Vancouver, Canada – tai chi
Madison – friends
Japan – Osaka – meet Dr. Nagita, Kanazawa – sights, Oyama – Jichi U. (talk), Mito – sights, Tokyo – Japan Society for Psychosomatic Pediatrics (talk) … Jiro’s sushi
Irvine – APAMSA (2 talks + panel)
Washington DC – NASPGHAN (Teri Li Education Award)
Mendham – grandkids
Princeton – Asian American Alumni: We Flourish (panel)
Pittsburgh – 2nd Nausea & Vomiting Conference (talk, CVS guidelines)
Washington DC – National American Academy of Pediatrics Conference (3 talks)
Boston – Massachusetts General Frontiers in Gastroenterology (talk)
Mendham – grandkids birthdays
Mendham – grandkids Thanksgiving
Denver – X-mas with Ben & Theresa

Tally:  35 cities (14 int'l), 20 invited talks etc. – whew, most ever
It began and ended in Denver – Rocky Mountain (cannabis) high
I was disoriented – where in the world is B Li?
I hit platinum – bioupgradable
It’s downhill from here – enjoyed it while it lasted

Highlights of 2015:
Buckeyes are undisputed National Champs - win historic first playoff
APAMSA's 20th anniversary - it is still up and running
Trekking to Vietnam’s Hang En caves – the 3rd largest in the world
Japan – omnipresent aesthetics that I revel in, Jiro’s sushi lunch
Vancouver – humbled but still learning from my Tai Chi master

and most important
Dad’s memorial celebration – closure but more to be done
Wrassling and floor time with Naomi and Jack 
Ben’s graduation and engagement to amazing Theresa

Happy Holidays to all!

Highlights in pictures

Against many odds, my Bucks did it and I wore my Buckeye hat!

Keynote at APAMSA's 20th anniversary - an organization that I co-founded in 1995

Immensity defined, a human but a speck

Encamped on a sandbar inside Hang En cave 

Shirakawa-go village - idyllic World Heritage site

I eat Jiro's dream of sushi, it is out of this world

Sifu Paul Tam Nat'l Champion of Southern Fist and Master of Chen's (original form) Tai Chi 

Jack and the bean stalk

A berry, berry happy Naomi
Ben graduates in East Lansing (Teri was there), begins residency in Denver

Theresa and Ben blissful in Hawaii

Friday, July 3, 2015

Dad's Memorial Celebration in Kansas

On May 30th, 2015, we celebrated the life and career of Prof. Chu-tsing Li at the Alumni Center in Lawrence, Kansas.  He taught at Kansas for 24 years and was the first Judith Harris Murphy Distinguished Professor of Art History at Kansas University.  On the 31st, his ashes were were placed next to those of our mother at Pioneer Cemetery on a quiet hilltop overlooking the KU campus.

The celebration was attended by around 40 family, friends and former colleagues ranging in age from 2 (grand daughter Naomi) to 95 (James Kemper).  There were a good number of his former PhD graduate students including Claudia Brown, Janet Baker, Pat Graham, Anyi Pan and Marilyn Gridley.  Many others work overseas, a number our retired and other were unable to make it because of conflicts or health issues.  My mother's closest friend from grade school in Guangzhou Ruth Wong (retired pathologist) near 90) came from California with her nephew Nick Liang as support.  An important artist friend Hong Xian and husband TC Chang (nationally ranked tennis player > age 80) came from Houston.  Martin Cheng another important artist friend attended as well.  Our father had outlived many of his colleagues.

James Kemper


On behalf of the Li family, I am delighted to welcome you to this celebration of the life and career of Prof. Chu-tsing Li.  I extend a special welcome to friends, KU colleagues, artists, and most of all his former graduate students who represent a lot of blood, sweat and tear equity.  In fact there were 78 total graduate student progeny in all who earned 28 PhD and 50 MA degrees.  This was, I’m told the largest graduate number for a single professor in the College of Liberal Arts … that is quite an academic family. 

Prof. Li would have turned 95 years old 4 days ago.  There are 3 indicators of the expanse of his life.  First, many of his Asian art contemporaries had predeceased him.  Second, a number of his former graduate students Marilyn Gridley (UMKC), Julie Yuan (UMStL), Yoshi Shimizu (Princeton), Bob Thorpe (Wash U StL) and Bob Mowry (Harvard) have already retired.  Third, there are 2ndgeneration academic progeny such as Li Junyi who is was a PhD student of Claudia Brown, an ink painting protégé of Liu Guosong, and a mentee of Prof. Li.

Prof. Li was a history buff and pleased that his path crisscrossed so many historical events in China.  A few years after the fall of the Ching Dynasty, he was born during the chaotic Republican era when his father was the #3 military man (commanding 10000) in Guangdong Province.  Most of his schooling took place during WWII.  As a high school student, he exited Nanjing a few months before the infamous massacre.  To reach his college campus then relocated to Chengdu in Sichuan Province, he had to travel by way of ship to Hainan Island and Hanoi, by rail and truck up the Burmese Road.  After the war he journeyed two weeks by boat with Mom to the U.S. to attend graduate school in English, she in Botany.  Following the Communist revolution of 1949, he faced the critical decision of whether to return to China.  He fortunately, decided to stay in the U.S., and knowing what we now know about the Cultural Revolution, I can imagine how different my life path would have been had he chosen otherwise.  He returned China for the first time just after Nixon ‘opened’ it in 1973, and then nearly every year or other year through 2007 when Teri and I took him back to his home village of Chong Hua after a 71 year absence.

A few visible milestones.  In 1959, he received Ford Foundation Grant to retrain in Chinese art history at Harvard and Princeton since he was trained in western/Northern Renaissance art.  In 1963, he received an ACLS Grant to circumnavigate the globe for a year during which he was one of the few scholars to document the treasures of the Palace Museum which were being removed from mountain storage for the first time since 1949.  He published his seminal work Autumn Colors of the Ch’iao and Hua Mountains by Chao Mengfu.  Marilyn Stokstad recruited him in 1966 to work both at KU and at the Nelson-Atkins Gallery as a research curator with Laurence Sickman.  In 1972, he taught at the Chinese U. of Hong Kong that led him to visit his homeland for the first time in 26 years.  In 1979, he was in the first group of Fulbright Exchange Scholars to China.  And addressing an entirely different era of art, in 1963 he began the appreciation of contemporary abstract ink painting that was emerging in Taiwan that literally changed the field and the careers of many artists such as Liu Guosong.  As I have witnessed, he has always had a discerning eye for new, unique and outstanding Chinese ink painting even from untrained painters.  Mom was his support.  Amy and I were the beneficiaries of these worldly experiences.  

Accolades came in the form of the dedicated conference and published Festschrift organized by Claudia Brown and Joseph Chang, the exhibition of his painting collection by Bob Mowry, Claudia Brown and Janet Baker, recent compliments of his work by other Yuan scholars such as Nancy Steinhardt at U. Pennsylvania, and a wonderful profile by Bob Mowry and Claudia Brown in Orientations.
But as I am sorting through his files, I see the less visible side behind the scenes.  I see collected dissertations, hundreds of letters of recommendations for jobs, travel awards, fellowships for many of you.  Scores of letters to Chinese art historians and Chinese artists all over the world to set up interactions, meetings, viewings, exhibitions, and exchanges.  Always researching, organizing, developing, teaching, mentoring, promoting .…

Even past the age of 90, Prof. Li’s contributions did not stop.  Two books of his collected works were published in Chinese, and an original article appeared in Wen Fong’s Festschrift.  He was repeatedly asked to grant permission to reuse and republish prior articles.  He was asked to review presumptive works of Wu Guangzhong for authenticity.  He was interviewed by a social historian writing on the development of contemporary art in Taiwan.

Prof. Li was an unsentimental and analytical person, philosophical but not religious.  And if he were here today, he would want to know what you are doing and what the latest is in Chinese art and the art history field.  His avocation was his vocation and vice versa – even well into his retirement he continued to write down every viewed painting on his omnipresent 4X6 note pad ... I’ve said that if he were stranded on a deserted island, he would ask for his library.  I hope there is a Chinese art library, ink paintings and gallery in heaven! 

Curator Janet Baker (also for Marilyn Stokstad)
Former Dean Del Shankel

Prof. Claudia Brown


After going around the room with self-introductions, Janet Baker read a passage by Marilyn Stokstad his former Chair who recruited him, Del Shankel his former Dean recounted his important contributions to Kansas University, Claudia Brown placed his accomplishments in the context of the field, and Janet Baker provided a heartfelt view of his effect on her career.  I read a statement from Yoshi Shimizu who received his MA under my father before finishing his PhD in Japanese Art and entire teaching career at Princeton.

We then had statements from the family - son Ben, daughter Rachel, husband John, kids Jack and Naomi, and sister Amy and son Daniel (who graduated from KU).  Rachel spoke of her memories of him, Ben read a letter of advice his grandfather had written to him.  I read the comments below:

B's comments

My personal comments reflect the last years of Dad’s life.  As many of you are aware, I cared for Dad the last 3 years of his life when he lived down the hall, responsible for him 22/7.  After repeated falls in his apartment when he no longer called me, towards the end I placed him in assisted living against his will ... ‘Teri always promised me I wouldn’t have to go to a nursing home’  ‘Dad, Teri is no longer with us and I am still working full time.’

Dad required a walker and could live by himself but needed food, transportation, and full administrative support.  Early on he was able to read daily Chinese World Journal and the Sunday NY Times with me, watch Turner classic movies, and work on his autobiography.  He became progressively more confused occasionally wandering off.  The past - art history and early memories (street addresses of places he lived 65 years ago confirmed on google street view) – was alive and intact.  Over the last year of his life, he was unable to do these things and spoke less and less, his short-term memory increasingly impaired, perhaps depressed, but never uttering a word of self-reflection or self-pity.  He remained an indomitable optimist about life.

Two anecdotes illustrate this optimism.  One, he kept telling me that the Mongolian prime minister was coming to deliver a potion that would restore his mind and memory to the age of 65.  I responded, I needed it too, even though I was not yet 65.  Two, he once asked how far the science of prolonging life had advanced as he wanted live to 130 years in order to complete all his conceived academic projects.

Personally speaking, Dad was absent both physically and emotionally as my father.  I have no memories of hugs from the time I can remember, no memories of father-son activities (always with friends’ fathers), and no memories of a single word of praise in my lifetime.  I do recall him typing every night to 2 am that put me asleep, and, unhappily visiting innumerable museums as a child.  I do recall 20 years of searching for a father-mentor figure during school, college, medical school, residency and fellowship.  I do understand that it was partly his Chinese culture, partly that era, and partly his personality developed while attending boarding school from an early age of 8.  I also now understand too well that he gave his all to his scholarly work, to the understanding of contemporary ink painting, and especially to his many graduate students, but it still left an empty space in me.

Over the past 3 years since Teri passed, Dad and I became closer, he dependent upon me and he the center of my life.  I took him walker and all to his favorite Vancouver three times for 10 weeks, to New Jersey see his 2ndgreat grandchild Naomi, sister of Jack, and to KC and Lawrence to be honored at the Nelson Gallery and to visit friends in Lawrence – not without significant snafus.  I came to appreciate that he left his legacy through his research, through his academic progeny, and that through his distinct eye, left the world a more beautiful place.  So, at the end, the empty space in my heart became filled with these recent son-father memories even though he was not at his best.  I grew to accept him, come to peace with him and to love him.  I miss him. 

John, Rachel, Naomi, Jack Cullvan, B & Ben Li, Amy & Daniel Lee

Books, photomontage, and food

Kris Ercums the Asian Art Curator at the Spencer Museum organized a display of many of his published books and catalogs - that were used.  It the background I and a daughter of a friend made a continuous photomontage beginning with his young adult life, family, colleagues, artists, books he wrote, and paintings he either researched or collected, accompanied by the Pastoral Symphony by Beethoven.  The food was Indian (had to be ethnic) and quite good but my father would probably not have relished the non-Chinese cuisine.

Thanks to:

Teri Li my wife who passed away in 2011, who took care of him remotely after my mother died and moved him to Milwaukee in an apartment down the hall from us and set up his medical team
Norman and Helen Gee who looked in on him weekly, took him to appointments, rescued him from falls, fixed the house and cleared his house with me

Marilyn Gridley who provided support in Kansas

Ted Kurana who also provided support during crises in Kansas

Tony Lam who looked in on him regularly and brought food in Milwaukee

For this memorial thanks to:

Janet Baker who contacted former graduate students

Rachel my daughter who organized menu; Ben my son for scanning all the photos

Sarah Wong who put the photo montage together
John Kennedy, Director of East Asian Studies Center for obtaining the Alumni Center for this special day 

Thursday, May 21, 2015

A Son’s Sojourn to Commencement

Michigan State University College of Human Medicine Class of 2015 - where in the world is Ben?

Ben where are you?

A family affair - only physicians are allowed to hood new graduates.
Chris (Pediatrics), Aditi (Emergency), Dave (Pathology), Melodie (Pediatrics), Vinnie (Pathology), Ben (Emergency)
buddies on the threshold of many sleepless nights

Tricoastal: Pacific, L. MI, Atlantic - Theresa, dr. Ben, Dad, Rachel, napless Naomi, John, dapper cross-legged Jack

As I prepare to hood you, on your momentous day, emotions bathe, overflow, and clarify my perspective.  

When I mention your upcoming graduation to family, friends and colleagues, they imply that this happened predictably because I’m a physician, and yet this has been a singularly unique voyage that I couldn’t imagine 11 years ago.  Although when I took you on rounds at the age of 8 (the highlight being cafeteria fare), you stated that you wanted to have a desk facing mine when you grew up … how that warmed my heart.

It began four years ago with a white coat ceremony to denote the beginning of your life inside medicine.  Except that this did not occur at school as is customary but in our home, among friends and family, your mother dying of myriad complications of a unsuccessful bone marrow transplant for acute myeloid leukemia.  As physician friends offered advice and admonishment, your mother beamed through rivulets of fulfillment as she placed the white coat on your shoulders, hugged you, her bucket list nearly complete.  Mom … would not survive until you returned the following weekend to say goodbye.  

What a way to begin your first year.  Fortunately you found good friends, including one who had just lost her father.  You studied relentlessly.  You passed.  Your sister, nephew Jack and I visited for your birthday.  It couldn’t have been easy.  The acute loss swirled beneath waves upon waves of medical factoids, necessarily so.  You survived.  

But your growth really began after your BA in sociology, unclear as to what to do next.  Then began your two 2 year walkabout.  Taught college English in China close to Zhengzhou and traveled throughout.  Returned, found a restaurant job making pizza.  Traveled to Equador to volunteer in a cloud forest farm making physical and cerebral contributions, and traveled throughout. 

In Equador, a tragic fatal bus-truck accident in which you and Daniel were fortunately not seriously injured jarred you to life.  At close hand, a profound experience of the transience of life.  As you’ve told me, that single life-altering event galvanized you into action, maturity. 
And really it began in infancy.  At age one, you developed alopecia universalis.  If forced you to become prematurely self-conscious.  Some stared, others said things, some stole your hat, and we fretted.  Mom ferried you and I coached your basketball team, to shelter you, perhaps overly so.  Special dispensation for your cap in school, and your bandana in soccer.  And you made great friends that remain for you today.

I never urged you in a medical direction as I didn’t see the requisite self discipline or passionate purpose.  After the accident, you began the post-baccalaureate sciences, beginning at the starting block.  You did well, but quit the Chicago program to move nearer to friends in S.F.  You found a research job and completed the sciences one by one over 3 years.  You proved that you could do the work inspired by Paul Farmer’s Mountains beyond Mountains.  Mom remained steadfast in her belief that you would be successful.

And in S.F., you found your individual stroke.  You left the post-bac program against our advice to swim (or sink) on your own in S.F.  You chose not to take the MCAT prep course (and may have lost some points).  When your score was satisfactory, you decided to take your chances and not to retake it.  Deciding on the competitive field Emergency Medicine, you gained enough confidence to avoid having a back-up plan.  And in the last week there, you started a long-distance marathon with Theresa.

I may have opened the gates of opportunity but you swam through, maturing your stroke, perfecting your breathing, applying discipline to practice, and most of all finding what you are made of, the most important.  But it was Mom who imbued you with self worth, empathy towards the underserved, and who remained unwavering in her belief in your ability to triumph.

And so on this momentous milestone, the end of one incredible sojourn and beginning of another, I observe in amazement.  Taught so well by your mother, gates opened by your father, a village of Koslov’s to help, and spurred by traumatic experience, you have evolved into your own person with your own voice, a mature and disciplined learner, passionate for the underserved, carrying a calm, thoughtful and articulate demeanor.  How unimaginably far you have come.  I share this special moment with you, especially as a father, also as a physician.  Today, unrelenting joy is a watershed for those here, and especially your mother, also here, who so lovingly supported you and bore the bulk of the responsibility for who you have become and your achievements.  Who, in her last moments, was fulfilled by knowing that you would embark upon and succeed in this incredible journey … which has only begun.

[This was one of the highlights of my life.  Both Ben and I, separately, the night before thought a lot about Teri and her effect on this moment.  I barely held it together during the hooding, but when I read my thoughts to Ben, gentle torrents ran free...]

GI Blog #2 Why milk drinkers are mutants and lactose intolerance is the new normal

Years ago while doing my training in gastroenterology, I performed the very first lactose breath test in a 32-year-old volunteer who often drank milk and ate ice cream. After an uneventful first hour, the test confirmed his lactose intolerance in dramatic fashion – a rapid dash to the bathroom that resulted in watery expulsion, along with a rise in hydrogen gas in his sampled breath. This was my first confirmed diagnosis.
So why milk? (Disclosure, I am not paid by the National Dairy Council.)

Milk is an abundant source of calcium and vitamin D. Vitamin D promotes calcium absorption and bone health and prevents rickets and osteoporosis (thinning of bones). In Florida, ultraviolet light activates vitamin D in your skin, but in Wisconsin, higher calcium intakes compensate for the lack of sun exposure in winter. But milk is also full of lactose, the milk sugar. 

Lactose absorption
Your small intestine is lined by villi, which are small, finger-like projections that absorb nutrients. These villi are lined at the tips by lactase enzyme, which is the protein that splits lactose, a double sugar, into glucose and galactose for absorption by the intestine. In someone with lactose intolerance, the unabsorbed double sugar traps water and passes on to the colon where it causes gas, cramps and diarrhea.

Testing for lactase deficiency
The original test was to give lactose sugar in water and measure rising blood levels of glucose. This has been replaced by the noninvasive breath hydrogen tests, which are great for kids and adults. We also can measure lactase enzyme in biopsies taken from the small intestine during endoscopy, but it is too invasive and costly to do when trying to diagnose lactase deficiency alone. 

Who gets lactose intolerance and who doesn’t?
All babies have lactase enzyme during breastfeeding, but in most of the world once they are weaned, the enzyme is turned down, and they eventually become lactose intolerant. The same pattern applies to the animal kingdom: Dogs, cat, cows … all mammals, in fact, become lactase deficient when there is no further milk exposure after weaning. In Asia, Africa and the Middle East, lactose intolerance can affect 80-90 percent of the population. 

It’s the other way around for those of northern European descent as 90 percent or so have lactase persistence and can drink milk as adults. They deviate from the normal biological pattern due to a mutation that allows the lactase enzyme to persist beyond the point of weaning. Yes, a mutation leads to milk drinking!  

What is the advantage of lactase persistence?
When a trait is common, there is usually some biological advantage to it. And so it is with lactase persistence. Over the past 10,000 years, it allowed hunter-gatherers to become stable dairy herders. Because calcium for bones is so important, it also allowed people to live in such inhospitable locales such as sunless Sweden – and even Wisconsin! Having lactase enzyme beyond infancy may have even prevented pelvic rickets and allowed normal babies to be born.

What symptoms do you get?
We mentioned the typical symptoms – gas (topic of another blog), bloating, grumbling, crampy abdominal pain, and diarrhea. However, a number of studies in kids and adults show that giving lactose sugar to lactase-deficient patients doesn’t always cause symptoms. There is also evidence to suggest that you get symptoms from milk when lactase deficiency is combined with irritable bowel syndrome (IBS). That is, the lactose in the colon causes gas, triggers spasms and pain from IBS. Hmmm, so it is complicated, less clear than one would think.

So you are lactose intolerant, what to do?

The latest National Institutes of Health consensus panel (of which I was an early member) suggests continuing to drink/eat some milk/dairy due to its high nutritional value, rather than eliminating it. In fact, most lactase-deficient individuals can drink up to one-half to 1 glass of milk without symptoms – you have to find your tolerance level and stay below it. Cheese and yogurt (because it contains bacterial lactase) are better tolerated than milk or ice cream. And there are over-the-counter lactase enzyme pills you can take with dairy.

That volunteer subject with lactase deficiency? That was me. Now I know I am quite normal and don’t have a disease! Caucasians who are lactase persistent, on the other hand, are mutants. I had to spill the milk and speak the truth. See you at Culver’s.

Lactose (sugar) intolerance – you develop GI symptoms when drinking milk
Lactase (enzyme) deficiency – you have low lactase levels but may or may not get symptoms when drinking milk
Lactase (enzyme) persistence – you have normal lactase enzyme levels from a mutation

- B Li, MD, gastroenterologist, Children’s Hospital of Wisconsin


Monday, March 30, 2015

Announcements - Match, Memorial, Vietnam

Ben's future

It's a match!

Ten days ago on the day when all 4th year medical students learn where they will spend the next 3-4-5 years in residency training ... Ben opened his envelope and was surprised to discover that he will be going to the Rocky Mountains, his far and high (literally) reaching first choice.  This is Denver Health (U. Colorado), a top five program in adult Emergency Medicine.  He is so excited.  His papa (and mama who always believed in him) are so so proud.

Dad's second memorial celebration

This will take place on Saturday May 30th, 2015 at the Kansas University Alumni Center in Lawrence, Kansas from 4:00 pm - 8:00 pm.  There will be an informal celebration, photos, followed by an Indian dinner.  This is primarily for his local Lawrence friends and colleagues, and his grown-up former graduate students.  We look forward to seeing some of you there.

Ben Theresa and B's trip to Vietnam

Ahhh delightful. 
Ho Chi Minh's house on stilts - his peaceful hub of wartime decision making

A 'family of 4' scooter

Phong Nga with tower karst like Guilin - where we trekked

2 day trek down/up the mountain through the jungle

Theresa and Ben, wading through leechy waters - she caught one!

Entering the crease into the world's 3rd largest cave - 300-400 ft high, 1 mile long



Camping on a sandbar in the middle of the cave

Happy, happy hour at the opera

Ben's bamboo bicycle - brown, logistics

Ubiquitous markets, bargains, 1,000,000 dong = $46

Tuesday, February 17, 2015

B's GI Blog - The Straight Poop: How bugs in your bowel affect your health

This is the first installment in a pediatric GI blog that I started at Children's Hospital of Wisconsin.  Hope you enjoy.

“Poop,” my 2-year-old granddaughter says enthusiastically. “Me. Look … Woooow!”

She’s acquired the curiosity bug and wants to view the poop before it’s flushed away. She’s clearly on to something, because that poop is a significant indicator of her health.

Wait, what?

I am talking about the intestinal microbiome (the entire colony of bacteria that resides in our bowel) and the intestinal microbiota (the specific bacteria that live in the colony).

We used to consider bacteria in the bowel as purely discarded waste and the source of contamination and serious infections. But over the past two decades we have come to view them in an entirely fresh light.

Here are some fun facts about the bacteria that live in our intestine, mouth and skin:

100 billion bacteria live in stool the size of one’s pinkie
The entire colony of bacteria weighs about 3 pounds, nearly the size of your brain
We have 10 times more bacterial cells than we do human (eukaryotic) cells

The colony of bacteria affects our health in two main ways: Our immunity by influencing the development of inflammatory bowel disease, food allergies, and even celiac disease; and our metabolism by influencing the development of obesity and diabetes.

How is excess weight gain linked to bacteria? We’ve known that they help keep us well hydrated by fermenting sugars to short-chain fatty acids that help absorb water from the colon. When your child takes antibiotics like Augmentin, you reduce this fermentation and water absorption, and may develop diarrhea. In obese individuals, the microbiota profile is altered to work at high efficiency to absorb extra calories from carbs. In one clever study, the colonic bacteria from human twins – one obese and one not – was injected into sterile mice. Those receiving the obese bacteria gained weight faster than those given the slim microbiota. This excess weight gain could be reversed by using the “slim bacteria” or by a vegetarian-type diet. So, mouse obesity may be transferred (and reversed) through those little bugs in the bowel!

Bacterial diversity
How do we acquire our own intestinal microbiota? It begins when we become fully colonized by bacteria within 24 hours of being born. Birthing profoundly affects the microbiota, as those born by cesarean section have different and less diverse microbiota than those born vaginally. This appears to increase the subsequent risk of developing food allergies and inflammatory bowel disease (IBD), Crohn’s disease or ulcerative colitis later on. Although the microbiota largely become set by the time we’re toddlers, other factors influence its composition. Diet is a major one, especially poorly digestible sugars and fibers. Repeated courses of antibiotics in toddlers reduce the bacterial diversity and raise the risk of developing IBD. Finally, probiotics (beneficial bacteria) can alter the microbiota as long as they are taken, but in most disorders we don’t know exactly which bacteria, the exact dose, how long to treat, or whether they should be used in combination.

I could wax probiotically on and on but I’ll save that topic for another blog.

Poop transplants
Dangerous infections like Clostridia difficile (C. diff) illustrates the potential power of the intestinal microbiota. This bug can colonize (live without causing symptoms or disease) the colon, but under conditions of prolonged pest control (antibiotic), the flowers (good bacteria) are destroyed, and the weeds (C. diff) overgrow, causing fever and bloody diarrhea from serious colonic inflammation. This infection can resist our best antibiotics. In an exciting recent development, fecal matter transfer (FMT) aka poop transplant from a healthy donor (usually a family member or volunteer at a fecal bank in Boston where deposits are deposits) can eradicate resistant infections in 90 percent. This therapy is usually administered through a colonoscope while the child is asleep. This odiferous approach is likely to be used to treat other conditions as well.

Steve Werlin, MD, in our gastroenterology group has been our local FMT champion here at Children’s Hospital of Wisconsin and has cleared institutional concerns and followed the latest national guidelines to ensure that family donors are safe. We performed the first one together, and are now up to seven, all successful, in eradicating C. diff. Can you imagine wearing a bold sticker proclaiming “I donated poop today!”

What is the bottom line?
Joking aside, bugs in the bowel are a vital key to our overall health.

This area is so important that the NIH has the funded a national Human Microbiome Project – Dr. Nita Salzman in our group is a leader in the basic science research. It appears that a more diverse population of bacteria of better microbiota could protect us from developing a slew of common chronic disorders.

We are just scratching the surface of a very complex area, but will eventually know how to treat or “untreat” (with fewer or more selective antibiotics) the intestinal microbiome.
Prepare your noses and get used to it. Poop transplants are here to stay.

As for my granddaughter who started this, if she doesn’t outgrow her toddler fixation in a few years, maybe she’ll become a gastroenterologist like Grandpa.