This is a very technical book and it took me a good 3 months to read it, a little bit at a time.
Here is one section I highlighted and it is a good representation of what you're in for if you decide to read this book: "The creation of novel biological computational models and a clear path to move from microbiome association to causation are essential steps in providing a mechanistic approach to gain insights into the development of noninfectious, chronic inflammatory diseases and possible targets for personalized interventions or disease prevention. This can only be done if studies focused on the microbiome are placed in the context of the biological ecosystems in which we live and interface each day."
We know that microbiome composition is associated with various diseases but that doesn't necessarily mean that changing the microbiome composition will cure the disease. This can't be deduced in the lab... i.e. we need human studies that make sense. Because the microbiome of each individual is, well, individual, it's hard to put together a one size fits all study that will satisfy the pharmaceutical companies and the FDA (my words, not the author's). One strain that works particularly well for one individual may not work for another.
The author presents 5 elements that lead to chronic inflammation, a serious problem in the west and a problem of aging. This includes, genetic predisposition, environmental factors, loss of gut barrier function, hyper-belligerent immune system, and an unbalanced microbiome. We can't just blame our genes if all of these things are factors. In the last chapter, these things come up again as the author talks about inflammaging as one of the factors at play in aging.
Another thing I made note of is that people respond differently to cancer treatments based on their microbiome composition. Given how destructive current cancer treatments are, it would be nice to be able to take a sample of the microbiome and measure it to see how effective said treatment might be before even attempting it.
As a nutritionist, I appreciate that the author recognizes how much cheaper it would be to implement healthy nutrition habits over the huge cost of drugs currently prescribed. However this statement made me a little sad: "With the appreciation that diet is the most influential factor shaping our gut microbiome, and that dysbiosis can be associated with a variety of chronic inflammatory diseases, more affluent people are now moving away from junk food and making healthier food choices." This implies that regular every day people are still sitting in line at the fast food restaurants and eating junk food. The thing is that eating healthy doesn't have to be expensive, it just requires more time, something that regular every day people do not have in our modern society.
The author is careful to note, more than once, that longitudinal studies are needed before we can begin to understand all of the many factors at play. Right now we can associate certain microbiome compositions with disease but that does not prove causation.
If you are familiar with terms such as dysbiosis, the blood brain barrier, pathogenesis and epigenetics then you may like this book. Otherwise, you might find yourself spending a lot of time looking up definitions.