Ethics in Medicine

Old Friends, Hygiene Hypothesis and Autoimmune Disease

Kristen Sparrow • August 26, 2014


statue of Kuan Lin
Kuan Lin
Goddess of Compassion
“She who hears the cries of the world”

This whole concept of “old friends” and hormesis fascinates me because of what I see every day in the clinic with patients’ resilience to stress, physical challenges and immune function.  The microbiota of the gut is complex and seems to be related to everything.  Besides avoiding antibiotics and factory produced fish, chicken and beef, I’m not sure what to suggest.  Probiotics.  How do you know if you’re getting the right ones?  Europe is way ahead of us on this and hopefully will show us the way.  Not that we will choose to follow it.

Adv Exp Med Biol. 2014;817:319-56. doi: 10.1007/978-1-4939-0897-4_15.
Microbiota, immunoregulatory old friends and psychiatric disorders. Rook GA1, Raison CL, Lowry CA.

Author information

  • 1Centre for Clinical Microbiology, UCL (University College London), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK,


Regulation of the immune system is an important function of the gut microbiota. Increasing evidence suggests that modern living conditions cause the gut microbiota to deviate from the form it took during human evolution. Contributing factors include loss of helminth infections, encountering less microbial biodiversity, and modulation of the microbiota composition by diet and antibiotic use. Thus the gut microbiota is a major mediator of the hygiene hypothesis (or as we prefer, “Old Friends” mechanism), which describes the role of organisms with which we co-evolved, and that needed to be tolerated, as crucial inducers of immunoregulation. At least partly as a consequence of reduced exposure to immunoregulatory Old Friends, many but not all of which resided in the gut, high-income countries are undergoing large increases in a wide range of chronic inflammatory disorders including allergies, autoimmunity and inflammatory bowel diseases. Depression, anxiety and reduced stress resilience are comorbid with these conditions, or can occur in individuals with persistently raised circulating levels of biomarkers of inflammation in the absence of clinically apparent peripheral inflammatory disease. Moreover poorly regulated inflammation during pregnancy might contribute to brain developmental abnormalities that underlie some cases of autism spectrum disorders and schizophrenia. In this chapter we explain how the gut microbiota drives immunoregulation, how faulty immunoregulation and inflammation predispose to psychiatric disease, and how psychological stress drives further inflammation via pathways that involve the gut and microbiota. We also outline how this two-way relationship between the brain and inflammation implicates the microbiota, Old Friends and immunoregulation in the control of stress resilience.