Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany · info@clinicum-stgeorg.de
Microbiome Medicine
A large share of the body's immune tissue sits in the gut wall, and the gut-brain axis reaches mood, sleep and cognition. St. George Hospital measures the microbiome and the intestinal barrier before treating them, then rebuilds both in a staged program on the ward.
You know which restaurants are safe. You know where the restrooms are on the drive to work. Antibiotics for something else made it worse; a probiotic from the pharmacy did nothing. Your doctor said IBS, which named the problem without explaining it.
This page is the gut module of our longevity program and of the functional medicine work-up. It describes what a microbiome analysis shows, how the result turns into a five-step plan, and where a microbiome transfer belongs in it.
The gut carries trillions of microorganisms, the microbiome, which take part in immune regulation, nutrient absorption, hormone metabolism, neurotransmitter production and the balance between inflammation and tolerance. The immune system has, to a large degree, evolved to keep this partnership stable, and a microbiota that has lost diversity is linked to the rise of inflammatory and autoimmune disorders (Belkaid et al., Cell, 2014).
Two things go wrong in a chronically ill gut. The community shifts, with fewer fiber-fermenting species and more inflammatory ones; this is dysbiosis. And the barrier opens. Zonulin, the protein that loosens the junctions between intestinal cells, is raised in several autoimmune and inflammatory conditions, and an open barrier lets bacterial endotoxin reach the bloodstream (Fasano, Physiol Rev, 2011). The consequences reach past the abdomen: nutrient deficits, a low-grade systemic inflammation, and, through the vagus nerve, microbial metabolites and immune signaling, effects on mood, sleep and cognition that the gut-brain axis literature now describes in detail (Cryan et al., Physiol Rev, 2019).
That is why the hospital treats the gut as a component of nearly every program it runs, from Lyme disease and chronic fatigue to oncology and longevity medicine.
The work-up starts in the first two days of a stay. Samples go to our own laboratory and partner laboratories; the physician who ordered them reads the results with you in the room, usually within the first week. The functional medicine testing guide explains the individual markers.
Bacterial composition and diversity, beneficial and pathogenic species, fungal overgrowth (Candida), parasites, digestive enzyme output, inflammation markers (calprotectin, lactoferrin) and short-chain fatty acid production. This is the baseline every later measurement is compared with.
Zonulin levels and the lactulose-mannitol test estimate how open the intestinal barrier is. A raised value explains why endotoxins reach the bloodstream and drive systemic inflammation, and it is one of the markers we repeat to show whether the barrier has closed.
IgG and IgA antibody panels against foods are used as one input for a time-limited elimination diet. The European allergy society does not recommend IgG4 testing as a stand-alone diagnostic (Stapel et al., Allergy, 2008), so the panel never decides a plan by itself; symptoms and barrier markers do.
The plan follows five steps in order. Which steps you need, and how long each runs, is decided from the stool analysis and the barrier markers, not from a template.
Pathogens identified on the stool analysis (bacterial, fungal such as Candida, parasitic), trigger foods and environmental irritants are removed. Antimicrobial therapy is targeted to the organism found, combined with dietary change.
Digestive capacity is restored with pancreatic enzymes, hydrochloric acid support where indicated and bile acid supplementation. Many patients with long-standing gut symptoms have reduced digestive secretions, which the stool analysis shows as undigested fat or protein.
Beneficial bacteria are rebuilt with strain-specific probiotics chosen from the stool analysis and with prebiotic fibers that feed those species. Where the community is too depleted for this to work, usually after long antibiotic courses, a microbiome transfer is considered as an individual treatment attempt decided with the patient after medical consultation.
The intestinal lining is supported with L-glutamine, zinc carnosine, butyrate, collagen peptides and anti-inflammatory botanicals such as curcumin, aloe and slippery elm. The aim is a closed barrier and less endotoxin reaching the blood, and the permeability markers are repeated to show whether that happened.
Stress physiology, sleep, exercise and long-term diet are addressed, because cortisol opens the gut barrier and a low-fiber diet starves the species the program has just rebuilt. You leave with a written diet plan; the anti-inflammatory diet for chronic disease is its basis.
The link between the gut microbiome and chronic illness is well documented. That repairing the gut changes the course of those illnesses is emerging evidence.
The link between gut microbiome and chronic illness is well documented; the evidence that repairing the gut changes the course of those illnesses is emerging. Patients with myalgic encephalomyelitis have reduced bacterial diversity and signs of microbial translocation into the blood compared with healthy controls (Giloteaux et al., Microbiome, 2016). In COVID-19, the composition of the gut microbiota tracked disease severity and inflammatory markers, and the dysbiosis persisted for a month after the infection resolved, which the authors suggested could contribute to persistent symptoms (Yeoh et al., Gut, 2021). Repeated antibiotic courses shift the gut community within days and recovery is often incomplete, with the community settling in an altered state (Dethlefsen et al., Proc Natl Acad Sci U S A, 2011). On the treatment side, close adherence to a plant-rich Mediterranean diet is associated with higher short-chain fatty acid production and fiber-degrading species (De Filippis et al., Gut, 2016), which is why diet is the first and last step of the protocol.
What the evidence does not show: no trial has demonstrated that a staged gut-restoration protocol improves fatigue, cognition or infection outcomes in these conditions, so the hospital judges each plan by the markers it repeats, not by the literature alone.
Reduced microbial diversity and translocation of bacterial products are documented in ME/CFS. The gut module runs alongside the mitochondrial and immune work-up.
See the chronic fatigue program →Dysbiosis persists after the infection. Gut restoration is one module of the Long COVID stay, next to the microcirculation and immune work.
See the Long COVID program →Long antibiotic courses deplete the microbiome. The gut module sits at the end of the antibiotic phase and supports immune recovery.
See the Lyme program →Donor microbiota delivered by colonoscopy or capsules when the community is too depleted to rebuild. Strong evidence for recurrent C. difficile; individual treatment attempt elsewhere.
What microbiome transfer involves →Rectal ozone is used in the removal phase against pathogenic gut bacteria and to support the mucosa, in the weeks before any transfer.
What ozone therapy involves →Immune modulation where the immune profile shows exhaustion, supporting the gut-associated lymphoid tissue that the microbiome trains.
What immune therapy involves →NAD+ supports cellular repair in the intestinal lining during the repair phase, as part of the infusion program.
What NAD+ infusion involves →Thyroid and sex hormones affect motility, microbiome composition and intestinal inflammation; the hormone panel is read with the stool analysis.
What hormone therapy involves →The metabolic, hormonal and mitochondrial tests that place the gut findings in the context of the whole patient.
What functional diagnostics include →Your written, itemized cost overview shows a package price plus individual add-ons. After the International Office has requested your records and a physician has reviewed them, you receive a written treatment proposal and an itemized cost overview in EUR; billing and out-of-network claims are explained on costs and insurance, travel and the International Office on information for international patients.
If you have a stool analysis, a gastroenterology report or a long antibiotic history, send it with a short description of your symptoms. A physician reads it before the video consultation and tells you which of the five steps your plan would contain.
The initial inquiry is free of charge. The International Office reviews your message and your case directly and gets back to you.
Munich Airport (MUC), about 60 minutes by car.
