08/25/2026
We might be asking the wrong question about the microbiome.
I was listening to a conversation with microbiome researcher Kiran Krishnan recently, and something he said stuck with me. He drew a distinction that I think actually matters clinically:
The microbiome isn't broken. It's an ecosystem — and ecosystems respond to their environment.
That one shift changes everything.
And honestly, it's not even a new idea. It's terrain theory, which is an old argument that the environment the body creates matters more than the specific pathogen or organism living in it. Pasteur had germ theory. Béchamp had terrain theory. For most of the last century, germ theory won. We built antibiotics, vaccines, and an entire medical system around identifying and eliminating the bad guy.
But the microbiome conversation is quietly bringing terrain theory back in through the side door.
Because instead of asking "which probiotic should I take?" you start asking "what kind of environment am I creating inside my gut?"
And that's a much harder (and, in my opinion, more interesting) question.
It pulls you away from the supplement aisle and toward things like microbial diversity, what you're actually feeding those microbes, how well your intestinal barrier is holding up, how your immune system is talking to your gut, whether you're sleeping, how stressed you are, how much you're moving, what you're being exposed to in your environment.
Suddenly nutrition isn't just about hitting your macros. It's about building conditions where a resilient ecosystem can actually take hold.
You're not trying to add more bacteria. You're trying to create the right environment for the right ones to thrive.
That's terrain thinking. And it's a fundamentally different model of health.
Clinically, I think we're slowly moving toward a more ecological view of the body — where the real question isn't "what's wrong with you?" but "what environment is producing this?"
Podcast link: https://podcasts.apple.com/us/podcast/191-kiran-krishnan-how-to-rebuild-your-gut-microbiome/id1773578243?i=1000784007725
Book now to get your microbiome in tip-top shape: https://my.practicebetter.io/ #/61968aef3980330aec84e5c3/bookings?step=services
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