as a clinician I am looking for the relevance of this information to gearing testing and treatment for my patients. Are there any recommended tests -such as a complete digestive stool analysis, for determining risk of an individual? And are there either well validated treatments for those with higher risk or studies that the panel knows of that are focused on testing specific treatments?

The field of how gut microbes impact on diabetes and obesity by affecting the body burden of chemicals linked to these diseases is an emerging one. There are not currently tests that can be recommended at the current time. If there are opportunities to collaborate on a research basis, we would encourage those in this field to make the CHE community aware of these opportunities.

This was a great talk. Thank you to all the speakers. My question is for Dr Snedeker and Dr. Hay. I realize that your review is very recent, but I find your suggestion that researchers begin to explore ADME for chemicals very compelling. Do you have any information on who might take you up on this, or any plans to do so yourself?

Hi Allison, thanks for the feedback and for the informative blogging you did about our review: I sent my parents to your blog rather than have them read the review itself (http://blogs.edf.org/nanotechnology/2011/12/19/1653/). As I mentioned during the live discussion, I am not aware of anybody else looking at this in the toxicology arena. There is some older work coming from the food toxicology and colon cancer end of it, and there are a few people doing interesting work in pharmacology. While many of the findings are likely to be applicable, direct work with environmental toxicants definitely needs to be done. We are doing some preliminary work in my lab in anticipation of submitting a proposal in the near future.

Are you aware of the relationship between methanogenic bacteria and reverse peristalsis, constipation and diabetic gastroparesis?

I was not aware of this / these relationship(s). Are you asking if there is a relationship, or do you have evidence of such a relationship? If so, I encourage you to post references that can be shared.

Just to follow up a little bit on the type 1 diabetes issue, Dr. Vaarala in Finland has published a few hypothesis papers on the gut and type 1 diabetes, like this one (http://www.ncbi.nlm.nih.gov/pubmed/18820210) that proposes an interplay among gut biota, gut permeability, and immunity. I would also mention that CHE has a diabetes and obesity working group that anyone is welcome to join.

An interesting overview piece, from the Wall Street Journal (of all places), this week: http://online.wsj.com/article/SB10001424052970204468004577164732944974356.html?mod=WSJ_WSJ_News_BlogsModule#articleTabs%3Dcomments

Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys: http://humrep.oxfordjournals.org/content/17/7/1704.full.pdf+html

Here are other links to articles of interest on the question of the role of microbes. microbial infection, and inflammatory pathways in endometriosis, as well as the classic 1993 paper on TCDD (dioxin) induction of endometriosis in Rhesus monkeys: On TLR-4 and endometrosis: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21214494 \ Shigella infection and endometriosis http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17888583 TCDD (dioxin) induction of endometriosis http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8253297

The American Journal of Clinical Nutrition has just posted an article (minutes ago!) on a Brazilian cohort study that has found children delivered by Cesarean section have a "58% higher prevalence of obesity." Others have shown this, but this study draws data from three large birth cohorts. The hypothesis is that the gut will colonize different microflora with a C-section vs. vaginal delivery, and differences in colonizing the gut microflora may impact on obesity risk. See http://www.ajcn.org/content/95/2/465.full.pdf+html

That's interesting; C-sections are also associated with a 20% increased risk of type 1 diabetes, thought to be perhaps from gut microbiota: http://www.ncbi.nlm.nih.gov/pubmed/18292986