The Business of Changing Minds — When it comes to health, the CEO of AMILI trusts his gut

There’s one particularly striking study that examined the effects of microbiome transplants. Researchers introduced stool samples from children with autism into germ-free mice, noting that the mice developed autistic-like behaviours. ‘This discovery challenges traditional classifications of autism as a non-communicable disorder,’ says Dr Jeremy Lim, co-founder of AMILI. He wonders, ‘If microbiome transplants can induce these traits, could we also develop treatments based on microbiome health?’

Still, for all its promise, the idea of microbial transplants — or “poop transplants” as they are often irreverently called — still meets resistance. Some of it is due to the “ew” factor, but much is due to conservatism within medical communities. “In Singapore, microbial transplants aren’t used for children with autism spectrum disorder,” Lim says. “We’ve had discussions with the professional community, but let’s just say they’ve been progressing slowly.”

That reluctance to engage with emerging, non-traditional therapies isn’t unique to Singapore — it reflects a broader issue within medicine. Lim describes that the field has often been slow to integrate new knowledge when it challenges established norms. “Microbial transplants won’t be a cure,” he concedes, “but the data has shown encouraging results in a significant proportion of patients.”

The idea of exploring uncharted territories in medicine is at the core of AMILI’s mission. Lim acknowledges that pushing the boundaries of traditional medical practices comes with its own challenges, but he believes in the importance of innovation. The microbiome is still an unfamiliar concept for many people, but its potential to revolutionise healthcare is vast. It’s not just about curing diseases — it changes how we view health from a reactive approach to a proactive one.

“We’re not trying to fix what’s broken,” Lim demurs; “we’re trying to prevent people from breaking in the first place.”

Learning from history

Reflecting on the history of microbiome science, Lim shares, ‘The microbiome connects past practices with future possibilities.’ Ancient Chinese treatments involving probiotics demonstrate a longstanding understanding of gut health, now validated by modern science. “The Chinese were actually the first to perform microbiome — or ‘food’ transplants. In an ancient Chinese medical text, often referred to as the Yellow Book, there’s documentation of medicinal practices, including one rather unique treatment for the emperor’s health.”

Lim describes how this process involved taking stool from healthy 12-year-old boys, sealing it in a golden container, burying it for two years, and retrieving it as a concoction known as ‘yellow soup,’ (human fecal slurry, to be more specific) which the emperor would drink. “It sounds unappealing,” he admits, “but it produced a nutrient-rich broth full of beneficial microbes — an ancient, thermally charged probiotic, in a sense.”

Recently, Lim explains leaning in closer and slightly more animatedly, scientists in China revisited this process, recreating it under similar conditions of pressure and temperature. “In this controlled environment, beneficial microbes thrive, consuming harmful bacteria and undigested food, resulting in a potent probiotic broth,” he notes.

Forgotten for centuries, this practice eventually resurfaced in the Western world around the 1950s and only entered mainstream use around 2010, when American doctors began employing microbiome transplants to treat bacterial overgrowth syndrome.?

This condition, marked by an overpopulation of harmful bacteria, can cause severe gastrointestinal issues that are otherwise hard to treat. By introducing healthy bacteria from a donor, doctors were able to repopulate the patient’s gut with beneficial microbes, restoring balance and alleviating symptoms.

A library of life

Today, from a nondescript office at Science Park, Dr Jeremy Lim is on a mission to change how we think about health. AMILI, just five years old, is Asia’s first and only gut microbiome transplant bank and is building up the world’s largest multi-ethnic Asia gut microbiome database, aiming to explore how these invisible ecosystems shape our bodies, our cultures, and our futures. His journey into this complex world of microbes didn’t begin as an academic interest; rather, it emerged from an existential question that many high-level executives eventually grapple with — what do you do after a successful career when your heart craves something more?

“At the end of 2018, I’d actually decided to retire,” Lim confesses, his voice hinting at a kind of wistful relief. He had spent years building a flourishing healthcare consulting practice. It was thriving, he was thriving, but he knew consulting was “a young person’s game.” After decades of late nights and frequent travel, Lim wondered, “Do I really want to keep doing this for the rest of my life?” The answer, ultimately, was no.

After initially considering retirement or a quiet academic position at NUS, Lim’s conversation with his future co-founders led him to a new calling. Their message resonated: ‘If we don’t do this, no one else will.’ Today, Lim and his team at AMILI maintain Asia’s largest multi-ethnic microbiome database, aimed at understanding the unique needs of Southeast Asia’s diverse populations.

Unlike many health technologies imported from the West, AMILI’s research focuses on people living in Southeast Asia — multi-ethnic populations whose microbiomes differ vastly from those in the West. As Lim points out, “Across regions, microbiomes differ significantly, which makes sense — people in tropical, rice-eating areas have different microbes compared to those in temperate, wheat-eating regions. Microbes evolve and adapt to the environment they’re in.”

The uniqueness of our microbiomes is shaped by our diet, climate, and lifestyle, meaning that findings from Europe or America don’t necessarily apply here. Instead of asking, “Does Bulgarian yoghurt work for us?” Lim and his team focus on finding, “What is the equivalent of Bulgarian yoghurt for multi-ethnic Asia?” This kind of specificity — this precision — is what AMILI aims to offer.

AMILI’s work can potentially bridge the gap and connections between cultural practices and modern health. What Lim and his team of researchers seek to do is to understand these relationships better and provide more effective and culturally appropriate healthcare solutions.?

The ability to know how different populations respond to different treatments could, in no small way, reshape global healthcare and reduce disparities in medical outcomes.

A change in approach

Lim’s story of embracing the microbiome’s potential is a poignant one that feels, at its core, existential, challenging the very boundaries of what it means to be well.

“The microbiome literally encompasses the microbes that live in and around us,” he says — saying “us” in a way that blurs the lines between human and microscopic life. “There are many different microbiomes: the gut microbiome, which is the most complex and the one we primarily focus on, as well as microbiomes on the skin, in the lungs, and in the vaginal area, among others.”

Yet, this attention to detail was not commonplace thirty years ago… (Read the rest of this story here)