Blood Type and the Microbiome

More and more, we hear and read about the importance of the microbiome, the ecological
community of friendly and unfriendly microorganisms that share our body space. The
human body contains as much as ten times more microbial organisms than human cells,
and increasingly, changes to the microbiome are being associated with alterations, both
good and bad, to our health.

Blood Type Connections

Most laypeople and physicians can be forgiven for wondering what could blood type
possibly have to do with the microorganisms in the digestive system. Blood type, after all, is
just an ornament on a red blood cell, right? A complication of transfusion. Sadly, not much
else about blood type is taught as part of the standard medical curriculum. However
readers of my books and followers of my diet theory already know that there is a much
deeper and important role that blood type plays in conditioning our digestive tract; both in
terms of the characteristics of the lining (mucosa) and the variations of the secretions
(digestive juices) produced by the stomach and intestines. These blood type specific
differences can themselves have an important effect in altering the microbial balance of the
digestive tract. But there are even more elemental and direct ways that blood type can
condition the microbiome.

The blood type antigens (the marker that distinguishes one ABO blood type from another)
are widely distributed throughout the digestive tract, embedded in the mucus lining that
insulates the gut tissue from the rather harsh internal environment. The most common
blood group antigens are proteins that contain the sugar fucose. This the most basic
building block, and is called the H antigen. Although we commonly think of blood type O
and not possessing a blood group antigen: The name 'O' was chosen to signify the number
zero. The rationale behind that label only relates to the fact that type O blood does not
trigger an immunologic reaction when transfused into the other ABO types. Type O blood
does in fact possess an antigen, the so-called 'H' antigen. However since all the other ABO
types also make H antigen, it is not immunologically reactive in them, and allows type O to
function as the 'universal donor.'

So, to tie this important relationship together, let's put it in a table:

Blood Type Antigens Produced Antibodies Produced

O H Anti-A, Anti-B
A A, H Anti-B
AB A, B, H None
B B, H Anti-A
Blood Type Antigens as Bacterial Snack Food

There is good evidence that the ABO blood type antigens are a major influence on the
specificity of the bacterial enzymes produced the microbiome, serving to 'condition' the
microbiome. Much like how putting sunflower seeds into your bird feeder will tend to
encourage Cardinals to hang out in your backyard, the microbiome of a person who is
blood type B will tend to have bacteria with a preference and enzyme capacity for degrading
the B-antigen. Human feces contain enzymes produced by the bacteria of the microbiome
that degrade (break down and metabolize) the A, B and H blood type antigens lining the
digestive tract and convert it to an energy source for their own use. The population of fecal
bacteria that produce blood group-degrading enzymes is highly correlated with the ABO
and secretor type of the host. In fact, blood group specificity is common among intestinal
bacteria with almost 50% of strains tested showing some blood type A, B, or O specificity.
To give you an idea of the magnitude of the blood type influence on intestinal microflora, it
has been estimated that someone with blood type B will have up to 50,000 times more of
some strains of friendly bacteria than either blood type A or O individuals. Thus you might
be surprised to discover than much of a healthy microbiome is the result of harboring
bacteria that like to 'Eat Right for Their Blood Type.
Here are just a few:

Blood
Mechanism Organism Disease
Type
Adhesion Candida albicans Yeast Infections Type O
Diarrhea, 'Delhi
Adhesion Shigella Type B
Belly'
Poor Antibody Response Neisseria gonorrhoeae Gonorrheae Type B
Influenza virus
Poor Antibody Response The 'Flu' Type AB
substrains
Poor Immune Response Staphylococcus aureus Staph Infection Type A
Urinary Tract
Poor Immune Response Various Uropathogens Type B
Infections
Antigen Mimicry Giardia lamblia Diarrhea Type A
Increased Inflammatory
Vibrio cholera Cholera Type O
Response
Increased Inflammatory
Plasmodium spp Malaria Type A
Response
Increased Inflammatory
H. pylorii Stomach Ulcers Type O
Response

This is especially interesting in light of the fact that many of the fucosyltransferase
enzymes convey blood group and/or secretor status. (15) Human feces contain enzymes
produced by enteric bacteria that degrade the A, B, and H blood group antigens of gut
mucin glycoproteins. The autosomal dominant ABH secretor gene together with the ABO
blood group gene controls the presence and specificity of A, B, and H blood group antigens
in human gut mucin glycoproteins. There is evidence that the host's ABO blood group and
secretor status affects the specificity of blood group-degrading enzymes produced by his
fecal bacteria in vitro. (16) Comparatively small populations of fecal bacteria produce blood
group-degrading enzymes but their presence is highly correlated with the ABO /secretor
phenotype of the host: Fecal populations of B-degrading bacteria were stable over time, and
their population density averaged 50,000-fold greater in blood group B secretors than in
other subjects. In fact, the large populations of fecal anaerobes may be an additional
source of blood group antigen substrate for blood group antigen degrading bacteria:
antigens crossreacting with blood group antigens were detected on cell walls of anaerobic
bacteria from three of 10 cultures inoculated. (17)

Gut bacteria can have direct effects on gene activation that may be essential for proper gut
development. Bacteria induced expression of mammalian genes has been known since the
1980's when Japanese researchers were able to show that a fucosyltransferase enzyme
(fucosyl-asialo GM1) was induced by bacteria but was absent from germ-free strains. (14)
This is especially interesting in light of the fact that many of the fucosyltransferase
enzymes convey blood group and/or secretor status. (15) ABO blood groups and infectious
disease The previous section appears to imply a selection disadvantage for group A, and it
has been argued that under present day civilized living conditions O carriers have a
preservation advantage over blood group A. (52) This may be the result of the deletion of
the selection factor “infectious disease” which may nevertheless regain importance if
environmental changes occur. (53) Infectious diseases, especially the worldwide epidemic
diseases, have to great extent selective effects. This is demonstrated inter alia in the
different "selection values" in the ABO blood group system. During the eons prior to anti-
microbial intervention, selection variability via ABO polymorphism was the preeminent
natural survival mechanism. A morbidity and mortality variation among the ABO and
secretor groups is presented in the following tables. A special examination of polymorphic
differences in uropathic infectious disease is presented in the final table. For a more
detailed examination of particular infectious scenarios, the reader is referred to a previous
comprehensive survey by the author. (54)