Gut Test Giveaway, On-Air BIOHM Gut Test Interpretation and How to Balance Your Microbiome

Hi, this is your host Lindsey Parsons with The Perfect Stool: Understanding and Healing the Gut Microbiome. Today I have Dr. Mahmoud Ghanoum back on the show. He's the director of the Center for Medical Mycology at Case Western Reserve University and the creator of the company BIOME. And on today's show, he interprets my BIOME gut stool test results, helping me make sense of the many bacteria bacteria and fungi found in my gut and comparing them to a healthy normal person's gut. And then it gives me recommendations for food and supplements that will help bring my gut into balance. And also listen through to the end for instructions on entering a giveaway of a Biome stool micro and microbiome test with dietitian recommendations. And you do need to be in the US to enter, however. But before I start, I wanted to invite those of you who are struggling with gut or other health issues to sign up for my 6-week Gut Reset program that's starting September 2nd, 2019. Or if you have a friend who has gut health issues, please point them to the program. This is perfect for people who are experiencing symptoms like bloating, cramping, pain, reflux, gas, constipation, loose stools, diarrhea, or even people with a diagnosis like IBS or SIBO, Candida overgrowth, Crohn's disease, or ulcerative colitis. But it's also great for people with autoimmune conditions, which are often triggered by or in turn impact gut health to help reverse those conditions. And also for people suffering with skin conditions like eczema or psoriasis, or people with persistent mental health issues depression or anxiety that don't seem to be situational, and also for fatigue. And of course, just people with high blood sugar, type 2 or prediabetes, or people who are just wanting to start eating better and losing weight. It's just a great chance to start over with your gut, your diet, and your overall health. So I'm gonna be delivering the program through Facebook Lives once a week. There'll be written materials and an amazing phone app that everyone will get access to. And so what's gonna happen is we'll kick off with a 4-day bone broth or elemental diet fast. Then each participant will receive 2 half-hour coaching calls with me, one at the beginning so that I can send send you to an appropriate nutrition plan after the fast depending on your situation and your symptoms. So I have options for all of the conditions in the situations I mentioned above, and every person will get access to this Coach Connect app that has eating plans and recipes for every type of diet, plus the ability to track what you ate, your sleep, and your symptoms so that I can keep up on your progress. And you'll have a private Facebook group where you can ask questions whenever you like and get support and encouragement from me and the other participants. Studies have shown that having a coach help you through diet changes and protocols to help your health increases the success rate of these protocols Then as you start feeling better, I'll be moving you towards recommended probiotics. And if you're not feeling better, pointing you towards herbal antimicrobials and antifungals that can finish the job. And eventually we'll move towards reintroducing foods and helping you determine if you have food sensitivities. So if you're thinking at all about the program, but you're not sure about committing, just drop me an email at Lindsey with an E-Y at High Desert Health Coaching dot com, and we can chat over email or set up a time to talk to determine if this is the right program for you. Or you can go to HighDesertHealthCoaching.com and scroll down to find the link to sign up for the program. It's $297 for the 6 weeks, and it's by far the least expensive way you can access the expertise of a health coach for 6 whole weeks to help you on your healing journey. And if you have a friend you can bring along, I'll drop the price to $250 for both of you. So I encourage you to go check that out at HighDesertHealthCoaching.com. And now on to the show.

Welcome back, Dr. Ghanoum.

Thank you, Lindsey. Thanks again for having me.

Yeah, well, thanks so much for coming back and for this gut test. I'm so excited to talk about my results.

Oh, likewise.

Like, so for those people who didn't listen to the previous episode, what's happening today is I got my gut tested by Biome, and now I have the results, and I want everybody to be able to look at the results while we're talking about this. So I'm going to give you the URL to go to. So if you go to highdeserthealthcoaching.com/the-perfect-stool/, and you'll also find that link as the first link in the show notes, you can pick up my gut test results and you can look at them while we're discussing them. So I'm going to give everybody a chance to go get those while we're talking. So I'm also just gonna mention that we are also going to be doing a gut test giveaway. So later on in the podcast, I'll give you the URL for following up on that gut test giveaway, but I just wanted to mention that so you have a minute to go get the, uh, get the results.

And before we launch in, I'm just gonna ask you something.

So way back when I did one of the, uh, American Gut Project stool tests, and back at that time they were talking a lot about Firmicutes versus Bacteroidetes and about that relating to obesity and type diabetes. Has that— has the literature on that changed, or the knowledge on that changed, where Firmicutes were more likely to lead towards obesity and type 2 diabetes, or is that— is the thinking stay the same on that?

From that point of view, yes, it's still the same. If you have high level of Firmicutes, it tends to be in people with obesity as well as in pregnant women. And why it's good for pregnant women is that because Firmicutes is able to harness the nutrients and give more energy to a pregnant mother, which really not the same for obese patients because we don't need more nutrients to be taken in when you are overweight. So it's a good idea to have lower Firmicutes.

And is that because they can extract more calories out of fiber?

Fiber, and as well as other nutrients, they are able to use more of that.

Okay, well, now hopefully everybody's had time to open up the gut test results, so let's just launch in. You've got, you've got them open too?

Yes, I have.

Okay, great. So take me through them.

Great. So as you can see, the front page is basically say Biome Gut Report, which no need to explain what it is. It's very clear. And then we go into the second part one, which is page two. And in it, you give— gives you the date the analysis was done and show you sort of an arc where it describes the diversity, diversity, and gives you a diversity score. And you can see there is poor, okay, and good, different colors. Now, why is this important? Diversity of microorganisms, what does it mean? It means that you have a large number of different organisms, diverse organisms in your— or microbes in your gut, which means the more you have diverse, the better. Usually is associated with better health. So that's why what we would like to see is to see the scoring value high. In your case, it is 4, which is in the okay side, but it could do a little bit better if we can push it towards the dark blue.

Okay, so how do I do that?

That's where we are gonna talk about later on in the recommendations to what, what type of food you should eat. If you like, we can go over it now. For example, if you have fermented food, or we can do it later. It's up to you. Let me know.

Well, let me ask this before we, before we jump into that.

I've taken a lot of antibiotics in my life.

I assume there are strains of bacteria I'm not getting back at this point because they are anaerobic and they will have no way of getting in. Is that accurate?

I think what you need to do is you try to use the probiotic or some food that have anaerobic organism in it to try to rebalance. Your gut. And some of the probiotics, for example, Bifidobacterium previ, like we have in our Biome probiotic, it's anaerobic, and this is a good organism to have. So you can build it back even though you use antibiotics, which usually, as you know, kill both the good and the bad. Having a probiotic or a source of these anaerobic organisms will be very good. And I gave you an example of Bifidobacterium, for example.

Okay, so, okay, well, let's keep going down the Gut Report, and then, then we can talk about the recommendations at the end.

That's great. So now let's move into Part 2, and in this Part 2, what we are giving you is an overall picture of your microbiome, both bacteria and fungi, and this is presented as a pie chart. So let me take you through. The top panel, left-hand panel, shows you a pie chart of what phylum you have in people who are healthy, okay? Whereas in the top right panel, we have your microbiome. In other words, what sort of bacteria we were able to detect in your fecal sample, okay? The same applies for the lower two pie charts. The one in the left is healthy or normal microbiome, whereas in the right is specifically what sort of fungi or microbiome is present there. So let me take you first to describe what is in the bacterial phyla, which is the top panels.

Okay, and just, just to be clear, when you— the whole classification of animals, it starts with kingdom and then it goes to— what's under kingdom? Is it phylum?

You can— kingdom, phylum, you have some class, and you have then a genus, you have then species.

Okay, great. Okay, thanks.

Okay, so if we look at the phylum level, which is quite high in the taxonomic classification, you look in the normals, what we have most, we have Bacteroidetes, followed by the Firmicutes, which is in dark blue. And then we have Protobacteria, which is in green. And finally, you have others, like you, you combine— there are a number of other phylum, but you can put them together because they tend to be at low percentages or low levels. Okay, so that's what you see in normal. When we look at your bacterial phyla, you notice that the dark blue is much larger than what we see in people. In other words, we have a lot of Firmicutes. We also have larger green, which is the Protobacteria. Okay, we had a reduction in the light blue, which is the Bacteroidetes. So your profile of the microbiome is really different in a number of aspects than what we see in normal healthy people, if you will.

And question: how did you establish what normal was? Because is normal average, or is normal healthy? I guess that's my question.

Very good question. You know, this is always difficult to say. You say normal and healthy, but really people, you tend to use these terms interchangeably. Where did this normal came from? We have two sources. The first source was the Human Microbiome Project, where people or scientists and researchers, they did analysis of 250 people and they tried to exclude certain criteria like people who are healthy. In other words, they are not on antibiotics, not on antifungals, not on immunosuppressive agents, and then other sort of criteria which were excluded to make sure they are not obese, for example, so that we can define what we consider to be normal. In addition to this, Biome have done thousands of samples, and what we did, we have our bioinformaticians, which are these scientists which analyze data, and we looked at about 1,000 people where we tried to see these people are normal as far as we are concerned And again, the same definitions which the Human Microbiome Project people use. They are— don't have any disease, they don't have any condition, they don't really use antibiotics, medications, and this sort of thing. So this is where the definition of normal came from.

Did you say the Human Microbiome Project only had 250 people to set normal?

Yes.

That doesn't seem like a lot.

Yes, this is where all the basis where it started. The good news is that You know, people like Biome and other companies have looked at larger samples. Remember, the Human Microbiome Project was funded by the National Institutes of Health to start teaching us and really give insight into our microbiome. So it was the first discovery stage, sort of.

Right.

Okay.

Okay. So we talked about the bacterial phyla. What about the fungal phyla? And you can see the biggest by far is the light blue, which is called Ascomycota. Okay, Ascomycota is really— this is, as you can see, is the majority, whether it's normal or in your gut. At the same time, you have Basidiomycota, which is the dark blue. This Basidiomycota, really a lot of mushrooms belong to this. And studies have shown that you have these from the food we eat. A lot of the time the food we eat, it has fungus. Or as you know, a lot of people love cheese with fungus in it, so you are likely to see that as well. So apart from the mushrooms, that's another source. And these usually tend to be transient. That's why the most representative is the Ascomycota, which is the light Blue.

Okay, well, that would explain why I have very few Basidiomycota, because I don't eat dairy products and I don't eat mushrooms.

You see that? I'm glad to hear this. So I think, as I mentioned before, what we just went through is a very high-level description of what phylum both bacteria and fungi in your gut compared to the normal. Okay, now I would like to move to the next page, which is page 4. And this part 3, we call it, it's basically explanation of the pages that comes after this. It explains to you what you see. Like, for example, you have light blue dot. This tells you the light blue dot is the percentage of a particular organism, whether it's bacteria or fungi, that present. This is your— the light blue dot is where you are on the scale, okay? Then have dark blue line, and that shows you the range of organisms in which you fall. This is what we see in people, and that's where you, you fall. And then We have a small circle with a plus, and this tells you about the organism we are looking at is that it is beneficial or it is a good guy, whereas the circle with a cross, it tells you this is not a good organism or pathogenic organism, and we don't want much of it. Okay, and then we have a sort of diamond. This indicates a neutral strain. We also have the last sort of sign, is a blue square. This square, it depends on the color. If it is dark blue, is high. If it is light blue, is normal. And if it is gray, it's low. This means the level of the organism, it could be low, it could be normal, or it could be high.

Okay, okay. And now as we hit the next page, I have a question. So The blue, the blue bar you said was where my levels fall, or is that the normal range?

Yeah, that's the normal range. Okay, where you—

what is that line though in the middle? That's not necessarily in the middle. Is that the—

sometimes it's the median. It's not mean, it's the median.

The median. Okay.

Yeah, usually if it is in the middle, usually they have how many readings you have. They let— let's say they make 100 organisms and they find this organ Bifidobacterium is present at, you know, it varies between people, obviously. So when you add all of them and divide them by the 100 person, this will be the mean. This one is the median, which is just the middle. Yeah, yeah, the middle.

Exactly, the middle number if you take everybody.

Yes. So now we are taking each phylum and we put the name in a little bit, uh, bolded, uh, this is the phylum. And then under it, we go into couple of species or genus which is under this phylum. Because remember, the phylum is sort of like the family, okay? And then within the family, you have the father and the mother, and they have the, the kids. So The father and the mother could be, let's say, the genus, and then the kids could be the species, okay, which has two names usually. So like, if you look at— just to explain this further, like Actinobacteria, this is the phylum. The Bifidobacterium, it is the genus. It's a little bit under that. And then Lancella aerofetinis is the species, is the child. Okay, so they all under— they fall both of them the genera, which has— it could have more than one species. Okay, right. Okay, let's look at the Ascentobacteria phylum. Okay, you can see this tends to be a low percentage anyway, as I showed you before in the big picture where we looked at the different phyla. We talked by far Bacteroidetes should be high, Firmicutes, and then Protobacteria. So these are the major ones. But in addition to these, you have the other phyla which I'm gonna go over, such as Actinobacteria, which tend to be only a small portion of that. And you can see, but you have the name Actinobacteria phylum, and then between brackets It tells you 1.57%. So the level of this phyla in your total gut is very low, let's say 1.5%. Okay, and now we look at what we expect. We expect it to be, let's say, the range from very low up to 1.2%. You are at 1.5%, so it's a little bit high when you look, you look at that, but it does not have a lot of issues from that point of view because, as I mentioned, it is not the major one. But what we— I like then to talk about is the Bifidobacterium because this is a good organism. Okay, you can see you have 0% and it's signed as low, it's gray. So what I would like to do, I would like to increase Bifidobacterium because this is one of the anaerobic organisms which you mentioned. Okay, this is a good organism, we really need to rebuild it. Okay, yes. Now, the Collinsella, which you see here, which is neutral, it's neutral, so this is fine to have, and anyway, it is in the normal range with you. Okay, okay. So then we go into the Bacteroidetes. The Bacteroidetes, we have a number of species listed under First of all, when we look at the bacteriodetes in general in your gut, it tends to be in the low. And you can see how the blue line, it's quite high, like you need about 30%, you are only 13%. So it tends to be low. Okay.

Now, does this sort of indicate that I'm eating too much junk food and not enough healthy food? Is that sort of just the—

is that the—

am I— have I been like I feel like, you know, revealed as a junk food eater here.

Well, that's what we want to talk about in the— what you should have more fruits, obviously more vegetables. That's what we need to talk about because we need to try to rebalance this. You need some more fibers, for example, and we'll talk about that as well.

Okay. Well, you know, yes, but I'm just going to just in my own defense, I'm going to say that I did this test about 2 weeks after finishing a low FODMAPs diet that had gone on for about 2 months to deal with SIBO. So that may be why my fiber was low and my bacteroidetes, because I was trying to keep out most of that fiber to let the SIBO die off.

Exactly. No, no, I think, listen, the good news about this in general, I think we identified a couple of things we can fix and these are fixable. That's the good news. You know, and that's why it is so powerful that now we understand more about the microbiome. The good news is that we are able to hopefully balance it, not only with diet, but also I'm gonna talk a little bit about lifestyle, for example, you know, like stress. When we looked at your questionnaire, because in addition to doing the analysis, we have a questionnaire which you submitted, and in it You indicated that you have high stress, so we need to bring this down.

And if you can tell me how to do that on this call, you're a magician.

Oh my goodness, you put me in a very, very tough situation. You know what's the problem? We all are very busy. Life is stressful, but I'll give you a laugh. I am Lebanese from Lebanon. And I never did yoga before I came, really before recently, because I am so busy and of course stressed out. So I started to do some yoga and now I'll try to take about 15 minutes during the day and I really fight for that where I just close my eyes and relax a little bit because, you know, it's very difficult to deal with all what we deal, even though I love what I am doing, but there is a lot of work which puts stress. So that's why I wanted to talk to you to try to adopt some of these less stressful activities, or at least activities that will make your stress level go down, even if temporarily. Okay.

Okay. Well, I actually, you know, it's funny because I started about 3 months ago doing a practice called Hormone Yoga, which is a unique kind of yoga that is meant to balance your hormones and thyroid and female hormones that I learned from a local practitioner who is one of my referral partners here in Tucson. So I actually do yoga every morning, although I'm not— I'm not sure it's the most relaxing kind because I usually listen to podcasts and stuff while I'm doing it. And it's not like a meditative time. So maybe I need to kind of preserve that time as meditative and not just to just to get the physical stuff done.

It's so funny you say that. I wake up in the morning and I go into an elliptical machine. Okay. And I used to watch the news. And these days, like any channel you look at or you listen in television, the news is stressful. So now I said, okay, I'm not going to watch any more news. What I'm going to watch is I Love Lucy. Honestly, I love that program. And the last 2 days I discovered Cheers. I know it's an old episode, an old rerun, but I found them and Andy Griffith. So my friend, these are the programs I advise that you should do.

I have watched all those shows probably through the early series. But if you're hitting the old shows, boy, my husband would have a whole slew of recommendations for you.

Please let him give me that advice because I love this show. Okay. Okay, so let's go back into the microbiome and look at the— we started talking about the Bacteroidetes phylum, and I said it tended to be low, really, in you, with the light blue well below what we look at the median as we talked about. Now when we looked at the different species, I think you have a couple of them which are normal, okay? And these are neutral, the Barentsella species and Odorobacter species. You have also, however, low in Prevotella, which is a good organism. So we need to increase that with the recommendation, I hope, which we will talk about.

And I think, you know, let's take a pause on Prevotella because I hear a lot about Prevotella. And in particular, I did a— my previous interview to this one was with a doctor who researches autism. And he was saying that Prevotella is, you know, if you take kids from Africa, they will probably have 53% of their bacteria is Prevotella versus like 0.5% in Western civilizations and even less in children with autism.

Yes, yes, I really agree with you. Also, this is interesting because, you know, because I'm in this field, I looked at a study where it compared people from Africa, Guinea-Bissau, and people from Europe, and they found definitely what you are saying. Really, they have more beneficial organisms, including the Prevotella, with the kids in Africa because of the type of food, the grains they eat, the more whole food stuff they eat, than we in the Western world. So let's move then into the firmicutes. And remember, you mentioned the firmicutes, this tends to be high in people with obesity, also in pregnant women. So that's where it is high. But sometimes, remember, all these percentages are relative, which means one compared to the other. If you have a low bacteroidetes, then the chance of you having more Firmicutes is higher. Okay, so now, now if we look at the organisms under it, we have two organisms which are neutral: the Clostridium species in general and the anaerobic Trochus. This is sometimes these names they defeat me all the time, but you can see the name there. Yeah. And you can see it's normal. The good news also, we looked at Clostridium difficile, which as you know is called C. diff, which causes a lot of issues. And as you can see, the sign is a circle with cross in it, so it is bad. And the good news, you have zero of it, which is really nice. Excellent. Okay, okay. So then we'll go into continue with the Firmicutes, and now we are talking about some good organisms. Like for example, I'm gonna talk about the third one, Faecalibacterium prausnitzii. This one is a good organism, and you can see you are 1.9, like nearly 2%, and it is normal. So this is good to have. Because this organism tends to have anti-inflammatory activity. So I'm glad you have that. Finally something. However, we need to increase Rosoboria, for example, Lactobacillus, which are good organisms. So that's where we are going to talk about some probiotics and food to help that. Okay? Okay. Now the last one we need to talk about is Fusobacterium. Bacteria, and you are in normal situation, so we don't have to worry about that. Okay, okay. Now let's look into the page number 7 of Part 3, and here we have the Protobacteria phylum. This is of great interest. Okay, why? Because this phylum, if you have it high in your microbiota, it indicates that there is some underlying inflammation, okay? For one reason or another, it is sort of a red flag for that. That's why we really need to bring this down, okay? And I will tell you about what approaches to do. The good news, we, we know, for example, taking fibers, vitamin D3, which we will talk about are good to bring this down. Okay, okay. With respect to E. coli, one, or Escherichia coli, one of the species which tend to have really bad effect, you have it normal, which is fine. And so all in all, this is the phylum itself is big, but the specific pathogenic organism, or that could be pathogenic organism, E. coli, is normal in you, which is really very nice. Okay, now the same with the Vorrachromobacterium, okay, or Chromomycroba. You are normal, so there is no problem whatsoever. Okay, so this, this really wraps up the bacterial microbiome, what sort of bacteria present in your gut. One thing additional we do in Biome gut testing is we look at the fungi as well. So you may ask, why do you bother? Everybody talks about bacteria. I can tell you why. Because studies have shown that in our body we not only have bacteria, but also we have fungus. And a lot of people, a lot of women and mothers, including mothers, they know of the issue of Candida, for example. Candida, if it overgrows, what happens? It may cause vaginal candidiasis. It could cause gastrointestinal issues. So it's very important that we look not only at bacteria but also at fungi as well. And that's why we started to do that at BIOM because if you don't have a full picture of your microbiome, then you only are answering half of the story, which is the bacteria. So that's why I want to go over now your profile of the fungi. And remember, when I showed the pie chart, by far the phylum which is dominant is Ascomycota. And you can see in your results that you have nearly 99% of the total fungus is Ascomycota, okay, and you are within normal, as you can see. Now let's go into some organisms which are good and some of them which are bad. Let's start with the bad one, and I want to tell you the good news first, is that we are talking about Candida species, which is— remember, this is the genus, and then you have Candida albicans, which is one of the species which cause a lot of problem, and Candida tropicalis also cause a little, a lot of problem. Now I would like to clarify, sometimes we all may be carrying Candida. Maybe 50 or 60% of people, they have Candida in their gut. Okay, now what's important about this is the level. If the level is low, we can consider it as colonizer, which means it really lives there, cause no trouble. In fact, it may help us in fermentation and breaking down, breaking down of food, and it works with bacteria to really break down the food and help each other. Okay. Now, if it overgrows, you mentioned SIBO, which is small intestinal bacterial overgrowth. There is also what we call SIFO, small intestinal fungal overgrowth. Okay, now we look at yours here. Candida is very low. You have less than 1% of Candida species, the same with albicans, and you don't have any of Candida tropicalis, which by the way we found that this organism, Candida tropicalis, this fungus, is elevated in Crohn's disease patients. The good news, as you can see, it's all normal for you.

Okay, very happy about this.

Yeah, I really also, I am very happy about that because, you know, it has indication. And I don't want people to worry if they see a little bit of Candida. It's fine. Maybe up to 3-4%, you are fine. Okay, so now let's look at the other organisms. We have Pichia, or Pichia, it depends how you want to pronounce it, and it is low. We did a study a few years ago where we found that this particular genus is a good fungi, or it's a good yeast really.

Why?

Because in our study we showed that people with high level of Pichia, they tend to have low level of Candida. Okay, so I would like to encourage that Pichia because it helps. But the good news for you is that you have no overgrowth of the bad ones, so it's fine. But it's good to have it. The other thing which is important to have is the Saccharomyces species, and Saccharomyces sylvicia is one of the yeast which we all know. Like, for example, Saccharomyces cerevisiae is the yeast we use for baking, the yeast we use for beer. So we all consume a lot of, a lot of this. Having it is a good point. We should increase that level in you. Why? Because the studies have been showed that people who have high level of Saccharomyces, it tend to antagonize the bad organism. And in our study, we showed that Saccharomyces antagonizes Candida. Okay? And we and others have shown that in Crohn's disease patients, healthy controls tend to have more Saccharomyces while the patients with Crohn's they have more Candida. Okay.

So I'm guessing that this is low in me because I eat a gluten-free diet because I have autoimmune conditions. So I don't eat a lot of baked stuff other than gluten-free breads and don't drink any beer to speak of.

Sure, sure. But that's why maybe you can get it through a probiotic or through some of other fermented foods, which may have that.

Now, Saccharomyces cerviciae, that is in fact the same as Saccharomyces boulardii, right?

Absolutely. Saccharomyces cerviciae is the main species and Saccharomyces boulardii is a subspecies. And the Saccharomyces boulardii, as you know, is the one that is used in probiotics like InBiome. It has Saccharomyces boulardii, Lactobacillus acidophilus, Rhamnosus, as well as Bacteroidetes Bifidobacterium previ. So this Saccharomyces boulardii have shown to have a number of beneficial effect in people when you use it.

Now, I was surprised to see it at zero because I have been taking Saccharomyces boulardii every day for the last, say, 3 years.

Huh. You know, the thing about probiotic is that these organisms are transient. And so it may be because of the time you collected your fecal sample or stool sample could have been way after you took the probiotic, or your body is able to really not retain at all this and it goes out as fast as it comes in, you know, maybe within hours.

Yeah, and I may have run out of them before I took this test. I can't remember, but I think that happened. But So does Saccharomyces cerviciae colonize your, your body? Is that— or not?

Most of these probiotic strains are transient. They may stay 1 to 2 days, but then you really need to replenish them.

Okay. So the fact that it's listed as a normal component of the gut does not imply that it is a colonizer. It simply implies that because of what normal people eat, you will typically find it in a gut.

Exactly, exactly.

Okay.

Yeah. So now there is one last thing I just went very fast over. Forgot to tell you about the Basidiomycota phylum, and we talked about it. This is mainly— it is really important if you detect it, if you have mushrooms, as we mentioned. So since you don't eat mushrooms, as you mentioned to me, while we don't see it at all, and it is normal. A lot of people don't have it because it's, again, it's in the food, and if you are not eating that type of food, you are not gonna see it. And I put Zygomycota here, and usually this is a normal organism. You have it normal, but I put it because sometimes there is a study published from a lab in Spain, very well-respected lab, where they showed that this zygomycota could be detected in people who are losing weight, a lot of weight. They were obese and then they started in a program to lose weight, and this tended to be associated with weight loss and this sort of thing. But so in this case, you can see there isn't much here, which is fine because I had the pleasure of meeting you and you don't need to lose much weight.

Yeah, that's why I'm always, you know, it's funny because I've done these tests multiple times and my Firmicutes are always super high. And yeah, I've, you know, other than, than sort of a little extra baby belly I had for a while before I cut out the sugar, I've never had a weight problem. So yeah, I'm always a bit mystified at the fact that I have this, that somehow I'm managing that with my totally out of whack Firmicutes-Bacteroidetes ratio.

I really think that's where it is. As we discussed earlier, it's really because you have high high Protobacteria and Bacteroidetes, sort of this imbalance, low. So one high, one low, and when you put it all together to the 100%, you tend to have more Firmicutes.

Yeah.

Yeah. Yeah. So I think this, we went over the microbiome profile. The other thing, as you know, we also collect a questionnaire from people to try to understand what type of food they had, as well as what type of lifestyle, you know, so that we are able— our nutritionist can talk to them and they have a consultation with our nutritionist, which they can go over both the gut microbiome report as well as the questionnaire and try to put a plan together. So let me summarize to you what we saw particularly in both, okay? Basically, the key points of the lifestyle, key points, we talked about high stress, which you have. It's clear you have no gluten, no dairy, no soy. You are doing some yoga. You have some occasional bloating, some stomach, occasional stomach pain. You have used antifungals, and as you told me, used a lot of antibiotics as well. You took non-steroidal analgesics, which, as you know, these have been known— there is studies, published studies to show that consumption of this non-steroidal analgesics can cause dysbiosis or imbalance of the gut. The good news, you are taking fish oil, the probiotic, as well as the Super Green, which very, very good because it has both probiotic as well as fibers and some components which will help with healing the gut lining. Okay.

No, actually I haven't ever taken the Super Green.

Really? It looks like maybe, I don't know how, but in my, the summary which they sent me, I asked them for the summary, there must have been a mistake in doing that.

Okay. So, but the Super Green is your product, right? The BioNTech product.

Yes.

Yes.

Yes. Yes. Now, what are the recommendations? So basically, the overall recommendation is that it would be a good idea to have increase in fruits and veggies to 9 good handfuls, for example. That would be very good. Also, it will be important to have variety of— not just you eat fruits, but also have vegetables as well. It's possible to have some beans, lentils, leafy greens, and cruciferous plants. The issue with this one, some people may have bloating or GI discomfort when they start this, so it's very important to really ease into this. Maybe you can cook some of them to build tolerance. That would be a good idea. And why am I suggesting this dietary approach? The reason behind it is that we want to increase the fiber and fiber have been shown to reduce proteobacteria. It also shown to support bacteroidetes and reduce Firmicutes. So in general, this will improve the overall diversity.

Yeah.

Okay.

That makes sense because while I do eat a lot of fruits and vegetables, I had been avoiding beans and sort of have been avoiding beans since I went through SIBO again. Because that obviously is one of the foods you can't eat when you're on a low FODMAPs diet. So I probably need to get back to the beans.

Yeah, I would ease into that. I really, I would do that.

Then we—

the second recommendation with respect to fermented food, especially since we talked about Saccharomyces, why do we want to use some fermented food is for a couple of reasons. Number one, we want to increase the diversity because, you know, they have different type of organisms there in that fermented food. And also we want to support the good organisms which are— they produce short-chain fatty acids like Bifidobacterium, Lactobacillus, and we talked about it. You know, you have low levels of those, so that will be a very good idea to start. I mean, you have the choices: pickles, veggies, sauerkraut, kombucha, kefir. It's what's your taste, what you like. Because some people like certain things, not the others. I would recommend that. Also try to avoid those fermented foods that have a lot of sugar, because even though you have Candida very nice, you don't have an issue, high sugar content does not help at all. Okay?

Yeah.

So if you follow this approach, or at least this second recommendation of fermented food, it's gonna help the diversity, overall balance, and support your digestion overall.

Now backing up, you said it's the Bifidobacteria that produce the short-chain fatty acids?

Lactobacillus does that. Bifidobacteria also produce metabolites which are very good. But a lot of the data literature about different Lactobacillus that produce the short— lactic acid bacteria basically.

Right, okay. Yeah.

Okay. So now I want to move to lifestyle and we already touched upon the stress management. Okay. So my advice, stop those podcasts when you are exercising. You know, also try to relax when you are eating. We all are eating so fast. We don't take our time. Now, if you go to France, for example, oh my goodness, the dinner lasts 4 hours.

That's for sure. I studied abroad in France, so I'm actually a fluent French speaker.

Oh, that's great. That's great. I know a little, un peu, a little French, not too much. So try to see if you can have a little bit more breathing, you know, take deep breaths. And it's funny we are talking about this because this last Sunday when I go for my yoga, we have a new instructor, really great guy. And for the first time he said, I want to do these movements, but I want to do them with focusing on breathing. You know, so you inhale, stop, exhale, stop. So take your time. And sometimes we all need to exercise breathing and take a little bit time in doing that, because once you have breathing exercises shows that there is really bring down the cortisol and overall inflammation, because you remember there is the gut-brain axis communication. So we need to bring down the cortisol, which makes us basically stressed out.

Okay, well, this is all stuff that I train my clients on, so this shouldn't be hard to implement. I already do try to to some extent, but—

That's great, that's great. And then we want to talk about other ways to support the microbiome and bring down proteobacteria. One of it is vitamin D3. Studies have shown that vitamin D3 consumption will bring down that proteobacteria, as well as, as we covered, the fiber will help. Okay. And you know better than me about what is the good food to take for this. You know, you teach this, this is your specialty, you know. So the fish, the flax, the marshmallow root, whatever, I leave it up to you. I'm not gonna step in your territory, my friend.

Not at all. The funny thing is though that I do, you know, at my last blood tests, which were I think, well, no, they were a while back now. I guess they were last February. My vitamin D level was finally optimized after the longest time where it was low, and I sort of backed off on vitamin D because my vitamin D was high dose. So, okay, yeah, I'm curious to retest and see where it stands.

That would really make sense. And also, if you were taking high dose to try to elevate it, maybe you just take the medium dose now or low dose just to maintain it, right? You know, just to keep it under—

yeah, I started, I started moving to once a week with the high dose just to use up those pills.

Yeah, good, good. So with that, of course, there are other recommendations with respect to supplements. You already take fish oil, so we are not going to talk about that. Probiotics, obviously, if we want to increase Saccharomyces, S. boulardii, will be a good way to do it. Also, if you want to increase short-chain fatty acids, we need to give organisms that produce short-chain fatty acids, use prebiotics. One of the best prebiotics, inulin, for example, have been shown to meet all the criteria of prebiotic. And, you know, other— I know sometimes we take non-steroidal anti-inflammatory. If you can I don't know if you have some supplements, maybe ginger, and try to cut down if you can, but sometimes you can't. But if you—

Yeah, I don't take them off, and I was having back pain, but I bought a new mattress, so that's over.

Oh, great. That's great news. That's great news. So that's really a summary, if we can say that, for the analysis.

Okay, now I missed it though. Were you going to recommend a particular prebiotic?

I mean, the prebiotic, the one that Biome produce has Saccharomyces boulardii, it has the Lactobacillus—

No, no, prebiotic.

Oh, prebiotic. Again, inulin in particular to be the constituents. And there is a probiotic that the company Biome sells, you are welcome to have, and it has inulin. But inulin, whether it is in our product or others, have been shown to be good.

Okay, and that's also in onions and garlic, right?

Yes, yes. Yeah, you know, that's the other— you raise a very, very important point. You don't have to take too many supplements if you really have a good balanced diet. And again, as I say, I defer to you because that's what you teach people. But sometimes if you feel you take an antibiotic, you feel you are under the whether a little bit, it doesn't hurt to try to use some of these supplements. But I want to encourage people to have good diet, healthy diet, and then if you need to supplement it with some probiotic, prebiotic, I think this is a good idea as well.

So since I went through SIBO, and actually the second time I got it, it really kicked in when I was taking a cheap probiotic that looked like a clone of a more expensive probiotic I had taken that had lactobacilli and other things in it. And I started having incredible bloating and it was awful. And finally, after enough time had passed, I'd stopped it. I thought, no, I've, I've gotten given myself a case of SIBO by loading up on the lactobacilli. And so I am a little bit afraid at this point of taking lactobacilli because I'm afraid the SIBO will come back.

It all depends also in the dose. Sometimes you go to shops to buy probiotics and they have huge, like 100 million, 100 billion counts, or so many different strains. It's not a matter of how many you take. It's a matter you need to select a probiotic that have the right combination that can address the imbalance of both bacteria and fungi. And that's why, for example, in our probiotic, we limited it to 4 organisms, and we selected these organisms based on correlation analysis to see which one or which probiotic strains is able to attack or antagonize the pathogen, which as example we talked about E. coli, Candida tropicalis, and Serratia marcescens, for example, and additional one, and that's why we selected these. So it's not the more the better. You need to have— you are absolutely right— the right balance of this.

Okay, so the Biome probiotic has— you were just saying it has Lactobacillus acidophilus. Is it L. rhamnosus?

Yeah, Lactobacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium longum. Brevi, B-R-E-V-I, as well as Saccharomyces boulardii.

Okay.

So those are all relatively common strains. And, you know, some people who, after I posted the first podcast, were asking why should they buy the Biome probiotic, which is relatively expensive. I think it's like $60 for a month's worth when you can source those, source those probiotics in other places, at other, you know, relatively cheaply individually?

I mean, this is very good question and reasonable question. What I can tell you is that what we did, we looked at different strains and not in addition to the ones we have, and we were trying to find out, first of all, before we even selected anything, we did correlation analysis analysis. We have data, thousands of really reads and of different organisms, and we did correlation analysis to see which probiotic strain or species is gonna work. And based on that, we selected the 4 different species. Then we took those and we put them in different ratios, like, and we tested them, and we found that This combination compared to other strain types, we were able to show activity against, for example, Candida, activity against biofilms, which is the digestive plaque which forms in our gut similar to what we have in our teeth.

And that was because of the inclusion of amylase, right, in the probiotic?

Exactly. And we put amylase, exactly. So Even though we started with known organisms, we optimized them and put them in acceptable ratio to have the best effect. And I just recently published a paper in April of this year where we showed that this combination is able to completely destroy or inhibit this pathogenic biofilm or digestive tract. So that's why we stick with these.

So given my situation and my gut report, do you think the Biome probiotic is appropriate for me?

From my point of view, I think it will be helpful because you have— we are going to increase the Saccharomyces, which gonna keep the fungi, the Candida in particular, under control since you have used antifungal recently. So it's good to keep that under control and not allow the growth of Candida again. Also, it's gonna help you with respect to having beneficial organisms that can produce short-chain fatty acids. And as you remember, when we talked about what sort of probiotic you need, we needed some organisms such as the Lactobacilli we have that can produce short-chain fatty acids. And gonna help you overall with respect to underlying inflammation, if there is any.

Okay, great. Well, this has been super interesting, and I feel very fortunate to have gotten a personal, uh, a personal analysis of my gut. And I know that my listeners are really excited probably about the, um, fact that we're going to be giving away one of the Biome gut tests. So everybody knows that there's gonna be a link in the show notes, but to enter that drawing, which we're gonna do hopefully 2 weeks from when I publish, which hopefully will be within a few days. So I'm gonna set the deadline date as Monday, September 9th, um, for entering the drawing. So you need to go to this URL, https://tinyurl.com/2X7X7X7 tinyurl.com/guttestgiveaway, all one word. So it's tinyurl.com/guttestgiveaway, and you can link, go to the link in the show notes, and that's where you can enter to win a Biome Gut Test. You won't get Dr. Ghanoum personally analyzing it for you, but you will get a chance to get a report like the one I did.

As well as you may have a chance to talk to our nutritionist.

Oh, okay. Will they get the nutrition consultation too? Oh, spectacular.

Okay.

So, so that is going to be an awesome value of— what is the value of that? Like $229 or something?

Actually, actually the pricing is quite— it's not that high. It's $180, $150 based on the, on the You know, because they are running sometimes discounts and helping people. Also, with respect to the probiotic, I don't think it's as high as $60. I think it's less. Oh, okay.

Sorry for quoting, misquoting the prices. If you want to check, you can go to buy— what is it? biomehealth.com?

Yes, please. Yeah, that will be great because they can find out that information. Because listen, I am the scientist. I have no idea about about the first. I know it's lower, but I don't know. It's good to check. Okay, yeah.

So what is the significance of gram-positive versus gram-negative bacteria?

You know, gram-positive usually refers— like, the most important organism, gram-positive bacteria, is Staph, for example, Staphylococcus aureus. Staph aureus, okay? Whereas the gram-negative, you have E. coli and as well as Pseudomonas, and these usually are bad bugs. Staph could be a problem as well, but that's the difference between them. Like, there are the most famous of the gram-positive and gram-negative is gram-positive Staph, and you have gram-negative, you have E. coli as well.

What does it mean in terms of the actual bacteria. What does that— what do those phrases mean?

Oh, this means, you know, they call it gram-positive. There is a test, microbiology test, where when you isolate an organism from a patient to identify it, you do a test. Basically, you put a dye, and then if it gives you a given color, it's gram-positive. Like, it's positive for the Gram test Graham is a doctor who developed this test. It's gram-positive or gram-negative, because in a way you split the world of bacteria into two groups, and then you will be able then to do additional tests that are— for example, if somebody has gram-positive, and by the test, by just simple smear test, then I say I want to identify it to know is it Staph aureus or Streptococcus or whatever, then I need to do additional tests. And because I know it's a gram-positive, I will do different tests from when I know it is a gram-negative.

So this pre-exists all of this, you know, DNA sequencing?

Oh no, no. Yeah, this is— I am now 69 years, and that was there before me.

Yeah, okay. And so, but but there's good bacteria and bad bacteria in both categories?

Absolutely.

Absolutely. Okay. And there's no relationship between gram-positive and gram-negative, anaerobic and anaerobic, is there?

No, no, no. It's just the actual test. Basically, you put it, you color it. If it is blue, it's this organism. If it is reddish, it is that organism.

Okay.

Okay.

That was just a random question because I was listening to a podcast on the way home before I came came to do the recording.

Oh, sure, sure.

Yeah. Okay. Well, thank you so much for coming back on the show and talking about this. And tell me again the name of your book and when that's coming out.

It's called Total Gut Health. It's gonna come out December 24th. It's already in Amazon, and I'm delighted to tell you we selected a beautiful cover. Even though I say it myself, it took forever for us to select a cover that means something. And we have, you know, Dr. Mark Hyman gave also support statement in it. So we are excited about it. It should be— it's already, you can see it in Amazon. If they look at my name or Total Gut Health, at least you will see the COVID We are in our last stage of finalizing it.

And it's due out when?

December 24th.

Oh, okay, right there before Christmas. Wonderful.

Yeah, yes, yes. Also, I think if your audience would like to visit the Dr. Microbiome website, there are a lot of information there that can help them, and we are adding more and more to that.

Yeah, and I discovered that there was a biome podcast Yes. Well, which is doing much better than my show.

No problem. I hope with this session, and maybe we can have one on the diet, it'll also attract more people. Yeah, yeah.

No, it's called The Microbiome Report and it's quite good. So I will recommend that as well.

Thank you.

Sure. Thank you so much for being on.

Well, that was fun. I feel like I do have to defend my gut, however, as a health coach. I really do eat lots of fruits and vegetables and very little junk food, but clearly I could be doing better, as I'm sure we all could. Just another reminder, if you're interested in my 6-week Gut Reset program starting September 2nd, 2019, please go to HighDesertHealthCoaching.com and scroll down. You can find out more there. And if you have questions about it or about my interviews or about gut health in general, feel free to write me at Lindsey lindsey@highdeserthealthcoaching.com. And be sure to include whether I can read your letter on the air. And I could use a few more 5-star reviews on iTunes if you're an iTunes listener to balance out the jerk who gave me 2 stars. So please go to iTunes and give me a 5-star rating.

And thanks for listening. And here's wishing you all the perfect stool.