The Mycobiome, Biofilms and Crohn's Disease

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today on the podcast, I have Dr. Mahmoud Ghanoum, who was born and raised in Lebanon and is now the director for the Center for Medical Mycology at Case Western Reserve University. And myco means fungus. And it was Dr. Ghannoum who actually gave the world the scientific name mycobiome to describe the variety of fungi that live on the body and in the gut. So he is the author of over 400 peer-reviewed papers and textbooks on fungi, antifungal therapy, and microbial biofilms, among other topics, and has been cited some 20,000 times in other people's scientific papers. And in 2016, he founded a company called Biome with his son, which sells pre- and probiotics and related products and does stool, myco, and microbiome sequencing. Now on to the show, and don't forget to press subscribe. Welcome, Dr. Ghannoum, and thanks so much for being on the podcast.

Thank you for having me.

So tell me how you first came to be interested in the gut microbiome.

I start to be interested in the gut microbiome over a decade ago because of the fact that we started to learn that the organisms that live in our body, including the gut, really influence our health. And I have known about this for many a long time because I always knew that if we have disturbance in the gut, you will have some certain issues like digestive issues. And that's why I thought, you know, I should look into this because this could be the way to try to really help people with respect to their digestive issues and really let them feel better and also address different aspects which started to be apparent to me that, you know, the microbiome or the community of organisms that live in the gut affect our health. But really What pushed me to go into this area is the fact that for years I knew that both bacteria and fungus affect each other. And when I looked at the literature and what people talking about the microbial community or the microbiome, they were talking only about the bacteria and ignoring the fungus completely. Now, with my background, I always knew that if somebody takes an antibiotic guess what happens? Their fungal growth increases.

Right.

And because of this, you start to have digestive issues which are not only caused by bacteria, but also by the fungus. And that's how I thought I should start looking into this. And we really should not only look at bacteria, but also fungi as well if we want to have total gut health. Mm-hmm.

And so how many different species of fungi live in the human gut? And like, who are the good guys and who are the bad guys?

This is very, very good question. I think we have at least in the, what we tested, about over 100 different species live there. And some of them are good, like for example, Saccharomyces, whereas some others are bad, such as Candida. But also we have some fungi that live in our guts because of the food we eat. A lot of us have cheeses, for example, where you have all penicillin, penicillium in it. And the cheeses, we also eat a lot of mushrooms, and these mushrooms are fungus. That's why in addition to what really usually colonize our gut, we could have other fungi that are just passing through because of our food.

So those don't colonize, the ones from the mushrooms and the cheese?

Exactly. Exactly.

Okay. And so, so are all Candida bad or is there any species of Candida that's good?

You know, there are many, many species of Candida, but there are top 6 species that tend to be bad. In particular, Candida albicans, Candida glabrata, as well as Candida tropicalis. We sometimes have others such as Candida parapsilosis, which also cause some issues, but not as much as the other three.

And what was the second one you said? Candida— glabrata.

Glabrata.

Glabrata. Okay. And so are they pathogenic in any amount, or is it only when they're overgrown that they're pathogenic?

This is really very good question because I don't want people to be so afraid of Candida because a lot of us, maybe 50% of us, harbor or have Candida in our gut. As long as the level is low, up to, let's say, 5%, then you are fine. Where the problem is when we have overgrowth. And this, as you know, relates to the fact that when we use antibiotics, we killing the bacteria which tend to keep Candida under control, and this will give the opportunity for it to increase. So overgrowth is the problem, not the fact that you may find some Candida in our gut.

And so I know that traditional doctors will acknowledge that one can have an overgrowth of Candida if you have HIV or some sort of really systemic problem. But for the average person, you know, my own pediatrician said, I don't believe in Candida overgrowth in the guts. What would you say to that?

Well, I think clearly we need to educate the clinicians about Candida because there are well-established studies that if you have Candida in your gut and it overgrows, it causes gastrointestinal infection and causes intestinal problems. So really, the right way to look at it, these organisms are our friends if they are in low abundance or they are present in low levels. But if you remove the control that— or let's say, if you remove the community of bacteria that keep them in check, then they are gonna start growing and start causing issues to us. So no, having a little Candida is good, but having too much of it, it's a problem. And this has been established, very well established in the literature.

And so when you say 5%, are we talking about 5% of the total makeup of all of the microbes and fungi in your gut?

Yes, it's like 5% of the total abundance of fungi. So when you look at all the fungi there, you don't want have more than 5% of Candida.

Oh, okay. So just in comparison to the fungi?

Yes, relative abundance.

Okay. And what would be the symptoms of an overgrowth?

There are a number of issues. Some people have pain, some people have, you know, some bleeding. You may have some sort of really feeling fatigue, a little bit of different digestive issues, including— it could affect constipation, for example, sometimes.

And not diarrhea?

Diarrhea could, could be also another important symptom. Thanks for mentioning that, because there were studies to show that Candida is also associated with some diarrhea when it is in large abundance.

And what about bloating? That's the one I hear a lot from naturopaths.

The problem with these symptoms is that they could be multifactorial. So even though Candida could cause some some bloating. But there are other organisms also in our gut that also could cause it. So it is a little bit nebulous regarding bloating and the association there. Basically, it's because of fermentation of food. Like, if you— like, for example, if you take a lot of fibers and then you are— the organisms in our gut start to break them down, we produce some gases, and the bloating occurs because of that. And fungi, especially Candida, can do some of that.

Okay. And so you were talking about taking antibiotics and that the overgrowth can happen after that. So what do you recommend to someone who is taking antibiotics or has just taken them?

Once you really— one of the ways to do, to try to rebalance the gut, as you said, like you take antibiotic, it's gonna cause imbalance or what we call dysbiosis. So once you finish the drug, it'll be a good idea to take some probiotics so that we can support the beneficial bacteria in our gut to help them take over and keep Candida under control.

And, you know, I, I know there's so many studies out there showing the benefits of probiotics in particular in that scenario, but there was one that came out within the last— it feels like maybe 3 or 4 months— that said that it took longer for a normal gut to return to normal when you took probiotics after antibiotics. Do you have any, any thoughts on that study?

I think the good news, at least from the fungal point of view, Candida or fungi in general in our gut can very quickly re-establish itself. It takes longer for bacteria to do so. And you know why is this interesting? Because once you deplete the bacteria and we have an overgrowth of Candida, Candida actively try to keep the bacteria down, you know, as if it's now, okay, I am overgrown, you have too many of myself, let me keep bacteria under control because I like as it is, because you are not competing with me. So after an antibiotic, to try to rebalance it, fungi can come back to its low level, for example, very quickly. We can affect it, and we can affect it through diet, for example, and establish it at low levels, whereas bacteria, we really need to help it even more because a study showed that for bacteria to come back, it depends on long-term diet, whereas for fungi, it can come to normal levels, which we would like to have, which is low colonizing level, in a short-term diet.

Okay, so tell me about biofilms and how it relates to different disease processes.

Okay, just to make— what is a biofilm? You know, the best example is the plaque in our teeth is a biofilm, where if we don't brush, you start to have the plaque, which we all know. And what is this? It's basically organisms, microorganisms, both bacteria and fungus. They come together instead of living as floating around, not attaching to anything. They come and stick to our gut. And then once they start to stick to our gut, they start to reproduce what you call matrix. Matrix is type of jello which protects them, and they cover themselves and they are living inside it. Once they live inside the matrix, it will be very difficult to get rid of them. And the same applies for fungi. In fact, fungi can grow very thick biofilms by themselves. We did the studies, many studies a long time ago, where we compared the ability of bacteria versus Candida form biofilms, and Candida can form much thicker biofilms by producing a lot of these gelotype of material I mentioned. But both of them will protect the organism. In a way, bacteria protect itself against antibiotics as well as our immune system, where we have immune cells coming trying to get rid of these organisms, but living within the biofilm or inside the biofilm under the COVID of this gel protect them against our immune system.

And do all bacteria form biofilms, or is it just certain ones?

Not all bacteria produce biofilm to the same extent. We have different species are good biofilm formers versus others are not as good. Interestingly, even within the same species, like if we take an E. coli, for example, one of the bacteria, or if you take Candida albicans, for example, if it is isolated from the environment or from outside, not exposed to the human, it does not make very good biofilm. But when it is in our gut and sticks to our gut lining, they sort of rev their engine and they start to make more biofilms. In fact, we published a study many years ago where we showed that fungal organisms in the environment or isolated from the skin, they make less biofilm than those that come from patients who are infected, systemic infection, or they, for example, have kidney infection with Candida. They tend to be better biofilm formers.

I've never heard of that kidney infection with Candida. What does that look like?

Oh, what it does— Candida infection in the kidney, if you— we did the studies, especially if you look at what happens to the kidney, especially post-mortem, or sometimes some people look at it in animal models, and you find that it forms sort of like islands, little white spots in the kidney. The organism come together and they form this aggregate or accumulation of organisms which are really biofilms. And when you look at them, they look— you know, the kidney is red, you know, reddish in color. You see these white spots there, and these are aggregation or compilation of different organisms in this area. So you have a lot of white spots telling you that this kidney is infected. Yeah, and that's really what happens is it causes kidney failure.

And what leads to that? I mean, is this something typical more in like a person who's immunocompromised, or is this happening to normal healthy people?

No, very good question. It's really the immunocompromised.

Okay.

For example, I mean, in the tongue, for example, HIV-infected patients, they develop oral thrush. But the systemic infection, for example, cancer patients, 50% of cancer patients because their neutrophils or host cells, host immune cells, are low in number, they can take over and start infection. That's why I call fungi is the disease of the immunocompromised. If you are healthy and you have low number of Candida, there is no issue whatsoever.

Mm-hmm. Okay. Now I know that you've studied a particular set of fungi and bacteria that form biofilms in Crohn's disease. Can you tell me a bit about that research?

Sure. What we did, we looked at Crohn's disease patients and we looked within a family. We took— we looked at different families and members in the same family who are living in the same household, they with Crohn's and their siblings with no Crohn's, and we compared their microbiome or the pattern of fungal and bacterial colonies. And what we found in these patients, the children or the family members with Crohn's had an elevated level or an increased level of bacteria as well as fungi. In particular, E. coli, the bacteria, Serratia marcescens, another bacteria, and Candida tropicalis is the fungus which was increased.

Okay, so just for everybody listening, the second one he said it's spelled S-E-R-R-A-T-I-A-M-A-R-C-E-S-C-E-N-S.

Yes.

That one's not so well known.

Oh yes, it is not. Serratia marcescens.

Serratia marcescens. Okay.

So we have two bacteria and one fungus. They come and really interact together And what they form, we form what we've been talking about, a biofilm or digestive plaque.

And Crohn's disease, if I understand it correctly, involves problems in particular in the small intestine, like where you have sores and such ulcers in the small intestine. Is that correct?

Yes. And sometimes you can see it also in the colon as well.

Oh, okay. And I thought when it was in the colon, it was called ulcerative colitis.

It depends of— no, even Candida, we can have some colonization in the colon as well.

Okay, and so what have you found that can break up those biofilms?

We recently developed a probiotic which we showed that it can break this biofilm. In fact, we identified 4 different organisms 3 bacteria and 1 fungi, which is Saccharomyces boulardii. They seem to work together and they are good guys. And the bacteria is Lactobacillus as well as Bifidobacterium, and the fungi was Saccharomyces boulardii. They seem to come and work together and they start to break down these biofilms. As well as in our study, we looked at can they influence, for example, bacteria. And what we showed is they will inhibit the ability of Candida to form germ tubes, or what— it's like thread-like material, like as if you have threads instead of round cells. And these threads, like filaments we call them, they are able to invade the gut lining and cause some issues.

Those are the germ tubes?

Yes.

Yeah, okay. And so you were studying this at the level of the petri dish or in people?

We study this in the level of petri dish, but also we haven't published this work yet. We looked into animal models where we were able to show that these biofilms come together and form in the gut of mice.

Did you introduce the biofilms into the mice and then they took, or did they develop? Did you just introduce them or get them to start the same way that happens in humans with antibiotics?

Yeah, we introduced the organisms because we wanted to see, okay, we are seeing these biofilms in vitro in a test tube. Do they grow in vivo in our mammalian system, for example. So we introduced these organisms and we were able to show that using scanning electron microscopy, which is able to magnify the microorganisms to a very— like 5,000 times, for example— we were able to see that these biofilms occurred also in vivo or in animals as well.

And did you then use the probiotic to break them up?

We're starting to do that. And our first experiment, again, this is a work in progress, our first experiment showing that yes, they can do it in vivo, but, or in animals, but we are continuing to do that and refining it and trying to understand, okay, if it is in the gut, what does it do? What we think is that once they form a biofilm in the gut, they start to break our gut lining, and some of the organisms will start to go in, and we have what we call, similar to leaky gut, where organisms can start to go in, or metabolites, which means small molecules, small chemicals produced by these biofilms, are able to go in and into our blood. So having a biofilm has a number of disadvantages. Number one, they are happy campers because they are protected from antibiotics or antifungals for that matter. So they can survive very nicely. But at the same time, when they are living together, we showed in our work that they start to become more virulent, okay, or more pathogenic, and they start breaking the lining. So we have problem with the barrier of the gut and also our immune— cause immune system or inflammatory response. So it's really very well orchestrated activity taken by these organisms living in a biofilm.

And once they start leaking into your gut, is that where we start to see autoimmune issues?

Well, you will start to see inflammatory responses, you know, like pro-inflammatory. Like for example, you see there start secretion of pro-inflammatory cytokines, cytokines which make us more inflamed. Whereas in healthy people, just to contrast it, we have organisms such as Faecalibacterium are known to be anti-inflammatory, which means they stop our system from causing inflammation. So the pathogenic biofilms, that's what they do, they cause inflammation compared to other organisms which are good guys. They make cytokines which are anti-inflammatory, and therefore we are in better health and well as far as the gut is concerned.

And so are the inflammatory cytokines in the gut itself, or is that all over in the body because of the leakage?

What we usually do, we take blood and we look in the blood, you know, in serum. And, but sometimes even if you take tissues, like we take, let's say, colon segments, and you can extract the immune cytokines or immune markers, let's say, and you'll be able to see it. But I think they are more really, they go through to our circulatory system.

Okay. So they're all over the place. Yeah. Okay. And so you have not yet tested any of this on people though?

You mean the probiotic?

Yeah.

We actually tested the probiotic in people, but what we did, We just wanted to look at if we use this probiotic, will it be able to change your microbiome from having the bad guys or the pathogen to a better microbiome where we have the beneficial organism? And we were able to show that, that this is what actually happens. We took sample at baseline before they start to take the probiotic, and then after 4 weeks of using the probiotic, we were able to show that we have more of the good guys than the bad guys, and definitely we show a reduction in Candida, significant reduction in Candida.

And were those healthy people?

These are, yes, ordinary people. We just took samples and we compared them to themselves, but we are hoping to start doing some experiments in people who are, you know, with certain diseases. One of the things we are planning to do is to look at people with breast cancer and try to to see whether this probiotic is able to rebalance their gut so they are in a better situation.

And how many people were in your small experiment?

We had a total of 50 participants.

Oh, okay. And so none of them had gut problems at all, or did some of them just happen to have?

Yeah, you know, people, of course, as you know, they are interested into getting into these clinical trials because they have some underlying issues, but they did not have frank disease. They have you know, some constipation, some bloating, this type of thing, but it was not a disease.

Nothing diagnosed?

Yeah, no.

Okay, so tell me about your company Biome and how that came to be.

Well, how it started is when I start working on the Crohn's disease patients and we came out with the publication, many, many, many people start calling me and sending emails saying, you know, how you can help us and, you know, to help us in the Crohn's disease and really to help us with our gut issues. At that time, my son Afif, A-F-I-F, he came to me, he said, Dad, you really need to start a company because people are sending all these messages and and we need to make a translation to your finding. And based on that, we really started, we established the company and we started to design the probiotic to target these pathogens or these virulent organisms. And that's how it started. It was really my son telling me, Dad, you have to do this. And, you know, to my delight, I listened to him for once.

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Yes.

Okay.

It was November, just after we published the paper, November 2016, but the actual probiotic was launched in March '17.

Okay. And I know we're not allowed to give medical advice here and all that, so anybody listening, do not construe this as medical advice. Or claims about healing. But anyway, I'm just curious about the kind of testimonials you're hearing. I assume that those Crohn's patients who reached out to you, you then let them know about your new probiotic?

They kept contacting us, and I tell them, but really, I agree with you 100%. We are not diagnosing or treating any disease. This is a nutritional supplement which hopefully is going to help people have better digestive health. And most important thing, we are targeting the microbiome or the microbial community in your gut, and we're trying to bring it to have more of the good guys rather than the bad ones.

And so, so are you hearing testimonials from people with Crohn's disease? Have you heard from any of those?

Yes, definitely. We are getting Crohn's and other people who use it for different sorts of of things. You know, some people when they have digestive issues, they go, they are buying the product, and we're getting a lot of feedback. And many people, like, they are, they order it again and again. Like, they subscribe sort of.

And what is the name of the probiotic?

It's called Biome, B-I-O-M-E.

Okay, so just the same as the name of the company?

Yes.

Okay. And so there's just the one, right? Just the one formulation.

We have one formulation for probiotic. We are working now on trying to do more specific, you know, more targeting or personalized probiotic. And how are we trying to do that? And it's through our— what we do in the company besides having nutritional supplement, we are doing what you call Gut Report. People send us their fecal samples We analyze them and we see where is the imbalance. And based on this, we have thousands of people who send that to us. We are looking at all this data and trying to see, are there different categories of people, like different profiles, and how we can adjust those profiles. And I am delighted to tell you that we really are seeing very interesting stuff, but this is sort of the future. Uh, hopefully we will be developing products that are more personalized than just the general ones.

And so you mentioned people, you're seeing different profiles. What do those look like?

We are seeing at least 3 different profiles in the bacterial side. Like, for example, one which is what we expect from healthy people. They have balanced gut. You have, you know, Firmicutes, you have Bacteroides, and the other Protobacteria. But Protobacteria is very low level in these healthy people. Then we have another profile. We are seeing a lot of increased abundance or increased level of Protobacteria, which really tells us that there's some inflammatory underlying issues for this person. Okay, and then the last group we see, we see an elevated level of Firmicutes. And this Firmicutes, when you have high number, have been associated with obesity. Also, you see a lot in pregnant women, they have high level of Firmicutes, which makes sense because these bacteria in this phylum, they tend to really derive a lot of energy from the food. Which the mother needs it to give nutrition to the baby. But in obese people, you really need to rebalance. So we have 3 different profiles of bacteria. But if you look at the fungi, what's interesting in these 3 different profiles I mentioned, some of them may have high levels of Candida, others don't. So in a way, if you Put it all together, you have 6 different profiles, and there are approaches to try to control the basically dietary as well as nutritional supplement approaches that will allow us to rebalance this particular profile.

And you have done some research on the, on the dietary rebalancing?

Yes, I mean, in this regard, I In fact, I have a book deal where we are coming out with a new book which should be published on December 24th of this year, where we try to look at how we can provide total balance. And what I mean by total balance is we are trying to control both bacteria and fungus. And this diet, we have tested it in a small size and small number of people,. And we really got very good preliminary data or proof of concept data where we were able first two things. Number one, we were able to show that we improved the microbiome profile to show more beneficial organism. But really what's so interesting, and we have testimonial from these people where their digestive issues, whether it's constipation, whether it is bloating, it really improved. And with these exciting results, we just got approval to do a larger sample size because, you know, we did 10 people in the trial. That's not enough. We are doing an additional 60 people, and that should give us a good confidence that our diet is working very well.

And it's the same diet for everyone? It's not different based on your profile?

No, the same diet. And that's why we are taking people as is, where we look at their baseline and then we see what happens to them at the end of 4 weeks basically on the diet.

And so is the diet anything revolutionary or is it sort of like, you know, a healthy Mediterranean diet with whole grains and—

Very good question. You know, our diet takes the good stuff from different different diets. Like for example, the Mediterranean diet. Even though we borrow from the Mediterranean diet the good stuff, but there are others, like for example, complex carbohydrates, which are used a lot in Mediterranean diet, we try to avoid. Also, the Mediterranean diet people like to have a lot of alcohol, you know, in Europe and Italy, people like to have their wine, which is great, But our diet, even though that does not prohibit alcohol, you need to take alcohol in moderation.

So it sounds like you're reducing the food for the fungi.

Exactly, reducing the food for the fungi and increasing the fiber, for example, so that we can support the good bacteria so they work together and keep everything under control. That's why it's total balance. Total Gut Balance.

Right. That's the name of your book, Total Gut Balance: The 24-Hour Jumpstart for Improved Digestion and Wellness.

Exactly.

Yes. That was what I found on Amazon. Okay. Now backing up to the stool testing and gut sequencing that you're doing, is that RNA sequencing?

No, this is DNA sequencing.

Okay.

So what we do, we take the, let's say fecal sample or stool sample. We extract DNA for both bacteria and fungus, and then we do deep sequencing to try to see— like, we use 16S for bacteria and ITS for fungi, and then we are able to characterize what sort of organisms are in a person's gut, both bacteria and fungi.

And even if they're dead when you get the sample, you can still sequence them?

Certainly. Because of DNA-based approach.

Okay. Yeah, no, I had heard about different types of sequencing and, and what— why one is superior to another. The 16S.

The 16S is for bacteria, which is really quite good. With the fungi, people used to use 18S, but studies have shown that ITS, which is internal transcribed region, you know, or space, and that really is much better for identifying the fungi. So ITS and 16S.

So what does it actually look like in the lab when you're sequencing? Is it like a machine and you just stick the sample in and it just does its work, or how is that actually done?

Oh, actually it's a multi-process. So what you do, the first thing you do, you extract the DNA And then you do PCR, you amplify the DNA you extracted, because as you, as you know, sometimes the amount of DNA is not enough, so you have to amplify it, increase the quantities. And once we do that, you build a library, and then you put it in a machine which will spit the sequencing data. Then you need to take all that data, put it into a software, and what we call bioinformatician will work on it to try to find the different levels. And a lot of the time you have to ensure that, because remember when we take stool samples, not only we have microorganisms or DNA from microorganisms, we have also human samples. So we need to clean it a little bit so that it doesn't get overwhelming. But this is a the DNA extraction and then PCR, and then you make the library and you put it in the sequencer and you have all this data. It takes really the whole process about 3-4 days, but because it is expensive to do, you try to have, for example, at least 96 samples. Otherwise, the kits to do this is very expensive.

So you sort of, at the company, you'll hold on to them until you get 96 and then you'll run a group?

Yeah, well, yes, but this is no problem because you have enough. At least you have to have 96, and then, and now we are able to go higher numbers, like up to 500 samples you can analyze in one run.

And what does PCR stand for?

PCR, polymerase chain reaction.

Oh, okay. So then the reports that people get, what do those look like?

The reports, as you know, doing this sequencing, you are going to have a huge number of organisms. You know, you may have 700, 1,000 organisms. But what we need to do, really, we try to filter it down to identify what organisms play a role in our gut health. And other, other, other types of diseases. And we made a report where we present first what's the phylum. The phylum is very high taxonomic level where you can see is there Protobacteria, is there Firmicutes, what I mentioned before. So you look at the phylum first, and then within this phylum we selected certain genus and the species which are known to cause issues or are good for us. Okay, and so the report comes with, let's say, 50 different organisms, and also both for bacteria and about 10 different organisms for fungus, because these are the ones that really have been shown to play a role in affecting our gut.

Okay, so you don't mention the ones that are just not doing any harm or or good, they're just in there. You kind of just ignore those.

Yeah, but, but what we do sometimes, we look, for example, at do we have Lactobacillus? Because these are good guys. Do we have Bifidobacterium? Because we would like to see whether somebody has this organism or not. We look if we have E. coli or Clostridium, C. diff, for example. These are the bad ones. We need to know whether they are. In the fungus, we look, do we have Candida? Or do we have Saccharomyces? Because Saccharomyces is good, Candida is bad. So we, we will be able to see this, and that's where we can guide a person what to do from the dietary as well as nutritional supplement to try to rebalance and maintain their microbiome.

Now what about other Clostridia? Because I know C. difficile obviously is not a good one, but, but I heard that some of the others have some impact on allergies, maybe in a positive way?

You know, it is true, you can, you can do that, but what we focus on, like for example, in fungus, there is a lot of organisms such as Aspergillus, or Alternaria, or Cladosporium. These are known to be allergens, but we really don't look for them because Cladosporium, which is present a lot in the air and cause allergy, you are able to see it, but we are focusing more in the gut. However, there are some studies showing like other fungi or other yeast that can cause allergy. We really don't look as much at that as we look at what will affect our gut health.

Okay, so it's really a gut health test.

Yes.

Okay, and so one thing I've wondered about for a while is that all of these stool tests that I've done they say use the stool from the toilet paper, but I'm thinking, well, what if just that section of stool did not— is bacteria and fungi, are they evenly distributed throughout stool or might they be, might you miss something because of where you took the sample from?

You know, this is very good question. Certainly it's not as distributed, like well distributed. It's not like we are making milkshake or something. Yeah, you know, no, you have, you know, it could be in different parts. That's why what is critical is that when you want to send a sample, you need to have enough of it. And that we say when we send this, when you send a swab to collect a fecal sample, we say if it is white, it is not right. It has to be brown. You need to collect enough so that it will increase our chances to really isolate enough DNA.

Right. No, I mean, I'm just wondering though, then at the end of the day, you could get a sample that is highly skewed towards something just because that's where it happened to be on that piece of stool or after, you know.

That is a possibility. And what happens here, let's say sometimes we have out of 96 samples, We may have two that really, when we looked at the sequencing and we look at the data and it's not helping at all. So what we do, we say, please send us another sample because there is some issue here. We could not see much.

Uh-huh. Okay. Well, this is all really interesting stuff. And the exciting thing for our listeners is that I have done sequencing and I am going to have Dr. Ghanoum back on the show in 4 to 6 weeks or whenever I get my sample back, and we are going to discuss my results and talk about the kinds of recommendations that the company makes. And you have dietitians on staff, right?

Yes. Well, what we did to try to help people, we have a team of dietitians and nutritionists which really have looked at the data and looked at published work, and we really have They have very, very good grasp of if you have this dysbiosis or this imbalance, this is what you need to do. Okay. Now the other thing which we also, our dietitian help people, we have a questionnaire because we ask questions. For example, are you stressed out? And you know, these days we are all stressed out the way we are. So we also give recommendations, some lifestyle profile. If somebody says we are very, very stressed out, we try to really guide them to do a little bit of yoga, a little bit of meditation, because stress has been shown to influence our microbiome. So we not only look at the microbiome, also we look at their lifestyle and try to help them in that regard.

So in fact, it really is an overall health test along with the, along with the gut test.

Yes.

Okay, cool. So I'm looking forward to seeing my results in my report and seeing how my gut's doing.

Yes, likewise. It will be fun to see, and I'm sure, I hope it will be great.

Yeah, I hope so. I hope so. It hasn't historically been great, but I feel really positive about this sample. I think I did a good job. Okay, well, this has been a fun conversation, and I look forward to our next one. Any parting thoughts?

I really enjoyed very much talking to you, and I'm also excited for next time, and thank you for having me.

Thank you. I thought that was a great conversation. So if the stool testing that we mentioned is of interest, there is a link in the show notes to Biome so that you can order a test from them. I'd appreciate it if you went through my link to support the show, and I'll also link to Dr. Ghannoum's book on Amazon, which I think is in pre-sales. And before you shut off the podcast, can I ask one small favor of you that won't cost you anything and will help me stay on the air? So can you go to HighDesertHealthCoaching.com and go to Supplements and Lab Tests and then choose Recommended Products? Or you can also find the link in the show notes, and there's a link there for Amazon. So if you buy regularly from Amazon, will you click on that link and just leave it open on your computer or on your phone? And the next time you order something, will you go through that link? And there's also a link to Vitacost, and if you get supplements regularly from Vitacost, if you go through my link, I get a small commission. Boy, they should be paying me for advertising as much as I talk about them. And then you can also just find other affiliations and lab testing options there through my site. I've chosen to affiliate myself with a variety of products and stores in order to be able to stay unbiased and recommend what I think is the best product, if any, given, you know, the situation of my different clients. So rather than, you know, making or hawking my own line of products, as many health coaches, doctors, and naturopaths do. So I appreciate any support you can give me through my affiliations for those products. And thanks so much for listening. If you're enjoying the show, please rate it on iTunes or your favorite podcasting app. It only takes like 5 seconds to just give a star rating so that others can find me. And if you know somebody who's struggling with their gut health, please share about the show with them. Podcasts spread more than anything by word of mouth. And if you have any questions on gut health or ideas for shows, please reach out. You can email me at Lindsey@HighDesertHealthCoaching.com. That's Lindsey with an E-Y. Or follow and write me on Facebook, Instagram, or Twitter at my High Desert Health pages, and all these are linked in the show notes. And thanks so much for listening, and here's wishing you the perfect stool.