Star Edwards - Advanced Microbiome Testing for Every Age and Stage of Life

Welcome to The Clinician's Corner, the go-to podcast for functional health practitioners who want to deepen their clinical skills and deliver exceptional client results. I'm your host, Margaret Floyd-Barry, Master Restorative Health Practitioner and Executive Director of the Institute of Restorative Health. Each week I interview leading experts to bring you the latest research, case studies, and evidence-based strategies for reversing chronic disease with actionable insights you can implement immediately to elevate your practice and transform how you deliver health.

Welcome! Welcome everyone to this week's episode of The Clinician's Corner. I am Sarah Fields. I am a lead instructor here at the Institute of Restorative Health. I am sitting in for Margaret today and I am super excited to get to be here because I have the pleasure of speaking with Star Edwards of Tiny Health. So Star is a former Women, Infants, and Children high-risk dietitian who's helped her own clients in private practice, where she focused on food allergies and sensitivities, the gut microbiome, athletic performance, and pediatrics. And for much of Star's career, she has worked for food allergy and microbiome testing companies, training and mentoring healthcare professionals on test interpretation and microbiome recovery protocols. And as the healthcare practice director of Tiny Health, She works closely with healthcare professionals to assure that Tiny Health testing is actionable and helps them solve their patient microbiome grievances. So this is very exciting. Thank you so much for being here, Star.

Thank you so much for having me. I'm excited to be here and talk about Tiny Health with you all today.

Yes, absolutely. And I'm looking forward to this conversation because we, you know, have had a lot of interest in Tiny Health within our community at IRH and You know, just looking at the test myself, there is so much information on these tests that, you know, we're probably only going to be able to scratch the surface today, but that is okay. So let's just jump in, start, and let's start with you and, you know, tell us a little bit about what got you here into this microbiome health space and specifically what drew you to Tiny Health.

Yeah, so I've worked in the microbiome space for probably 10 years now in laboratory testing, probiotic industry, and I don't know, there's something about the microbes that call my name. I'm just a nerd when it comes to the microbiome. And I think it's super interesting that as a dietitian starting out many years ago, we're not really taught about the microbiome. It's, you know, kind of a newer field, but it has so much to do with our health. And especially what we eat, because what we eat is directly impacting the microbes that are in our gut, which are directly impacting our health, essentially. So I feel like every dietitian— just putting a plug in there— should know how to feed the microbiome because it is so important when it comes down to figuring out what we need to eat. So I just— I've always been interested in GI health and the microbiome. And then I had a son who had a lot of GI issues, CSID, EOE, SIBO. I mean, you name it. It's kind of— that's the way I learned is through him, basically. So I started studying. And once I was in the field of microbiome health, Tiny Health kept popping up here and there. I think they had just launched and different people were bringing them to my attention and I started looking into them and I wanted to join the best. I was at another microbiome testing company, but I just felt like Tiny Health was just kind of blowing everyone out of the water and they were just evolving so quickly. And I wanted to be on the forefront of that and I wanted to be on a team where we were constantly evolving because microbiome research is evolving all the time and we just have to stay on top of it. So one of the things I really liked about them was their ability to be agile and to evolve with the research and constantly push out new metrics and make updates as the research evolved.

Oh, I love that. And I think that's such a good point. I mean, I feel like in, you know, my like decade plus of being in this space too, I've seen that evolution. And so I know what you're talking about. It's rapid, right? It's, it's moving very quickly. So that makes total sense. So tell us a little bit more about the story behind Tiny Health. You know, what, what is their focus? And, you know, what, what really sets them apart in this space other than the agility that you mentioned, which is obviously very important? But, but yeah, what can you tell us about them?

Yeah, I call them a unicorn and I'll explain what that means. But we were founded by Cheryl Sohoy, and she essentially developed the test because she had a C-section birth. Baby went on to develop eczema, sesame allergy, colic. Then she had a home birth, vaginal delivery. Baby didn't have any of those issues. So she started digging into the research papers in PubMed and found that there's a strong connection between C-section-born babies and atopic march. So she put— there wasn't obviously any other testing on the market. She had no way to test her baby's microbiome because there wasn't a microbiome test that focused on infant health, the first 1,000 days of microbiome development. And she got in touch with a Mayo Clinic researcher who helped her develop the test. We now have a very robust team of researchers and advisors who have helped develop the test and help with that continuing involvement. And so that's how we, we developed. But why we are a unicorn in the space is because we are the only microbiome test. That has reference ranges and metrics that are specific to different age groups. We're the only one for under age 5. Everyone else's age group started around 4 or 5, but the microbiome becomes more similar to an adult microbiome about the time that toddlers start eating an adult-like diet. So you can say 2 or 3, but really about 5-ish. So That is very important to test babies with the appropriate reference ranges and metrics. The other thing that sets us apart is the, the technology that we're using, and we can go into each one of these things a little bit more, but we are using whole genome sequencing, and we can talk about why that is important. But we're also the only whole genome sequencing— you may also hear it called shotgun sequencing— the only shotgun sequencing plus stool chemistry tests on the market. So that includes your markers like calprotectin, lactoferrin, lysozyme, pancreatic elastase. We also have this really cool interactive results portal. Instead of just having a PDF, you can see it online, and it's really interesting because you can click through it, and it has all the microbiology, all the education, all the training built in. But then it also pulls specific information into your action plan. So based off of the patient's results and what they added in their survey, maybe they said they had constipation or eczema in their survey, then it creates this action plan for them that has recommendations for different probiotics and supplements, diet. I love the diet recommendations because they're very specific and lifestyle recommendations. And then last, I would say, is our pricing. Our pricing is incredible. We've kept it as low as possible, and that really encourages repeat testing because we want to make sure that protocols are working, which is important throughout the lifespan, but especially during those first 1,000 days of development when there's such a high correlation between dysbiosis and conditions like atopic march. And neurodevelopment as well. Wow.

Yeah, that's, that's incredible. All of those things. So, you know, one of the things that you already kind of touched on here is the difference between the, you know, pediatric microbiome and the adult microbiome. Right. And so that's what was one of my questions for you. Why develop a test specifically for kids, and what are some of those key distinctions that you see between the microbiome of a young child and an adult?

Yeah, great question. And this is something that I'm very passionate about, having a child with autism and all these immune system type disorders. He had anaphylactic allergies when he was young, and his case is really the perfect example of how things can go wrong with the microbiome in those first 1,000 days. And how you can start— I don't want to say they cause, but they increase the risk of developing things like anaphylactic reactions. So during the first 1,000 days, our microbiome plays a very important role in training the immune system and also helping with neurodevelopment as well. And one of the ways to think about this is the functions, the metabolites. What are the microbes doing? And the microbes are very important during that time for producing things like short-chain fatty acids that we've probably all heard of, also toxins like LPS that create inflammation, and other metabolites and functions that will impact the way that baby's immune system is trained. So during that first 1,000 days, like I said, there is a, an increased risk of, um, atopic march. We just launched a study, or we just published a study a few weeks ago in C-section-born babies, and we're very excited about this, that showed that babies who were born C-section that took our test, followed our recommendations, 6 months later they had an 83% decreased risk of developing eczema, which is huge. And actually, on our direct-to-consumer side, about 60% of our customers come to us because of eczema. Most of them babies, toddlers, but some adults as well. So, in the baby microbiome, it's very unique from the adult microbiome. And I guess I would say it's a little bit simplified as there's less diversity, but it is so profound and magnified, the difference. That those changes and what is happening in the baby's microbiome can make. So, for example, with babies, we want about 80% of the microbiome to be taken up by Bifidobacteria, but specific Bifidobacteria like infantis. In adults, we want lower levels of Bifidobacteria. We want more diversity. But that Bifidobacteria in those first 1,000 days helps to do things like degrade human milk oligosaccharides, And that's something that we can look at on our test is not only do you have the right Bifidobacteria, but do we have enough of the HMO-digesting genes? So do we have enough genes from the microbiome who can help degrade HMOs? And what happens as a result of the degrading HMOs is that we produce more short-chain fatty acids like acetate, which helps lower the odds of atopic march. We also, in babies, another key difference is it's okay to have more pathogens than in adults. It's a very fine line. We don't want too many, too much inflammation, but pathogens help to train the immune system a little bit. So the reference ranges are adjusted for babies on the test, but also the metrics. And that means that for babies and toddlers, pregnant women, we look at HMO digesting species. We don't look at that if you're an adult woman or adult man. We're not going to report on that. And vice versa for adults, we look at things like TMA production, but we're not going to look at that on a baby's test. So I think that answers your question.

Yeah, absolutely. More than answers it. I mean, that's incredible. There are obviously so many distinctions, and I think that is brilliant. So, and fascinating about the study with the eczema and that reduction, that's significant. So, you know, I was going to ask this later, but since you mentioned it, you were talking about the age ranges and how, you know, the ranges will adapt to the age. Is that something that is— does that happen automatically? So the ranges are adjusted automatically based on the age of the person who's taking the test.

Hi friends, it's Margaret here with some news I am super excited to share with you. As many of you know, I am not just your podcast host, I am also the executive director of the Institute of Restorative Health. And for years, we have been getting the same request from practitioners everywhere. They'll say to me, I've heard incredible things about your clinical training programs, but I can't wait for your next certification cohort. Can I start learning now? Well, the answer is finally yes, and I couldn't be more thrilled about what this means for practitioners who are ready to transform how they approach client care. We are launching Mastering the Art and Science of Gastrointestinal Healing Core Curriculum Self-Study. Study through the Institute of Restorative Health. This gives you immediate access to the foundational curriculum that has equipped over 1,400 certified practitioners worldwide. This is perfect if you're searching for the most effective approaches to help your clients feel better faster and get meaningful results. You're gonna get all foundational training modules, curated Q&A sessions from previous cohorts, and dozens of real-world case studies all at your own pace for one full year. Now, I want to be clear, this provides foundational knowledge and curriculum access. It's not comprehensive clinical training. You're not going to receive live instruction, the personalized mentorship, or the certification through the Institute of Restorative Health. Think of it as exploring our methodology before deciding on full certification. So for $1,400, you can dive in today instead of wondering whether our approach is right for you. And if you decide you want a complete certification experience later on, you can upgrade anytime and we'll apply your investment towards that full certification tuition. Visit instituteofrestorativehealth.com to learn more and enroll in the core curriculum today. Your next breakthrough starts with understanding these foundations. The question is, are you ready to begin? Again, that's instituteofrestorativehealth.com. We'll see you there.

Exactly. If you go to tinyhealth.com, which is our D2C site, we also have Powered by Tiny, which is our practice site. But on tinyhealth.com, you might see the Baby Gut Test, the Child Test. It's all the same test. If you purchase a test on the practice side, you're just purchasing the Gut Health Test. And when the patient receives their test kit, it'll prompt them to go online, fill out a survey, and that survey will ask things like their age, if they're pregnant, etc. And then the references and the metrics are adjusted from there. So the report or the results that the customer, the practitioner receives is all based off of that survey and the age that they added to it.

Okay, perfect. And so that, you know, lends to another question, and you kind of just mentioned that. I know that Tiny Health has other tests, right? And And, you know, we're, we're focused on the gut microbiome testing today. But what are the other tests? And, you know, yeah, what does that suite of tests look like?

Yeah, so it's pretty simple. We have 3 tests and the first one is our Gut Health Test, which is for all ages and stages of life. That's our whole genome sequencing test. The second test is our Pro Test. That is our whole genome sequencing plus stool chemistry test. So if you like those calprotectin, pancreatic elastase, inflammation, inflammatory markers, then that's the test for you. And then our third test is our vaginal health kit, and it is using the whole— the same whole genome sequencing, and it's for ages 18+.

Okay, awesome. Oh, we'll have to get into that one another day so we can talk about cases for that. Um, only one test at a time here, so, okay. Um, so then, you know, you mentioned the, the whole genome sequencing, right? And we do hear a lot about the different testing methods and technologies out there. Um, how does that, you know, that testing method that Tiny Health uses, how does that compare to something like traditional stool culturing or qPCR technology that, uh, many of us are familiar with?

That is a wonderful question. PCR has been around forever, tried and true for testing for pathogenic infections, has a very quick turnaround, very specific and sensitive for specific microbes. Whole genome sequencing— and with— I'll back up a little bit. PCR basically is able to capture a small part of the genome, and then it amplifies that information to identify who is in the microbiome. With whole genome sequencing, we can identify the entire genome of the microbe, and that has several benefits. One of them is that it scales a little bit better, so that if you're not looking for a couple of specific microbes, you can use the whole genome sequencing to identify everyone in the microbiome. With our test, we give you an alpha diversity score or richness score, and that tells you how many microbes you have in your microbiome. For adults, it's common to have 450 to 500. So it'll say you have 450, and then with that technology, we can list them all out. So we will give you a list in the microbiome breakdown of all 500 microbes if you want them in your microbiome. I love that because again, I'm a microbiology nerd. If it's overwhelming, then we teach you how to categorize the information and use it appropriately. But with our microbiome breakdown, every microbe has a little dropdown that basically tells you what that microbe does and what's it associated with, which is really cool. So that's one thing that is really beneficial about whole genome sequencing. The other is that we can use it to identify functions. So I always say that if you want to think about a framework of what the test is going to tell you, from a high level so you don't get overwhelmed. It's gonna tell you, first of all, who is there. It's gonna list taxonomy, the microbes that are there. The second thing it's gonna tell you is what they're doing, and that is by identifying their functional genetic pathways. With PCR, a lot of times we're inferring. We're saying you have Akkermansia and it produces butyrate, so you have a healthy level of butyrate production, but that may or may not be the case, and it's not really taking the whole entire microbiome into consideration. Consideration. So we can look at all these functions with the functions are my favorite thing about whole genome sequencing. And we look at the functional genetic pathways. It doesn't matter which microbe it comes from. We're just looking at the entire microbiome and saying, do you have sufficient capacity to produce short-chain fatty acids, to digest fibers, to digest protein, to— do you have too much that can create too much TMA production, for example? I'm trying to think of some of the others. We just We just launched a Urolithin A that tells you if you have the ability, if you have the microbes who produce Urolithin A. We have a ton of functions and we can get more into which ones apply to different age groups. But that is the second important benefit of the whole genome sequencing. And for me, functions are really the next frontier in gut microbiome testing. And when you learn about the mechanisms of the functions, then you can start going down all kinds of rabbit holes. If you know what LPS does, we look at hexa-LPS production as a function. So if you understand the mechanism behind that and what LPS is, you have a patient with a thyroid condition, you can ask yourself, huh, I wonder if LPS has anything to do with thyroid health because their LPS is through the roof. And if you do a little research, which actually is built into our test, but you will see that it does apply to thyroid health. If you have a patient with non-alcoholic fatty liver disease or a patient who has preeclampsia, you can just research these functions and start making all these connections about what the microbiome is doing and how that can impact the symptoms and conditions. So, it takes it way past taxonomy and identifying who is in the microbiome. It's really about what they're doing, what functions they're performing. And then to finish out those 4 in the framework, so who's there, what they're doing, what are they associated with is number 3. And we build in specific condition associations to the test. We have condition associations like menopause, preeclampsia, hypertension, GLP-1 production, uh, colic, sleep issues for our babies. So we can tell you if the microbiome of your patient looks similar to the microbiome of patients with those conditions. And then number 4, or last, would be what to do about it. And that is where we pull in the action plan. So who's there? What are they doing? What is it associated with? What symptoms and conditions? And what do we do about it?

Oh, wow.

That's incredible. Yeah. Like I said, so much information about this test. So understanding how different that is from some of the other tests that are out there, You know, how can the knowledge that practitioners already have from interpreting some of those other tests like a GI Map or a Doctor's Data stool culture, you know, how can that knowledge that they have serve as a foundation when looking at Tiny Health? Like, are they, are they going to know what they're seeing? Are they going to know their way around?

It's a start. And I would say that what we have been really good at doing and using tests for in the past, like PCR and culture test is identifying pathogens and then learning how to treat them. So, that's always a good place to start, but we want to expand our mindset a little bit. In addition to those pathogens and how to treat them, we want to know about the overall ecosystem of the microbiome. And one of my soapboxes is making sure that we're including the beneficials. We don't wanna leave them out. We wanna make sure we have enough of the beneficials and the right amounts because they will help to police the disruptives or the pathogens. Sometimes we don't have to give antimicrobials if we just boost our beneficials. And that's usually my number one go-to when I'm looking at how to improve the microbiome is let's focus on how to improve those beneficials, maybe probiotics, maybe we need to make sure that we're feeding them well, which is something else that I would say when it comes to knowledge that you have about using tests and expanding your mindset a little bit, really start to think about who you're feeding. Pathogens typically like a special diet— no surprise, it's the Standard American Diet— and beneficials typically like more of the Mediterranean-type diet. So you can use the information you have about who is in the microbiome and change the diet to feed who you want to feed. And as a result, it's going to produce metabolites that you do or don't want. So it's all about what is happening after those microbes consume the diet that we're eating and how does that impact our health.

Oh, wow. Yeah, we'll definitely have to get into that more because I definitely want to spend some time talking about the application of this information and how you take some of this stuff and translate it into actionable steps, which it does sound like. And I have seen the portal. It— you all do such a nice job of building that in and making it really easy for the, the practitioner to see, um, some of that. But yeah, I definitely want to talk about that. So this test, you know, obviously we're not looking at it, um, you know, here on screen, um, which would be wonderful if we were, but for our people who are just listening, we can't do that. So There's clearly a lot of information on this test and it's impressive. But what I would love for you to do is, you know, kind of start at the beginning and walk me through the key sections of the test results. And I know we're probably not going to have time to get into all of them because there are a lot of, of sections. But like just starting at the top, right, the microbiome score that you all report at the very beginning of your test. What does that mean and how is that calculated? And then, you know, moving from there, what are some of the other key sections that you really focus in on when you're looking at this test?

Definitely. And I think the nice thing about our interactive results is we take a layered approach. So there's really— if you're new to testing, then I would point out a few things that you really want to focus on. But if you want to go deeper, you have the ability to go deeper into the information. So the first thing you will see when you open the test result is is that microbiome summary score. And this is a machine learning model where our microbiome specialists— we have a whole slew, I think we're up to 14 now, of microbiome specialists who work with our D2C customers and our practitioners to teach them how to interpret the test. We have divvied up hundreds of reports amongst us and we manually score them. What would we give this kit based off of our clinical knowledge? And we feed that to a machine learning model. So then it will give someone a score of 0 to 100, and that's all done within the same age range. So it'll compare you to your age range and tell you within that, how does your microbiome compare? What is the overall health of the microbiome? And it takes all the metrics into consideration. So it's just an overall summary score of your microbiome.

Okay, awesome. And then from there, you know, moving into some of the other key sections, You know, well, and I guess actually I would, I would be curious that microbiome score and this might inform your answer. Are there sections on the test that are weighted heavier than others that, you know, when you're calculating that microbiome score, like the disruptive microbes or the beneficial microbes or the short-chain fatty acids, right? You know, all of those sections, are any of those weighted more significantly when developing that score?

Yeah, so a lot of our metrics are, and I work closely with our science director to help to prioritize different metrics. So we come up with a priority order in the way that we want different metrics to be, yeah, weighted and prioritized. Yep.

So then moving through some of those other key sections. So we have that score that's reflective of kind of the overall results. What are some of the other first things that you would look at? Like, you know, I guess if you're doing the PRO test, right, you kind of have that, that section next. But what are some of the other places where when you get test results back, you're like, let me go look at this?

Yeah. So when you land on the landing page, you will see the microbiome summary score up top. And then if you scroll down, you will see the top 3 priorities. And this is where that priority order comes in. So these are for anything that is out of range. We pull in based off of priority and what we're weighting the 3 top concerns. So you will see that at the very beginning if you just want to see off the bat things like, and what I'm looking for are hexa-LPS, mucus degradation showing up. And I know there's a lot of inflammation in this kit, or if there's a pathogen that has an— there's an infection that a disruptive or pathogen is really high, it'll show up there. Our functions will too. And then if you scroll down, we have our condition associations, and these are the associations— they're called signatures or patterns, but I describe them as if you were to look in the research for specific symptom or condition and look for what the microbiome looks like, what microbes are elevated, what are decreased, what functions are elevated or decreased in those conditions or patients who have been sampled in those conditions, it'll show you. So it'll give a list of metrics and markers that tend to be elevated or declined in those situations and how many of your patients' metrics match that. So what that tells you, that's where we have like GLP-1, thyroid, menopause, colic, eczema, food allergies. All— we have many, many, many of them, but those are a few examples. So what that tells me as a clinician, if if my patient is presenting with constipation and they have several metrics in their microbiome that we also see in patients with constipation, then if we improve their microbiome, then there's a greater chance that we can improve their symptoms because there's a good chance the symptom is tying back to the microbiome. You know, that doesn't always happen if you think of something like thyroid, thyroid conditions, thyroid health, then sometimes it'll improve it, sometimes it won't. There's other things that are playing a role there, but it— I do feel like it gives you an increased chance of moving the needle and making a difference when you're influencing the microbiome if a lot of those markers are showing up. So we have condition associations, and then you'll see on the right-hand side our gut type. And our microbiome breakdown. For babies, there's a special, very important metric here called microbiome maturation. During those first 1,000 days, it's really important that our microbiome is maturing at a certain rate. If we aren't maturing fast enough, it can not train the immune system properly. If we're maturing too quickly, so a, um, very young infant looks like their microbiome is that of a 2-year-old, we're overstimulating the immune system. And when our microbiome isn't maturing along that trajectory, it increases the risk of atopic march. So we want to make sure that we're falling within the current range or the appropriate range. And things that will impact that are not having enough diversity as we age and start to introduce solids, or having too much diversity early on, because a very young infant shouldn't have very high diversity. So that's a very important score or metric for babies. And then underneath that is the gut type. Babies, we want to have the Bifidobacteria gut type. For adults, we typically see 3. I think there's 6, 7, 9 gut types that are possible, but I typically see Lactobacillus acidophilus, Bacteroidetes acidophilus, and the other gut type. I'm going to launch into like a whole gut review here. I'm not careful.

Tell me what you know when you say gut type. What, what exactly does that mean? Is it just like the predominant, you know, the predominant species that, that you're seeing in the microbiome overall? And, and what then does that tell you about someone and their gut health or, you know, if it extends beyond that to their overall health? What does that— yeah, what does that gut type mean? And then what does it tell you?

Yeah. So it does mean who is taking up the most space, the most abundance. In the microbiome. Again, for babies, we want that to be bifido. For adults, when I see Lactobacillus fermentis, it usually likes more starch. When I see Bacteroidetes, it typically likes more of the standard American diet, more heavy protein. Like, this is very generalized, but it gives me a clue for things to start looking at further in the report. Because if I see things like Bacteroidetes, I'm thinking we might need to work on protein digestion. We might need to work on diet a little bit. And then the other gut type, this is also known very— it closely resembles beta diversity. Someone with the other gut type, they either have a lot of unknowns in their microbiome or the composition is just different than what we typically see. Sometimes it's not unhealthy. I see this a lot of actually in the older population. And we're doing research right now on the population over the age of 60 because their microbiome tends to be different than the typical adult too. But I will see it because if you think about when they grew up, they were spending more time outdoors, they were eating more plant-based foods, their lifestyle was just different. So their microbiome is very different as a result. Sometimes it's because we have a lot more pathogens. But I will take that information and then look at the microbiome breakdown, which is where we list all the species species that you have, and they are listed in descending order of abundance. So I will see, you know, if, if it's Bacteroidetes, then who is there specifically in that gut type that can give me a little bit more information about the species. Because the more you know about the species and the strain, the more specific you get, you know more about how they're impacting your health. So I'll start to see if we have a lot of disruptives, um, a lot of like, who, what do they need? What do they like to eat? What environment do they like to grow in? And once you understand what environment they grow in the best, then you can start to look at upstream processes and see why they're thriving there and how we can change that.

That's amazing. I love that. It's very much a backing out and looking at the whole picture. Right, like not just coming in and saying, oh, you know, we, we don't want all of this, we need to get rid of it. It's, it's really understanding the mechanisms that, that lead to the development of, or the growth of that population. So it sounds, you know, it sounds very holistic, um, a very holistic approach. Okay, so I know we could get into all of these different sections, you know, like the, um you know, the balance and robustness, digestion and absorption. We could get into all of those things. Um, but one of the things that I know, you know, on the test we see is all of those different sections and then, um, the metrics that are sort of listed out for, um, that section. What are those metrics? What does that mean when we see, you know, let's say, um beneficial microbes, right? And then we see the list of metrics beside it. What is that telling us?

Great question. So this is where we've taken those 500 microbes and divided them into meaningful categories that make it easier for you to interpret. So if you don't ever want to look at that list of all the microbes, you don't have to. You can just skip over to this section. And we're looking at really two things. First is taxonomy, who's there. So we have beneficials, and we have a list of a few beneficials. That's not all of them, but those are what we consider keystones. They have a very— they're very important for everyone's health. If we're missing them, then we're going to be missing some of those important metabolites like short-chain fatty acids and vitamin production. And here we list things like Akkermansia, Faecalibacterium, and Bifidobacteria. And then we have our disruptives. Or our pathogens. So, we list a long— we have a long list here of some pathogens that we're calling to the front that most people are interested in learning more about. We have bacteria, fungi, we include H. pylori, parasites, so, protists, not helminths. And then, we look at things like methane production and Methanobacter brevibacter. And then, we— the rest of the metrics, most of them are really functions. And we divide those functions up into functions that that create inflammation like LPS and mucus degradation. And then we've got— you mentioned the balance and robustness. We include beta-glucuronidase, histamine production, GABA production, and GABA breakdown. And we have— we just added an oral microbe section. So we're looking at the microbes from your oral cavity that are growing in your colon. They shouldn't be. So they should be killed off mostly by stomach acid and digestion before they get there. So we can get some clues here. About digestion and the overall health of our gut when we are colonizing a lot of these oral microbes in our gut. Um, what else is there? HMO-digesting species. But that's really anything that says capacity, that's looking at a function. It's looking at, do the microbes have the capacity, the genetic pathways, to produce this?

Okay. So this is the metrics that we're looking at there then, if I'm understanding this correctly, it's a way for us to, you know, see the impact of the species that are there and the other things that are measured like cellulose or pectin or whatever. So it kind of takes all of the individual findings and then creates these sort of, I guess, almost like a summary, right? Like the metrics are kind of like, oh, okay, if the inflammation or LPS production metric is flagged as being high, then that is giving you sort of a broad view of what is actually happening at the individual species level. Am I understanding that correctly, that it is just a way to organize and categorize all of that information in an actionable way.

Exactly. You can think of the disruptives and the beneficials as who's there, and then a lot of the other categories are what are they doing. It's the functions. And then I mentioned before the condition associations, that, that is what is it associated with, what is it doing. So that's step 1, 2, and 3. Who's there, what are they doing, what are they associated with.

I love that. That's, that's definitely makes it a little bit easier if you're new to the test and you don't want to sit and look through all these hundreds of microbes and figure it out. Okay. So just thinking about some of the individual markers, I mean, there are many on this test that our audience would be familiar with. So things that we've talked about, like, you know, calprotectin, elastase, beta glucuronidase, those those sorts of things. But are there any markers on this test that are a little bit more unique, or that are unique to Tiny Health specifically? You mentioned earlier one of the ones that I flagged was the hexa-LPS, which I don't know that that's necessarily unique to Tiny Health, but it is not necessarily a marker you see on most stool tests that people are looking at. So I'm just curious, are there any of those markers that are more unique and that stand out, especially within the context of Tiny Health?

Yeah. So I think that LPS is an important one. Hexa-LPS is the worst type of LPS. And for anyone who's not familiar with LPS, it stands for lipopolysaccharide, and it is attached to gram-negative bacteria. Not really a problem until these bacteria die off, which they do when we eat a lot, especially eat fats. But they create a lot of inflammation in the gut. They leak into systemic inflammation, circulate through this superhighway and create inflammation in whatever organ they come into contact with when they're elevated. So they upregulate the immune system. And so LPS on a lot of tests is measured based off of taxonomy, meaning that it's identifying different microbes who produce LPS, which is typically your pathogens, and like Enterobacteriaceae, which includes things like E. coli. But we are looking at it as a function. I'm not sure if there's anyone else out there who's looking at the functional genetic pathways right now for LPS. There might be, but one of the really, I think, important benefits of that is is that I mentioned the other gut type that has a lot of unknowns earlier, and you will see in your microbiome breakdown if you have any unknowns, it just lists random numbers. It doesn't have a name like Ruminococcus or E. coli. So sometimes we may find a test, we may run across a test, and hexa-LPS is really high, but maybe all the pathogens that typically would produce LPS are at normal levels. So it's kind of interesting that LPS is so high, but it might be because of a specific unknown. We don't know that that unknown, what it's doing, because it's unknown. But yet, because we're looking at the functional genetic pathways to do these different things, we're still able to see that the sample has a lot of LPS production in it. So, that is, I guess, a tangent again on the functions. But other things that are unique to us, I'm not sure there's anyone else who is looking at HMO digestion. We look at it in two ways. We look at HMO-digesting species, so who is there that produces HMO, but we're also looking at the functional genetic pathways for HMO. One of the things I love about us constantly innovating is we are constantly adding functions. So, I feel like we're a little bit ahead of the game with that. And we have more functions than some of the other companies do. So, I'm trying to think, TMA is one that we recently added that I find super fascinating and interesting, especially for metabolic health. My personal case, when I took my first Tiny Health test, my TMA production was off the charts, and I have a strong family history of heart attack and stroke and grew up on a cattle ranch. So we know that TMAO or TMA a lot of times is produced after microbes eat these bacteria, they eat red meat. So I immediately decrease the red meat in my diet. Is that going to decrease my TMAO capacity? Not necessarily, but I don't want to feed these microbes what they need to make TMAO until I get my microbiome in balance, because I'm increasing my risk of heart attack and stroke. So for my age group and for metabolic health. It also— it plays a role in preeclampsia, which is super interesting too. So for our pregnant moms, um, right?

Is that right? Okay.

Yep. It's made by the bacteria after they consume choline or, uh, carnitine from our diet, goes to the liver, produces TMAO, which is connected to heart attack and stroke, endothelial energy, preeclampsia, very strong connection with metabolic health and cardiovascular disease. So that is one— that's one situation you can use these functional markers for specific patient cases and even change diet and do interventions that can have immediate impact on the patient while you work on helping to balance the microbiome.

Wow, that's fascinating. And that would be in the— that sort of guidance and direction would be in those the associations section, right? Like you would get insight into that and then what actions could you take, right? Like reducing the choline-rich foods or the red meat or what have you. That would be sort of spelled out for you there in, in those sections. Is that right?

Yeah. So in our hypertension condition association, it'll show TMA as one of the metrics. And then yes, in your action plan, if TMA is high, it'll tell you, you might consider— it'll tell you first of all what TMA is. So it spells all that out for you, gives you some background information, and then it'll have specific recommendations, dietary changes, for example. And one thing that's really cool about our interactive results is we do have this action plan that you can filter by supplement or food, but you can bookmark different recommendations for your patient. So if you're going through there and you see these diet recommendations you want them to try or specific specific supplements, you can bookmark it and then they can pull up their bookmarks and see everything that you bookmarked for them.

Oh, that's cool. That's cool. Makes it nice and easy for them for sure. Um, okay. Oh, I just could ask about so many of these markers. Um, those were two, the hexa-LPS and the, the TMA. Those are actually two that I had flagged and kind of put on my list. But I think, you know, I can see how, um, You can get very granular with these results and, you know, it's just so much cool information with each of these markers. But I would love to like back out a little bit and, you know, what do you feel like are some of the key or the unique insights that, that practitioners can get from this Tiny Health Test? And I think you've already spoken to a lot of this, but, you know, one of the things that we haven't really touched on, but that I, I've feel like might fit into this category is something like the gut-brain connection, right? Because, you know, again, we can get into these very specific markers and we can get into the weeds with the, all the, you know, the individual species, which is so cool. But like backing out, what are some of those key insights that you feel like are unique to Tiny Health? And that was a little bit of a leading question with the gut-brain connection.

Yeah. So my cheat sheet. For basically how to interpret or use the microbiome test for any symptom or condition. It all starts with the gut organ axis. So you've got dysbiosis or eubiosis that impacts the health of the gut. It impacts systemic circulation. Which metabolites are we putting into systemic circulation based off of which microbes are there? So if you have eubiosis, healthy diversity and balance, you're going to have lots of short-chain fatty acids and vitamins. That's going to create immune tolerance, and that's going to go into the blood and, you know, impact all your organs. On the other side, if you have dysbiosis, then it's going to create more LPS, more mucus degradation, more inflammation, more immune dysregulation, which then is going to travel in that superhighway to all organs. So when you are interpreting for anything, including gut-brain, you're looking for basically the same patterns. You want to make sure that you have enough of the beneficials because they're producing these metabolites that improve your health. You want to make sure you have low levels of disruptives because they're producing LPS and immune dysregulation. So first of all, you want to make sure you have balance, and you can only do this if you have a test test that gives you a complete picture of the microbiome. You want to be able to see the genetic pathways from all 500 microbes and what they're doing. If you're only able to capture a few of the beneficials and a few of the specific disruptives that you ask the test, which is what PCR is basically doing— you're asking, is this here or not? It's telling you yes or no, giving you an amount. But with whole genome sequencing, we're giving you an overall picture. Of the microbiome. So in order to interpret it through the gut organ axis, you have to have that complete picture of who is there and then what they're doing, what functions they're performing. So if you know those things, you can really simplify it. Yes, it's super interesting to get into the nitty-gritty of it, but if you're not there yet, it just comes down to that basic framework of improving the balance of microbes in the microbiome feeding them appropriately because you have to feed them if you want them to produce those metabolites and functions. You could have a high capacity to do something, but they're not going to do it if they don't have the correct substrates to do it.

Yeah, that makes sense. That makes sense. Okay. Um, all right, you've answered so many of the, the questions that I wanted to cover, and I'm going to turn it over to chat here in just a second and, and see what our attendees have for you. But I would love to just touch on briefly, you know, we know that this test was originally developed for, for kids, you know, those first 1,000 days. I would love to know, you know, what are some of the common childhood conditions that this test is best used for? And, and then I think beyond that, what are some of the common associations that you see? So one of the ones I know I've heard you mention, not today, but in previous conversations, is the sort of the link between the high Ruminococcus navis and eczema, right? So are there little clinical pearls like that where you're like, oh, okay, this, you know, this condition, you know, these are some of the things that we commonly see associated with that when, when viewing these results?

Yeah, and one thing we didn't touch on with with what is in the report and specific metrics that are really, um, unique and maybe even proprietary to Tiny Health is our C-section signature for babies. And this looks at the microbiome of babies born C-section and who's there, and it compares the infant. Now, the C-section signature— you do not have to be born C-section to have this signature. Typically, it's low Bifidobacteria, elevated pathogens, increases the risk of conditions like atopic march. So we see this in babies who, um, maybe mom had antibiotics during birth for Group B strep, or babies who had an extended stay in the hospital. There was some gut disrupting factor, even formula, formula feeding and a lack of HMOs. There was some gut disrupting factor early on that led to the C-section signature, and that we often see connected to conditions like eczema, food allergies, and it's basically just general dysbiosis in these babies. We have a lot of colic and gassiness, fussiness as well. One of the interesting things, I wish I knew this when my kids— when my babies were little, I wish I knew it so bad, but if you do not have species that will degrade human milk oligosaccharides, baby's not going to feel full. They're going to be eating and maybe they're not going to feel full because they're not— their microbiome is not breaking those HMOs down for them. That can lead to a lot of colic and fussiness. So that is something that we also find. But, um, yeah, most general, I think, conditions that a lot of babies and toddlers are dealing with that parents are concerned about, we see a lot of connection with the gut microbiome and we're able to turn around a lot of those symptoms when we are able to balance out the microbiome.

It's fascinating. I wish I would have known that too, about the, the hunger and the colic and all of that. I wish I would have known that with my, my first one. That is— that's fascinating. Okay. Okay. And we've already kind of talked about then how you would take this and build out an action plan. And it sounds like, you know, it's, it's robust, right? So everything from like, if you did need to address, you know, inflammatory dysbiosis, right? Or, you know, thinking about certain types of foods, there, there's a lot of information that you can pull from this to really build out a very comprehensive action plan. Um, so I think that's— we've, we've talked about that, and I think that's very cool. Um, okay, uh, let me just pop over here and see if we have any, uh, questions that we haven't covered yet. All right, I found it. Okay, very good. Um, so Min was asking, is the online support for results available if this test is ordered through Avexia? And that, that Actually, I should say before you answer that, Star, where can people access Tiny Health? Right. So we know that it sounds like they can go straight to Tiny Health, but is this something that can be ordered through Avexia or Rupa or any of those other platforms?

Yes, we do work with Avexia. We work with Rupa. We work with Nordic Labs if you're in Europe as well. So those are the 3 distributors that we work with. For our pro tests, you do have to be licensed to order diagnostic testing in order to order it. So if you aren't, then you can go through Avexia or Rupa and use their physician services to order it.

Okay, that's great. That's great. And then to get to Min's question, you know, the, the online support for results, is that available if you go through those other platforms, or is that only available if you're ordering directly through Tiny Health?

Tiny Health. It's available through Avexi and Rupa too. Yep, we have 15-minute, 30-minute, and 1-hour consultations. We also do onboarding and intro calls, so if you just want to jump on the phone with us and talk more, if you want us to give you a demonstration of the interactive results before you buy a test, we're happy to do that as well. And then we have monthly office hours, which are a lot of fun. Everyone's invited to those. We usually have a short topic Actually, one of our topic— this is tomorrow, but our topic tomorrow is by one of our own who went through the RWS program. So she's presenting on our vaginal health kit tomorrow. And we do all of our updates and announcements during that time as well and just get to know our team a little bit better. So we do that every month too. And we answer questions about our test during that time.

Now, that's very cool. So lots of great— that was one of my questions is, you know, not only where can practitioners access this test, but how do they continue to learn and get support? And it sounds like you'll have a lot of awesome options available for that. Okay. Is the, uh, the PRO test— is that— is it only the PRO test that looks for H. pylori, um, or is that also available on the regular Gut Health Test?

Both of the tests. Our Gut Health Test looks at it with whole genome sequencing, and we are measuring the compa— we're measuring the the H. pylori there with the whole genome sequencing. So the PROTEST is the whole genome sequencing test plus stool chemistry. So you'll get the H. pylori regardless. We also have a PCR test add-on specifically for H. pylori, and if you really suspect H. pylori, then I recommend that you do the, the qPCR add-on. It's a little bit more specific for H. pylori than the whole genome sequencing. There's two guys that we usually run into issues with on whole genome sequencing, and that's Candida and H. pylori, which are just tricky on stool tests, especially the H. pylori, because it is in the, you know, it's in the stomach. It's not in the colon necessarily. So it can be a little trickier to catch. And we have the add-on if you suspect it.

Okay. Okay, great. Yeah, it seems like, you know, yeast is it's kind of difficult to, difficult to capture just in general. All right. So this test is very similar to Microbiome Labs BiomeFX. Is— are there— the, the person wants to know if there are like some key differences there.

Yeah. So the first one would be the age-adjusted reference ranges and metrics. Their reference ranges are based on 5+ but mostly adults.

Results.

That would be the first. Um, their metrics are not adjusted either based off the population that you are looking at, and we have more functions. They also don't have the interactive results or the action plan. You're seeing the PDF. So there are some key differences there. Our sequencing is a little bit deeper, and we will give you again the list of all the microbes. So we'll tell on average $450 for an adult, will give you a list of all of those microbes.

Okay. Okay. That's helpful. And then I think we've already kind of answered this, but when practitioners are using this type of test, I guess, you know, if it is a non-licensed practitioner, will they still have access to Tiny Health? Can they still schedule a call or, you know, is there a way to get support directly from Tiny Health? Yes.

So did you ask about a customer, a D2C customer, or practitioner?

This was for practitioners. Okay.

Yes, we do have a one-on-one call. You can go into your account when you create an account and book a call with us, and we have 1 hour, 30-minute, and 15-minute availability. Yeah.

Okay, that's awesome. Um, all right, and so, um, if you are interested in trying out Tiny Health Health, you can sign up for an account at poweredbytiny.com, and you can receive $50 off your first Gut Health or, or Pro Gut Health test. And we do have a code for that that we will put in the chat for our live attendees, and for our listeners, it will be in the show notes. So definitely, if you are interested in signing up, take advantage of and then when you're in there, you, uh, can check out all of these additional resources. Um, anything else, Star, that, um, you, you feel like before we sign off for today that you feel like we haven't touched on that would be a really good or really important thing for people to know as they're first being introduced to this test?

No, I think the most important thing is just knowing that we meet the patient where they are in their age and stage of life. And really thinking about moving from the mindset of who's there and taxonomy and pathogens to what are they doing and how is that impacting the patient's health one way or the other. So, I think that is the most important thing, and being able to use a test that helps you— helps compare your patient to the appropriate references and metrics is very important for that because we can't infer that everyone's microbiome should be the same. And that's one of the benefits of our gut type. But even for the age— less than age of 5, it's so different, their microbiome, than an adult. So especially when you're seeing pregnant women and babies, you want to make sure you're using a test that has the appropriate references and that you're looking at the right things.

That's awesome. That's great. Thank you so much. And yes, I will repeat that. the site for opening an account is poweredbytinyhealth.com. All right, Sar, this has been so enlightening and just such a cool conversation about the microbiome and how to take a broader, more comprehensive and holistic approach to it. So thank you so, so much for—

Thank you. Yeah, I've enjoyed it.

This is great. All right, take care everyone. We'll see you next time.

Thank you.