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Episode 41: Personalized Medicine, Drug Non-Responders, Ancient Microbes [Straight From The Gut]

Episode 41: Personalized Medicine, Drug Non-Responders, Ancient Microbes [Straight From The Gut]

Pretty often, we get into interesting discussions about the direction of the microbiome space or a new piece of research coming out of the lab, but we have no way to draw you - our listeners - into the conversation. 

That’s all about to change. Starting with this episode, we’re launching a new monthly segment of the show called “Straight From The Gut.” These episodes will feature Andrea (our podcast host), Afif Ghannoum (co-founder and CEO of BIOHM), and sometimes, a special guest in a free-flowing discussion about whatever’s on their minds or in the news. 

This first episode delves into research on the microbiome and its tie to autism, how we’re using big data to mine for information, personalized medicine, resurrecting ancient microbes and more.  Have your own questions or resources that you’d like the team to discuss on-air? Email them to themicrobiomereport@gmail.com, or reach out on one of our social channels @BIOHMHealth.   

Transcript:

Andrea Wien: Welcome to The Microbiome Report. I'm your host, Andrea Wien, and today we're announcing a new monthly segment that we are calling Straight From the Gut. Look, we hear about so many interesting studies and we are constantly thinking of all of these different ideas that aren't necessarily in-depth enough to do a whole show about. But they're still, nonetheless, very interesting and we've been trying to find a way to create a space where we can tell you about them. So in addition to the regular show, we're now going to have a Straight From the Gut episode once a month, where we'll talk through these what if scenarios that we brainstorm. And get you up to speed on the latest research that's coming out of the lab. So these shows will really be much less structured, more conversational and free-flowing, but we hope just as insightful and interesting.

                        Joining me on these shows is Afif Ghannoum, the founder and CEO of BIOHM Health. His last name probably sounds a little bit familiar to many long time listeners. He's the son of Dr. Ghannoum, our favorite resident researcher. So he is very well versed in everything that Dr. Ghannoum is doing at Case Western out of his lab, and really the microbiome space in general. He's privy to a lot of interesting conversations with people who are creating products, working in the lab, or working in doctor's offices. So he really brings a rich background and a lot of intel about what's happening in this space. So on this first episode, we dive into how far off we are from personalized nutrition, as it relates to the microbiome. When will you be able to go to your doctor, get some of these testing done, and really create something that is meant just for you? Is that something that's in our lifetime? Are we getting close to that?

                        So we discussed that, we also touch on ancient Babylonian diets and talk about them in the context of microbes. And what we know or what we don't know about when it comes to the microbes of our ancestors and the ones that we come into contact with every day. Again, this conversation is very freewheeling. It goes a lot of different directions, down a bunch of different rabbit holes, and that is the point. So if you have any topics that you want us to discuss or any questions that you've been noodling about, feel free to send us an email, TheMicrobiomeReport@gmail.com, or feel free to reach out on any of BIOHM health's social media channels. So you can find them at, @biohmhealth across Facebook, Instagram, and Twitter. Again, that's B-I-O-H-M, if you're looking for that. All right, let's jump.

                        Afif, what's up? How you doing?

Afif Ghannoum: I'm good. It's been one of those crazy weeks, a lot going on. Obviously, we do microbiome data testing, so we're starting to go through the data and we're seeing some really cool things from the autism microbiome trial we did. So one of the things everybody talks about is the connection between the microbiome and various different conditions. And we're really, really seeing it in the data so we're going to be publishing our autism data. And we do this really cool, we have a computer scientist... I sound like a dad talking about the Facebook. We have a scientist who was at IBM Watson and we basically were like, "Here's all the data we've been collecting, we have tens of thousands of tests. Tell us what you're seeing in the data. Can we see different things?" And he applied these machine learning models, which I barely understand but basically, we always hear about AI and machine learning. So what does that mean?

                        So my understanding is that a lot of this data that we collect from, not just microbiome but I mean just in general, it's almost worthless if you can't apply machine learning to actually make sense of it. So for example, in our database, we have a lot more women than men that have taken the test. That makes sense because frankly, women take better care of themselves, they want to understand what's going on. So the problem is it's really hard to analyze that data because there's a big imbalance. So this guy has spent months analyzing the data and really balancing it out using machine learning, so that the data all of a sudden doesn't look so tipped one way. And he started doing that with these different data sets we have for lactose intolerance, autism. And if you and I were just looking at the data before he analyzed it, you'd be like, "Oh, it looks like just a blob of dots." So he applies it and Andrea, the stuff just explodes out.

                        And all of a sudden you can see blue cluster of dots that are people with autism and red cluster of dots, people without autism, and they're completely different. So it's really fascinating to look, "Okay, well, there are clearly differences, so how can we now bridge that gap? And what does that mean?" So take autism, people with autism tend to have pretty severe digestive issues. Not all, but a lot do. So the question is, what I've learned is that a lot of people with autism, they're very picky eaters, diet wise. So then it becomes a question of, well is it becoming self-fulfilling that there's a microbiome difference because of the way diet comes into play? Or is it actually to do with autism? So there's a lot to unpack in this stuff, but it's really, really interesting to dive in because there's clearly differences in microbiome of people with various conditions and people without. But now it's like, okay, well, what can we actually do with that?

Andrea Wien: The last time I was at your dad's lab at Case, he actually showed me some of those charts and it's really startling. Like you're saying, you can very clearly see the people who have autism and the people who don't. And he said, "Even just by looking at these charts, I can tell just by looking at that. I don't have to know any of their symptoms. I don't have to know any of their history, just by looking at the microbes that they have." And the question that I asked is exactly the one that you just posed, is the autism spectrum disorder causing the dysfunction? Or is the dysfunction there first and then that's causing some of the other problems? And that'll be so interesting to dig into because really, you can come up with so many more therapeutic solutions, if you know that you can alter certain microbes to change the composition of what's happening in the body. Which we know from the mind-body connection and the gut-brain connection.

Afif Ghannoum: Well and what's cool is it's, so we always talk about it in the context of conditions, but it's not just conditions. Right now, if you are a 50 plus adult and you want a supplement, there's a bunch of age specific multivitamins. But really, and I don't honestly know, but I imagine those were designed just with generalities. What's really cool about the potential of this data, and we're not there yet but this is where we're headed. Is we can literally look at our data and say, "Okay, I wonder if there's a difference between the microbiome of a 50 plus woman and a 30 year old woman?" And we can look and see, okay, well, what are those differences? Are there certain organisms that degrade as you get older? Are there ones that for people that get really old are present in people that are only 50? And then can we actually use that to design products that can help the 50 year old woman, her gut look more like a 30 year old woman.

                        That's where it gets really interesting, we can do it even with diet. What does the microbiome of a vegan look like versus someone who's a meat eater, and does it make a difference? That's the secondary parts of it. What I would say is, especially microbiome data generally, the way to think about it is we're where cancer research was in the '70s. We understand some things going on, but there's a lot of work to do. And that's where sometimes I get weary in the industry of, people will make giant leaps in what these connections mean and so it's that old correlation versus causation. It's really interesting.

Andrea Wien: There's so many pieces that you've brought up that I want to touch on, so it's going to sound maybe a little bit erratic. But the first one is you mentioned that mostly women are taking the gut testing kit, which is so unique because women historically have been underrepresented in science and in science research. And so to have that wealth of data on something like the microbiome that's so cutting edge and to have it be mostly women... Although, I recognize the benefits of doing the data analysis to be able to level that playing field so we're looking at all populations, but to even have that raw data for women is something that's very unique. So, that's one point that I think is interesting.

Afif Ghannoum: But it's funny you say that, literally, and this is off topic of the microbiome but even in sexual health, I was just talking about this. There's a lot of articles about how when it comes to... Oh, I know what it was. There's a guy who does some really interesting collaboration stuff with dad at Case, he's a really big urologist in the space. And he was saying, "Listen, even in sexual health, there's very little research that's been done for women versus men." And it's just, when you start looking at, not to again sound like the 40 year old dad, but when you start coming woke to some of this stuff, why is that? But when citizen science, which we're not... Obviously, we run a business so it's not just science for science's sake, but when we're putting clinical testing in the hands of people, and guess what? It's women coming forward to your point and saying, "Well, I want to know what's going on. I want to understand where I'm at."

                       So it's really interesting, you can't... Even science, which I've grown up my entire life around science, it's not unbiased. Just like you're saying, a lot of the issues in the science that we, even clinical trials... Again, we're going down a little bit of a rabbit hole here, but a lot of people in clinical trials, it weighs Caucasian. It's not a general demographic but even tying it back to the microbiome, and here's the really cool potential of the microbiome. So a lot of people, do you ever get headaches?

Andrea Wien: Rarely, but yeah. I got them a lot when I was pregnant, which is interesting in microbiome because we know the microbiome changes so much in pregnancy. Which it goes back to your point of, do you have different microbiomes at different life stages? And I think the answer has to be yes.

Afif Ghannoum: So let's say you get headaches and for me, I used to get awful migraines. And then I found out Aleve, just over the counter Aleve is the only thing that will work for me. Why? I have no idea. But what's funny is when we take a drive, we just assume, "Well, this drug will work for whatever it's for." Headache pain, knee pain, something. But what a lot of people don't realize is that for every drug, there's a population of people that are called non-responders, the drug just doesn't work for them and we don't quite know why. And it's a big problem in clinical trials because in clinical trials, a clinical trial can end up failing because you accidentally have too many non-responders to the drug. So it's not that the drug doesn't work, it's that for this type of person, for whatever reason they just don't metabolize it right, something's going on.

                        Now, how this ties into the microbiome is, and this blew my mind is that in... My dad's doing a lot of this work. They've identified that your microbiome can impact how well you metabolize certain drugs. So that's important because what you will end up probably seeing is when they're doing these drug trials for drug approvals, they'll actually screen people's microbiomes to weed out people that are likely to not be drug respondents. You see what I'm saying? So, it's really amazing how tied into everything our gut is. Think about that, you could literally just have never gotten the right dose of an over-the-counter medicine that, how many... There's stuff for me, I'm like, "It just doesn't work for me." Well, it might be, I just don't need the regular dose, I need a different dose because I'm a microbiome non-responder for that type of a drug class.

                        So we are probably headed towards not only way more understanding of that, but where these things start to edge towards true personalization, which you and I are now keeping a running list of topics to cover. And that's why I was putting personalized nutrition, is it real as a topic to cover? But that's where I think the real potential of microbiome is, to really help hone in on what are these things that impact the way my health is impacted medication-wise, food-wise, that sort of stuff.

Andrea Wien: I actually hand out a handout to people who take a lot of NSAIDs, so non-steroidal anti-inflammatory drugs. These are the aspirin, Aleves, Advils of the world, to my clients who are taking a lot of these because it can increase intestinal permeability. We know it changes the composition of gut flora, and it can cause serious complications over the long-term for exactly this reason that you're talking about. And some of those mechanisms are not so clear yet, we're still learning what that looks like. But something as innocuous as taking an Advil can really over the long-term have impacts on the microbes that are in there. So, whether that's because-

Afif Ghannoum: Well, your microbes might stop that drug from being effective.

Andrea Wien: Exactly.

Afif Ghannoum: That's the wildest part to me. So we may have had drugs that failed in clinical trials and never got to market because the people in the clinical trial just were never going to respond to that type of a drug. Do you see what I'm saying? That's where it's like, wow, that's insane.

Andrea Wien: And so then when we talk about personalized nutrition, it's like how... I mean, in your opinion, how far off are we from personalized medicine? And from people going to their doctor and getting like a full workup done of gut microbes and whatever else they might be struggling with? And then having a doctor be able to turn around and create something with a manufacturer or someone else that is targeted to that person?

Afif Ghannoum: So in the wellness industry, personalized nutrition is the buzzword of all buzzwords. People love this idea, can you give people exactly something made for them? So where I fall on it is, I think we're pretty far off of that and it might not be a big deal ultimately, but I think we're pretty far off of it for two reasons. One, the logistics are extremely tricky. It is very hard, and there's some companies that have tried this, but for you in a way that's not going to cost 500 bucks, give you something personalized to you. It's very tricky to do that at scale. And when the closest they've gotten with personalization, there's a lot of these quiz based personalized. And you'll talk to 10 people about them and you'll get 15 different opinions. I personally don't think that's true personalization. I think it's classification, you're closer to this but it's not actually based on you, it's based on you answering questions that throw you into general buckets.

                         I think we're pretty far off, but it might not actually matter because especially in microbiome, what we've seen is when we analyze people, microbiome is a little bit like a fingerprint. That's what people think, at least. What we think is that, what the data's showing us is that you're more likely to fall in one of a handful of clusters. And so even getting you into one of these clusters and giving you nutritional solutions, or even potentially medications based on that cluster is probably for 99% of people going to be a giant jump from where they're at. I don't know that that extra last piece of personalization is going to end up being worth the cost. And that's a long winded way of saying I don't actually think we're anywhere near that, and we may not end up needing to be near that.

Andrea Wien: And I think the medical model would have to change so drastically when we have doctors who are meeting with patients for, let's say six minutes at a time or four minute appointments. Versus when you look at some of the functional medicine doctors that they're meeting with patients for an hour to two hours. So, that seems like a more sustainable route if we were going to move into personalized nutrition, to have more time with the patient. Just more face-time and trust.

Afif Ghannoum: To give you an idea, so not as much anymore but a few years ago, my dad, we were approached by literally billionaire types that had read about his research on what we were doing. And they were saying, "Could you give me true one-on-one concierge from..." And the way this one guy put it, he's like a Bruce Wayne type. He said, "Just analyze me from the microbiome out." And so we actually paired up with a very big functional medicine physician. And so my dad and this guy actually divided and conquered, my dad analyzed microbiome, analyzed nutrition, and then functional medicine physician put him through an enormous battery of tests.

                        So for us to go through all of his results, it was pretty wild. The guy flies into the Burke Airport here in Cleveland, private, comes right to a hotel and then for two days. Two days going step by step through all the results and even that, the recommendations at the end, they were personalized but they weren't like, "Here are powders made up for you." Do you see what I'm saying? So, to be able to do that level of true personalization, it's so involved.

Andrea Wien: And not scalable. I just am thinking it's so cost prohibitive, it's not scalable. We talk about equity in the wellness space, certainly, basically the farthest end of the spectrum away from that as you could get.

Afif Ghannoum: So it just opened my eyes like, "Oh my God. This is the closest you're going to get." Super expensive, super high touch, and it took days to go over all of these results. You know what I mean? It's really been cool to see some of these things. On the personalization front... And I think the dirty secret is and we see this in the data, is that for a lot of people, unfortunately we live in a society, everybody wants a silver bullet. If I just know this or I take this, my issue would be solved. So a lot of times when we see people taking the BIOHM microbiome test, there's a very low hanging fruit things they can be doing to optimize their gut that they're not doing. They're eating fast food, they're eating a lot of processed foods.

Andrea Wien: They're smoking, not getting enough sleep, all these basics.

Afif Ghannoum: You're very stressed and so we always look at this. This is a lot of effort and energy to take one of these tests. You don't probably need to if you just took care of a few of these things. The analogy I always give is, we've all been stuck in traffic behind the guy on a carbon fiber bike, wearing a Lycra suit, amazing aerodynamic helmet and he's 80 pounds overweight. And you're like, "You don't need that carbon fiber bike or the Lycra suit. If you just lost some weight, that would make you better at cycling." So it's the same analogy where we're not going to find that you're missing some rare type of fungi and if we just help you get that, you'll be in great shape. It's like you have to manage some of these other things.

Andrea Wien: I think the closest that we have to this is some of these specialized elimination diets, for lack of a better term, the GAPS diet that was created by Dr. Campbell McBride. That really targets, to bring it back to what we were talking to earlier, autism, ADHD, it's the gut and psychology diet. So it's getting your gut in a place where that brain-gut connection is functioning better and we really see amazing results with that. And so to your point of putting people more into a bucket, it's not personalized per se but it may be personalized enough for what you're struggling with. Or ketogenic, we see ketogenic now for weight loss which is not what it was originally designed for, it came out to help with seizures in children that were unresponsive to medication. Or now it's being used for targeting some different cancer therapies and things like that. So you have these diets that you really can change so much of what's going on in the gut and in the body. Again, not personalized, but personalized enough to make a huge difference.

Afif Ghannoum: And listen, we will continue to make incremental changes. I was actually joking with someone the other day about, I was at the grocery store and my son, we don't buy any of the stuff we would buy as kids like sugary cereals, all those kind of things. And he saw Fruit Loops or one of these type of cereals from our childhood and it was so amazing to see just that marketing effect work on him. But I was telling my friend what's wild is, not really purposefully but just incrementally, the things that were just "food" when we were young, like powder lemonades, these types of cereals, all sorts of chips, all sodas. We just don't have those in the house anymore and I feel like a lot of people don't have those in the house anymore.

                        It was just a slow, incremental change where by the time we became parents, we're not doing those things. It's almost becoming taboo so, that only happens slowly. So I think the same thing's going to end up happening in... Or even 2015, 2016, when we really got into this, some of the things we're talking about you really only saw in the MindBodyGreens, Well+Good, Goops world of these really high touch wellness. You're starting to see that seep into true mainstream, so it's pretty interesting.

Andrea Wien: And I think people get very down and out a lot about the state of the food industry, which I do too. I think there's a lot of work to do, but I think you can look at organic as a way to bolster the reserves, if you will, or bring some optimism to the table. 20 years ago people were saying, "Organic could never be anything more than a specialty store that only the weird hippies go to." And now you can find organic foods at Walmart, and not that that doesn't its own set of issues. We don't need to get into that, but people voted with their dollars and we are where we are now. And so I think you're right, it happens slowly but it gives me a lot of hope that a lot of people are raising their kids without the Fruit Loops and the Pringles of the world, at least on a regular basis. Those are treat foods, not regulars.

Afif Ghannoum: No, totally. And to that point, so I heard on actually, the Joe Rogan podcast, Gabby Reece I think. She said, "I explained to my kids, those things that are really tasty, that's fun. It's not food." So as long as you think of it that way, and I'm like, that's a really interesting way to think about it. So when you said that, like a treat, I thought that was useful.

Andrea Wien: And I think it helps to not be so militaristic about what you're giving your kid all the time, because then they're going to go back the other way and that's all they're going to want to eat. So you'll have undone the good work that you've put in at the beginning, if you-

Afif Ghannoum: No one wants to talk about this, but a lot of it really comes down to the most boring thing in the world, which is just moderation. One time, I was at a conference and we were presenting our results. And I was explaining how we've talked about the fact that we have this cohort of women, that they were having very aggressive fungi building in their guts and it was called zygomycota. And so we typically only see that fungi growing in people who are immunocompromised, literally cancer, HIV. So there were enough of these people though, that we thought something else is up here. And what we found was that when they totally cut out carbs and they totally cut out dairy, those are great gut-friendly foods and that was allowing this fungi to grow out of control.

                        So I was at this conference and I was explaining that, "Hey, dairy actually might not be as bad as it seems for people that don't have obviously, lactose issues." And this woman bit my head off, she was very pro vegan and she identified as that at the conference. And I was trying to make the point to her, "Listen, I'm not saying average American, the amount of dairy they have is enormous. But the problem is saying reducing it doesn't necessarily mean you have to go to zero." So I think that's the problem is we found some dairy was actually helpful, but not meaning you can just have all the ice cream in the world you want. So a lot of these things, it's being mindful about what you're doing and doing it in moderation which is so boring.

Andrea Wien: Absolutely. But it's true and there's different variations on dairy. You could be having, like you're saying, the ice cream or the very sugary yogurt that's packaged as a health food but really has 40 grams of sugar in a serving. Or you could be having good, high quality, high fat dairy that's from the farm and grass fed, and all those types of things that will be really supportive for health. Like you're saying, if you don't have an issue with lactose. So I think we lump, again, things into one category and label them as good or bad. When really within that category, there's a huge spectrum and variation on what could be considered helpful or not.

Afif Ghannoum: I think it's frustrating for people because, to your point, people start actually feeling bad because they're trying to make these great choices. There seem to be a million, "Should I be having this source of vitamin C? Should I be having that?" It's literally overwhelming and I think one of the things we don't do well as an industry is make it simple to understand the basics of really, this is what you need. Now, part of it's just the dynamic of companies need to come out with the latest and greatest. And, "Try this because we have this new thing."

                        But I think for consumers, it ends up making a lot of people that are really earnest to eat well, take care of themselves, it ends up being... I don't want to say dire, but we've literally, we have people that when they talk to our nutritionist, they're almost, they have angst because they want to eat well. They want to be doing what they should, but they're so overwhelmed by the information and the latest and greatest that it's... I almost wonder if we're going to have, especially after COVID where you started to realize what you really do need and what you don't. And what's available at the grocery store, it'd be interesting to see if we have a back to basics a little bit.

Andrea Wien: I think so. I can't tell you how many clients I've worked with that have emailed me or texted me after we've gone through their initial plan and said, "Well, I read this article that X is supposed to be great for this. Should I be eating that?" And it's like, well to your point, the silver bullet, you're not going to eat avocados and suddenly everything's going to be fine. So yes, maybe that's part of the plan in a larger scale, but you can't expect to take one supplement or a handful of supplements, which I see laundry lists coming in. People are taking 20 supplements a day and it's like, "Okay, let's scale this back and see, what are we really taking these for? What can we replace with food and how can we get back to basics?" And that moderation that we were talking about, because really that's where most people will thrive.

Afif Ghannoum: And something my dad I always say is that dietary supplements should be a supplement to your diet. You're not going to take a pill... You're not, to your point, 14 pills away from perfect health. Those things are only supposed to be adjuncts to what you're doing with your diet. And what we see is a lot of people, their eating is a mess. They're just not eating well, or they eat well but they drink heavily. Or there's this one woman my dad always talks about where she was beside herself, dealing with digestive issues. And when you look, she's like, "I don't know what else I can be doing. I'm eating well, I take all of these products." And then the part that she overlooked and again, one of our nutritionists honed in on was, she identifies as severely stressed.

                        And so again, that's one of the things that is frustrating about this space that makes it interesting, is it truly is multifactorial. There's so many aspects that you have to be juggling in order to really feel better and be at optimal wellness that it can be really frustrating for people. And that's something like, for me, that's the next challenge I'm looking at as someone in this space. How do you make this stuff, not just accessible, but useful?

Andrea Wien: I think that's the goal of this whole show. And we've done so many episodes now on these different facets that we've talked about, stress and sleep and gut brain connection. And it all comes back to what we're talking about now. And so people who are interested in learning about those other facets, certainly go back and listen to some of our past episodes. And we'll have more on the horizon but it really does come back to that all the time.

Afif Ghannoum: So some of these other things we're putting on the list, let's pick one of these other ones. Which one of these do you think is worth taking a look at?

Andrea Wien: I think this is an interesting what if. This guy recreated these meals from 1750 BC, so he went back and got these old scrolls. And essentially recreated all of these foods and it got me thinking, we talk a lot on the show about the hygiene hypothesis. And how we've lost a lot of the microbes that our ancestors had and we just talk about in terms of immigration and travel, how people in different countries that are eating different foods. Different indigenous diets and things like that have so many different diversity of microbes than we do here in America, especially. And so it got me thinking, what if we could eventually somehow mind those microbes and recreate meals from the past that featured them. How would our bodies react? Have we evolved to a point that we can't even know yet in science, far away from what our ancestors were eating, that that would completely throw us for a loop? What would that look like? It got me just going down that what if rabbit hole.

Afif Ghannoum: You tap into a bigger point which I think is, it blew my mind when I really understood it is that, and I'll use COVID as an example. So you're talking about ancient organisms. When we talk about probiotics, it seems like, Oh my God, there's so many different strains I could be taking. The reality is, and I'm just ballparking this but we've probably tapped into one 100th of, if even that of the probiotic organisms that actually exist out there that could be helpful to us. So why do I mention COVID? COVID, the big problem with it is that whatever the origin was, bats or wet markets, we unleashed this novel virus that we weren't used to. And so, one of the things that they talk about is scary is that our bodies have not been exposed to it and all the consequences we've seen.

                       But the exact same phenomenon, not only with viruses, but with bacterias, fungis, there are so many organisms out there we're not even aware of yet. So going to your point about ancient, ancient is super interesting. But to me, it's also mind-boggling that even now, there are organisms we're not even aware of that could be helpful. And so if you think about it, just with COVID there's good organisms out there that either we'll find through mining... This one company, they created their novel probiotics, do you know what they did? They found basically uncontacted tribes, I believe in Africa, and they sequenced their guts. And they found organisms that the rest of us had not really been exposed to, so going back to ancient organisms. So they found these novel strains from these uncontacted tribes so it's a little bit-

Andrea Wien: Did they work?

Afif Ghannoum: Yeah.

Andrea Wien: Did they have different impact?

Afif Ghannoum: Yeah, yeah, yeah.

Andrea Wien: So, that's interesting to me. Are there... I mean, this goes back to a couple of different episodes that we've done, William Parker, we were talking about helminths, which are intestinal worms. And saying we've gotten rid of all of these worms in our system but actually, the human body and the immune system evolved to have those. And similarly, we talked about that with viruses, with Dr. Dennis Carroll, so we've evolved to have these things around. And we've inadvertently, or very intentionally, depending on which way you look at it, killed them off and now we're struggling with a bunch of other issues on the other side. There are things out there that we're not even aware could be helpful.

                        So I think talking to Dr. William Parker, we even know some of these things and we're trying to figure out now how to bring them back in a way that the FDA will approve of, let's say. But it's also a game of numbers. We know now from his research and other people's research that if you put too many of them into someone, then they have severe distress in the digestive track, versus doing it more slowly can have a better impact. So I think that's also where this will go. And you brought up COVID, people automatically I think are in the mind space of where we were with bacteria. All viruses are bad and now we know with bacteria, that's not the case, we have this symbiotic relationship. There's good, there's bad, it's too black and white to label them that.

                        But I think viruses for people are still in that place of very black and white, good or bad, and they're all bad. People are always saying they're just all bad and I don't think we can say that yet. And then it brings me to thinking too, let's say that maybe we do find some ancient microbes that we can put into a supplement. Will those even take hold? Are they going to be very similar to our modern day probiotics, which are more transient in nature and can help in the short term? Or are they really going to take hold in the gut and create a different ecosystem there? These are all questions, too.

Afif Ghannoum: Totally. Once you find a strain that's interesting in the lab, there's so much more to get to see if it will actually, and as we're talking, I'm trying to find more information on that strain I was just talking about. But even if a strain is, this actually has some interesting effect on biofilms or something that we always talk about, there's a gigantic difference between that working in the lab and it being something that we can then manufacture at scale.

Andrea Wien: Okay, cool. Well, I think this was so much fun just to go down these rabbit holes with you, and we'll certainly put out calls. If anyone has questions, even now that they want us to dig into, feel free to send us an email at TheMicrobiomeReport@gmail.com, or hit us up on any of the social channels. And we can add those to the list, but we're going to just be in this space every month now, going through some of these what ifs and going through some of the latest research. We'll certainly be excited to see as the autism research continues with your dad, Dr. Ghannoum. Thanks so much for coming on to chat.

Afif Ghannoum: Thanks for having me, this was actually really fun.

Andrea Wien: Have a good one. Bye.

Afif Ghannoum: You too, bye.

Andrea Wien: As always, thanks so much for listening. We hope that you enjoyed this new segment called Straight From the Gut. We'll be back with another episode of The Microbiome Report. As always, you can find the episodes with our guests on Thursdays, the first Thursday of every month. And then this episode will be on either the third or the fourth Thursday of every month, depending on how many weeks of that month there are. So, please tune back in. Of course, you can always follow us and all of the past episodes by going to biohmblog.com and clicking on the podcast tab. Again, B-I-O-H-M and as always, I'm Andrea Wien. Until next time, stay safe.

 

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