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How Inflamation Impacts Your Gut's Microbiome: Interview With Dr. Nathan Klingensmith, Emory School of Medicine

We had a chance to sit down with a very special guest, Dr. Nathan Klingensmith!

He is from the Emory School of Medicine and has just completed a really fascinating study on the interaction of your gut’s microbiome, immune system, and systemic inflammation that he sat down to talk with us about.

Watch the interview here, or you can read the transcript below. If you're ready to grab your BIOHM Health Probiotic, Prebiotic and more to optimize your digestive system, head over to the BIOHM Shop!

Afif Ghannoum: Hi everyone! Thanks for joining us today. I’m Afif Ghannoum, CEO of BIOHM Health, and I wanted to introduce you to an awesome guest that we had the privilege to talk today, Dr. Nathan Klingensmith. He is from the Emory School of Medicine. He is in general residency in his post doctoral research fellowship medical care. Point being, he is sort of like a NASA scientist compared to what we are internally here. He was kind enough to talk to us because he just completed a really fascinating study on the interaction of your gut’s microbiome, immune system, and systemic inflammation. Obviously, we hear a lot about inflammation now and hear all sorts of stories about it and I’m sure that Dr. Klingensmith will talk a lot about that. However, this is really cool because he really studied how inflammation reacts with your gut’s microbiome. A little side note about Dr. Klingensmith and I is it turns out that we both have the same undergrad at Case Western Reserve here in Cleveland. He was smart enough to leave, whereas we stayed here in Cleveland. And with that introduction, thank you for joining us today doctor.

Dr. Nathan Klingensmith: Absolutely! Thank you for that. It’s really a great opportunity that I get to speak with you. So, just to fill everyone in with a little extra background, I went to Case Western Reserve for my undergrad, then went to West Virginia University for medical school, and now I’m at the Emory School of Medicine doing general surgery residency. My interests have sort of led me within general surgery to do critical care and that’s how I got interested in the microbiome. Given that, a lot of our patients in the ICU are known to have changes in their microbiome.

Afif Ghannuom: So, that’s really interesting as I was going to ask, because we don’t think much about it in that context, what differences do you see in the critical care in the microbiome?

Dr. Nathan Klingensmith: Given the fact that the microbiome has been a hot topic in the past few years, there have been some baseline studies on critically ill patients in the ICU looking at their intestinal microbiome. We know that as soon as they enter the hospital or even into the ICU, we see changes in their microbiomes within just hours. No matter what we’re doing to that, in the event that it is an infection or sepsis (a host response to your infection), you’re getting antibiotics, fluids, and other medicines that will all change your intestinal microbiome. We don’t know if it’s the microbiome changing you or you changing your microbiome, at this point the jury is still out. We know that there are a lot of differences that seem to be impactful on our patients.

Afif Ghannoum: So, this is really cool. Let me unpack that slightly because your average person watching this is like “well, I’m actually not in an ICU, so how does this relate to me?” However, I did hear some pretty interesting things that you were saying. It sounds to me that there is a combination of a bunch of things happening at once. So, lets unpack that a little bit. The science is really clear, especially when you mention medications and antibiotics having an impact on your microbiome. Obviously, antibiotics and medications are something that 99% of us can relate to. That seems to be one factor. The other thing I seemed to hear you say was, God forbid you’ve been in a serious car accident or something and your body is now just full of shock and inflammation. Obviously, it’s an exaggerated situation because it’s really impactful in the moment but inflammation is something that we all kinda deal with. Keeping in mind that doctors of your prominence are always careful about what they say, is it fair to say that when you do unpack some of these things, that some of the practical inflammations that you’re seeing in a very quick window of time when someone is emitted into the ICU are things that could actually apply to how the microbiome can be affected in a normal person whose medications deal with inflammation or general, large adjustments to your body?  Is that fair to say?

Dr. Nathan Klingensmith: Absolutely! Any sort of change that you’re going to introduce to your body is really going to change the direction of what your microbiome is and what it becomes. As simple as picking something up and putting it into your mouth, the food that you eat will change it as well as the disease processes that are going on. Whether it be something as serious as sepsis (where you have this host and a full body of dysregulated inflammation) or maybe just some local infection or some other disease process that we know is going on, we research the changes related in the microbiome.

Afif Ghannoum: You mentioned a term there that I just wanted to clarify. To be honest, I had to look it up before we talked. I generally knew what sepsis meant but I’ve always kinda thought of it in terms of blood poisoning. You made a good point before we went on the air that it’s more accurately systemic inflammation. Inflammation is something that many of us are familiar with in life. Can you talk a little bit about what you’ve seen in the way inflammation relates to the microbiome?

Dr. Nathan Ghannoum: Sure! I’ve seen news articles about a lot of famous people who have died recently because of sepsis. The easiest way to understand it is when you get an infection your body tries to get rid of it but somehow something goes wrong and your body has this dysregulated response and there is too much inflammation occurring. It can then start to infect your other organs in the process. That is why you need to be in an ICU to help out your kidneys, lungs, intestines, and everything else. You are very right when you mentioned other states of inflammation and other varying degrees of sepsis in that it will alter your microbiome in some sort of way. It’s hard to say specifically what it’s going to do and where it’s going to go, but we know that there are changes.

Afif Ghannoum: Yeah! One of the things we always talk about is that your microbiome balance is truly a multifactorial situation. It can be effected by genetics, diet, stress, and things like inflammation. Going off of your point, it’s not just one size fits all and people will react and have different adjustments to their microbiome based on how inflammation affects them. To your point and what the science is pointing to is that inflammation is another factor that can have an affect on your microbiome.

Dr. Nathan Klingensmith: Most definitely! It also goes both ways. The microbiome that you have there will influence your immune system which is the key generator (that and your intestines) of generating inflammation for whatever reason. It’s a back and forth between your intestinal epithelium, microbiome, and immune system and how they all interplay that really determines your outcome in whatever the case may be.

Afif Ghannoum: Just for those watching at home, when you say the epithelial that’s essentially the lining of the gut. Is that correct?

Dr. Nathan Klingensmith: Yep! It absorbs the functional capacity of the intestine itself.

Afif Ghannoum: Okay! So, when we’re optimizing things and making general take aways, it’s funny when Chris first said, “Oh! There is this doctor who did some really interesting work at Emory School of Medicine in ICU patients.” I didn’t really know that a lot of people would be able to relate to this but it’s really interesting when you unpack it. What you’re seeing is this hyper-situation that really does have many practical implications when you break it down. To your point, if you’re optimizing your immune system and keeping inflammation in check, there could be a positive correlation to your microbiome balance.

Dr. Nathan Klingensmith: Absolutely! It’s unfortunate in patients or people who have chronic inflammatory diseases such as inflammatory bowel disease or auto immune diseases because they have this ongoing inflammation that unfortunately impacts their microbiome.

Afif Ghnannoum: Exactly. Before we went on air you mentioned alcohol in the microbiome. One of the things that I often mention is that general alcohol has a negative impact on the microbiome. However, you mentioned that the exception to that, in moderation as always, is red wine because of the polyphenols. There is evidence showing that polyphenols can have a positive impact on the microbiome. If you have a few more minutes I would love to hear what you saw this recent study showing.

Dr. Nathan Klingensmith: Yeah! There was this recent study that came out that was using an animal model meaning that there were not adult patients involved. In this mouse model, they took the microbiome from animals that had been drinking alcohol chronically for three weeks.

Afif Ghannoum: So, party animals?

Dr. Nathan Klingensmith: Yes haha!

Afif Ghannoum: I’ve been sitting on that line since we started so...I’ll let you continue!

Dr. Nathan Klingensmith: That’s alright! So, taking the microbiome from the alcohol mice and then giving it to the mice who had only been drinking water for that time, the mice soon became sick via pneumonia. The animals that received that microbiome from chronic alcohol ingestion mice did much worse and had much higher inflammation in their intestine. They were not able to create the inflammation where it was needed in their lungs where they had the infection. Elsewhere in their body they had this dysregulated response. So, drinking the alcohol and changing the diversity of their microbiome in a way that was not beneficial and caused the mice to have a worse outcome when they did become sick.

Afif Ghannoum: Okay! So, two things that are really important because I believe that a lot of people will hear about a new study in animals and they will immediately assume it means something for humans. We really prioritize science and our founder, Dr. Ghannoum, who I think that everybody knows is my father. The main take away from animal studies is that there is further research to be done to really get to the bottom of this. My second take away is that alcohol can affect your body’s immunity response. Is that fair?

Dr. Nathan Klingensmith: First thing is right. Animal studies are just beginning to scratch the surface and we need to validate statements through more clinical trials before we can absolutely say anything. You’re also right that somehow the microbiome was influencing their immune response and then was playing back on the microbiome and the rest of the host (the animal at the time) causing this not appropriate response.

Afif Ghannoum: Right! Thank you again for taking the time. For everybody out there who is not familiar with Emory, Emory is truly one of the preeminent medical institutions in the country and I’m surprised that we were fortunate enough to talk to Dr. Nathan Klingensmith today and for his time. The two main take aways that I’d have from ICU patients to mice, what the evidence seems to suggest, is that when there is a big impact on your body’s microbiome from inflammation, medication, or various things that can affect it, it will have a negative correlation on your body’s ability to protect itself through an immune response and ultimately you’d have some optimal health.

Dr. Nathan Klingensmith: Absolutely! Your body likes to be at the status quo. It has a generalized state that it wants to be in, including the bacteria that’s in your gut. When you disrupt the system by changing more or less and not what it wants to be (in this happy diversity) this will affect the microbiome. If you go one way a lot or add a whole bunch more that are pathogenic, you will disrupt the system; your body doesn’t like that and won’t handle it the best way.

Afif Ghannoum: Yeah! We’ve seen that when the balance of bacteria versus fungi in the gut are disturbed you will see candida flare or issues with yeast infections. It’s amazing how much of a balance there needs to be. Is it safe to say, as a general take away, that optimizing the diversity of your microbiome is positively correlated with optimizing your immunity and overall health?

Dr. Nathan Klingensmith: Absolutely! Having a diverse microbiome, with not just bacteria but also fungi, will lead to having improved overall health. Diversity is key for all of it to stay healthy.

Afif Ghannoum: Thank you, doctor for your time and we really appreciate it. I know you’re in Atlanta, so I know you probably have like six diet coke cans right there below the camera but we will let that be your secret.

Dr. Nathan Klingensmith: Haha! It’s on tap!

Afif Ghannoum: Thank you, again. This was Dr. Nathan Klingensmith from Emory School of Medicine. We will put a link to your actual study so people who want to read that will get a chance to check it out. So, thank you again and we really appreciate it. For everybody at home, I am Afif Ghannouom, CEO of BIOHM Health, and this has been Dr. Nathan Klingensmith from the Emory School of Medicine.

Ready to grab your BIOHM Health Probiotic, Prebiotic and more to optimize your digestive system? Head over to the BIOHM Shop!

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