Podcast

Episode 50: Your Gut Questions Answered!

A few weeks ago, we posted on our social media channels for questions you have about gut health and the microbiome and let’s just say: you are a seriously curious bunch!

On this episode, Andrea is joined by resident researcher, Dr. Mahmoud Ghannoum, BIOHM CEO, Afif Ghannoum, and Olipop founder/microbial magician, Ben Goodwin, to answer your burning questions about the ins-and-outs of the microbiome.

You've all been wondering things like:

Why healthy people should care about the microbiome?
What are the common and uncommon signs of digestive health?
Does everyone needs supplements?
Where do I start when figuring out my gut issues?
What foods are easiest and hardest to digest?
And SO MUCH MORE!

This episode dives into it all in an "ask me anything" format.

Didn't hear your answer on the show? Check below for a list of questions that were asked and their answers. Have something to ask that we didn't cover? Email us at themicrobiomereport@biohmhealth.com or reach out on Instagram @DreEats or @BIOHMHealth.

Approximate Timestamps:

Why should regular people care about the microbiome? (2:50)
Common and uncommon signs of digestive health (8:37)
Length of healing (17:53)
FODMAPS and different diets (19:26)
Does everyone need a supplement? (31:42)
Antibiotic usage and probiotics (35:17)
Where do I start figuring out my gut issues? (39:58)
Foods and digestion: easiest to hardest (42:43)
Can healing your gut help with…? (44:43)
Allopathic medicine and naturopathic medicine (47:39)

Mentioned On This Show:

Shows on immunity and viruses
Resources that touch on leaky gut:

Ben’s previous episodes on microbes and how to shop smart for prebiotics and fiber
Show notes for this and all episodes
BIOHM discount code: BIOHM10
Ben's company, Olipop

Questions from all of you (hyperlinks link to relevant podcasts):

General gut health questions:

Gut health + lifestyle:

Cleansing and detox:

Fungi:

Supplements:

Transcript:

Andrea Wien: Welcome to the Microbiome Report powered by BIOHM Health. I am your host Andrea Wien and today, we have a very special episode as I am joined by three guests. Our first guest is resident researcher, Dr. Mahmoud Ghannoum. Dr. Ghannoum has been doing microbiome research for the last 40 years. His work is funded by the National Institute for Health and he currently conducts research out of the Case Western Reserve School of Medicine. I also have a Afif Ghannoum on the line. Afif is the CEO of BIOHM, a consumer facing Gut Health company with a line of products and a gut testing kit. Our third guest is Ben Goodwin, the founder of Olipop. A revolutionary prebiotic soda. Long time listeners will of course recognize all of our guests from previous episodes on a wide range of topics.

So, this episode was driven 100% by questions post by our podcast followers and listeners across social media, about all things gut health and the microbiome. These are questions like, why should regular healthy people care about the microbiome. What foods are easiest and hardest to digest? What is the ideal diet look like? Is gut health related to thyroid health? And what's the best course of action to take when trying to figure out digestive issues? We talk about all of these things and a lot more on this episode and while we weren't able to get to every single question on the show, many, many, many of the questions asked can be answered by other episodes of the podcast. So, if you don't hear your question on today's show, or if you're interested in getting more specifics around something, head to biohmhealth.com/pages/podcast, where I've included a long list of questions, corresponding episodes and extra resources for you to peruse.

If you have other questions you want us to dig into in the future, please don't be shy about emailing me at themicrobiomereport@gmail.com. Let's get to the show. Hey, guys thanks so much for being on the line.

Afif Ghannoum: Thanks for having us.

Ben Goodwin: Yeah, a pleasure.

Dr. Mahmoud Ghannoum: Great pleasure, thank you.

Andrea Wien: We'll see how this goes. This is our first episode where we've had multiple people on the line. We have a lot of questions to get through today from listeners and followers of BIOHM. These questions all came just so everyone knows, from our social media channels, so people had an opportunity over the last few weeks to ask these questions. Now, we have some experts on the line to talk about them. A lot of them as I mentioned in the intro are podcast episodes that we've already done. We didn't talk about a lot of general questions, but I do want to start with just one for the group. Why should regular people care about the health of their microbiome? Why is this important?

Ben Goodwin: Oh my god, so many reasons. [inaudible 00:02:54] you want to pick it up and get it started?

Afif Ghannoum: Yeah I think, the general thing to think about and be aware of is that, increasingly what the science is showing is that, your GI, your microbiome is tied to a number of different health outcomes. Now, the tricky part with that is, you'll hear people talk about gut-brain axis, stress and mood. You'll talk about even pain, you'll talk about potentially even cancers, all sorts of conditions. But, one word of caution I always like to throw out there is that, microbiome science is very much in the age of correlation, potential [causation 00:03:32], but we're trying to figure that part out. But, what the science is showing and I'll call him dad, Dr. Ghannoum can expound on this, but there's definitely a connection between the two. So, really microbiome health is critical because it does seem to be tied to many different parts of our health and wellness.

Dr. Mahmoud Ghannoum: Yeah. I really agree. When people start looking at the microbiome, they just try to understand what is there and the good news is that, they move into the next phase which is trying to see, okay, does the presence of certain organisms, whether it's in our gut or on our body in the skin affect out health. Now, we are starting, as Afif mentioned, correlative studies, even sometimes we are starting to see more causes as well as the science is being developed. I really think what's exciting about this, with this background, now people are starting to think the third phase of the microbiome to say, okay, we know it affects different parts of our body, so now how we can rebalance this microbiome, so that we have better health and wellness. So, I'm sure Ben can add to this as well.

Ben Goodwin: Yeah. I'm not in disagreement with anything you guys have said. The reason why I've been more or less focusing on it from a formulation standpoint for actually the last 15 years or so is precisely what the two of you have pointed towards, which is the systemic implications of microbiome health on the greater body. If you explain brain gut access, even things like hormone production. One of the things that I find really, really interesting is, it's not just about the microorganisms that are present in the digestive tract and the digestive microbiome. It's also how and what you're feeding them might generate different metabolic outputs. Based on the food sources going in to what's basically what's an unsupervised biochemical react [inaudible 00:05:40] in your digestive tract, it's going to impact what compounds, obviously different organisms basically ferment and turned into metabolites which then are going to have chain reactions in the microbiome and have impacts on the human body including immune systems, stuff like that.

So, it's a very interesting system in that it affects some of the other parts of the body. The other thing that I would point out is, and this is one of the reasons I think, that I focus to work on it and I'm sure it has some influence on the two of you on your approach as well, but the only other areas of the body that I can think of that have such a global impact would be literally the brain and the greater nervous system and maybe genetic expression. Those two areas of the body are going to be substantially harder to impact through supplementation and through lifestyle in the way that you can impact the microbiome. So, that's one of the other things that I think is, it's an area of the body that has the systemic implications, it's also a lot safer to influence with diet and lifestyle supplementation than the other areas of the body that may have similar effect and happens to affect those two areas of the body as well. So, I think, it's also pretty interesting from that length.

Dr. Mahmoud Ghannoum: I really think, Ben brought up a very, very important point. So, in addition to the diet, lifestyle is very, very critical in how our microbiome is maintained and rebalanced. It's very important for example, three different things [inaudible 00:07:17] lifestyle, the exercise, moderate exercise, stress, we are all stressed, specially in this day with the COVID and the way of life we are leading, it's really a different world. That definitely can affect our microbiome and finally, sleep. People are not sleeping very well. Also, it will impact it. What you need to do is try to understand what's there and how we can really influence through the diet, the lifestyle and other activities which will be very important for gaining a overall wellness.

Andrea Wien: Just to jump in, we do have some questions to get into that a bit more down the line, but I just want to stop you guys and take a quick step back because we had a lot of questions just generally about what constitutes symptomatology of an unhealthy or a healthy digestive system and gut? For example, how do I know I have a poor microbiome or microbial imbalance or just a food allergy or intolerance? Questions like, why am I suffering from gas and bloating. Is that tied to poor microbiome, is it what I'm eating. I just want to lay the groundwork of people don't know which side of the fence they're on here. So, how do you think about the common and uncommon signs of digestive health?

Afif Ghannoum: Let me jump in and add science like perspective on this. When we look at our data from our microbiome test, a lot of times when people are reporting having digestive issues, what we'll notice is that, their diet can typically be pretty poor, right? The problem is, it's not necessarily always that they have a standing, unbalanced microbiome, a lot of times, going back to where we just talked about lifestyle, diet, they're doing things that are proactively probably impacting the balance of their microbiota. A lot of times, it does become a little bit of chicken or egg, so you may not be only experiencing digestive issues because of the fact your microbiome is imbalanced, you may actually be contributing it. Now, what gets tricky sometimes, is the changes that people need to make to start coming imbalance can sometimes be digestively uncomfortable. I'll give you a a simple example-

Ben Goodwin: It's a great point, Afif. Yeah.

Afif Ghannoum: Yeah.

Ben Goodwin: Yeah.

Afif Ghannoum: Because we've seen this. So, there was one guy, former UFC fighter that came to us. Guy looks like he's cut out of marble, tries to eat well and he kept saying, it was like, "Every time I try and go and mostly eat plant-based, I just feel so bloated, so uncomfortable," and we force the issue and said, "Listen, you have to stick with it. Your body's not used to it. You don't have the enzymes built up, you really have to give your body a chance to adapt, then you'll start feeling better." Sure enough, he saw that. So, a lot of times the symptoms you are experiencing, it's in large part self-created in a lot of times.

Dr. Mahmoud Ghannoum: Maybe I just want to talk about the symptoms, so that really responding to the question. What are the common symptoms? First of all, you know that you have digestive issues, really the way is to look at yourself. You have discomfort in your digestive tract and this can be seen through a number of symptom. Nausea, vomiting, for example, lack of appetite or excessive appetite. Sometimes, you have sore tongue, mouth ulcers, swollen gums, bloating. Everybody talks about that belching, flatulence, of course diarrhea and constipation also. So, there are a number of things that can tell you, you have a digestive issue or an unhealthy gut. But, in addition to this which was alluded to before, with respect to the gut-brain axis or gut-skin-brain axis, you may have issues of mood, lethargy as well as some skin issues. All of these could tell you that you may have a really unhealthy gut.

Ben Goodwin: So, I'll pop in and basically I'm probably in the worst position to speak to symptomatology and it probably wouldn't even be advisable from a legal perspective because I'm not a doctor and we actually are doing some of our own research with Olipop with Purdue and Baylor College of Medicine, but still doesn't feel appropriate to necessarily speak people's symptoms. But, I think, one of the things, there's two things that pop in with, one of the things is something that I've actually already covered, Andrea with you on some of the prior podcast, which is the relational composition of what happens in the microbiome in relation to how it impacts people. There's unfortunately this chain reaction that can occur when we're not getting the proper nutrient inputs and specifically in the western world, its these three pillars I talked about before. It's fiber, prebiotics and nutritional diversity broadly, which obviously includes a diverse micronutrient profiles. If we aren't getting enough of those key nutrients, we end up underfeeding the microorganisms, under nourishing other ones that might lead to an imbalance.

The other issue being is that, if truly, these microorganisms or certain microorganisms are basically starving, they're going to turn and start eating away that mucosal layer that lives in your digestive tract, that separates the contents of your digestive tract from your epithelial cell wall layer. As that layer becomes more and more thin, you're going to end up start having these undesirable interactions between the contents of your digestive tract and the tight junctions in your epithelial cell wall layer which is going to end up leading to discomfort and inflammation and immune system hyperactivity. If you're chronically inflamed, then you're going to be chronically uncomfortable. If your immune system's hyper reacting all the time, that's going to make you exhausted and lethargic. And those issues, unaddressed for an extended period of time can also then lead to endocrine system issues.

There's a big chain reaction there and that's one of the reasons why, despite not really being able to speak to a symptomalogist and certainly not being able to speak to [inaudible 00:13:46], one of the things that I really recommend to people to take a look at is, it's really hard because of the state of microbiome science and the state of microbiome testing because we're usually doing fecal tests, which have a host of challenges intrinsically associated with them. In terms of truly getting comprehensive accurate data, so try to just stick to solid principles around the nutrient inputs for digestive and microbiome health and obviously our belief system is that, to making sure you're getting the fiber, prebiotics and nutritional diversity. The only thing I'll piggy back on really quickly is, that point Afif made around, that there might be some discomfort during changes in diet is super, super true.

There's actually some really good Italian research that, there's a physician in Italy that was doing where he was actually using prebiotics to try to help people get off of chronic FODMAP diets. As you can imagine, people, one of the FODMAPs, one of the key FODMAPs tends to be oligosaccharides, well, one of the most well researched prebiotics is the oligosaccharide family. As he was putting his long term FODMAP patients on oligosaccharide rich diets, there's a lot of discomfort and gas and bloating pain, he titrated up the amounts of oligosaccharides over time and he did find that the titration did help to reduce discomfort as the patients became acclimated. They actually were able to start shifting away from their FODMAP diets for the first time in years. Obviously, that's just one study, but it does point to it. I think, one thing that, I'm just probably a little bit above most people's pay grades in terms of what they want to spend their time thinking about, but it's worthy of noting that, your microbiome is like an entire ecosystem.

So, there's primary fermenters, there's secondary fermenters, there's [inaudible 00:15:45] fermenters, the list goes on and on. There's a whole group of organisms that just eat the food that you're eating and then there's a whole group of organisms that just eat the byproducts from that first group of organisms and so on and so forth. Sometimes, when you're bringing in new quantities of food that you're not used to, the microorganisms that can eat that into [inaudible 00:16:07] the enzymatic production in your body has to catch up, but then the second layer which is now that, that population is growing.

They're now producing more of a particular metabolite which might be uncomfortable in excess and the whole secondary fermentation group has to then grow in order to be able to break down that metabolite. It's like this entire ecosystem that has to be shifted that can take some time and that can create some discomfort. That's why it's important to stick to solid nutritional platforms that have a lot of good science and evidence behind them, but then obviously work with a physician or a nutritionist as you're going through the process just to make sure you're in good shape.

Andrea Wien: I think, you bring up a good point because I do talk to a lot of my clients and they'll often say to me like, "How long is this going to take?" It's a question that everyone wants to know and my answer is typically, "You didn't come to me with these issues that developed overnight. You didn't come to me with chronic constipation that you've had for years. That has been an issue for you for years, so to reverse that, is going to take some time and typically, people can tend to start to feel better two weeks to a month out, but to really change the composition of what's going on in your microbiome, can take quite a while." And doctor, I do want to say one thing before I move on from this, Ben brought up some of the things around intestinal impermeability and some big terms that people might not be familiar with, so in our show notes, I will link some information. You may have heard of this called, leaky gut. That's the more colloquial name for it. I'll link to some of that information on our show notes and we certainly can also link to some other podcast episodes, where we've talked in more detail about that.

Dr. Mahmoud Ghannoum: One thing I would like to add with respect to how long it will take. As you know, in our total gut balance diet, we did a clinical trial and we get people, it's a four week trial and we observed what happens in during this period. We noticed that the first week, people, not feeling too much difference and then, the second week, a little bit better and by third and fourth week, definitely they start to see a complete change with respect to their digestive issue, whether it's constipation, bloating, fatigue as well has start really disappear, people slept better. So, I really agree with you, Andrea with respect to, how long it takes. I would say, at least it should be four weeks to start feeling as a new person, if you will.

Andrea Wien: Great. Okay, let's move on to a little bit of the questions of diet because, we had a lot of people read them and say, "I eat right or I have [inaudible 00:18:58]" We touched on this a bit, but what is diet? [inaudible 00:19:03] Did people know what they should be eating, what constitutes a poor diet versus an ideal diet? Ben brought up FODMAPs, which we did have some questions around that on. So, can we just talk about overall, FODMAPs, general diets. Dr. Ghannoum, I know you put together a entire diet plan, so this is a question people really had a lot of questions on.

Afif Ghannoum: Can I just set the stage with a couple of just general points on this?

Andrea Wien: Absolutely.

Afif Ghannoum: I think, the problem is, and this is not just about diets, it's about everything, we're in a society where everyone wants the secret answer. A lot a times-

Ben Goodwin: That's another great point, Afif.

Afif Ghannoum: Yeah. Listen, Ben, I'm just going to talk all day and just, I'm going to have on [inaudible 00:19:49]. In all seriousness, people want the answer and a lot of times, they'll end up doing things that are extreme. A couple of years ago, for example, we saw a subset of women that were reporting pretty serious digestive symptoms and when we looked at their microbiome test, we saw elevated levels of, this is fungi zygomycota. Zygomycota, you typically see in people that are immuno compromised, like pretty serious things like cancers, HIVs, but there is enough of these women that we thought, it seems unlikely that there's these many undiagnosed. What we ended up looking at, when we dug a little bit deeper into their profiles, they're almost universally cutting out dairy and carbohydrates. Why? Because there's been this messaging that carbohydrates and dairy are just not good for you. Because what? There's a very good prebiotic, probiotic fostering foods.

Ben Goodwin: Yup.

Afif Ghannoum: So, when we saw them start to reintroduce at reasonable levels, guess what? They started to see their digestive symptoms go away because that to me is one of the best anecdotes I've seen of the problem with the way we typically approach. Dairy, gone, carbs, terrible. And the reality is, a lot of times, the answers are a lot more boring than people want to acknowledge, which is truly moderation. I just want to set that tone that, there is no silver bullet, there's things that you can definitely do optimize, but again, sometimes it's not just your digestive tract. My dad will tell you, several people he's dealt with, where they seem to eat amazingly, but they're either under extreme stress, they don't sleep well. We even had people that are elite athletes or body builders, they don't realize the stress they're putting on their bodies from over exercising. You know what I mean?

Dr. Mahmoud Ghannoum: To me, I think, you really asked very important question. Okay, what to do? There should be an overall strategy for how you can balance your gut. What we want to do is basically, we need to promote beneficial organisms, both bacteria and fungi. We need to them to be there because as mentioned before, they can work together to help up really digest the food. One organism for example, break the component, the other one will live on it and then everybody is happy camper as they are in a little sandbox, okay? The first time is, promote beneficial organisms. Second, you need to eliminate the bad ones, those can produce molecules that are pro-inflammatory, in other words, they'll increase your inflammation. We need to keep them under control. Another thing, which is important, we should in our studies that bacteria and fungus work together and they make what you call digestive plaque. It's like the plaque in your teeth, but it's in your digestive tract and this will be a problem not only for causing damage and leading to leaky gut as you mentioned, but also what they can do really, they can inhibit absorption of nutrients.

So, you need to take a high level approach. Get rid of the bad ones, encourage the good ones, get rid of this barrier they form and then let's have good food that have a lot of anti-inflammatory such as cruciferous vegetables, for example will be really very important as well as good vitamins to support the growth of the good guys.

Ben Goodwin: One way I would advise people to think of it to make it a little more engaging and because to Afif's point, and moderation a key aspect of this. I think of that as like your gardening yourself. You got these ecosystem inside of yourself and you're gardening it for the best outcomes. It's like if you've got poisonous plants in there, then they're producing, there might be toxifying soil producing poisonous berries or something, you don't like that for your system. If you're taking care of your microbiome in a really good way, then you're gardening for basically success. So, I really encourage people to think of it from this ecosystem standpoint. Another thing that's worthy of note is and again, I can jump off under the philosophical deep end a little too often, but it's worthy of noting that there's three relationships [inaudible 00:24:24] three relationships in nature.

There's basically mutualistic symbiosis, there's commensalism symbiosis and there's parasitism. So mutualistic symbiosis means that two independent organisms that are working together and benefiting each other. Commensulate relationship means that one organism is not affected, the other one benefits and parasitism means, one organism benefits and the other one is negatively affected. Because all these bacteria and microorganisms are living through their own reasons, what you're trying to do is create the environment where they maximally align at the greatest numbers to provide benefit to you as the host organism. I think, this is one of the big areas as well, where the nutritional diversity plays in a lot because there are even times when at certain numbers, certain microorganisms will act beneficially, but at too small of a number, they don't have enough fire power to do so or a too large of a number, they can actually be problematic.

And actually, we see them when we look at microbiome behavior, when certain organisms are normally beneficial get to a certain size, they engage something called quorum sensing and they actually start changing their behavior to be less beneficial. This is where the diversity of nutrient inputs also matters a lot because not only are you then going to support a really broad range of microorganisms which means they're going to be more likely to keep each other at reasonable population levels, but you're also giving the added benefit of with all the different nutrient inputs, you're then getting a lot of different metabolic outputs from fermentation in your digestive tract. Which then means you're getting really board range of compounds that your body might need or that might affect different fermenters down the line. That's a high level interesting philosophical way to think about it.

Obviously this is also where genetic plays a part. If you do have awareness of your personal ancestry is, it can be useful to then look at what a more indigenous diet is for your particular ancestral tract because that might be a little better of a fit for your body and then, to the point around moderation, so then, don't over do it on fats and meats. I think you want to have at least 70 to 80% plant foods, is a general good rule of thumb. Including carbohydrates, but then obviously the quality of those and the diversity of those inputs also matters a lot. So, you can be eating carbs from Pop-Tarts, or you can be eating carbs from wild rice and black rice and quinoa and that makes a really huge difference obviously not only in your microbiome, but also metabolically improves your blood sugar response.

Dr. Mahmoud Ghannoum: Well, I want to pick two things that then [inaudible 00:27:05] talked about which really very interesting. I love your idea of the gardening, okay?

Ben Goodwin: Yup.

Dr. Mahmoud Ghannoum: Because I tell people, your gut is like your own garden. If you want to have roses, you need to give them good fertilizers, while we are trying to kill the weeds. So, it's really, what I want to add to what you said is that, it's all in your hand. It depends how you feed it, what's your lifestyle and you will be able to do this change. The other thing which you really brought up which is very interesting is related to the balance. I can give you an example with candida. Candida which is a yeast and as you know people know about it because of thrush and other systemic infection, but when we have it in our gut at low levels, it can work with bacteria to help each other like we talked about. One will break down one component, let's say complex carbohydrate, the other will use that byproduct to produce something else where again, the bacteria will benefit. The one which started the whole cycle.

But, really what's important about this is, you need to keep the good guys survive very well because if you don't have this balance where they help each other, let's say, you take an antibiotic and then you kill all the good bacteria which keeping candida under control and then we have candida overgrowth and we have big issues. So this really balance is very, very important what you are talking about, Ben.

Ben Goodwin: Yeah. Thanks so much. One other thing I'll quickly point out and I'm really happy that this is actually one of the reasons why I love jumping on with you, guys because you have a probiotic product, but you're still so focused around the dietary inputs and the prebiotics and the full spectrum, which I think is really important. One of the reasons why Olipop does not have probiotics in it, but it has instead fiber and prebiotics and botanical extracts which have different beneficial compounds is because this is where prebiotics comes to the mix. It's going back to garden analogy, if you think about the microorganisms as the plants, then the nutritional inputs like what you're eating, even the stress you put on your body because that ends up becoming part of the profile because if you get stressed, you're producing all these stress hormones. Well, those stress hormones get metabolized somewhere and they get metabolized actually including in the body, but also in the digestive tract. Those different nutrient inputs is the soil health, the air quality, the amount of water, all of these different pieces.

Basically, if you take care of a plot of land like a forest, for example, the soil's really healthy, the air's really healthy, so a lot of beneficial stuff intrinsically grows, you don't really have to manage it as tightly, by planting a bunch of bushes and trees because this ecosystem's taking care of itself. Obviously, it's more complicated than that because of how we have-

Afif Ghannoum: No, but Ben, I think that's very important because-

Ben Goodwin: Yeah.

Afif Ghannoum:... a lot of times, when people talk about probiotics-

Ben Goodwin: Yeah.

Afif Ghannoum:... they're talking about externally adding probiotics, but the reality is, your body has an entire need of, what's that term-

Ben Goodwin: [inaudible 00:30:25]

Afif Ghannoum: Yeah, yeah. Where it's a-

Dr. Mahmoud Ghannoum: Oh, this is really commensal organisms. They are there, native to your gut.

Afif Ghannoum: Yeah. Exactly. So, part of what your getting is [crosstalk 00:30:40]

Dr. Mahmoud Ghannoum: Normal of floras, again another word, Afif.

Afif Ghannoum: Yeah. But, they're not external. Your body has them internally, so one of the things you want to do is encourage the growth of what's in there already. And yes, of course, you can add additional probiotics, too. The analogy I was using is prebiotics of top soil.

Dr. Mahmoud Ghannoum: Yes, absolutely.

Andrea Wien: The Microbiome Report is brought to you by BIOHM Super Greens. A super greens formula that combines 31 super greens with prebiotic digestive enzymes and biome probiotics, giving you a super charged in a single scoop. To check out BIOHM Super Greens, go to biohmhealth.com. That's B-I-O-H-Mhealth.com and make sure to use the code, BIOHM10 to get 10% off of your order.

We had a bunch of questions about, I'm a healthy 22-year old with a balanced diet, I'm a healthy individual who exercises and eats right. Do I need to be taking a supplement, what do probiotics actually do? Are they good for everyone?

Afif Ghannoum: So, the way, I know we were talking off the air about this, this is the way to think about, not just probiotics, but frankly any supplements. They should be a supplement to your diet, when you're doing dietary. That's literally why they're dietary supplements because the idea originally was, it's hard to necessarily get all the vitamins and supplements you need just from your diet. So, you can supplement it with dietary supplements. The problem is, and we see this often times when people are testing, they want to know, well which product should I take, which product [inaudible 00:32:15]. Listen, take a step back. You shouldn't think about any product until you get your dietary house in order. Because once you do that, then you can start adding these things in. So, I really think the way that people need to think about all supplements, not just probiotics is that they should be a compliment to what you're doing with your actual diet.

Now, beyond that, to your question, if someone who's healthy, do they even say, need this? The analogy I like to use and my dad talked about it earlier about oral plaque, but it's really oral care. Everybody's got that uncle that hasn't gone to the dentist in 15 years and never gets a cavity. Genetically, he has a very good oral care and then we also know that person that has cavities all the time despite doing everything they can to maintain healthy teeth. In all scenarios though, we daily maintain our oral health. Why? Because the oral cavity, much like the digestive tract is very dynamic. You have saliva, you have food, you have a lot of stresses coming in and out the oral cavity, so we constantly maintain our oral health, to keep it all in balance. Even if you have strong oral care or a little weaker genetically.

It's the same with digestive tract. When you are thinking about maintaining your digestive health through your diet, you also should consider what supplements can keep you maintaining because your microbiome is constantly under stress and it's not just about diet. There's environmental factors, there's stress. We've seen probiotics and digestive health as a category almost starting to be treated like multivitamins, where it's just part of an ongoing routine, as part of an overall healthy lifestyle.

Dr. Mahmoud Ghannoum: So, really to be honest, the way to look at it simply is, as we mention about the garden. It is in your hands. Try to pick the right food, so that you feed not only our host selves, but also the good bacteria and the good fungus, so that they thrive there and help us maintain our health. Now, if you take for example an antibiotics, what you are doing, you are killing some of the good guys, okay? In this case, having supplement where you have let's say, probiotic will be good because you are trying to help your body to rebuild back because of what happened because of the antibiotic. Also, if you have to have an antibiotic, it would be a good idea to take a narrow spectrum antibiotic. In other words, you don't want to have a complete and utter distraction of all organisms. Let's go target the bad ones, the pathogen only and this will be narrow spectrum antibiotics will be much better. And then, adding a nutritional supplement and adding some vitamins will really be very helpful.

Ben Goodwin: So, I, and again I might be the slightly the odd man out and I'm also not a doctor, so take my input with limited consideration. From the research that I've looked at, there's basically, I forgot the name of institute, I think, it's [inaudible 00:35:37] Institute [inaudible 00:35:39] is real. They just did a pretty big meta analysis for example on antibiotic usage and supplementing with probiotics afterwards. From their data and again, it's just one data set, what they concluded is that, there's actually a number of cases where consuming probiotics after a course of antibiotics actually elongated the time period for full balance recovery. So, I do think there is some mixed science there in terms of exactly the right way to recover from antibiotic use. Again, I'm not a doctor and there's a lot of data out there, so you should try to figure it out for yourself.

The other thing I'll point to with this is, if you're getting a really balanced diet, with a lot of diversity and you're supporting a bunch of different natural microorganisms, there is a lot of intrinsic redundancy by design built into the microbiome. There are cases where there are important native bacteria, native microorganisms like we were referring to earlier that over time, with a refined under processed diet, can be permanently lost. There is good data that would show that if those were reintroduced, you would see a meaningful benefit. The challenge is just that we don't know exactly yet because again to the point that Afif made earlier, microbiome science in general is just going to rapidly expanding field.

The problem is that we don't totally know yet which microorganisms each individual person could be construed as missing and beneficial to bring back in to the body and then even then we have to do safety test on them. So, the area of probiotics itself becomes a little bit complicated. I don't think there's certainly no harm in taking probiotics specially if you have a good probiotic like BIOHM that actually gets to where it needs to go to in the digestive tract and provides benefit. But, I think my only concern with this is and this is more just so [inaudible 00:37:52] that I've thought about [inaudible 00:37:54] sciences is which is probably obnoxious for me to say in the first place, but I do have a little bit of concern for individuals who are in this position where they're having this leaky gut because they're not properly attending to their diet and to their stress and then, they take a bunch of probiotics. Well, if the underlying issue is that, there's already basically too many microorganismal mouths to feed and not enough food to feed them and that is contributing to-

Afif Ghannoum: Yeah. Sorry I didn't mean to interrupt.

Ben Goodwin: Yeah, sure.

Afif Ghannoum: But, I think you're touching on a bigger issue, which is the place of supplements generally in health and wellness.

Ben Goodwin: Sure.

Afif Ghannoum: And I think the problem is, a lot of times, people that are well meaning and they're trying to be thoughtful about the medications they expose themselves to and be just thoughtful about their personal wellness. Sometimes the error on the side of trying to get health through supplements versus medication. Sometimes, what you're talking about, that's not something that a supplement really has a place to solve. Sometimes, you can have candida infections, something like that. You need medication. That's not to be solved by a probiotics. So, that's something that I think is a bigger issue. I remember... Oh, go ahead, go ahead.

Dr. Mahmoud Ghannoum: No, no. Also to frame the same thing in a different way, you really need to address the underlying causes for a given digestive issue. Having a probiotic without trying to get rid of the underlying issue. For example, if we have stress, for example, it's not going to help you. So, I think, probiotic supplement, it is something which you can use to really support what you are trying to do, but if you think it's a pill that is going to cure you, I think, this is not the way to go.

Andrea Wien: That's actually a great segue into one of other questions which is, what is the best course of action to take when trying to take care of gut issues? Where do people start with this?

Afif Ghannoum: So, that's a little bit of a tricky question. I think, let start by sharing this. Cleveland Clinic Center for Functional Medicine's here in Cleveland, where we are. We know a number of the people that work over there. One of the most interesting things I've heard, was that, you can't even see a physician in the Center for Functional Medicine until you go through their nutrition intervention and some crazy stat like 80% of people end up never having to see a physician. Do you see what I'm saying? So, a lot of times-

Ben Goodwin: That is awesome piece of information. Yeah.

Afif Ghannoum: Isn't it crazy?

Ben Goodwin: Yeah. That's awesome.

Afif Ghannoum: That blew my mind and because again, it's really reframing how we address our wellness. Because, you could have one answer to your first question, Andrea is, well you should go see your doctor or you should get on a treatment course for x, y and z symptom or you should take this antacid, whatever it might be. Sometimes, that is the right-

Andrea Wien: Don't take antacids.

Afif Ghannoum: [crosstalk 00:41:00] Sometimes, the right answer is, yup, just as I was saying before, if you have an infection, you need medication. But, a lot of times, people again, I use a framework of our own tests because we see their diet. We can see that they have not really tried to optimize their diet ahead of taking a microbiome test ahead of trying products, you know what I mean? So, again, it's I think the first thing people need to do is, really take an honest look at their diet, their lifestyle and whether they're doing everything they can to optimize. Now, if they are, then yeah, I think it's worth assuming you don't know you have some underlying issue. Look at other options, talk to a physician, a functional medicine practitioner to really start to get to a solution. But, I think sometimes, people jump too quickly to a silver bullet.

Andrea Wien: Yeah. Absolutely. What I'm going to do for this question specifically. So, all of the questions that we have been asked that have a corresponding podcast episode or some resources we can send people to, I will link to that in the show notes at biohmhealth.com. So, for this question, I will link specifically to some of the episodes that I think are the best for getting started with this because we have talked at [inaudible 00:42:21] really about all of these things and everything from sleep to exercise to diet and really, what to start eating to shift this balance. So, okay, we are coming up on time and I do want to ask just two more questions that multiple people wrote in about. So, the first one is, what foods are easiest and what foods are hardest to process and digest?

Dr. Mahmoud Ghannoum: Okay. So, I'll have a go at that. I think, the food that are easiest to process include very ripe bananas, cantaloupe, melons, avocado for example. As you know, everybody loves avocados these days. Also, apple sauce and if you cook food without skin or seed, these are really also easy to process. Now, the ones that are hard to really process include the cruciferous vegetables, the best examples are broccoli and cabbage. Also, the higher the fiber content of a food ingredient, the more it is hard to digest. So, you can see we are going from watermelon which I, as Lebanese, my dad used to buy all these watermelons at the start of the summer and we eat them and they are basically like water. So, it's very easy to process, whereas the others as I mentioned, the broccoli, they are fantastic, but they are really hardest to process.

Andrea Wien: Where does meat and fish fall into on that spectrum?

Dr. Mahmoud Ghannoum: I would say, fish is much easier to break down or to process because as you know, fish is more softer, it does not have all these muscle type of material, which you find in the meat. It's much, much harder and that's really, if I put the two, I would say the fish is much easier to process compared to the meat, which will take a little bit more.

Andrea Wien: The last question we have here. So, we had a lot of specific questions about different disease states which we don't have time to get into each of them individually, but I am at risk of, insert something, so, hypothyroidism, colon cancer, Alzheimer's, heart disease. Can healing my gut help lower the risk of this problem?

Afif Ghannoum: First thing I'd say is, gigantic disclaimer, you should not do any approach outside of talking to your healthcare practitioner. That sounds like a cliché thing to say, but I think it's very important. The reason I say that is, I will never forget, I was at a conference and I heard this woman and she had a talk, which is basically like, "Don't let your wellness get in the way of your wellness," and she started to explain the symptoms and feel well that literally turned to supplements, probiotics because she was feeling digestive issues. By the time she actually went to see a physician, she had stage 3 or stage 4 colon cancer. Her message was basically that, she was ignoring these giant warning signs because she didn't want to go the "traditional western medicine approach" and by the time she got there, she actually was in awful state of health.

So, I think any of these things, it's a giant caution flag that you should not look at if you can somehow balance your microbiome as an alternative to getting proper treatment. Because we understand collectively, I'm sure the four of us, why people are so weary of making sure that they're thoughtful about a medication and everybody always talks about antibiotics. But you know what? Sometimes you need those things.

Ben Goodwin: A 100%. A 100%. Yeah.

Afif Ghannoum: So, that's, that you can never lose sight of that. I almost don't want to answer the question because it should never ever be a substitute for a [inaudible 00:46:15] path. Now, along the way, yeah, there's no reason to not try and do everything you can to optimize your microbiome. It clearly can't hurt, but it should never be a substitute or a first place you start if you're looking at an issue like that.

Dr. Mahmoud Ghannoum: [inaudible 00:46:29] Let me also try to address a little bit your overall question, Andrea. Your microbiome play an important role in your gut health as well as overall health because of the gut-brain axis or gut-skin-brain axis. If you have disturbance in your microbiome, you're going to affect and communicate with your brain and then you will start to have the stress level increase in this thing and we have the other way around. If you are stressed, it's going to cause dysbiosis in your gut. Now, when you look more specifically about the thyroid and your gut health, there is a really strong correlation between the thyroid and gut health. In fact, there are some studies which showed that, if you have low thyroid hormones, this could lead to leaky gut, which as we said before, really, organisms from the gut then can go in much easier into your bloodstream and cause problems. At the same time, because of this, you are going to have poor gut health, can also suppress your thyroid function. So, it's two-way street.

Ben Goodwin: Basically, it's just worthy of noting essentially, there's two schools of thought on medicine and often times, they're pitted against each other, but I think, that's pretty silly. They're actually quite complimentary. So, there's allopathic medicine, which is more intervention based medical model and there naturopathic medicine, which is more preventative and lifestyle oriented and focuses less on symptomatology and germ theory and focuses more on ecosystem and terrain management. They really are quite complimentary. As a society, we've invested really heavily in the allopathic interventional route and so, it's developed and it's quite efficient at what it does. It has a particular tool set and same thing, naturopathic medicine broadly is studied less. It's thought of it as being less credible, a little bit more of a wild west in terms of actual certifications and even some scientific research which I think, is a huge shame because both systems are valid and have their place.

So, I'll give you a perfect example like, it's been an insane year for a lot of different reasons. Our company's going more like a 1000%, like pandemic. So, I'm just having chest pains recently and I'm in my mid-30s, so I'm thinking I'm probably fine, but my father's father died of a heart attack, so I was nervous. I did go see my primary physician and I got a physical, I got an EKG, had my blood drawn and I got a comprehensive panel. I ended up being perfectly fine. So, I was able to say, all right, this is probably really just stress and physiological tension. What I did, as I focused one night, I took a little trip and actually, I'm out of the office right now, I'm in the mountains of Colorado, I'm trying to work from the road to actually find a different way to manage my stress. I'm hitting the sauna a lot and that stuff's helping. [inaudible 00:49:38] the chest pain is down.

So, I think that it's just, there is this hand in hand to [inaudible 00:49:45] point which I think is very, very, very wise. You want to have that backstop where you are getting just interventional oversight, so if you do have an underlying infection that needs antibiotics, use them. If you do need blood work, you do modern medicine. You just make sure you didn't cover it off there. But, once you get it cover off there, then it's just plowing through the wild west of naturopathic information to approach your life and just balance a way between diet and stress. [inaudible 00:50:16] of people and we don't possibly have time to get into this right now, but I'm really big on addressing trauma. Trauma is this major thing that affects the physiological system, the mental system, sticks around in the neurology, it stick around the physiology and it causes super long term stress.

As a country, we don't we sweep drama under the rug and we don't deal with it, but that's another major place that physical disruption and microbiome disruption can come from and also meaningfully increases potential disease outcomes and there's a ton of good data based on those as well. So, I think, looking at all that holistically, you'll have as good of an approach, whether you're healthy, you're at risk for a specific disease as anybody could have.

Afif Ghannoum: The last thing I will add-

Andrea Wien: Go ahead.

Afif Ghannoum:... Quasi supported by science is sauna will change your life. [crosstalk 00:51:10]

Ben Goodwin: Yeah. Actually thermal cycling is one of my, sauna to cold plunge, sauna to cold plunge is such a game changer for your nervous system.

Afif Ghannoum: Oh, that's fantastic. Yeah. Ben and I have literally done this together.

Ben Goodwin: Yeah. We have done this together. It's absolutely my jam.

Dr. Mahmoud Ghannoum: That's great.

Andrea Wien: This is how us, nerdy health people find fun.

Dr. Mahmoud Ghannoum: I'll tell you something, I really liked what you said Ben, regarding the going out with the mountain and whatever. My approach all the time I'll tell people, listen, go take hikes, go take your dog for a walk, relax. I even tell them about, Andrea will love this because I always say, you know I go to this yoga classes and I'm the only male there and I think, men are missing a big part with respect to the yoga because it's so relaxing. You need to de-stress, you need to do some meditation during the day. It is not just about, let's keep going, let's keep going and about food and this sort of thing. We need to relax a little bit. Just to end up, and it's not a matter of advertising, I just submitted a paper called, Microbiome Driven Approach to Manage or Ease the Depression During the COVID. Because of all what's going on-

Ben Goodwin: Very cool.

Dr. Mahmoud Ghannoum:... and hopefully when it gets published, we will share it with Andrea because I really think we need to help people now at this hard time and always give them hope and the importance of as you say, dealing with trauma, talking with a family, help yourself because this is the way we are going to be all fine.

Ben Goodwin: Couldn't agree more.

Andrea Wien: This is excellent, you guys. Thank you so much and we will link to everything that we've talked about today and even things that we didn't touch on, I will have a whole list of resources on the show notes page. Even Ben, to your point about trauma here at the end, we did an entire episode with Dr. Keesha Ewers about trauma in the microbiome and overall health.

Ben Goodwin: Awesome.

Andrea Wien: So, we'll certainly link to that. It's all at BIOHMHealth.com. Remember it's B-I-O-H-M. And then, if you guys like this episode and you want to hear more, ask me anything episodes and have other questions, let us know, shoot me an email, themicrobiomereport@biohmhealth.com and we can get another one of these scheduled. Guys, thanks so much. Be well.

Dr. Mahmoud Ghannoum: Also you, thank you.

Ben Goodwin: Thank you.

Afif Ghannoum: Thanks.

Ben Goodwin: [crosstalk 00:53:29] with you guys.

Dr. Mahmoud Ghannoum: Likewise, likewise. Take care. Bye, bye.

Andrea Wien: Thanks so much for tuning in. If you enjoyed this episode, please consider leaving us a rating and review. I've included a clickable link in the show description to make it easy peasy for you to do so. Again, check out the comprehensive show notes for this and all episodes at biohmhealth.com/pages/podcast. And again, remember BIOHM is B-I-O-H-M. Until next time, I'm Andrea Wien.

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Episode 50: Your Gut Questions Answered!

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