Interconnected Episode 8 – Revolutionary New Tests and Treatments

(hopeful music) - Welcome to Interconnected. I'm your host, Dr. Pedram Shojai. Over the past several episodes, we've been looking at the promising science around the microbiome and learning how it touches almost every disease. It's the missing piece in the health puzzle and it's revolutionizing how we look at disease and now, we turn our attention to some innovative testing and procedures that are rocking the foundations of medicine, this is all new and exciting and just the tip of the iceberg. The next decade's gonna see a complete transformation in how we perceive and treat most health conditions. Now in our next segment, we're gonna look at a seemingly disgusting yet powerfully effective treatment called a fecal transplant. That's when human stool from a healthy person is used to inoculate an unhealthy person. Now before you gag, listen to this. It's proven to be over 90% effective for curing one of the most difficult and common life threatening conditions out there. Let's explore. (upbeat music) - In 2011, my cousin went into the hospital for routine surgery and came out with a C difficile infection, and C dif is a really aggressive intestinal infection that causes diarrhea as often as 20 times a day and a lot of pain and a lot of just difficulty eating and living a normal life and for him at least, he ended up trying antibiotics which is definitely the first line of treatment and he failed and he certainly wasn't alone. I think about half a million Americans get C dif every year and one in five patients will fail that first round of antibiotics, but for him, he kept trying and kept failing at antibiotics and over the next year and a half, he was on seven rounds of one of our last line antibiotic therapies and every single time he went off of it, the C dif infection would come back so it started to get pretty scary and he was looking around for options, came across some of the medical literature on a procedure called fecal transplant. Which is exactly what it sounds like. You take a sample of stool from a healthy person and you infuse it into the colon of the patient and then bacteria that live in our guts and that are found in that stool out compete the C dif and within a day, usually, the infection's eliminated. - Fecal transplants are therapy, if you will, an emerging therapy where microbiota is taken from a healthy donor and given to an individual who may be suffering from a particular disease. The process doesn't involve culturing of organisms because still many organisms in the human gut, we cannot grow in the laboratory, so it's moving the fecal material from a healthy individual to a diseased person. - So Johnny thought this sounded like a pretty good option and went out to try and find a clinician who could perform the treatment for him, but at the time in New York there was only one clinician performing fecal transplantation and his wait list was miles long and so my cousin thought that he really didn't have the time to wait and so he quite literally took matters into his own hands and asked his roommate for a sample of stool and did the procedure at home himself with an at home enema kit and it was crazy 'cause his roommate wasn't screened, but it worked and he's totally fine now. - When you're talking about human microbiome research, what specifically are you involved in? - We published the first human microbiome study in 2006 and that was work that was done by my team and at that time, we only looked at two individuals and found this tremendous diversity in the gut of people. My group currently has about 100 different studies underway right now, looking at various questions from viruses in the human microbiome, parasites in the human microbiome, all the way to looking at neglected disease and their microbial components such as malaria, adding microbial populations to a gut, for example, fecal transplants and maintaining those over time would necessitate in my opinion that you'd have to feed them the same way they were being fed in the donor, if you get a fecal transplant from somebody and eat what they ate, that it will maintain over time, I think most of the studies that have been looked at today in terms of fecal transplants, the populations change, eventually they kinda do not stay at the level of the donor, what was put in, and again, I think that comes back to host genetics environment and what you consume on a daily basis, which I think is part of your environment. - And that is the biggest challenge here is maybe the answer is where you live and being close to nature and close to the earth and gardening and all that. What recommendation would you give, like, a family member who, say, had some sort of disease and had dysbiosis? - I think the field is starting to converge on the notion that there is no such thing as a singly healthy microbiome. Putting data from lots of different studies together, I think we are now at the point where we understand that things like host genetics, geography, diet, other lifestyle factors have a profound impact on the microbiome and what that means is that somebody who lives in the northern versus the Southern hemisphere, they may have completely different microbiomes based on what we typically measure but yet they both can be functioning optimally, meaning that they're both healthy. In the earliest years of the microbiome efforts, there was this almost single minded focus on trying to define what a healthy microbiome is. I think based in part on the assumption that there would be a single healthy microbiome. But what we found is that that is probably not true and that I think is causing us to sort of rethink what we do and how we make measurements and what the most meaningful metrics are when we look at microbiome health and disease. - So C dif is short for a bug that's called C difficile. Which is a pathogen that is often antibiotic resistant and we see this kind of infection coming on often in people that for example go to a hospital and get large doses of antibiotics and so this bug is kind of taking over their gut and wiping out many other species and the symptoms are anything from diarrhea to losing weight. It's a real problem in hospitals and this is really one of the conditions where fecal transplant is very helpful. - One of the most promising things is actually FDA approved is a fecal microbiome transplant to treat C dif so this is in the news, there's a lot of talk about these microbiome transplants and the reason that they are working and that there's so much buzz about them is because instead of like a probiotic where you're just giving one, two, maybe 10 organisms at a time, you're now transplanting that entire ecosystem, so instead of taking a couple little seeds in their rainforest analogy, you're taking the whole rainforest and transplanting that so you're transplanting all of the organisms and then all of the other things around it, so all of the biochemicals and molecules that those organisms are producing, you transplant the whole thing so you can now reestablish a healthy ecosystem and that's why that's so powerful. - So fecal transplants have shown remarkable success in recurrent clostridium difficile infections. So people who have these recurrent clostridium or C dif infections have tried traditional therapies, largely antibiotics, which haven't worked and if anything they've made the problem worse and then fecal transplants apparently are successful in over 90% of the people who've been given this treatment for recurrent C dif infections. - One of the reasons that fecal transplants for C dif infections is so successful is probably because in those kind of infections, your healthy microbiome is completely ruined, you basically have a ruined ecosystem and then once you introduce a healthy ecosystem, it can take over. In other disease state, that might not be the case and that might be some of the reasons that fecal transplants doesn't work as well on those other diseases. - Open Biome is a nonprofit stool bank. We're the first public stool bank and that means that it's our job to find extremely healthy people to donate stool and then we process that stool and turn it into treatments for a really common hospital infection and also for research on the bacteria that live in our guts. - Fecal transplantation is a new and emerging area of probiotics, for people's health because the fecal transplant is really a mix of different things but also has live bacteria in it and ultimately we think it works as a probiotic and it's the only probiotic we know that once we give it to somebody, it literally sticks inside of us that it becomes more of a permanent conversion over a period of years, where a probiotic that we take off the shelf, it only lasts as long as you take it and maybe a month or two afterwards. You have to keep taking it where a fecal transplant you do not. - So to some degree, fecal transplant in different forms has been around for a while. I don't remember the exact date, but there are very old script from China I think where a physician suggested using fermented fecal suspension to treat many different diseases. I think it was called yellow soup because branding was an important issue over then as well. The nice thing about modern time is because we now have those technologies to assay the microbiome, we can see how did the microbiome look like before the fecal transplant, a day after the fecal transplant, a week after the fecal transplant and compare this to the microbiome composition of the donor. - Fecal transplants are generally given by two routes, either through the nasal or oral cavity. In some cases they're given by enema. - I think a lot of things could impact whether a fecal transplant would be successful or not. Some of those are genetics and diet and host life style. A big part is what you already have in your gut and it's the same thing that we see in macroecology, right, trying to introduce a new species to an ecosystem sometimes works great, in many cases doesn't work at all and the species completely get wiped out and in other cases, having horrible consequences because this new species is somehow interfering with an important part of the ecosystem. We do know that indigenous population usually have a more diverse microbiome. There is undoubtedly a lot of things in the westernized world that is reducing the diversity, all the way from hygiene to our diet which is probably less diverse than some of the indigenous populations. Generally we think that a more diverse microbiome is healthier, but again, at the end of the day, it's a matter of scale, I'm not sure I can tell you with high confidence how diverse your microbiome should be specifically given your lifestyle and your genetics and your diet. - But you can't conserve species without thinking about putting them in the right environment and the exact same ideas are at play here when we think about our microbiota. Whether it's taking a probiotic or receiving a fecal transplant, these organisms are not going to persist longterm unless we make sure that they have the appropriate environmental conditions to thrive and most of the time, then that's gonna come back to diet. - From what I've seen being trained as a microbiologist, microbes can do something today that's different from what they do tomorrow and so the gene expression analysis seems to be a snapshot in time and I think for individuals they should do multiple studies maybe once a month for a year to see if the pattern is the same but I would suspect that the same population of bugs is gonna differ based on what they're fed, if there's a bloom, if there's a phage insult, and it's not gonna be the same from day to day to day. I'd be very surprised because we don't eat the same diet day to day to day to day. - So when you're receiving all this DNA and all these genes from a donor, whether that be a stranger, family member or whatever it is, there's a lot we don't know within that box of chocolates. Like life's a box of chocolates, you never know what you're gonna get, but it can be also a Pandora's box for all we know. So at this point, you use it when you need to but otherwise it's not a cure all. That's the danger in applying it to everything. - So we were looking at this thinking okay, this can't be how we solve this problem. On the one hand, you've got the most common hospital reccurent infection in the country and on the other you've got a treatment that was in the literature demonstrating to be about 80 to 90% effective for treating these patients who don't respond to standard therapies and the only thing bringing them together at the time was an at home enema kit and a very relaxed roommate who was happy to help and I think we saw that and said, you know, there's gotta be a way to reduce the barriers to clinicians being able to offer this to patients. And so out of that conversation came the idea for a stool bank, like a blood bank so that patients like him can have safe access to the treatment. - How does it go, how does it work? So people come in, they donate, you freeze it, just give me kind of the process. - Our work starts from our donors and so we scan the population around our lab in Massachusetts, in Boston, to find really really healthy people and about 97% of the people who come to us to participate in our donor program actually fail out and so we accept only 3% of applicants. - I think we're gonna find that poop has value and that I predict, just now if you were trying to assess a new drug and you were going to do a clinical trial, every clinical trial needs blood tests. - Once we find these super healthy people, we then have them enroll for at least two months in our donor program and those folks will come in every day that they can over that two month period to contribute a sample and so when they drop off a stool, that's when it starts to go into our lab and we screen it and we filter it and we mix it with a cryopreservative that lets us freeze it and keep the bacteria alive in that frozen storage and then when it's ready to go, we ship it out to hospitals and clinics around the country. - I think that all the clinical trials in the future are gonna have poop tests and they're gonna put them aside because there's tremendous information in the poop. Mostly undiscovered but eventually scientists are gonna discover what's the message there and that will help us guide health and disease. - Beyond C dif, one of the areas where researchers are most excited about a potential therapy using the microbiome to treat disease is in ulcerative colitis, which is part of the family of inflammatory bowel disease and ulcerative colitis is chronic, it's difficult to treat. Patients often face really dire outcomes if they failed available therapies and what's promising is that research in using fecal transplantation in ulcerative colitis has shown that we can induce remission in these patients through a fecal transplant. - An 18 year old young woman came to see me with ulcerative colitis. And she was pretty desperate because her doctor, her gastroenterologist said, okay, here's the last drug I can give you 'cause the last three failed and the next step is to get your gut cut out, okay? And, you know, 18 year old girl, sorry, young lady, that's bad, she said, well, let's go see an alternative doctor, see if that's some kind of perspective on this. She came to see me and of course I did my history and said, well, tell me about your life, what's going on with you? And as I discovered from talking to her, at age nine, she was having chronic urinary tract infections, so rather than trying to find the cause of chronic urinary tract infections, she got standard care which is daily antibiotics. - We work with gastroenterologists and infectious disease specialists to treat C dif. The body of clinical researchers we work with range from, I mean, it depends on their area of interest, but they'll be experts in the disease indication that they're interested in researching and then to their expertise, we come in with our experience with fecal transplantation to support their work. - Well, by age 11, she was noticing all kinds of gastric upset and while she wasn't having urinary tract infections, she was still taking the drug and her gut was really messed up. By age 14, she was diagnosed with ulcerative colitis and by age 18, it progressed so far that she was in serious trouble, so clearly, the antibiotic wrecked her gut microbiome, so I put on my standard protocol for ulcerative colitis, which is basically no wheat or dairy, omega 3 fatty acids and good quality probiotic so did all these things with her and she got maybe 1/3 better, started to use the drugs, she was doing better but just wasn't quite there. And then one day she came to me and said I want to do one of these fecal transplants. What do you think about that? I said, well, probably a good idea, but at this stage, this was 10 years ago, at this stage, the legality of it is not clear and I don't want to lose my license by prescribing this. But I think it's a good idea. - C dif infects people at the point in the intestines where the small intestine and the large intestine meet in the cecum, and so if you want to administer FMT, you want to target it at that site so that you can be sure to position the bacteria in that stool sample to out compete the C dif. There are three common ways of performing an FMT. The first is to administer it through a colonoscopic administration, and there is a specific formulation for that delivery route through the lower GI tract. You can also administer it by enema that way as well. That is the most effective way of performing a fecal transplant and is usually about 85% effective. Infectious disease specialists don't perform that procedure but they do offer delivery through a nasoenteric tube, so it's a tube that runs through your nose into your intestines and that's how we deliver the material in the fecal transplant to the site of the infection and that is about 75 to 80% effective in the literature. We also developed an oral formulation, a pill that you can swallow and that makes it a little bit easier on the patient because there's no procedure involved, but it's also a little bit less effective. It's about 70% effective, at least in the research that we've done, part of that is the way we designed the capsules and I think future generations of FMT pills are a lot more effective than this first generation. - So she figures out how to do it, uses her father's fecal material for the transplant, does the transplant. After one transplant, 75% reduction in symptoms. One month later does another transplant. Now all her symptoms are gone. She's off all the drugs and her ulcerative colitis is clearing up, few months later, no more ulcerative colitis, and the last time I saw her, second to last time I saw her, she came to see me and said my ulcerative colitis is all gone now. And now my farts smell like my dad's. (laughs) Okay. - Over the last decade, a lot of compelling research has started to find associations between the trillions of bacteria that live in our guts, the microbiome, and a whole range of health and disease and so these findings include relationships between these gut bacteria and metabolic activity, immune function, even neuropsychiatric disease and so the work that we support is trying to uncover whether those relationships are causal. If you intervene in the microbiome, can you support better health outcomes for patients? - So this 18 year old young lady, her disease was caused by the antibiotics, okay, disrupting her gut microbiome and even though I tried to give her the best probiotics I could, the probiotics that she evolved with, you know, as a child were the ones that came from her family, they're the ones her body was expecting. That was what was necessary to get things working properly and her comment about the feces, her farts smell like her dad's, tells us how complex are the molecules that are being released by these organisms in our gut. It's really quite fascinating. - On the Open Biome website, we have a map that patients can use to find one of the doctors that we've partnered with to provide fecal transplants for C dif so a patient can type in their zip code and it'll come up with a list of all the hospitals and clinics in a certain mile radius around them who already perform FMT. If they're struggling to find someone in their area who does perform fecal transplantation, we do work with gastroenterologists and infectious disease specialists every day to register new partners into our network to make sure that they can provide the treatment to their patients. - And so this young lady, we're now 10 years later. The disease never came back. So she went from being told from gastroenterologists, next step is losing your gut, and still the cause of the problem was still there to now she's totally healthy. - Clostridium difficile or C dif infections are a horror for those afflicted and they can kill. Fecal transplants are saving lives and restoring a healthy microbial balance in these patients. Look, it sounds gross, but it's better than dying. Now this field of medical research is blowing up. There's even some suggestion that the stool from a happy person can help someone suffering with depression but only with a few administrations and a diet change to match that of the donor. We've all become to quick to think that we can just take a pill to fix everything and make problems go away. Without any lifestyle change, even to the point of taking crapsules. Look, don't get me wrong, if you get C dif fecal transplants are highly successful and could be your best bet. But we've got to switch from that old reactive lens of the broken healthcare model to a new proactive lens of microbiome medicine. It's about how we live and what we eat. It's not just about taking probiotics, again, it's about living probiotically. Here's some key takeaways from this segment. (upbeat music) We have 450,000 C dif infections with almost 30,000 deaths in a year in the United States. It's a dangerous infection with very little hope if traditional therapies fail. Enter fecal transplants, why? Because many of these beneficial organisms, we haven't been able to grow in a lab yet. And so these fecal transplants allow us to move an entire ecosystem over into the patient. They're generally given by two routes, either through the nasal cavity or the oral cavity and sometimes they're given by enema. What's promising is that the research in using fecal transplants for ulcerative colitis has also shown that we could induce remission in these patients. Here's the challenge for cases outside of C dif. It may take a few attempts to get the results to stick and you need to eat like your host in order for it to work. That means something very important. You can't simply do this and get a get outta jail free card, you still need to change your diet and lifestyle for lasting results. Living probiotically is the future of healthcare and if you want to share this series with your friends and family, here's the best way to do just that. Click the link below so you could own the complete Interconnected documentary series at home and when you purchase the full set, you're gonna qualify for some amazing bonuses, including the extended interviews, two Q&A sessions where you can ask the experts anything you want and then the collection of companion guides that cover everything from cooking to gardening to fermenting at home. Guaranteed, Interconnected is leading the way to the next frontier of medicine. Join us, won't you? Hit the link below, check out our limited time discount offer, it's only available while these episodes are live, come back later and it's too late and you miss out on the big discount, so grab your copy of Interconnected. It's the power to heal from within. Grab it today and spread the word amongst your friends and family, help me get this information out there for a happier, healthier future for everyone. Let's now look at another innovative area working to bring microbiome based science to the masses. The real revolution is gonna happen around personalized healthcare and that's been a tough nut to crack, there is no one size fits all diet for my lifestyle, for my microbiome, so what do I do? What's inside my gut and what does it need more of, less of and the right balance of? With advances in RNA sequencing, powerful computers crunching big data and artificial intelligence, the answers are coming. And new companies are now embracing this technology and making great strides. (gentle music) - You know, if I have a patient coming in, one of the first places I look at is their gut microbiome, so we've had many tools in the past that have looked at the gut microbiome, all of those tools that were available to me as a clinician were always identifying what's there, what organisms are there and even though we know how important the microbiome is in overall health, they were very limited tools because it didn't allow me to determine exactly what my patient needed. We now have access to a technology that not only can identify what organisms are there, we can identify what those organisms are doing and I think that's the real game changer is that we now know is these organisms are using this certain food and they're making this certain substance and we know what those substances do so now we can take that information that comes from a stool or microbiome test and we can say exactly that this person will benefit from this type of food and actually this food, which may be healthy for someone else, is probably not going to be healthy for you, so we have that ability in a stool microbiome test by using RNA sequencing and looking at what the organisms are doing. - Our gut microbiome is composed of hundreds of different species of microorganisms and the variety of organisms is such that you have a technology that can for example quantify some bacteria or some viruses or some other organisms, you're only seeing a very small portion of the picture and so really, the ability to take a stool sample, for example, or any other part of the human body and all in one snapshot, get a very crystal clear picture of all organisms that are currently living in that ecosystem, that's just a fantastic source of data that you can then use to understand how that community is affecting someone's health or human health and that's just one part of the technology, that's not actually the most important part, the most important part of the RNA sequencing, is that you're actually getting a very clear picture of what those microorganisms are doing. - We're dealing with antiquated systems, antiquated thinking in healthcare, right? - We need to solve the healthcare problem by understanding exactly what's happening inside each individual body. The reason we haven't had the solution so far is we're looking for one silver bullet, one drug for everyone, so what we do is we look for the set of symptoms and we call the set of symptoms, we give it a name, the fact we give it a name, now we can have a drug for it, we can have an insurance code for it and everybody's happy. Mayo Clinic published a research on the breast cancer being caused by microbiome and we just had a research two weeks ago on liver cancer being caused by gut microbiome and you start to think about all of these chronic diseases, the science is clearly showing where the things are coming from and every drug company's resisting because they cannot make money from this. This has to stop. - For me, it's obvious that you have to first try and figure out what are all of these organisms doing in your body and so we started with, you know, biological testing of your stool sample, which is the most direct way of getting access to what is going on in your gut microbiome which is the largest concentration of microbes in your body, then we get a lot of information from our experts in biology, in nutrition, in functional medicine and so forth. We have a great community of people who have developed an understanding of how to turn that information and interpret it for people's benefit. - What we people don't realize is there's no such thing as lung cancer, it just happens to be a cancer in the lung, and there may be different types so we need to rethink as opposed to the people who are lung specialists, the people who are heart specialists and people who are kidney specialists, people who are pancreas specialists, really saying let's start to look at each individual by itself. - We also can get information from people's interaction with their environment, like when you eat certain foods, what's going on with you, right? You can explain your symptoms, your phenotypes and that information can also be integrated. - And you will realize soon enough that chronic diseases are caused by chronic inflammation and the chronic inflammation is caused by the imbalance of the gut microbiome and that's really where the key is. Understanding what's happening in the gut and most people have completely ignored that in the western medicine, right? Three months ago I found out that my dad had the pancreatic cancer. And I'm telling you that I've never ever thought I would hear this news, I'm helpless. They put him on chemotherapy and after six weeks of chemotherapy, he cannot walk, he cannot talk, he cannot even get up from the things. We stopped his chemotherapy, I mean, they are killing him with these drugs. And I told him, Dad, I don't know if I'm going to be able to save you, but I can promise you one thing, if I had started the company to solve the healthcare problem, and these chronic diseases, if I started two years ago, we would have found a cure by now, I don't know if I can save you but I can promise you that I'm gonna stop everyone else from suffering from any type of cancer because we now realize that pancreatic cancer actually comes from the gut microbiome actually coming from leaky gut moving into pancreas, shutting down the immune system and what the research that was published was specifically about how pancreatic cancer is caused by the gut microbiome. - So what I do is I analyze all kinds of molecular data in the context of pathways, so we call this, it's called pathway analysis and that allows you to understand the underlying biology of the situation, so that could be in the gut, that could be how the organisms interact so it's really the molecular pathways that tell me what functions are being carried out by your microbes so what your microbes are doing is basically what this entire role is about. We take human stool samples, so customers would send us, they get a kit and they send us stool samples and from there we sequence everything. On the RNA level, so that's the meta transcriptomic technology. - Here's very interesting that people don't know that there are more foreign cells in human body than the cells that we get from our mom and dad. Our DNA produces only thousand genes and our microbes in our gut produce somewhere between two million to 20 million genes, think about it for a second. That means we are less than 1% human and that is just the beginning of us becoming an ecosystem and connected within ourselves and connected to the nature and environment outside us, and anything that happens outside of the environment affects us and what happens inside us which is impacted by the food we eat, really changes who we are and that's why I would believe that once we understand the connectedness of the human body and the ecosystem that is humans as a walking, talking ecosystem, living in this larger ecosystem we call universe, everything changes. - So metatranscriptomic technology allows you to see the activity, so the activity of the microbes. But even more interestingly, it shows you not just how active they are over all, but it shows you what are they actively doing, like what are they doing in there, so are they processing something, are they excreting something? They could be doing something good for you like producing butyrate, a short chain fatty acid that's very beneficial for you on many levels but primarily for gut health, it has so much benefit. - Every microorganism is performing biochemical reactions. They are required for their metabolism for their life, they produce and digest molecules and so every organism, every microorganism is able to perform all kinds of different biochemical reactions, but they don't perform all reactions all the time, so they have the capacity to do that and by sequencing DNA, you can tell what their capacity is but you don't actually know which ones they are performing. And so with RNA sequencing, you get a very clear idea of what exactly they are doing and what exactly they are not doing. And by correlating that to human health and disease you can understand what makes essentially a healthy gut and what makes an unhealthy gut. - And then finally there's a lot of scientific knowledge that's out there, that, you know, comes from various clinical trials and so forth, so you can take all of that knowledge, put all of these sources of information together and start to build models or kind of an approximation of what is really going on at the molecular level in your body. - At Viome we have the largest dataset of metatranscriptomic analysis of human stool in the world and so we have a lot of metadata associated with that dataset. We know what people should be eating because we made those recommendations, we know how well people are following those recommendations, and we also get feedback from the customers as to how well they're feeling and so based on this massive amount of data, the AI engines can actually make sense of them and make recommendations. - We will tell you who they are, what are they actively doing and how that may impact your health because the next step is to affect any of this, to do anything about it, to support the good functions to balance out the bad functions, that's where the recommendations come in, so you can do something about it. - Once you build these models, you can then start to explore, you know, why things are happening the way they are, what might happen in the future, meaning predicting whether a certain state is eventually going to lead to a disease state or a wellness state, so all of those kinds of techniques can be performed through the toolkit of artificial intelligence. - For instance, you can have some probiotics that you're taking, maybe if you take enough, the DNA based microbiome test will pick 'em up and say that they're there, but they're gonna be kind of sometimes dead, you don't know, so RNA will tell you, yes, they're actively transcribing because what you want to do is make sure that they're not just trespassers, sorry, that they're there to stay, you want to make them your residents, not just guests for a day so if you have consistent newly acquired RNA activity, that's how you will know, plus of course, if you test longitudinally, you will know if certain organisms are there, who they are and if they're really active, so looks like they're living there, they're thriving, they're making it a home. - I want to give you a sense of the amount of data that you can get form a single sample, right? If I get a gut microbiota workup, a stool sample, go through the lab process and generate the data that corresponds to that one sample. It's several gigabytes of data. In fact, if you think about it as the number of books that you might want to read or something, in one sample there's the equivalent of like a public library's worth of books. - It may take a million people for us to solve most problems, but we can already solve the low hanging fruit and we're already helping thousands of people at this point in time with very precise nutritional recommendations as to what they should eat and what they shouldn't and the reason for that is that we actually are generating a dataset that tells us, that informs us about what the microorganisms in someone's gut are producing in terms of biochemicals and we already know many of the chemicals that are bad and many of the chemicals that are good and so, but we're also learning some new ones, some new players and so based on all that information, we can already make very precise recommendations to improve people's health and wellness. It's impossible for a human being to be able to go through all of that data and make some pattern or judgment call about it so we bring the heavy duty machines to start making sense out of this, so you know, we first get as many samples as we can from across the whole community so we get a diversity of data and then we start looking for what are the common patterns, meaning common microbial communities, that tend to provide certain kinds of clues towards a person's phenotype. - Once we have enough confidence that something can be assessed, with accuracy, then we basically try to organize it in a way where the AI system will incorporate that into our recommendations that will be viewed by all of the thousands of customers when they get their results so for instance, I mentioned butyrate, right? Recommendations will actually work all of the levels of butyrate activity, or pathway activity into this whole system. - I could say every person who has, let's say, regular bowel movement, it's a very simple thing that you can think about with respect to a gut microbiome, right, everybody who has a regular bowel movement, what is common in terms of their microbial composition? I can ask that question to a computer and I can get an answer, it'll say look, here are the species of microbes and bacteria and virus and so forth that happen to be common across all the people who report regular good bowel movement and on the other hand, people who have constipation or people who have diarrhea report lots of issues with their body and of course their microbiomes are also quite different than the people who report normal bowel movement, it's a very simple direct way of associating what's going on in your gut to something that you can explain to other people, right? So artificial intelligence ultimately, you know, when you look at it from a technologies perspective, it's a very large toolkit of different approaches, algorithms, infrastructures, and methods and so forth, all of my colleagues and my team members, we all apply these methods to the data that I just mentioned which you can get from a person's biology and then we ask all the hard questions, you know? Why, you know, why is a person's microbial environment out of balance? If it is out of balance, how can we bring it back into balance, what has been the history of this person's microbiome and has there been a time where this person was healthy and they had a very good balanced microbiome, can we take them back to that state? - And what we hear back every single day is people say we lost weight or people say our acne's gone or our eczema is gone, people call us and say, my depression is gone and people are calling from around the world and saying I used to have anxieties, I no longer have it. - So we can start asking questions about for people who have the following phenotype, what is the pattern of the microbiome? In some sense, what we start doing is we start building a map, start building a map of okay, so if a person is healthy, they're over here on the map, you know, person is unhealthy in one ways over here on the map, unhealthy in a different way over here on the map and so on and so forth. - And now that we're understanding at a very good level how the gut bacteria control, how their biochemical activity controls our inflammation, if we can reduce that inflammation by adjusting the diet and making the bacteria produce the good chemicals and not the bad chemicals, we may be able to get rid of other secondary symptomatic diseases. - I went to see Dr. Marvin Singh here in Ancenedis and he's the one who got me onto the microbiome. And that's changed my life. He had me do the Viome testing and with that, it's funny 'cause I had already done the diet changes to heal the leaky gut, by the time I had gone to him, he said, Patty, you've already healed the leaky gut. Now let's see what we can do to even heal it more through the microbiome. Things that I'm doing for my microbiome is I'm adding more probiotics to my diet. Viome head suggested certain probiotics for me, actually, three of them and I take those on a daily basis. Then I also do things like I eat more sauerkraut and kimchi, pickles, things like that to get more probiotics into my system. - And so we've had testimonials where people say, I've had acne all my life and nothing has helped and after trying my personalized diet, they went away. And we had other success stories, mostly having to do with weight reduction, we've had some amazing successes with weight reduction, the way I think of that, weight reduction is that the activity of these microorganisms likely causes us to feel hunger and so people are just simply compelled to eat constantly whereas after we fine tune their gut, those signals just disappear and all of a sudden the person can eat normally and just naturally they lose weight. - I actually love the Viome approach to things and I feel very blessed that I was able to take the test and that I have that pinpointed accuracy to it, especially for somebody who has suffered for so many years that I'm not having to do a shotgun kind of approach to things, I really appreciate them and that they're able to say, Patty, you need this one and you need this one and you need this one and also that they are able to identify what foods are best for me and which foods I need to stay away from. Because I've suffered too long and I love it that at 63, I'm able to say I'm in excellent health. - I think this is going to become a personalized medicine approach, once we have enough solid data, we can go into clinical trials and show that this actually works using the standard FDA model or not, it depends on the use case, but this will definitely turn into a primary mode of disease management. We're going to shift from wait until the symptoms show up, wait until you have your heart attack and then we'll treat you, wait until you showed signs of dementia and then we'll treat you, wait until you have retro arthritis in your 40s or 50s and then we'll treat you. - I think we can turn much of this data into recommendations for daily life, so foods that people can eat, supplements they can have, lifestyle changes that they need to make, right, those kinds of things we believe we can already give the initial recommendations. Now do we know everything there is to be known and actioned upon in the data? I don't think so, I think it's going to take a long time but I think we have enough to make a difference in people's lives and if you want real proof of that, there's been a whole bunch of clinical trials that have shown that a certain diet changes your microbiome in order to make you less prone to depression, for example. That's been shown. There's been studies that show the same thing for metabolic diseases and for arthritis and other kinds of autoimmune kinds of disorders, so those kinds of things are actionable. - Why not start eating healthy in your 20s and 30s so that you know for a fact that you will not develop rheumatoid arthritis, you know for a fact you will not get a pancreatic cancer? That would be such a profoundly beneficial concept to the whole humanity and our disease burden would not just decrease, but also look at all the economic drawbacks of having such a large disease burden, the national healthcare systems are falling apart because they're just, disease management after symptoms show up just costs too much money. - Now it's still cutting edge and these studies are only coming out in the last year, two years, three years, so these are, you know, things that you need to be looking for and be at the forefront of, but these are things I believe we can get started with right away. - And now we can study the human body the way it should have always been studied which is as an ecosystem. We exist as an ecosystem, we affect the microbiome and the microbiome affects us and if you study both of those we can really understand how we can prevent chronic diseases and so that is really the mission of Viome is to make illness optional. - And we wonder that we don't focus on any of these symptoms, all we are doing is putting the gut in balance, reducing the inflammation in the gut, fixing the leaky gut and all these symptoms that people used to have are seen to be disappearing, so I just want to be very clear We are not diagnosing any diseases, we don't claim to cure any of these chronic diseases, but interesting thing is, simply by fixing the gut people are telling us that all of these chronic conditions from acne to eczema, from depression to anxiety, from diabetes to obesity, these seem to be just disappearing and to us, I mean we are still at a very early stage, don't get me wrong, this is a very new science. We are the only company for the first time has underlying technology that is able to look at every gene expression of every organisms in your gut, not only we know what organisms are there, we know how active they are but more importantly, what they're actually doing. That has never been done. - I'm really excited to see where this is going and it's not just my personal take, I constantly talk to people from all kinds of different backgrounds. Of course I have the scientific network, but I also know wonderful physicians, people that are more on the precision oncology side, people who are wellness coaches, people who are perinatalogists, so when you see that, I tell them what I do and they get really, really excited. They're like, oh wow, we wanna try this, we wanna do a study with you. We want to work together because this is where it's at, you know, you have to take the whole picture into account and we're actually doing it, so yeah, I'm extremely excited about that. - People think I have a death wish. They really think somebody is going to kill me, the pharmaceutical companies, I am not worried because genie's out of the bottle now, the movement is started, it doesn't matter whether it's me or someone, this movement is not gonna be able to be stopped, you cannot put this genie back in the bottle again so I'm gonna constantly push the boundaries and get as many people as I can to stay healthy and once they get control of their own health, become the CEO of their own health. There is no doubt in our mind that we are going to essentially change the trajectory of how humanity is going to live and someday we're gonna live in a world where illness is truly optional. - What an exceptional time we live in, to think the technology is here that'll help us personalize our diets and teach us exactly what our individual microbiomes need to thrive. That time is upon us. There's still a good amount of work that's needed in the field but we're seeing profound results in the lives of the early adopters to this technology. Here's some important highlights to remember. (gentle music) Metatranscriptomic technology allows you to see the activity of these microbes. Looking at RNA versus DNA allows us to see realtime activity versus who's simply there. Stool samples give a clear picture of organisms living in your gut. Not all quote unquote healthy foods are necessarily healthy for you. Retesting annually or even more often helps you track your microbiome and guide your healthcare decisions. We're at a difficult time in the emergence of these new fields of medicine for many individual patients. Many doctors have little idea of what's going on in this exciting field, yet they're the gatekeepers to your health, in this segment, we're gonna look at available testing you may want to consider. Ask your doctor about them or find a doctor that's open minded about testing. Some you can even order yourself. The point here is that it's your body and it's your life and it's important to take some ownership and work in conjunction with a good doctor to figure out the best possible course of action for what's ailing you. What you'll see next will help you get started. (gentle music) - Many companies and academic institutions will provide the service of sequencing a person's microbiome at a reasonable cost and then provide you with that data, in most cases, the data is largely descriptive, it'll tell you what organisms are present in you at one given point in time, obviously through repeated longitudinal sampling you can get a time series. - I love to test what's going on in the gut as much as I possibly can and so stool test is, I mean, pretty much everybody who's walking through my door, unless they actually, you know, just aggressively rail against it, they're doing the stool test. - But I think it's useful information because I do believe that someday, we'll have a better understanding of the function of particular microbes or the function of particular microbial communities and you'd have the information from years or decades ago to potentially use in treatment of diseases you may develop in the future. - We are in the infancy of our understanding of the microbiome, we now can do testing on the genetics of your microbiome, we can look at all these biomarkers in your stool to identify what's happening, and we can characterize those and they change over time, they change with your diet, they change with various factors, so as that becomes more sophisticated, we're gonna learn what it means. - I've been doing microbiome testing really since it first became available, I started doing the earlier stool testing where you look for certain organisms, so you'd see if they would grow, look at 'em under a microscope, but then when the DNA testing came out, we called this sequencing based testing, I was an early adopter so I've been doing this for many many years in our practice. - We're going to analyze the DNA of the microbiome and it's important, it's useful, it guides our therapy, it tells me what's happening in their individual gut. It tells me what kind of inflammation is generated or do they have enough of the various fatty acids they need to keep their gut really healthy and robust, anyway, it's an essential piece to my investigation and all my patients, we need to see what's happening in the microbiome. - What makes me really excited about the microbiome is where we're going with the ability to test. I've been doing this kind of testing for many, many years now and I've gotten pretty good at looking at patterns and recognizing patterns, but I think for the average doctor, it's maybe a little bit too complicated, I don't mean to say doctors don't know what's going on, but unless you're doing this day in, day out it's somewhat hard to interpret. I think where we're going in the future is using artificial intelligence. - One of the most exciting things, I think, coming out of this work, is that not only do you have your genome and your metabiome, which is all the metabolic things that happen as a result of your genes producing proteins and chemicals, but you have literally 100 times as many genes, if you have 20,000 genes, you might have two or three or four million bacterial genes in you and those are all producing molecules, they're producing proteins and they're producing enzymes and producing all sorts of things that are being absorbed and your body is actually using. - I'm very excited about not having to figure things out. I'm very excited about the idea that you can put all this data and when we're sequencing the DNA of 30 trillion bacteria, we are talking about massive amounts of data and we don't want to just know what bacteria are there, we want to know what genes are turned on, there's not just 30 trillion bacteria. There's three million genes, there's 20,000 human genes. There's 20 million bacterial genes. Wow. - So if you do a blood sample, we now can literally measure the metabolome of your microbiome and that's just a whole new frontier. - There are simple blood tests that we can do to see if that inflammation is going on in our body. One is called C reactive protein. You can get that done anywhere. There's actually mail in labs now that will let you send a pinprick sample, mail it in and a week later find out what your C reactive protein is. If your doctor says, well, I'm not gonna measure that in you, I don't believe in this, then I say, okay, do it yourself and you can find out, again, inflammation is the underpinning of any chronic disease that you can name. - Ayurveda, it's clear that their focus is on the gut as the foundation of health. I think in the 1900s, Eli Metchnikoff who won the Nobel Prize really built a foundation for this field by understanding that gut imbalances in the microbiome, you can call it that, were at the root of so many diseases. - A few years ago, when I was delving deep into the microbiome research, I used to use stool tests that would help me understand what was going on in my patient's gut, what was their in supply of different bugs, and what was the diversity, all these kind of things. - I see a lot of patients that come in for perimenopause and menopausal issues. So the questions they ask are what's the healthiest way to transition through this perimenopause and menopause process, I have a lot of patients that have gut issues. And I have a lot of patients that have mood issues, little anxiety, depression. And I use a similar approach, no matter what those issues are of the list I gave you so it's making sure that the gut is healthy. I want to make sure that they're not eating foods, I mean, people eat three times a day. I have to make sure that the foods they eat don't cause inflammation. - Now some patients will say to me, hey, doc, I just want the test. I want to be able to track this in three months and six months, fine, I've got no problem. I really like the doctor's data stool test. I think that's very accurate, very down, very to the point, it's got a good reliability data there, so that's the one I tend to use. - I want to know what their microbiome is, so I'll do a stool analysis. I'll look to make sure that their estrogens aren't recirculating through or because of bad bacteria. And that's through a different type of stool analysis. - So my first line is, assume that there's a gut microbiome problem, give them the recommendations that I know will improve their health and then if I need to, then I test, but even when I do test, the big thing I look for now is diversity, okay, it's not so much about the specific bugs, we know that a healthy microbiome is a microbiome where there is a diverse range of gut bugs. - So we really make sure the gut is functioning properly. Then we make sure there's not a lot of inflammation in the body, we make sure that there's no autoimmune thyroid disease, we want to make sure that there's enough nutrients, that there's no foreign body or I mean heavy metals that are causing problems, so it's looking for heavy metals, inflammation, hormonal imbalance and of course gut health. In the ideal world, you'll know what your toxic status is so there are tests out there to see what your toxic load is. - There's ways to test what's in the gut. There's ways to test the structure of the cells of the gut so for example we can do an endoscopy, an upper endoscopy, so we're actually putting a little probe down there and looking and biopsying sometimes and seeing literally what do we see in that lining, right? And then sometimes the cell can tell us what's in there. For example, we might biopsy and see that there is a bacteria called H pylori, which can cause gastritis and ulcers in the gut, in the stomach. - One of the things I remind our gastroenterology trainees all the time is that it's very rare in your practice that you're gonna see somebody who's really crazy. Most people are not crazy, just because you haven't figured out what's wrong with them does not mean they're crazy. What it means is you haven't looked hard enough. So most people are not taking time out of their busy day and paying money out of their pocket to come and see you just because they don't have anything to do. And that's really an important part of this is that we have to keep looking, we have to roll our sleeves up, and we have to figure out why this person is suffering and it really is our moral obligation as physicians to attempt to relieve that suffering. We're not always successful but just because your set of tests and the toolkit that you have has not unearthed the problem doesn't mean there's not a problem. - The gut sends everything to be processed to the liver and then back through the gallbladder and then back to the stomach, the pancreas gives the enzymes into the gut, so they're all linked together and they all communicate together, so the stool testing that I've done all these years have been just so informative, I can't imagine guessing and knowing if someone is digesting fat, if someone is digesting proteins, if they have viruses growing in their gut that I would have never known just based on symptom and if so, which ones, if they have yeast overgrowing, for example, is a pretty common one, and again, why, not just going in there and killing the yeast, but why is it growing? If they have bacteria that is overgrowing that in a normal human being maybe this amount is normal but if it's overgrowing, it could be problematic and so a lot of these tool tests measure how much is in there so klepcyala for example or citrobacter are two common ones that we see that can be problematic but not necessarily and this is where I say we're still learning. - I'm typically the third or fourth or sometimes the fifth or sixth gastroenterologist that people are seeing and one of the things that really brings me the most joy is the sense of validation that people have when I'm able to explain to them that there is something real going on in their gut and that that is responsible for the symptoms they're having and you can just see it in their face, they feel relieved, I mean, nobody's happy to have a medical condition but there's a sense of oh, I'm not crazy, this is real and that, again, that's one of the really rewarding parts of this and then all the better if you can actually make 'em feel better. - There are some doctors out there that see these and go straight to wiping them out. I tend to be more on the side where I pause and I say okay, is this really the root cause of the issue? And sometimes we really don't know, sometimes it's trial and error and it's looking at the research, looking at their symptoms and seeing the whole picture so what I like with the microbiome testing a lot of times which the one I use is called Viome which looks at not just what's in the stool but just everything that you have, it's kinda like genetics, okay, so you have this mutation. Does it mean it's active, it's turned on or do I know if it's turned off, how do I know that, that's the epigenetics, so it's often not about what you have but it's figuring out what are they doing, you know and who's talking to who, who's leading the other one to grow and that's where we still don't know as much as we'd like to and if someone's claiming that we do, we really don't. - One of the big challenges in medicine is something called the translational gap and this really bothered me when I was a scientist and then a clinician is it typically takes about 15 to 20 years before what we know in the science and what's published in the literature actually makes it into clinical practice. That's a crazy amount of time. And there's knowledge that's known in the world today that would benefit people today, why should they wait for 15 to 20 years before they have access to that information? It doesn't make sense, we really are striving to close that translational gap and really make available for people today what we know today so they can benefit today. - Often in a conventional setting, we're taught to be able to diagnose and the diagnosis is not what's the cause of the constipation. It's make sure you rule out cancer, make sure you rule out this, rule out, rule out, rule out. It's often about ruling out, it's not so much about what is it, it's often okay, well, it's not that, it's not that, it's not that so it must be psych. Let's consult psych, it must be too much acid. You know, it's not let's look at the stool and actually see what's in the gut, you know, well, it must be too much acid, let's just give an antacid and off they go. - Our allopathic model is a pill for an ill, right. And it's the easy way out. You've got a problem, you've got a symptom, take a pill for it, you have a disease, take a pill for it and even in medicine, that's how we're taught, right? Our hardest work as a doctor is actually in making the diagnosis so we're, the best doctor out there is the best diagnostician, it's someone who can name what's going on and that's what a diagnosis is is taking this collection of symptoms and putting a name to it, and then once that's done, that's the hard work. Now there's a pill for that name and that's really how medicine is done and that's the easy way out. - But I've also learned other things that have evidence, like herbs, like nutrition, that's out there that all these researchers are doing the work, they're publishing, but no one's reading it and it's not being taught at medical schools. They get four hours of training in nutrition so of course we're sort of brainwashed in those four years by our teachers, by our mentors, by what these people tell us to do and really it's fear, it's fear based medicine. It's you want to make sure you don't lose your license. You want to make sure that you don't miss the red flags. - So the old medicine was when you go to a doctor, you're diagnosed with MS or you're diagnosed with rheumatoid arthritis, here's the drugs that'll help you along. None of these treatments ever stop the progression of the thing, they can slow it down a little bit but it's a life jacket, you're still in the pond of the disease. None of them stop it. The new medicine is let's go to the prodromal period. Let's identify now if you have these antibodies killing off your brain. I had three antibodies killing off my brain. I did this test in 1997 when it was research only. This is what got me into this whole field of talking about this because I was 44 doing triathlons regularly, scoring in the top 10% of the 30 to 35 year olds at 44. So I'm just walking tall, I'm a stud, I'm healthy. And I did this blood test and I had antibodies to myelin basic protein elevated, that's MS, the mechanism of MS. Antibodies elevated to cerebellum, that's what shrinks your brain and old people can't walk up and down the stairs very well. And antibodies elevated to gangliocytes, that causes shrinking of the entire brain. You get non Alzheimer's dementia. I called the lab and I said what is this? This is a mistake, I'm healthy and they said no, it's no mistake, I said, do it again, they said, we did, we know it's you, we did it again, and that's when I got religion about this. Wow, and that's when I learned about this prodromal period so the new medicine is identifying if you are in the prodromal period, where is your genetic vulnerability, where is it showing and then what do you do about it? And so you do the tests now and you identify if you're in that period because if you find that you've got elevated antibodies to your brain, then that's gonna freak you out. Which is gonna be the motivation to ask the question why do I have elevated antibodies to my brain? Which then motivates you to get out of the pond and go upstream to figure out what the heck is happening. - There are many tests and many styles of doctoring. The old way or the new way. You need to find what works for you. Trust your instincts and ask for tests you want or go out and get them done on your own. Just keep going. My team's assembled a comprehensive list of the best tests out there and included it in the companion guide, but look, the science keeps moving forward and new tests will replace old ones almost daily so it's a moving target and it's an evolving science so just know that and roll with it. Here are a few testing highlights to keep with you. Take a test to analyze your microbiome DNA and RNA. You can order some tests without a doctor. Baseline testing will help you later in life. Look at your genetic vulnerability now. Discuss the results of these at home tests with your doctor. (gentle music) What we're learning is that it's time to take the power back into our own hands, conventional medicine has hit a wall with chronic disease and this new interconnected understanding of health is picking up from there so I urge you, click the button directly below this video and get the full Interconnected series. Every single episode for you to watch is there so you can rewatch and learn at your leisure. Plus you get a collection of our exclusive bonus resources. For a limited time, you get this entire package at a massive 50% discount, but only during this live launch. You get lifetime access to everything you've seen in these episodes, plus companion guides, extended uncut interviews and the how to live probiotically guide that helps you put all of this into action, the future of healthcare is personalized medicine, so get this Interconnected set right now and come with me on this journey. Knowledge is power. We can now look at preventing disease by knowing what we're vulnerable to and we can boost our resilience by strengthening the diversity of our microbiome and we can offset the harmful effects of environmental toxins. We live in challenging times, but we have an opportunity to rise and meet the occasion. We need our health for the journey. And that thought concludes this episode and gives us hope for the future. Next, we move to our final chapter and the last episode of the Interconnected series. Let's tie this all together and look at the future of medicine and personalized health. Let's reexamine the broken healthcare system and hear from those creating a better one that centers on you, again, I'm Dr. Pedram Shojai and I will see you in the final episode of Interconnected when we explore how to build and protect our microbiome for ultimate health and vitality. (inspirational music)