Functional Foods for Metabolic and Microbiome Health

Adapted from episode 63 of The Perfect Stool podcast and edited for readability.

Dr. Chris Damman, M.D. is the chief medical officer and chief scientific officer of UR labs and a clinical assistant professor of gastroenterology and medicine at University of Washington.  He previously led the gut health, microbiome & functional food initiative at the Bill & Melinda Gates Foundation.  His research interests have focused on the role of diet and microbiome-targeted therapies in treating gastrointestinal, metabolic, autoimmune and neurologic disease.  Chris earned his MA from Wesleyan University, MD from Columbia University, and is board certified in gastroenterology.  

Lindsey:  

Welcome Dr. Damman. 

Chris Damman, MD:  

Well, it’s a pleasure to be joining you. Great honor. And super happy to be talking with you today.

Lindsey:  

Yeah. Thanks for coming on. So nice coincidence. I actually am a Wesleyan University alum as well. Did you do your undergrad there or just your Master’s?

Chris Damman, MD:  

It was actually both combined. Yeah.

Lindsey:  

Okay, cool. What year did you graduate?

Chris Damman, MD:  

Oh, let’s see, it would have been ‘99 for my Master’s, ‘98 for undergrad. How about yourself?

Lindsey:  

‘91 was my was my undergrad so well, distant. Okay. That’s great place, though, isn’t it?

Chris Damman, MD:  

Oh, I love it. Yeah, it’s a campus that embraces diversity and it has a wonderful science program. I was pretty fortunate to be able to get involved in science pretty early, starting with just washing glassware and working my way up in Hall-Atwater. So yeah, I’m indebted to my mentors there and the wonderful faculty.

Lindsey:  

Yeah, my only relationship with science there was studying in the Science Library. I lived In Clark, which is right across the street from it. 

Chris Damman, MD:  

Good, quiet place to go. 

Lindsey:  

Yeah. My interest in science came much later. So anyway, I would love to hear more about your work with the Bill and Melinda Gates Foundation on the gut health, microbiome and functional food initiative. Can you tell me a little bit about that, and the kinds of microbiome-targeted therapies that were developed under your tenure? 

Chris Damman, MD:  

Yeah, absolutely. So first of all, it was amazing opportunity of five years. I’m indebted to my mentors there as well at the Bill and Melinda Gates Foundation, but also particularly indebted to the folks I was working with in low/middle income countries like Tahmid Ahmed, and Assad Ali at Center for Diarrheal Research in Bangladesh, and Ali Khan University and just really want to highlight the in country perspectives that were so important. But with that said, in collaboration, I think we made some really important strides in malnutrition. And I think historically, we have thought of malnutrition as a condition that’s impacted by foods naturally. And by bad microbes, or bugs or things like ecoli, that cause diarrhea. The new lens that we brought to the field was looking at the microbiome and the gut, in order to provide a new lens for understanding how malnutrition works. And we came to realize just how important the healthy bugs are, as well, and how they were depleted in the intestines of children in low/middle income countries and how the lack of those bugs was also very profoundly contributing to malnutrition. So that was the new lens that allowed us to develop some really powerful new therapies.

Lindsey:  

Cool. So I’m curious about that because when I think about people in lower income countries, the one thing I don’t think about is a depleted microbiome, I think that the lack of sanitation is leading to a lot more bugs or, you know, living closer to nature.

Chris Damman, MD:  

100%. And, you know, as we understood, the impoverished microbiomes, you can kind of think of a visual, like, look at a vibrant coral reef. Imagine that in your mind, and then think of one that has been bleached or devastated. And that’s essentially what’s happening in the guts of folks that have imbalances or dysbiosis, or in this case malnutritition. What we were able to do is use that understanding in order to come up with new ideas for therapies that actually in well designed studies panned out to be impactful. And we’re actually following up on those studies right now. But one of the new approaches was a very special probiotic that we were using in children, actually infants, very young children, and that helped them actually grow better. And then another intervention where…

Lindsey:  

Before you go on, let me ask you what, what strain? 

Chris Damman, MD:  

Yeah, absolutely. This is a strain of Bifidobacterium, longum infantis. And not all bugs are to be created equal. Not all Bifidobacterium are to be created equal, and this one has machinery within it that helps it digest the fiber that’s present in mom’s milk. 

Lindsey:  

HMOs 

Chris Damman, MD:  

HMOs. You got it. Yep. Human milk oligosaccharides. And these bugs are particularly facile at bringing those HMOs inside and consuming them. A lot of other bugs are kind of messy eaters and a bit like Cookie Monster, they might leave a lot of crumbs around for pathogens to consume. B longum infantis is different. It brings those HMOs inside and keeps it all for itself, and then produces healthy factors that help contribute to the child growing.

Lindsey:  

That’s awesome. Yeah, no, that’s the strain that I have handed off to every person I know who has had a baby, especially if the baby was born via C section.

Chris Damman, MD:  

Yeah, yeah, yeah. There’s some great companies that are working on strains just like this and are actually making a big impact in the field. 

Lindsey:  

Now, was there a specific strain, like down to like the number or just any infantis would be good?

Chris Damman, MD:  

Yeah, it’s a great question. And it’s one that’s unanswered at this point. I think the way we need to characterize strains is by their functional capacity, which basically means the genes that they carry, for taking in fibers and converting those fibers to things like short chain fatty acids, and B vitamins, and even neurotransmitter precursors. And if we can understand that capacity, then that will help us know whether this B infantis is good. And this B infantis may not be as good for consuming those. 

Lindsey:  

Right. Right. Okay. Is there a particular brand that they sell here in the US that you are a fan off?

Chris Damman, MD:  

Yeah, so the, the strain that we were working with in Bangladesh at ICRB was a strain, that company called Evivo*, has developed. And that is actually available here in the US. It’s available, direct to consumer online. 

Lindsey:  

Great.

Chris Damman, MD:  

And, yeah. There’s a lot of great research that’s been done now that supports the benefit of this specific strain. So the other major category of intervention that we’re working on with food, but not food with sort of a conventional approach, but food in order to grow the right bugs in our gut, and for those bugs, then to provide factors that help us grow. And this other approach was in collaboration with Jeff Gordon at Washington University. And it was so called Microbiome Directed Complimentary Food or MDCF. So pretty amazing line of research that led us to a very specific combination of locally-sourced foods from Bangladesh, that grew the microbes in positive associated with health and then when validated in a clinical trial did, in fact, improve the growth of the children as well. And this approach is one that we’ve taken for slightly older children, so not breast feeding children or children that are consuming mother’s milk, but rather, children that are starting to consume complementary foods.

Lindsey:  

And were these probiotic strains or prebiotics exclusively in this food?

Chris Damman, MD:  

Great point. So there were no live bacteria, it was purely a prebiotic approach. And it was a whole food approach, and basically combines things like green banana and different types of legumes, garbanzo beans, and it was the full component of those foods. But probably, if one were to distill it down to the essence of what those foods were doing, it may actually be the fibers that are present in those foods that are most specifically growing the healthy bacteria in the gut.

Lindsey:  

And what kind of food did you make out of those?

Chris Damman, MD:  

Excellent. So there are two major categories of food for malnutrition, there’s the so called ready-to-use therapeutic foods and ready-to-use supportive foods. They essentially come in a little foil pouch, and it is sort of the consistency of a peanut butter. It’s given to the child and yeah, so these are the foods that we were developing.

Lindsey:  

Okay and I assume you made it more palatable than the combination of chickpeas and green banana flour I would imagine to be.

Chris Damman, MD:  

Exactly, so I mean, there were some other things added like vegetable oils and a little bit of sugar. And yeah, there was work that went into making it organoleptically favorable, in other words, make it taste good.

Lindsey:  

Yeah. And so when you give it to the child, is that enough to help pull them out of a cycle of diarrhea and malnutrition? Or do you also have to give antibiotics?

Chris Damman, MD:  

Excellent. So antibiotics are part of the standard of care in some cases of malnutrition. And so those were given upfront prior to starting therapy. In fact, most children with malnutrition actually do have active concurrent infections that bring them into the hospital in the first place. And we were exclusively focusing on children that were admitted. But beyond the antibiotics, the prebiotics and the ready-to-use therapeutic foods then help promote the growth of the good bacteria over the bad bacteria and reestablish a healthy community or group of organisms in the gut.

Lindsey:  

Okay, and so would they be receiving the therapeutic food at the same time or after the antibiotics? And do you think that makes a difference? Or, you know, what’s your thought on the combo?

Chris Damman, MD:  

Yeah, that’s definitely after the antibiotics because most antibiotics that we have are broad spectrum.

Lindsey:  

Right.

Chris Damman, MD:  

And so, you know, equally contribute to decreasing the good bugs as well as the bad bugs.

Lindsey:  

Yeah. Okay. So when you’re done, then you get started. So is there something that you think that people should be taking while they take antibiotics in a developed world context?

Chris Damman, MD:  

Yeah, that’s a great question. And there is quite a bit of debate in the field right now as to whether a probiotic approach in the context of antibiotics is a good thing, or perhaps, maybe best to be avoided. There’s some work that’s come out of Israel in the last few years that suggests that taking a pretty diverse probiotic in relatively high concentrations actually impeded the reestablishment of a healthy gut ecosystem of organisms that are normally present there after antibiotics. And that was a big eye opener to the field. That said, I think the best approach is to basically provide probiotics for the natural bugs that are present in the gut. And that can happen at the same time as taking the antibiotics and beyond. And so that is essentially foods that are high in dietary fiber.

Lindsey:  

And what do you think about butyrate while people are taking antibiotics

Chris Damman, MD:  

As a concomitant therapy, like Tri-butyrate*? 

Lindsey:  

Yeah.

Chris Damman, MD:  

I’m intrigued by the possibility of giving butyrate, which is essentially one of the major end products of the bacteria, one of the major things that they’re contributing to the body and health. One of the tricks with butyrate is it exists in the context of other short chain fatty acids in the healthy state. So that’s propionate and acetate. And a balanced ecosystem is going to provide these short chain fatty acids in a balanced way, and in the right spots, so distal small intestine and colon is generally where they’re produced in the highest concentrations. When one takes Tri-butyrate, that is one of the components and one of the components that is probably most depleted. And so it may be therapeutically advantageous to do it. But I just think it’s important to think of the whole context of what a healthy microbiome is producing. And I think the closer we can get to recreating what happens naturally, we may be that much further ahead in preventing and addressing disease.

Lindsey:  

It’s just that, of course, in my work I come across so many people who are suffering from having taken antibiotics, and their problems started at that point. And so, you know, just sort of thinking back, if you can prevent the problems, maybe it’s giving a good probiotic with the with the antibiotics.

Chris Damman, MD:  

Yeah. And I think the other thing to think about is, if you’re starting with a healthy state, promoting that healthy state is very different from being in that sort of devastated coral reef already, and reestablishing a healthy state. And if you’re caught in the trench of inflammation and imbalance, sometimes you need a little jumpstart. And it may be that things like butyrate actually help that jumpstart, while at the same time, starting to reintroduce healthy, prebiotic foods.

Lindsey:  

Yeah, I’m a big fan of butyrate right now. It’s my current fascination.

Chris Damman, MD:  

I would love to hear more about your fascination.

Lindsey:  

Well, it’s the only thing that kind of helps me just stay solid. So for me, it’s like a miracle drug.

Chris Damman, MD:  

That is so exciting to hear. 

Lindsey:  

Because I have post food poisoning IBS. 

Chris Damman, MD:  

Post infectious IBS. 

Lindsey:  

Yeah, post infectious IBS, positive vinculin antibodies. So yeah.

Chris Damman, MD:  

Interesting.

Lindsey:  

It took me a while to figure it all out. But I think I’ve got it under wraps now with the butyrate.

Chris Damman, MD:  

That’s brilliant. And here’s another thing, perhaps you’ve already tried, but consider adding to the armamentarium. There’s some really fascinating research that’s just come out on psyllium.

Lindsey:  

Oh, yeah, I used to take that all the time. It’s just disgusting.

Chris Damman, MD:  

It’s just disgusting. Oh, yeah. It’s like drinking sludge. And you have to actually drink quite a bit of it. 

Lindsey:  

Yeah. 

Chris Damman, MD:  

But what’s fascinating is there’s a paper that just came out of the British Medical Journal that suggests, well, first of all, a large portion of folks that have IBS, it’s actually an intolerance to a certain prebiotic, inulin, or fructans, which is kind of the overarching category. And these are things that are found in onions and garlic, and actually added to a lot of processed foods. And when one follows the low FODMAP diet, it is one of the major things that that’s removed, and a lot of people have benefit. Now, I think we’re in this sort of paradigm, right now in medicine, especially food as medicine, of taking things away in order to achieve a therapeutic effect. I think where we could move and ultimately need to move is how we can add things back that are missing, because that’s how that healthy ecosystem is going to be reestablished. If you take things away, yeah, you might have improvement in your symptoms, but it’s going to further entrench you in low diversity, dysbiotic state. So what this paper shows is, if you combine pysillium with inulin, the symptoms of inulin go away. So it’s a new, perhaps very exciting approach to treating inulin-specific IBS. And it’s actually not that new. There’s plenty of studies that have looked at the impact of psyllium on IBS and shown benefit before; it’s just now there’s this new understanding of how it might be working. 

Lindsey:  

Interesting and how much psyllium was it?

Chris Damman, MD:  

A very good question. I would have to take a look at the study again, but most of the studies I think, have been 10 grams twice a day or something around there.

Lindsey:  

Is that like a tablespoon or more? 

Chris Damman, MD:  

Yeah

Lindsey:  

A tablespoon. Okay. Yeah, that sounds about right. Okay. And yeah, I would love to see the paper, if you can send me a link for it. 

Chris Damman, MD:  

Yeah, absolutely. 

Lindsey:  

Okay, cool. So tell me what you think we now know about the microbiome and its role in the body that we didn’t know 5 or 10 years ago?

Chris Damman, MD:  

That’s very good question. And I would say 10 years ago, we were very much stuck in the correlation phase where every study said, you know, microbiome is connected to the brain or microbiome is connected to inflammation, on and on and on. But it was just connections, just correlation, not causation; not certainly moving in the direction of therapies. I think now in the field, we’re actually starting to move in that direction. And the first shots on goal were big guns like fecal transplants. And now we’re moving in the direction of greater sophistication, and more nuanced, fully defined therapeutic bacterial approaches and companies that are leading the charge here, where, you know, they’re collecting a handful, up to even 100 bacterial species in a completely defined approach. So I think that’s a very exciting step forward.

Lindsey:  

So are the, like I know that there are purified fecal transplants that have been used in some studies and that there was a company working on those. But it sounds like you’re talking more about a probiotic that’s just very diverse.

Chris Damman, MD:  

It’s kind of like a probiotic that’s very diverse. The term that’s used in the field is live bacterial products. And this is regulated very differently from a probiotic by the FDA, much like a drug. And they’re basically, rather than either whole stool or purified stool, these are strains that are grown in the laboratory and then combined. So the problem with whole stool and even processed stool is, you know what’s there, but you don’t know entirely what’s there. And so there’s the possibility of transmitting infections or transmitting bacteria that are associated with long-term, adverse outcomes.

Lindsey:  

Right, right. Yeah. No, I occasionally work with people who want to do a fecal transplant from a relative or that sort of thing. Inevitably, they get them tested. And they have C diff, they’ve got H. Pylori, and they’re perfectly healthy. But I couldn’t recommend that you use that stool.

Chris Damman, MD:  

Yeah, yeah, there’s certainly a lot of asymptomatic carriage of these pathogens, and some call them actually pathobionts. Because in some contexts, they’re benign, like asymptomatic carriage, and it’s only in the context of some infection or inflammation that they rear their ugly heads.

Lindsey:  

So a lot of my audience, as you can imagine, is composed of people who have issues like IBS and H. Pylori and Crohn’s and colitis and gastritis, the whole gamut. And many of them have already seen  a gastroenterologist and have not been able to resolve their issues within the traditional medical system. And of course, some of them have been given suggestions on dietary changes, but more often than not, especially like with inflammatory bowel disease, I hear a lot more about pharmaceutical interventions coming from their doctors. So I’m wondering what kind of dietary changes and nutritional interventions are becoming more standard of care in traditional gastroenterology? And then beyond that, what nutritional interventions you’d recommend for various conditions that aren’t within the standard of care?

Chris Damman, MD:  

Yeah, yeah. Great question. And right now, there aren’t dietary therapies in the context of controlled disease that are necessarily within the standard of care, if you can believe it. It’s surprising. When one is having a flare, it’s actually recommended that somebody go on a very low fiber, low roughage diet.

Lindsey:  

For IBD in particular?

Chris Damman, MD:  

For inflammatory bowel disease, yeah. Which seems, you know, very counterintuitive. And so that sort of often carries through to dietary recommendations in the context of controlled disease, where maybe low fiber, low roughage diets are preferable. There is actually for ulcerative colitis, specifically (very different from Crohn’s disease because, you know it’s affecting just the colon but not the small intestine, as well a subtype of inflammatory bowel disease), there are a handful of studies that support the benefit therapeutically, not just by association, of increasing fiber in the diet. So I find that intriguing.

Lindsey:  

And any particular kind of fiber, or just from foods?

Chris Damman, MD:  

Yeah, so from foods, but also, maybe specifically from psyllium.

Lindsey:  

Okay. Yeah, well, psyllium is, you know, it’s funny, I kind of started there, and it’s like, coming full circle. That was one of the first things I did to try and turn things around for myself. And then, you know, one of the first things I recommended to people when I first started doing my podcast, and it’s like, it’s gross. And this kind of got me off it for a bit.

Chris Damman, MD:  

Completely. Yeah, no, it’s definitely not the most palatable. And there’s actually even choking hazards associated with it. And folks that have difficulty with swallowing because it becomes so thick.

Lindsey:  

Yeah, I would just add it to a smoothie but I’d have to add it at the absolute last moment, and then try and drink it really fast, so it didn’t thicken up.

Chris Damman, MD:  

Yeah, yeah, absolutely.

Lindsey:  

It’s also somewhat palatable if you throw it in some orange juice. And again, just chug it really quickly. And then just drink more liquid afterwards.

Chris Damman, MD:  

I need to take some notes here.

Lindsey:  

My husband takes it, I think, at least once a day, once or twice a day with water. Like he’s learned to just drink it with water.

Chris Damman, MD:  

Yeah, yeah . . .

Lindsey:  

But not me. 

Chris Damman, MD:  

I will say, there’s other approaches to dietary fiber using different fibers that aren’t as viscous or sludgy. And that are a lot more palatable, and put in the context of a pretty delicious delivery system that are being developed that I think are really exciting. And that might make it more accessible and palatable to people to consume fiber beyond whole foods, which at the end of the day is the best way to go. But what I learned, importantly, at the foundation is it’s not always possible to go that way; it’s quite a luxury to be able to eat whole foods. And these ready-to-use therapeutic or supplemental foods are incredibly valuable for their shelf life. And for their, quite frankly, cost of goods profile. And that’s relevant here in the US as well, for certain segments of the population below the poverty line.

Lindsey:  

Yeah, no for sure. So tell me about those, those other fibers and, and what those look like.

Chris Damman, MD:  

So I would say two of the other fibers that I think are most exciting are one, resistant starch and two, beta glucan. Resistant starch is found in a lot of different foods, but is perhaps in highest concentration in of all things green bananas, but also found in beans, and you know, even potatoes and wheat. The other one is beta glucan. And that is found also in a lot of foods, but specifically in oats. And a company that has been leading the charge on some of these other fibers has brought the two together to achieve synergy. Because they are very specific and the types of bugs that consume them in order to maximize the opportunity for producing downstream short chain fatty acids like butyrate.

Lindsey:  

What bugs consume them?

Chris Damman, MD:  

So it depends on the fiber, it’s actually amazingly targeted. And each of the fibers it’s really only two or three bugs that are the primary consumers and so for resistance starch, it’s Ruminococcus bromii and Bifidobacterium, various subspecies. And for beta glucan, it’s slightly different bugs. But what’s interesting is the secondary consumers, so those primary consumers essentially, in some ways, kind of poop out certain products, and then the secondary consumers will eat those, and they’re the ones that are producing the butyrate and propionate. And those are pretty consistent across individuals. It’s just the primary consumers that are the front men and consuming those fibers that are very specific.

Lindsey:  

And who are the secondary consumers?

Chris Damman, MD:  

Oh, yes. So the secondary consumers, they fall into the class largely have what are called Clostridium cluster IV and XIVa species, so you’ve probably heard of Fecalibacterium praznitzii, Roseburia. Yeah, these are the so called Firmicuties of the gut.

Lindsey:  

Are those Clostridia? 

Chris Damman, MD:  

Those are Clostridia.

Lindsey:  

Yeah, okay.

Chris Damman, MD:  

So if you go back to the childhood playgrounds and playing tag with your friends and saying you’re it, you’ve got cuties, you’re actually quite right on, you’ve got Firmicutes.

Lindsey:  

That is the worst microbiome joke I’ve ever heard. Congratulations.

Chris Damman, MD:  

Stick with me, yeah.  It’s one of my hallmarks, I embrace it fully. 

Chris Damman, MD:  

I’ve got three daughters at home. And so the bad dad joke is a hat that I wear proudly.

Lindsey:  

Yeah. My kids don’t want to to talk much about the microbiome. They’re just like “Stop talking about fecal transplants!”

Chris Damman, MD:  

We’ll have to invite you and your family over for dinner some night, and we can definitely indoctrinate them.

Lindsey:  

More like terrorize them. So what dietary changes, would you recommend for the average person who’s eating a standard American diet and just having some mild gut issues?

Chris Damman, MD:  

Yeah, well, I mean, it goes without saying, increase fiber in the diet. So the USDA in 2020, came out with their dietary guidelines. And I was shocked to see that only 5% of people meet the dietary guidelines. So around 30 grams, a little bit different for men and women per day. And it’s probably one of the most efficient nutrients in our diet. And now we understand what it’s doing and how important it is, more than just helping you have a good bowel movement, but incredibly important for your mental health and your inflammatory health and quite frankly, your metabolic health. So how you process nutrients and whether or not you gain weight, and what your cholesterol is, and whether you have high blood pressure and how your blood sugars are controlled.

Lindsey:  

Yeah, an old friend just sent me a study about black beans, half a cup of beans, you know, bringing down your blood sugar, and as well as yeah, helping restore your microbiome and the good bugs.

Chris Damman, MD:  

Absolutely. Yeah. So I think fiber is incredibly important. And legumes, beans are under-recognized. Invaluable.

Lindsey:  

Yeah, you just can’t get to your bang for the buck on fiber with anything else. I mean you can eat, you know, four cups of lettuce. Probably only get like five grams of fiber or something (Note – it’s actually only 2!).

Chris Damman, MD:  

Yeah, yeah, no, that’s true. But you know, what’s really interesting is specifically in terms of metabolic disease, if you look at the association with different types of plant-based foods, it’s strongest for grains, and for fruit, but less for other categories. So I think that speaks to how different fibers are important for different aspects of health. And for diabetes, and blood sugar control, it may actually be that the fibers that are taken off of whole wheat when they’re turned into white wheat or brown rice, when it’s turned into white rice, are particularly important for your metabolic health.

Lindsey:  

Now, I know you can get your resistant starches from the diet, and one of the ways is cooked and cooled rice and cooked and cooled potatoes. 

Chris Damman, MD:  

Yes. 

Lindsey:  

This applies to white rice as well though, doesn’t it? 

Chris Damman, MD:  

100%. 

Lindsey:  

Yeah. Because we have a lot of rice in my family. And then there’s a lot of leftover rice and I reheat it but not you know, extreme. Am I still getting my resistant starch?

Chris Damman, MD:  

Yes, resistant starch is definitely increased in cooled foods even after they’re reheated. I will say that rice may not still be the greatest source of resistant starch. You know, potatoes are good and really bananas too. But I don’t think many of us are going to go out and start eating green bananas.

Lindsey:  

Green bananas are not only disgusting, but they also make me feel pretty sick. So tell me why green banana powder doesn’t make you feel sick? Because I’ve never eaten a green banana and not felt disgusting afterwards.

Chris Damman, MD:  

But when you have green banana powder, you feel okay?

Lindsey:  

Well, I can’t say I’ve done a lot of experimentation with green banana powder. I do own some and sometimes add it to recipes.

Chris Damman, MD:  

Yeah, yeah. I don’t have a good answer for you. 

Lindsey:  

Maybe it’s quantity. 

Chris Damman, MD:  

It could be quantity, it could be all the other things that are present in green bananas that are not present in the powder. So the powder actually is refined to concentrate for the resistant starch.

Lindsey:  

Okay. Got it. Yeah, yeah. Because I guess an entire green banana may have a lot of resistant starch in it.

Chris Damman, MD:  

Yeah, you know, it’s surprisingly, it depends, though, on that specific type of green banana. And really, how it’s been harvested and you know, most of the green bananas that you’d find in the store actually are not a good source of resistant starch. 

Lindsey:  

Oh Okay. 

Chris Damman, MD:  

Yeah. Yeah. You know, it has to be harvested and processed in a very specific way in order to maximize the resistant starches present.

Lindsey:  

Yeah, no, I think the stuff I have might be green plantain flour.

Chris Damman, MD:  

Interesting. Yeah, yeah. No, it’s in plantains, bananas. They’re quite related and resistant starch is present in both.

Lindsey:  

Okay. Well so this is a sponsored podcast from Muniq and they have products involving this green banana powder and such. So can you tell me a little bit more about those products and what they’re what they’re good for?

Chris Damman, MD:  

Yeah, absolutely. So pretty exciting. And this harkens back to a comment that I made that whole foods are great. And they should be an important part of the diet. But there is a role for processed foods. And I think that as we understand the microbiome better, we can actually make those processed foods healthy. I’m a firm believer in that; that’s what I learned at the foundation. And the value of a processed food is it’s convenient, off the shelf, good cost of goods. And that’s the niche that Muniq is filling. We’ve been messaging for the last 10-20 years or longer of the importance of whole foods. And yet, the population continues to increase in obesity and diabetes. Things haven’t changed. And so I think there’s an incredible opportunity here for meeting people where they’re at, in their busy lifestyles. And that’s exactly what I think Muniq can do. And so this is a shake that incorporates two of the most powerful, prebiotic fibers, and that’s resistant starch and beta glucan. It’s quite delicious. It’s very, very low in sugar, and total digestible carbohydrates, and super high in fiber. So 15 grams per dose or per serving. Yeah, super high.

Lindsey:  

That would get me to my 30 or 40 a day. Because honestly, I’m not hitting it.

Chris Damman, MD:  

Yeah, no. So that’s just what I mean, it’s convenient. 

Lindsey:  

Yeah.

Chris Damman, MD:  

We have a number of consumers that take a shake a day. And that is sufficient to get them to that daily requirement of 30 grams, and pretty amazing results in terms of their gut health. And in terms of their metabolic health that we’ve seen, anecdotally. And what we’re doing right now, unlike perhaps a lot of other food companies, is we’re taking that next step in validation, and taking a gold standard approach, you know, above and beyond all of the amazing consumer experience, let’s validate this in the most scientific, rigorous way possible. And that’s through a randomized, placebo-controlled trial that you’d see in Biotech or Pharma. And that trial is actually ongoing and I’m super excited for those results.

Lindsey:  

And what conditions are you studying it with?

Chris Damman, MD:  

Good question. Yeah. So we use these technical terms. So inclusion criteria in medical trials, and in this case, two major inclusion criteria that people that we’re evaluating this in are folks that have diabetes, and folks that are overweight.

Lindsey:  

Type two diabetes. 

Chris Damman, MD:  

Type two diabetes, indeed.

Lindsey:  

Okay, so you’re looking at it as a potential weight loss aide, as well as bringing down blood sugar.

Chris Damman, MD:  

100%. And we’re also super keen in this trial to look at other health parameters. And so we are looking at things like gut health and mental health, not in as concentrated a way as we’re focusing on, you know, metabolic health and weight and diabetes. But there will be some information that comes out there for future uses.

Lindsey:  

Is there before and after microbiome sequencing?

Chris Damman, MD:  

100%. So we’re super excited to be working with one of the leaders into the microbiome, and that’s Justin Sonnenberg who will be analyzing the microbiome data.

Lindsey:  

Nice. So are you doing a metagenomic sequencing?

Chris Damman, MD:  

Yes. So a lot of the historical studies have been mired in 16 S RNA, which doesn’t get you down to strain level specificity, as we were talking about before, that is so important. And even beyond that, understanding the metabolic capacity of the microbes and metagenomics does just that. And so we’ll be able to know who’s there, and what they have the potential to do as well. And that’s so critical and taking these next steps forward and sort of next generation microbiome work.

Lindsey:  

Awesome. And you know, back when we were talking earlier, you were mentioning these live bacteria prep products. And I’m curious whether any of those have anaerobic strains in them, or are they all aerobic strains?

Chris Damman, MD:  

Yeah, no, actually, it’s mostly anaerobic strains that are present in these live bacterial products. And this makes them particularly tricky to work with, but a number of companies that are leading the charge here and some really exciting proof of principle trials that have reported out in the last year to more define their process of live bacterial products that have been effective for C diff, C difficile, and ongoing trials for inflammatory bowel disease.

Lindsey:  

Nice. Yeah, and I’ve been taking Akkermansia muciniphila.

Chris Damman, MD:  

Nice.

Lindsey:  

For the last few months. Seeing how that works out. 

Chris Damman, MD:  

Yeah.

Lindsey:  

Hoping I can eventually get off the butyrate.

Chris Damman, MD:  

That would be nice. Well, you should give Muniq a try.

Lindsey:  

Well, I’m waiting for my shakes. My mouth was watering when I saw that chocolate shake picture, and there was one that was dairy free, and I was so excited. So I’m like, I would like to try that one.

Chris Damman, MD:  

Yes, there’s both vegan and non-vegan versions and pretty tasty flavors. My personal favorite is the chocolate. But there’s also the vanilla and mocha.

Lindsey:  

Mocha. Oh, nice. 

Chris Damman, MD:  

Got some caffeine in it. So it gives you that little, little coffee type pep in the morning.

Lindsey:  

Okay, well, Where would people go to find these Muniq shakes? 

Chris Damman, MD:  

Yeah. So it’s online, direct to individual and through Muniq, spelled muniqlife.com,

Lindsey:  

Muniqlife.com. Anything else you want to say about those shakes? And how they are helping people or I know you can’t claim medical things being addressed but . . .

Chris Damman, MD:  

Yeah, I just think it’s super exciting for all the reasons that we discussed. And I think it’s one of the few companies that’s really leading the charge in the area and it’s a company that’s very interested in impact, and in connecting with the consumer like I’ve never seen before. I mean, this was the reason that I was so at ease joining forces with Mark, who’s the founder, and pretty amazing story too, as to what inspired him to start the company in the first place. And it’s on the website in his own words, a very moving story of his sister who passed away from complications of metabolic disease. And that was kind of this wake up call to use his gift in life for reaching the consumer, and his background, leading a large nutrition company, to create a product that can really make impact. Yeah, and I feel like I worked at the foundation before. And, you know, there, it was all about taking the latest and the greatest technology and applying it to underserved communities. And that’s exactly what we’re doing as well. There’s a huge underserved community of folks with diabetes and obesity. And we’re making a real impact in their lives. 

Lindsey:  

That’s wonderful. What’s his full name? Marc.

Chris Damman, MD:  

Marc Washington.

Lindsey:  

Okay, spelled with a “c” and is Muniq going to be sold in stores at any point?

Chris Damman, MD:  

It’s a great question. Right now, the approach that we’re taking is a direct to consumer approach through the website, but I wouldn’t rule out the possibility of ultimately products being available in the Big Box stores, but not where we are currently. 

Lindsey:  

Okay, great. Well, I’m really excited to hopefully try those soon. And, yeah, it was really interesting talking with you. This was fun.

Chris Damman, MD:  

I had a lot of fun too. And that invitation stands anytime you want to join us at the dinner.

Lindsey:  

You’re in Portland? No. Where are you? 

Chris Damman, MD:  

Washington State, in Seattle.

Lindsey:  

In Seattle okay. I don’t know why I thought Portland. Okay. Well, if we’re up there, I’ll be sure to get in touch. If you’re ever coming through Tucson, look us up.

Chris Damman, MD:  

Okay, look foward. 

Lindsey:  

Okay, thanks so much. 

Chris Damman, MD:  

Yeah, thank you, Lindsey.

If you’re struggling with your gut health, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my gut health coaching 5-appointment program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

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