Metagenomic Gut Sequencing with Dr. Robin Rose

Adapted from episode 55 of The Perfect Stool podcast and edited for readability.

Lindsey: 

So my first question is just since you are a DO or a doctor of osteopathy, and not a naturopath like many of my guests, I’m curious what it’s like to be amongst your DO and MD colleagues, but focusing on functional medicine; do you encounter a lot of skepticism?

Dr. Rose:

Interesting, it’s a good question. My colleagues, yes, I will encounter skepticism. However, from the people in the surrounding area where I’m starting to practice, they really are searching for this type of medicine. You know, I look at it as more of precision healthcare, precision medicine. It’s still driven by science. And it’s very data driven. And you know, there’s a lot of scientific basis behind it. So it’s just as good if not better than conventional medicine. And that’s what I have to say to my colleagues that don’t believe.

Lindsey: 

So today, we were going to focus on this Biome FX test, that’s Microbiome Labs’ gut health test. And I was just wondering why you like this, as opposed to the more traditional diagnostic tests in the functional medicine realm, like the GI Map or the GI Effects?

Dr. Rose:

Yeah, I like that there’s actually whole genome sequencing of the gut microbiome; I think that they do a little bit of a deeper dive. It’s a metagenomic test. And I just like that Microbiome Labs is so driven by R&D; there’s just so much research and development, and they put so much money into it. And a lot of their tests and their products are all backed by peer reviewed studies.

Lindsey: 

And do they give you the raw data? Or do you just know that they’re sequencing the whole microbiome?

Dr. Rose:

Yeah, I know who they use. I know the company that they’re using. And they’re really the only one that can do it. We’re not given the raw data, but I trust that it’s the real deal.

Lindsey: 

That you’re given the relevant data, right? Yeah, because I’ve seen Onegevity or what’s now the Thorne GutBio test. And that was really just a straight up Excel chart of everything in the gut. And now apparently, they’re not giving that anymore.

Dr. Rose:

Well, they’re not supposed to. But same with MBL. They’re not really supposed to give the raw data.

Lindsey: 

Why not?

Dr. Rose:

I don’t know.

Lindsey: 

Like, if people have information, they might do something with it.

Dr. Rose:

Well the contract that they have with the lab that they use. Actually, it’s the same, you know, Onegevity has the same issue. Right. And so it’s not something that I have – it’s proprietary information. I wouldn’t, I don’t know the legalese around it. But I don’t think that they should be sharing it based on that.

Lindsey: 

Do you know what the retail cost is to the consumers for this test?

Dr. Rose:

I pass the charge on to my patient. So we pay $299. And that’s what my patient pays. I don’t know if some doctors, you know, they might retail it differently. But that’s what the cost is. And that’s what I charge.

Lindsey: 

That’s pretty reasonable; that’s comparable, or less than some of the other gut tests. Okay. So I have a Biome FX report. And it’s going to be on my website for people to pull up. So let’s start looking at this test. And I’ll just ask you some questions about it.. So it starts with this summary and gut microbiome index, kind of amorphous. What does that mean?

Dr. Rose:

So the microbiome index score takes into account three factors. And that’s your alpha diversity, your beta diversity and your resistance. So let me explain that. So your alpha diversity is what your species richness is, so when you talk about your gut microbiome, and you’re looking at microbial diversity, right? So we have trillions of bacteria, friendly and unfriendly. And then we have about 250 to 300 different species, right. So how many species do you have occupying your microbiome? Okay, so that’s your alpha diversity. So what is your your individual species richness, then we look at beta diversity. And beta diversity is basically okay. So based on that richness, how do you compare? How does that compare to the US adult healthy population or people that are living in your geographic area? And so whatever is there, maybe your alpha diversity, isn’t that great? Or maybe it is fantastic, but whatever is there, how does that compare to the other people living around you?

Lindsey: 

And so wait, the alpha diversity is compared to what?

Dr. Rose:

It’s the norm, it’s norm of other people, right? Like, what their richness looks like.

Lindsey:

Like worldwide, then?

Dr. Rose:

No, it in the US or North America. I’m not really sure. You know, I always mean to ask them that question. I think it’s North America, I think it includes Canada as well. So for example, if I took you, and I put you into the Amazon rain forest, okay, you would likely still have good alpha diversity, but your beta diversity would likely be close to zero, because you haven’t been living there for long enough to accumulate that same type of microbial diversity that the Amazonians have. So does that make sense? So that’s how I explain it to my patients. Okay. And then, based on your alpha diversity and your beta diversity, so based on your species richness and your stability and the stability of your gut microbiome, how prone are you to perturbation? So if you get sick, you know, whether it’s the flu or you have a stomach bug, or a gastrointestinal virus, or you eat something that doesn’t agree with you, you know, how well does your gut handle it? How resilient is it? Right? How well does it handle those things? And so this person’s resistance is really terrible. They’re 1.71. Normally, they’re actually changing the test, it really should be out of five. Nobody I’ve never even seen, no patient was above 3.8. So this person, you know, they’re struggling. I see most people cluster in the threes, maybe I’ll see some people under two, barely ever under one. And so that’s what makes up that index score. So that person’s index score is 23.64. Right? At a 40 again, it’s a little skewed. I’ve never seen anybody’s over 28. I would say most people cluster between in the mid 20s, like this score. And then some people I will see under 20, as well. But most people cluster in the mid 20s.

Lindsey: 

And would it be safe to say that the people you’re seeing have gut issues?

Dr. Rose:

Well, I mean, here’s the thing, Lindsey, we see everybody, okay, and this is a really good point that you’re making. So I would say that the majority of people probably have some sort of gut complaint, okay. But there are a lot of my patients that have no complaints, but they have autoimmune disease, or they have a history of anxiety or depression or migraines or a skin disorder. And so we know that the gut is the guardian to your health and the gateway to disease and there’s so many connections that fan out from the gut, the gut-skin, the gut-brain, gut-hormone, gut-thyroid, like I could go on and on and on. Right? So everybody I feel, unless they live in a bubble and eat plants all day, I think that they have an element of leaky gut and dysbiosis. And I think that’s why the vast majority of people have some sort of struggles, I will see them struggling somewhere, or if not in many places on this test, because of the way we live our lives. I mean, whether it’s the standard American diet, obviously, which most of us eat, which is horrible, and that doesn’t feed our gut microbiome. And what destroys it from alcohol that we drink on a daily if not weekly basis to the tap water we consume to the non-steroidal anti-inflammatories we take on a regular basis, the antibiotics we’re prescribed, the air pollution that we breathe in, I mean, I can go on and on and on. And all of that is going to affect and chip away at the health of your gut microbiome. Right?

Lindsey: 

Right. So it may be that the sample you’re working with is a less healthy  sample and that their test is based on a group of healthy people?

Dr. Rose:

Right.

Lindsey:

Or some mixture?

Dr. Rose:

There’s a range; nobody’s test is the same. Every person is different; that’s the whole idea. Right? We’re all uniquely different, right? We all have our own unique biochemical individuality. And this is just another piece to that puzzle when we’re trying to figure that out so that we can really create bespoke health care plans for people and really treat them for their unique needs.

Lindsey: 

Yeah. Okay. Well, let’s go down to the next part of that same page, which is page two, and look at the pathogens. So the Clostridia difficile is high. So I’m just throwing this out, because you know the patient of yours, what actually was going on, but say this person was not suffering from explosive diarrhea seven times a day. Would you go ahead and treat C difficile?

Dr. Rose:

Yeah, so the vast majority of people are overgrowing it, they’re not pathogenically colonized with it. And so and I see a lot of people that have high C diff. I do not treat them with antibiotics. What I do is, is I restore, I repopulate and restore balance to the gut so that that C diff gets crowded out.

Lindsey: 

So you’re more using probiotics and foods and such.

Dr. Rose:

Yeah, the idea is, is that we’re all, and this is a summary page. So when you go down, you’ll see each one of these things is going to be teased out. But basically, that what we’re doing, like these pathogens, this pathobiome that you’re seeing in this patient, the C diff, the E. coli and the Bilophila, you will pick this up in many people. And even if you don’t pick it up, they’ll have very small amounts of this in their gut. It’s just when it becomes problematic is when it starts to overgrow, and it’s outside the reference range and it’s too high. That’s when you want to deal with it.

Lindsey: 

Okay. And just by chance, I happened to be thinking about this Bilophila Wadsworthia. And that’s one that tends to promote constipation, isn’t it?

Dr. Rose:

It’s actually consistent with SIBO because it’s a small intestine colonizer. And so that’s where we want to see Bilophila living, so when we start to see high amounts of it in the colon, that means it’s overgrowing. The small intestine spilling over into the colon. There’s two main characters that Bilophila, it increases secondary bile acids, which are very toxic to the gut lining. And they’re also hydrogen sulfide reducers. So anything that you eat with sulfur in it gets reduced to hydrogen sulfide. That’s what it wants to eat up and then, when it reduces hydrogen sulfide, hydrogen sulfide is extremely toxic to the gut lining as well.

Lindsey: 

So this is like a hydrogen sulfide SIBO bacteria? Okay, that may have been what was sticking in my head.

Dr. Rose:

Yeah, it’s really affecting your gut barrier dysfunction when you have Bilophila. So we want to definitely deal with that. And a lot of patients will say, yes, I have flatulence that is consistent with a rotten egg smell. They may get bloated a lot more. And although we love our cruciferous vegetables, and they’re very important for feeding our gut microbiome, while we try to treat and rebalance this person’s gut, we might have those people maybe eat those in much lesser quantities and maybe eat the other colors of the rainbow instead, while we’re trying to heal them.

Lindsey: 

Okay, so let’s scooch down since this stuff goes into more detail below and let’s look at page four and the Bilophila.

Dr. Rose:

Okay, so this is the analogy I make with my patients. You have basically four major phyla in the bacterial kingdom, okay, sort of like if you think of the animal kingdom. I don’t know if I can come up with four but you know, your amphibians, you have your mammals, your reptiles, right? So it’s the same thing in the bacteria, like four main players. And you have your Bacteroides and your Firmicutes and they are supposed to balance each other out. And then you have your Proteobacteria and your Actinobacteria and they are supposed to balance each other out. Okay. And so if you look at the adult US healthy population, you should have about 64% Bacteroides, 27.8% Firmicutes, and then you should have about 2.86%, proteobacteria and 4.21% Actinobacteria.

Oh, so now let’s look at this person. Okay. First of all, there’s so dysbiotic in the fact that they’ve flipped that Firmicutes and Bacteroides. They have like almost half of what they should in in the Bacteroides, which is not good. They have a little bit more than what they should in the Firmicutes and they have so much Proteobacteria and Proteobacteria tend to be much more inflammatory also. Then if you scroll down a little more, you can see the percentage of Actinobacteria that they have. It’s on the chart below, it doesn’t come up on the pie chart, but if you scroll down a little bit I can show you right here. Yeah, so they have about only 1.82% Actinobacteria. So that’s not great.

And then if you scroll right back up, again, Lindsey, I can show you one other thing on this chart, right here, this chart on this bar graph on the right, so as you can see, it has the four main phlya there, the Bacteroides, Firmicutes, Actinobacteria and it’s showing you the percentages. And then, what also is populating here, these are other phyla, but they’re just much more rare.

And we will pick them up in in people and so like for example, the Euryarchaeotas you know, underneath where it says bacteria_u_p, they’re methane producing organisms. The synergists are basically bacteria that are normally found populating the oral mucosa. And so if they are populating the colon that means that there’s likely an issue with low HDL or stomach acid or things being broken down above because it’s escaping. And it’s getting into the colon and colonizing there. The Ascomycota are associated with fungus and Candida and the Eukaryotas are like protozoa and parasites and fungi. Okay, so those are the main things; you’ll see people growing those out. I’ve never really seen anyone grow out the Fusobacteria or the Chloroflexi, so not really.

Lindsey: 

So one thing I’m noticing on here is that they do not have unknown listed. And I have seen in the metagenetic raw data that there’s a whole huge section, something like half of the bacteria

Dr. Rose:

I think that that’s what the bacteria_u_p is. It’s bacteria of unknown . . . I forgot. Yeah.

Lindsey: 

Okay. Got it. So, what’s the highest you’ve seen of Proteobacteria on someone’s report from these?

Dr. Rose:

This.

Lindsey: 

This is it? Hmm. Okay. Have you ever used Biohm? Their test?

Dr. Rose:

No. No.

Lindsey:

Okay, because I did one of theirs. And mine was 50% Proteobacteria. You know Lucy Mailing? She questioned their test, because she said, I don’t think that that’s even physiologically possible to have that much Proteobacteria.

Dr. Rose:

That’s a lot of Proteo, yeah, that’s a lot. Biohm? What’s the full name of the company?

Lindsey: 

Biohm Health?

Dr. Rose:

The one that you don’t need a practitioner, you just order it and send it?

Lindsey: 

Yeah.

Dr. Rose:

Yeah, I’m very familiar with that company. I’ve never used the test though.

Lindsey: 

Anyway, I kind of wonder whether there isn’t like some grouping of the unknowns. I couldn’t tell you if it’s if it’s real or not. But that’s a lot of proteobacteria. And I waited until I felt like I was doing really well, like I was having a great gut health week. And I thought, now I’m going to nail it. I got rid of those proteobacteria. Nothing! So what do you do when someone has this many proteobacteria?

Dr. Rose:

I mean, I would retest, I would retest them six months down the road after we’ve really cleaned up the terrain, rebuilt the foundation and planted some seeds, sprinkled some fertilizer, you know, and did all those things to really get that person into a much better place. And then I would retest.

Lindsey: 

Yeah, I had done all that stuff.

Dr. Rose:

So we maybe I can get you a test – when you’re done with this recording, what I’ll do is I’ll send it over, I know the owner of the company very well. And I’ll give them this. I’m sure they’ll send you a complimentary test.

Lindsey: 

That would be lovely.

Dr. Rose:

I’m sure they will, and then you do the test and Lindsey, I’ll look at it for you. And we’ll go from there.

Dr. Rose:

(p. 5 of Biome FX) Now see this, I don’t pay too much attention to this, families, because it’s really just the breakdown of what we just saw. So it’s showing you the different families and then it will be broken down into further genus, of what those four main phyla were and so the percentages are going to basically stack up, be analogous to the percentages, we saw the other four, you know, so I don’t get too crazy about this page. I’m like, “uh, you know”, unless there’s something crazy jumping out at me, which there’s not so.

Lindsey: 

Okay. So, now we are now on page 6.

Dr. Rose:

Yeah. So now these are rare bacteria that grow out. Okay. And I just had two I did though in the past few days, and they had eight rare species growing out and someone had six rare species. I would say the average I see on most people’s is anywhere from two to four, maybe every once in a while someone will have one, but I usually see a couple. And again, that’s based on dysbiosis, your gut microbiome balance and what’s going on. And then, you know, maybe some of these rare characters are just sort of rearing their ugly head. Not that it’s that ugly, but you know, just because they got space to because  a lot of the commensal and keystone organisms aren’t in there, right? So Desulfovibrionaceae, this guy is also a sulfur-reducing organism, right, so this person is going to have issues with gas bloating, probably rotten egg smelling flatulence at times, depending on what they eat. And the Eggerthellaceae species, they have some good properties and bad properties, you know, it’s like neither here nor there. That’s why they’re not really classified as pathogens, right. They’re just these rare organisms that we’re learning more about, and that we’re seeing and, you know, we’re seeing it more of an abundance in some people and more so in some samples than others.

Lindsey: 

Yeah you know, back in the day, when I was getting my first gut test, and you will get one of these – your sample is particularly enriched for some random bacteria, you know, and curiously search it in all the scientific databases. And at the end of the day, I’d be like, there’s really nothing I can do about this. I don’t know if it’s good or bad. I don’t know how to kill it or help it either way.

Dr. Rose:

Right? So it’s all about when we’re restoring gut health and restoring balance, like after we are done with what we’re really doing with this person in particular, these species should really go away, or we really shouldn’t see them as much, right. That’s the whole point. That’s why you’re seeing it because there’s imbalance right now. Okay, that’s how I look at it.

Lindsey: 

So let’s go down to the dysbiosis, which shows on page 7.

Dr. Rose:

So yeah, first of all, this ratio the Firmicutes:Bacteroides, no surprise is within norm, this is falling within range, because even though they had a lot less Bacteroides, they had some more Firmicutes, but they didn’t flip it. It wasn’t like they tripled or doubled their Firmicutes and did the same with their Bacteroides in the opposite direction. So they sort of still were balancing each other out. So because again, it’s all about balance, right. So this one’s okay, but look at the next one.

Lindsey: 

Okay, before we do that, let me just ask, is there a type of diet that tends to bring Firmicutes into dominance?

Dr. Rose:

I would say probably when you’re eating less plants, and having more of an inflammatory type diet, that’s what I would say.

Lindsey: 

Okay. So next one is the Proteobacteria:Actinobacteria Ratio. And speaking of which, I have zero actinobacteria from my previous samples.

Dr. Rose:

There’s like four of them. So this one’s out of control. Let me tell you something. When I do these, I want to see everyone’s ratio less than one because that’s associated with a really good, healthy metabolism. Good cell turnover, stuff like that. So when you see it like this, even when I see 1.5, I’m like yeah, that’s not good, your dysbiosis; this person is at 14.75, so not good. Okay, we got to fix that.

Lindsey: 

Yeah. But I mean, is it possible, so just based on my previous samples, I literally think I had zero. Is it possible I’ve just killed them all off and there’s no getting them back?

Dr. Rose:

No, you can get them back. You’ve got it.

Lindsey: 

I’ve got small quantities hiding in my appendix?

Dr. Rose:

Right. Yeah,you’ll get them back. So then and this one (Prevotella:Bacteroides Ratio) I don’t pay so much to. Everyone is always around zero. Every once in a while, there’ll be somebody that has really high Prevotella, and that’s when the ratio gets a little wonky and high amounts of some of the Prevotella species have been implicated in autoimmunity and things like that. But for the most part, I would say most people fall, even the vast majority are zero.

Lindsey: 

In the US . . .

Dr. Rose:

Yeah.

Lindsey: 

Okay, so scooting down to page eight.

Dr. Rose:

There’s their pathogens that we were talking about. Okay. Yeah, these are really high. So I mean the E. coli is six. The highest, actually, the other day someone had 7.2. Again, unless the person is really, really symptomatic and had some crazy thing like bloody diarrhea, you know, this isn’t giving me like, oh, this is E coli 0157 or something, right. But there’s clearly something going on where they have an overabundance of E coli. And again, I’m going to go after the C diff and the Bilophila anyway. And as I do that, I’m assuming that the E coli is going to get crowded out as I get some of those good commensal,  keystone organisms repopulating the gut.

Lindsey: 

And yeah, will they tell you if there’s E coli 0157?

Dr. Rose:

If you scroll down a little bit, it gives you all of the pathogens here, just go down to the next page. And, I don’t know. No, it just gives you E coli. You know, it gives you that type of salmonella. That’s what it’s giving you, those exact species and genus.

Lindsey: 

There’s E coli Nissle and there’s E coli 0157.

Dr. Rose:

And you’re assuming unless the person is like, definitely, you know, they’re really ill and extremely chaotic, then it’s just again, this overcrowding this dysbiosis, imbalance, right? The pathogens are really winning over the commensals.

Lindsey: 

Yeah, it just it sort of bugs me that when they don’t give you the strain, and they don’t give you the raw data, it’s like, help me out here.

Dr. Rose:

It’s hard to do that, though, I think, because I mean, not everyone’s a physician looking at this. And then unless it’s a pathologic issue, then at that point, if you think it’s really pathological, then you should just do a conventional stool test and see what you’re growing out.

Lindsey: 

It’s just hard to know with these numbers . . . what number would it have to say? Or would it be more be symptomatic?

Dr. Rose:

I want to say that I did have a case where the C diff was really high. And I feel like they said, if it was greater than five or something with the C diff, which I’ve never seen, you had to choose antibiotics. Okay, but again, I would maybe then do a standard stool test. And check it out. Yeah, you should go to the last page. Because the way I look at this, I would go to the last page first and I’ll tell you why. I like to look first who’s taking up real estate before I get to structure and function. I want to say who’s there, who’s taking up real estate, what good guys are there and what bad guys are there? Because I feel like it sets up the story much better.

Lindsey: 

This page here? Page 20?

Dr. Rose:

Yeah, I told them to move this up. I think it should be up above. So yeah, this is pretty bad. So this person really lacks a lot of good stuff. So Akkermansia is like one of your big, big keystone species. Huge for short chain fatty acid production and metabolism. They have none.

Lindsey: 

Yeah, that would be me.

Dr. Rose:

Faecalibacterium prausnitzii again, like none, you want to have a good amount. That’s protective against colon cancer.  Ruminococcus bromii, Ruminococcus flavefaciens these are both cellulose degraders. So anything that’s like coming down through the upper part of the GI tract, middle part of the GI tract that’s not really broken down very well especially like fibrous foods. These guys are there to really get them to a place where the bacteria can utilize their energy, use them as energy resources and that’s not happening. So you you’re going to need some help above, so this person I would definitely put on enzymes for sure. Roseburia, another one not detected. Let’s see what else we got here. No Eubacterium no, Bifidobacterium, no Lactobacillus. They have like nothing basically. What else? And very little Butyricicoccus. So what do they have? Do they have anything? Hold on, go back up? Tell me that. Anything? Yeah, they’re lacking like pretty much in all of their commensals. So the issue here is that’s why there’s probably so much Proteobacteria because they just are so crowded out and there’s no good keystone commensal organisms.

Lindsey: 

So looking at this, you might think, Oh, this is a person who must have a terrible standard American diet and who knows what else? But I had a report that probably wasn’t a heck of a lot different except I had tons of Faecalibacterium Prasnitzii.

Dr. Rose:

And you feel like you meet pretty good?

Lindsey:

Yes. I mean, gluten-, dairy-free, healthy, you know really high in fruits and vegetables. I mean, I eat meat and stuff, but not excessive quantities. So, you know, once you’ve sort of gotten into this situation and diet doesn’t seem to be turning it around, and you’ve killed everything off and you’ve replaced it, you kill everything off and you’ve replaced it like. . . Well, I know the answer my own case, because I’ve got sort of recurrent SIBO. But what do you do?

Dr. Rose:

Well first, I always ask these patients, especially if they’re like, well, I’ve been eating really good. And I’m like, Alright, so what what’s happened, though, in the last few years, right? Like, have you had extensive antibiotic use for something? Were you in the hospital? Did you have surgery? I’ll ask them all these questions that could really have really affected the health of their microbiome significantly. I want to know what has happened, right? Because it’s so important, we always want to understand where the person has been, where they are, and then where they’re going with their health in the context of their life, so that we can interpret these a little bit better, you know. And so that’s important, a lot of people will give me an answer, they go, “Oh, my God!” And so that person, because they had a major surgery, were on antibiotics, or something else, but whatever. They’re really, really, really behind the eight ball. And so they’re going to need a lot more help getting across that finish line. And especially, I can’t say, I mean, you’re probably a lot more diligent than most people, but most people just aren’t going to eat like a cow. And really just eating like a cow. And eating plants all day long is really going to get your gut microbiome to where it is. And then even it might not. And that can take like a long time, like a year or more. So I always support the patient, especially Americans, we’re really impatient anyway. But I always support the patient, I want to lay the foundation, I want to start getting rid of the bad stuff. We inoculate it with the good stuff, and then giving them the fertilizer and the things that they need to get that all growing fast and stick. And it can be hard, it’s not always the easiest thing.

Lindsey: 

Okay, so I’ve pulled us up to page 10.

Dr. Rose:

You’re in the right spot. Okay, so let’s think about this page for a second, right? So we know that they’re severely dysbiotic, right, they have severe dysbiosis, they have an imbalance, we definitely have all of the good phyla that they should have. Plus they have good significant amount of pathogens, right. And as a result, those pathogens and the lack of the good commensal organisms are going to affect structure and function. So we know for a fact they have leaky gut, like screaming leaky gut, actually. So that gut barrier is significantly impaired. They definitely have gut barrier dysfunction. And now we’re going to look at the metabolic function, right?

And let’s see, let’s see how that’s probably destroyed systems. Because we already see who’s taking up real estate there. And it’s not a good situation, right. So now we’re going to look at metabolic functioning. And so the bacteria, there’s two different sources of fuel that they utilize, and it’s through either breaking down and eating carbohydrates, resistant starches or high fibrous foods, right? And that’s their preferred energy source. Okay, this is the saccharolytic fermentation is what they want. Proteolytic fermentation is like a backup that was evolutionarily developed by these organisms, because I guess when there was feast or famine, right, because we were walking along eating plants picking this but and I guess, if there was drought, you know, of some sort, and like, nothing was really growing, then they had game for food, right? So they had this proteolytic fermentation as a backup. But the problem is, it doesn’t prefer it, it doesn’t want it. And a lot of the byproducts of this fermentation process are toxic to the gut lining, you know, the amines, indoles, sulfides, and they do other things in your body that aren’t great. So when we are seeing these things, it’s okay if we see them in a certain amount. It’s like that Goldilocks theory, because some of them, the amines and the indoles particularly, they do some good things for us. But it has to be just the right amount, right? So let’s see what this person’s doing with their saccharolytic fermentation. So the major byproduct of saccharolytic fermentation is short chain fatty acid production, right. So let’s look at what happened here. So it looks like they’re doing pretty good, which is sort of interesting, let’s see. So there’s three short chain fatty acids they’re going to make.  

Lindsey: 

Page 11.

Dr. Rose:

Okay, wow, they’re making butyrate. And that’s good because this person is suffering in so many other areas, so whatever few commensals they have, or whatever is there, they’re really doing a good job spewing out and making some butyrate. Okay. And then proprionate, proprionate is really good for T cell regulation. And not terrible. I mean, it could be worse. I mean, it’s a little low, but it could be way worse. So that’s not so bad. And then acetate’s your third short chain fatty acid and when you have acetate, so if you have some of these species, if you have enough of them like Roseburia, and the Faecalibacterium prasnitzii, what they do is they convert the acetate into butyrate. Okay, so if you have enough of acetate, that’s maybe whythis person has some butyrate too, because they have enough of the acetate that’s converting it to butyrate. Alright. And you know, why butyrate is so good. It’s great for everything like oxidative stress, metabolism, your immune system, all those wonderful things that we need and obviously, to help with that gut barrier dysfunction, right, and keeping our gut lining intact.

Lindsey: 

So do you supplement with butyrate for people who are deficient?

Dr. Rose:

No, no. If people really have none, I do like one or two supplements that can give you back butyrate and/or proprionate. There’s a lot of stuff circulating about that and how good it really is. But I feel like people just need it – I’ll do it for just a short period of time. While I’m sort of again, like planting new seeds, right, and getting those good commensals to start growing back so that then they can start making the butyrate. But I’ll do it for just a limited amount of time if people are really that depleted in that division. Okay. And then this person’s lactate, I find that the lactate will be on the higher side. And to me, I don’t like to see people’s lactate really more than 40%.

Again, this makes sense because this person has a lot more lactate producers, and then they have a lower abundance of the lactate utilizers. And lactate utilizers tend to be the short chain fatty acid producers, which are those keystone commensal organisms. So you know, you don’t want to have too much lactic acid production, which was just like how we hear it being toxic to our muscles, it also is toxic to the gut lining. Okay?

Okay, here’s our proteolytic. So this is now using protein as their source of energy. And the byproducts includes amines, so you can go down and we’ll look at these guys. So there’s three different polyamines,  there’s putrescine, spermidine, and cadaverine. Now, putrescine, and spermidine are good; cadaverine can be sort of a bad guy. But these guys are important overall for helping us stabilize RNA and DNA. And so you want to have some of it, this person’s on the lower side, it’s okay rather than be lower than higher, but maybe get a little bit more be fine. This person has a high amount of phenols, which is not good, you know, it is extremely, extremely toxic to the gut lining. It impairs the intestinal barrier function, and P-cresol, which is the main byproduct. It can be very toxic to your skin, like a lot of people that have really elevated levels of phenols or P-cresols, they’ll have a lot of inflammatory skin conditions too.

Lindsey: 

So phenols are not the same thing as polyphenols?

Dr. Rose:

No.  

Lindsey: 

The names could get you confused. Now, P-cresol, is that not a marker on the Organic Acids Test?

Dr. Rose:

P-cresol. I feel like there is a P something; you’re right. Yes, I think it is. Yes. I think it is on the OAT, I wish I had it in front of me.

Lindsey: 

I could tell you right now, but I don’t if I could pull one up real quick.

Dr. Rose:

Yeah. Okay. So now look at that. Ammonia production is sky high in this person, likely because of the really high C diff, you know, although there’s a bunch of other organisms that also produce ammonia. This person should definitely not go on glutamine. That’s going to push even more ammonia production. So we’ll leave that person alone with the glutamine for now.

Lindsey: 

Interesting. Okay, so that gives you a good marker about whether that should be good for them.

Dr. Rose:

Hydrogen sulfide production: they’re having a little issue with their vendor that does all the raw data for them and the hydrogen sulfide hasn’t really been positive and people that have it negative, but this person definitely I can promise you is producing hydrogen sulfide based on their high level of Bilophina and also that they have that other rare bacteria, the Desulfovibrionaceae.  Wo I’m sure this person and again, hydrogen sulfide is so toxic again to that intestinal lining. And again, people that have high protein, low fiber diets and sulfate reducing bacteria are going to eat up that stuff. So you basically don’t trust their hydrogen sulfide marker at this point. Yeah, they’ve got to work out-they are working on it. I don’t know why. Okay, no, methane didn’t surprise me. They didn’t have any methanogen producing organisms. So that’s good.

Lindsey: 

Okay, other than Methanobrevibacter smithii, what might be the other ones you’d be looking for?

Dr. Rose:

Oh, there’s a lot of methanogens. I don’t have them committed to memory. They fall under the Eukaryota. There’s a lot of different species. Okay. Okay. Psychobiome.

Lindsey: 

So we’re on page 14 for the listeners.

Dr. Rose:

So now we’re looking at neurotransmitter hormone production. So GABA we know is a really important neurotransmitter, like a vast majority of it is made in the gut. And they’re using it as a psychobiotic. They use certain strains as a psychobiotic. Like, I know, Lactobacillus rhamnosis is one and I can’t really name the other species, but they potentiate GABA production. We know that GABA is the calming hormone, the hormone that helps us sleep. And it balances out glutamate and glutamate’s the excitatory neurotransmitter, right ,and so really important to have a lot of this around. So some people see that they have none. And but that doesn’t necessarily mean that correlates with the GABA levels that are found in their brain, right? We know that there’s this bidirectional communication between the gut and the brain, where even the gut is communicating, I think even four times more with the brain than the brain is with the gut. But still, we don’t know, we’re still teasing out all that information, right? So, but having a healthy gut is going to help us have a healthy brain.

Lindsey: 

So I am assuming that you must see low levels of GABA in people with ADHD?

Dr. Rose:

So the thing is, it doesn’t always correlate right now, not on this test.

Lindsey: 

But I mean, in general.

Dr. Rose:

Yeah, probably, absolutely.

Lindsey: 

Yeah, like I give it to my son to help him calm down. But he doesn’t want to take it much. I mean, I give him I also give him phosphatidylserine. He doesn’t want to take the GABA. But he seems to think that that it kind of makes him not be him. And it’s funny. So when I was I had sciatica last year, and I was so desperate to fall asleep that I was taking literally everything in the kitchen cabinet that I could find to make myself go to sleep since I would have excruciating spasms. And I was taking GABA for a bit, like I’m like, okay, we’ll do the GABA, we’ll do the melatonin, we’ll do the ibuprofen PM, I mean, it was everything. Anyway, I found that after some time, I was beginning to feel kind of depressed. Like I was sort of not taking a lot of pleasure in life. And I’m like, I think that GABA has dialed me down a hair, like that was not something that was out of whack for me.

Dr. Rose:

Yeah. The other thing too that for the listeners to know the difference. So basically, melatonin is what is going to help you go to sleep. So there’s different people, different types of insomnia, right? You know, people that have trouble falling asleep, people that have trouble staying asleep. And then a combination of both, right? Melatonin is what helps you fall asleep. It doesn’t help you necessarily stay asleep, although there’s some extended release versions, but don’t know how good that is. But GABA is what helps you stay asleep. So that’s the difference. So it’s good to always know that distinction.

Lindsey: 

Okay, that’s good to know.

So now we’re on to the glutathione and this person has a massive amount of this too, which is great. I mean, it’s the most powerful antioxidant in the human body. And it also acts as a hormone. It can potentiate the release of GABA and dopamine. And, you know, it does a lot of other amazing things in our body, like obviously gobbling up free radicals, helping with oxidative stress, all those things. So, this person has a lot of that, which is good. Not terrible. Okay, I’m not going to be like, that sucks. It’s good. So, let me say a few good things. Not many, but where else we go next.

Lindsey: 

Okay, so we’ll go to page 16.

Dr. Rose:

Yeah, so indoles. Again, it’s the Goldilocks so you don’t want too much of this. I would say this person might have a little bit too much. I’d want them more in the green. But again, the production of indoles, it’s through the degradation of tryptophan, which is what we find in usually meats, especially turkey, you guys all know, it’s like the sleepy hormone, right? So basically, we want this guy because he helps increase the expression of the enzymes that help break down xenobiotics or toxins in our body. So you want you definitely want to have, again, that Goldilocks rule, just the right amount of this is important. Okay, so this is a good estrobolome. I see a lot of my females I find hug around this 20% which I think is good, just from my experience, my females that are premenopausal. I’ll see some people go up into the 30s. I think once you get it up into the 40s, then you’re dealing with estrogen dominance, that can be an issue, and then probably women that start to fall below like 15%, 13% that’s like, you know, you’re probably getting more postmenopausal or perimenopausal maybe. You might want to do a metabolomic test, like look at a Dutch or something to look at hormones.

Lindsey: 

Okay. So we’re on page 17.

Dr. Rose:

Now, vitamin A. So now we want to see how well are your gut bacteria synthesizing vitamins, right, or making vitamins. So it’s different. There’s a distinction between making the vitamins and having vitamins, right. So you can supplement, but that doesn’t mean you’re synthesizing them. It’s two different things. This is really showing us how well they’re being made in the gut. So let’s look and see how each vitamin is doing here. So B1 is decent, it’s not terrible. It could be way worse. I like it into the green area, like 40, 50, 60%. But that’s fine. B2 is good. They have a lot of riboflavin. So that’s great.

Lindsey: 

And if it’s not totally clear, the important part is that the gut bacteria are producing these.

Dr. Rose:

That’s right. So this is another snapshot of metabolic function, right? And because of who’s there and who’s not there, and the imbalance of the current gut microbiome state that this person has. So again,  B5, which is pathothenic acid, they don’t really have any of that.

Lindsey: 

So they’re probably fatigued, I’m guessing. As you need that to produce energy.

Dr. Rose:

B1, thiamine too, that one’s very important for energy as well. They had some of that. B6 looks pretty decent. I’m happy with that. Let’s see B7, they have a lot of B seven. And that’s good. Let’s see what else we got here.

Lindsey: 

Page 19.

Dr. Rose:

B9 not bad, folate.  And B12, not bad. I mean, I’d like to scooch it up a little higher, but not terrible. And K2, not as good. You know, again, K2, not only for helping us put the calcium in the right places like in our teeth and bones and making sure that they don’t get deposited in our soft tissue and our vessels. But also very important for VO2 max, cardiac output, energy, things like that. So you know, this person’s doing well here too.

Lindsey: 

Can you explain VO2 max?

Dr. Rose:

Cardiac output. This is really cardiac output like how well is your heart working right now. Well, is your heart pumping the blood to your extremities and to your tissues and your nerves and cells and all those things? And so when you give K to the people, there’s different forms of K2. The most commercially used is K27. Although the jury’s out on that. I’ve spoken to people that think we should be using the 4, M4. But that being said, they’ve done studies where and I know Kiran and Microbiome Labs has a product that they’ve done studies on and they increase VO2 max when they gave them the K27 at the dosage that was in the supplement by like, I feel like it was up to 20%, but it was like 15 to 20%. But it was a pretty big number.

Lindsey: 

And isn’t VO2 max something you can measure when you’re exercising?

Dr. Rose:

Yeah.

Lindsey: 

So how do you do that?

Dr. Rose:

I think that there’s a device you can wear that calculates it. That’s how they do it in the studies, but I don’t know.

Lindsey: 

Because I listen to another podcast that talks about VO2 max all the time and it says . . .

Dr. Rose:

It’s an equation it’s like VO2 equals blah blah blah or something. [added later, it’s: VO2 max = maximum milliliters of oxygen consumed in 1 minute / body weight in kilograms]

Lindsey: 

I thought it had to do with like the max heart rate.

Dr. Rose:

I can see it in my head but I’m like, what’s the calculation?

Lindsey: 

Okay, so now we’ve looked over this entire report and you’re seeing this so what do you do with this person?

Dr. Rose:

So I’m going to go after the C Diff first, because that’s going to have a lot of die off. There’ll be a lot of toxins released. So I’m going to put this person on binders, binds up whatever is going to die off. And I’m going to give probably a more specific, maybe supplements like a spore former that is good at basically cleaning up C Diff.

Lindsey: 

Like a spore-based probiotic?

Dr. Rose:

Yeah, like HU58 he has, it’s really good. (Find in my Fullscript Dispensary*)

Lindsey: 

So that’s a Microbiome Labs product?

Dr. Rose:

Yeah, that’s B. subtilis. I like that product. Another one I really like is Cleansxym by US Enzymes (find in my Wellevate Dispensary*). It’s shown that there’s activity against C Diff, and it’s ozonated magnesium. That’s really giving your whole gut a nice cleaning. It has built in binder as well.

Lindsey: 

You’re not getting into microbials, though.

Dr. Rose:

So I find that when I have people that tend to constipate, the MegaIgG 2000 (Find in my Fullscript Dispensary*), that’s the binder that I’ll use from Microbiome Labs, I need to balance it out. And the Cleansxym does the trick. Because it if you titrate it up, you can titrate up to like whatever, whether it’s two doses or two caps or four caps a day, you can titrate it up to having a good complete bowel movement. It will balance out the binder, the constipation side effect from binders sometimes, so I like using them in combination, and they’re both sort of cleaning up the house a little bit.

Lindsey: 

But no, wait, did you did you say the you use the MegaIgG as the binder?

Dr. Rose:

The MegaIgG 2000. Yeah, right.

Lindsey: 

Right. Which is like a derivative of colostrum?

Dr. Rose:

Yes. And then I’ll use that in combination with the Cleansxym.

Lindsey: 

With the Cleansxym, like at the same time?

Dr. Rose:

A lot of patients I will, unless the patient has significant diarrhea, then I’ll just leave them alone with the MegaIgG 2000. But a lot of people have the opposite issue. And then I find that they get even more constipated. So I like the Cleansxym because it helps you poop and it also helps with C diff, so I’ll use that with HU58. then.

Lindsey: 

Okay, yeah. So the MegaIgG 2000, I’ve always thought of that as sort of, you know, if you’ve got low Secretory IgA.

Dr. Rose:

I think you’re thinking more the Mega Mucosa (Find in my Fullscript Dispensary*). The Mega Mucosa has all the different immunoglobulins in it. And the IgG 2000’s just more specific and an acts as a binder.

Lindsey: 

Okay, because it essentially pulls out any toxins.

Dr. Rose:

Yes, exactly. So I’m talking about that. That I’ll give later, I’ll give the Mega Mucosa a little later after I’ve cleaned it up, you know, just to keep their gut lining intact. You know what I mean? And keep that gut barrier function optimal. Okay. So I’ll do that upfront for that person. Let’s see what else so then I want to clean up that Bilophila too. So there’s a product by Master Supplements also called TruFlora (find in my Fullscript Dispensary*).  And it really shows it does a lot. It has a lot of activity in the small intestine and helps with SIBO. And reversing SIBO and stuff. So I’ll use that for like eight weeks or so after I get them off the HU58 and the person’s feeling okay. And I’ll get them off the binder, I’ll keep them on the Cleansxym. I’ll put them on the TruFlora. At the same time, while I’m doing this, I’m usually trying to give them some sort of prebiotic, also, right. Because I’m trying to feed the good bacteria that’s being established now so that they keep thriving and growing.

Lindsey: 

So do you use the Mega Pre? (find in my Fullscript Dispensary*)

Dr. Rose:

Yeah, I’ll use the Mega Pre. I use that and I use another product called Sun Spectrum. There an ingredient in that that’s excellent. There’s so many studies that show it increases butyrate production and those butyrate producing organisms.

Lindsey: 

Is that Sun Fiber?

Dr. Rose:

Yeah, it’s Sun Fiber in that. Yes, you got it.

Lindsey: 

Do you find that that’s better for people who are constipated though than people who have, you know, soft stool?

Dr. Rose:

I haven’t found a difference really, to be honest with you. And I have a lot of both. The one I noticed the main thing is with the IgG2000 with my constipated patients. But with the Sun Spectrum, the only complaint I will get is they’ll get really bloated, if they use too much too fast. Same with the Mega Pre. So what I do is I have them put it a in a protein shake or something and they’ll do like a quarter of a scoop for 3,4 days. And if they feel fine, then they’ll go to half a scoop for three, you know, they just titrate, you know, go low, go slow. And then you get them there and they’re fine. I literally barely ever get a complaint if I do it that way. Now the ones that go off on their own and they didn’t listen to us and I’m like, “Oh, you didn’t titrate it up, did you?” And they’re like “No.” Okay, so I start over. Yeah. It’s funny. I haven’t noticed. Why had you noticed the difference? I’m so curious.

Lindsey: 

Well it’s just I personally felt like, well, because I was thinking about the, so I know that the Sun Fiber is partially hydrolyzed guar gum. And so I know that that’s an adjunct for Rifaximin for SIBO. And so I got some

Dr. Rose:  

But did you feel like they were going to make you more constipated? Is that what you were going to say?

Lindsey: 

No, no, the opposite. Well in my personal experience it felt like it kind of just went right through me and sort of sped up the bowel movements or increased them. And I thought that’s not what I want.

Dr. Rose:  

I haven’t had that. Do you think you just used it too quickly?

Lindsey: 

I’m trying to think, did I start with, I probably started with a full pack.

Dr. Rose:  

Go slow, go lower.

Lindsey:

I wasn’t using Sun Spectrum brand I don’t think. They were in individual packets.

Dr. Rose:

I love Sun Spectrum. And Sun Spectrum has other products in it that are really healthy for the gut lining. I think it has curcumin. Does it have vitamin in it? No, I can’t remember the other main thing and it’s like curcumin.

Lindsey: 

I don’t know. I’m the worst patient for myself though. Like I never follow the kind of advice I give my clients.

Dr. Rose:

No, try the Sun Spectrum. And try to just do a little like just a little bit, or try the Mega Pre. Either one.

Lindsey: 

Yeah, I’ve never done the Mega Pre either.

Dr. Rose:

Just try the Mega Pre, again, like just do like a quarter for like a few days. And just go slow and you’ll be fine.

Lindsey: 

So I kind of struggle though with like, philosophically, the idea of giving somebody a prebiotic powder. I sort of feel like they could and should be getting that from their diet and their food. Right? And that I should be getting it from my food.

Dr. Rose:

You’re 1,000% right. But the problem is, like I really tried to be plant based, right? Like I even think about myself, right? Let’s look let’s look at myself. So I do time restricted eating. Okay, so I do a 16-8. Usually that’s just my life pretty much, you know, except maybe like on one of the weekend days. But I’ll tell you, I just don’t even have time to get enough of the plants in. I mean, I’m not getting enough of those. Like, if we’re really being practical here. I’m just not getting enough of the servings in. I feel like to really help my microbiome to the best I can. I feel like I agree with you 1,000%. And everything we do in the practice is getting people to understand why it’s so important to be more plant centric, right? And I’m like, okay, I believe in moderation, everything. I am not really one of those people to demonize any one macronutrient even right?

But and you think about if you’re a vegan, this and I don’t judge anybody if that’s what they prefer, that’s fine. But I would say for the most of my patients, I’m like, “Listen, get like your plate to be at least 60% [plants].” Right? When you look at your plate, like 60, or if it’s 70, awesome, like to be the plant, right to be all those beautiful vegetables, different colors, your salad with all these different, colorful vegetables in it. And then the smaller portion of your plate can be a piece of wild salmon or an organic piece of chicken or organic ground turkey meatball or, you know, I don’t know, like, I guess, God, once in a while or once every two weeks, you want a beautiful piece, like a small piece of ground, grass-fed, grass-finished beef. It’s okay. As long as you’re talking about regenerative farmed animals, and then you’re not putting crap into your body. Right. And so, yeah, it’s like creating balance, you know, and I think once the people get used to having the plants as most of their plate that I feel like you’ve done such an amazing job, right? Because it’s so hard to get so many people there.

Lindsey: 

So yeah, where do grains fit into that?

Dr. Rose:

Yeah. So I’m fine with grains. I’m not against grains. I am in certain instances when I’m trying to heal up a patient and they have something going on. Maybe with some sort of autoimmunity or something like that. Right? But I’m fine with like little portion of your plate to be a little bit of like, quinoa, right? Or like maybe a little bit of brown rice or a little bit of, you know, like my kids even like, we don’t eat conventional pasta anymore, right. I don’t know how I did it, but I did it.

Lindsey: 

You must either be single or have a spouse who is compliant, right?

Dr. Rose:

Yeah, well, he doesn’t know it’s so hard to do. And listen, they’re all full of, any of the pastas out there will have so much carbohydrate in them. But the sugars aren’t so bad, right? Which is good, which I look at even more. Right. But I found this great brand that does a brown rice pasta. And we don’t really eat pasta that much. But when I serve it, it happens to be delicious, right? And so we make it with a really good homemade tomato sauce. And, you know, we make it with olive oil or whatever, and garlic and blah, blah, blah, and we mix it with a bunch of vegetables. And it’s great.

Lindsey: 

It’s great that they’ll do it becauseI can’t pass that stuff off on my family. I mean, it’s like complete mutiny, starting with my husband, then my older son, then the whole place mutinies.

Dr. Rose:

So I got all three of my kids to eat it, and my husband, they all love it now. It is such a good brand.

Lindsey: 

Which one is it?

Dr. Rose:  

I’m going to send it to you. It is so good. It’s Jovial.

Lindsey: 

Okay. I’ve seen that in the store.

Dr. Rose:  

Oh, good. Listen, my kids know when it’s chick pea. They know. And it’s like, when I give them the brown rice, they gobble it up.

Lindsey: 

I’ve just I’ve just given up. We have two pots.

Dr. Rose:

I got everyone in my family. We don’t have any more conventional pasta in the house. It’s brown rice. And it looks like regular pasta. It tastes the same. It’s really good. And they make the penne, they make farfale. They make elbow macaroni. I’m telling you.

Lindsey: 

No, you see, here’s the thing about my family is even if you don’t tell them and you try and just fool them, somebody is going to begin to sniff that out. Because if I’m eating it, and they’re eating it, there’s a problem. And so even if it tastes perfectly fine, somewhere in the middle, somebody will be like, “Wait a second, you’re eating this too? Somethings not right. You fed us . . .” and then I’m going to get reminded of the time when I tried to pass off turnip fries as French fries. And then it all goes south.

Dr. Rose:

No, really, honestly I’m telling you. You cook it for like eight minutes. I am telling you they will all like it. Put a yummy marinara sauce on it. I’m telling you, okay, there is no way. You have to let me know; you have to try it because I went and I gave it to all their friends. All of their friends eat it. Nobody doesn’t eat it.

Lindsey: 

Okay. Okay. I’ll trust you on this one. We’ll give it a try. Okay, so I’ve kept you much longer than I should have. How should we wrap this up? Any final thoughts on how you might help this person?

Dr. Rose:

Yeah, so basically, after I’m done with the C Diff, I’m going to go after the Bilophila like I just said with that [ProFlora], two, four [months]. I’ll probably keep them on the Cleansxym, I’ll keep them on a prebiotic, keep them on digestive enzymes. And I’ll probably retest them in six months.

Lindsey: 

Okay, but nowhere in here did I hear any antimicrobials? You’re just using probiotics, prebiotics, enzymes?

Dr. Rose:

I’m not, I’m not.

Lindsey: 

Okay. Now is that for most people or just this profile?

Dr. Rose:

I don’t use any antimicrobials, unless I see some weird pathogen.

Lindsey: 

Okay, so you’re using the spore-based probiotics to cull and shape the microbiome?

Dr. Rose:

A combination of those, or maybe some other type of probiotic, depending on what the situation is. Yeah.

Lindsey: 

Interesting. Okay. Well, so I will link to Microbiome Labs’ stool test*. This is the BiomeFX and products, if people want to use that and they can get a 20% discount using my affiliate account.

Dr. Rose:

Nice. And they have great products.

Lindsey: 

Yeah, I recommend Megasporebiotic to a lot of my clients.

Dr. Rose:

Yeah, it works great. It works great. I would say, like I said, everyone’s different. I had a person the other day that I did a consult on this through Microbiome Labs, and he was like, it just doesn’t work for me, the Megasporebiotic  doesn’t work. So I’m like, okay, we’re going to try something different. Not everything’s going to work the same for everybody. So we have a lot of tools in our toolkit, and we’ll just try something different for that.

Lindsey: 

I give almost everybody at least a month of it, but they’re so expensive, the good brands are expensive.

Dr. Rose:

All of them, everything is expensive.

Lindsey: 

On top of everything else, I feel like it’s just a lot to ask of people sometimes.

Dr. Rose:

Yeah, yeah. But listen so when you get this is done, you got to give it to me. I’ll get it to Kiran. Okay, I’ll get you a stool test. And then we’ll have to do a follow up.

Lindsey: 

That sounds great.

Dr. Rose:

We’ll see what your proteobacteria looks like.

Lindsey: 

Because, you know, I never knew if I could trust it or not. I’ll have to make sure my SIBO is not acting up when I do that.

Dr. Rose:

You should get rid of your SIBO.

Lindsey: 

Oh, I keep trying. I just did the ibssmart test and found out that I do have autoimmune IBS, essentially. It was positive for the anti-vinculun.

Dr. Rose:

So you did, was that the Vibrant Test?

Lindsey: 

No, the ibssmart.

Dr. Rose:

I think I have anti-vinculun antibody too.

Lindsey: 

I just did it like a week ago. I mean, I got the results a week ago.

Dr. Rose:

Well, did you you know that usually results if you’ve had an infectious an infected . . .

Lindsey: 

Right. And I did have a couple of nasty incidents of food poisoning.

Dr. Rose:

Yeah. And it’s funny that we were talking about before, I was I was hospitalized for E coli 0157 when I was in medical school.

Lindsey: 

Wow. And yeah, no, I had never had anything that had me hospitalized. But I lived in Costa Rica a couple different times. Once I got one some weird thing. I don’t know what it was, but I had to take some strange antibiotic for it. And then the other time was the full on food poisoning because I left mayonnaise sitting for two days, then made tuna salad.

Dr. Rose:

What are you going to do with your anti-vinculin antibody?

Lindsey: 

I’m sort of working on the prokinetic question right now. I’m playing with Iberogast. But I’m thinking I want to see if I can get somebody to prescribe me something. So we’ll see. I’m launching into a study on prokinetics now.

Dr. Rose:

Okay, that’s awesome. Let me know how that goes.

Dr. Rose:

Yeah. Thank you so much for coming on. And all this great information about this test. Nobody’s talked about this or, or worked on it before. So this is an interesting approach.

Dr. Rose:

Yeah. Thank you. It was a pleasure. Thanks so much for having me. I really, really appreciate it.

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