I have considered myself a feeder
and a bleeder for the last 25 years because I feed people stuff
and I believe them to see what happened to their cholesterol
or insulin or whatever. But I am now a feeder and a bleeder
and a pooper. Oh my God. We get shit from everyone and we put it in the freezer
and we analyze it. And this is a hot topic in nutrition. So I'm going to talk about that
for 40 minutes. And then when I stop, it's up for grabs. So you can ask me anything after that. And I'm an industry shill. I took some money from Beyond Meat,
and I'm on the advisory board for a group that I will talk about briefly,
but I don't get any money from them. So here's
the outline that I have for you for today. I'm going to talk about prebiotics
and probiotics, and you probably see this in tons of magazine
covers, the microbiome. I guess it's why you showed up
and it's in a whole lot of books as well. One of the top left I'm
totally going to pitch my collaborators, Justin and Erica Sonnenburg have written
a fabulous book called The Good Gut. They ferment everything at home. They make sauerkraut,
kimchi, kombucha, sourdough bread, and they
have some recipes in this as well. So I don't get any royalties from it that the envision here. We're not there yet. The Envision is we could diagnose your microbiome, see what kind of species
that you're missing. That would be helpful. And maybe we can introduce them or maybe we can give you the foods
that would support them and that this would help not only digestive health,
but all kinds of other things. That is our long term goal
and we aren't even close to there yet. But I do want to say that that is the goal
and it's really fun working with so many fabulous people on campus. So I'm going to highlight a couple of them microbiome. And so if and if you don't know this,
the NIH just committed $170 million to five years of studies across
five different centers. 10,000 people are going to poop
for all of us multiple times. And then a subset of them, 2000
are going to poop in a different way,
and 250 are going to give extra poop. And they're going to be characterizing
all this around the theme of precision nutrition
or precision nutrition health. So they have all these centers
all over the country that are doing this. Stanford isn't one of them. Actually,
we have no nutrition program on campus. I teach I my physicians
with the School of Medicine, the Department of Medicine,
which has 14 divisions. And I'm in the Stanford Prevention Research Center, which is kind of like
a little mini school of public health. But I teach in human biology,
which isn't nutrition, but actually get a lot of students interested in sports nutrition, child
nutrition, nutrition policy. And so that's usually a good home for me. And once in a while I come to the business school
because there's lots of entrepreneurs. They're coming up with new food products
that they'd like to try out. If you dig deep into this,
they're not even that deep into this big niche funded thing. There is a huge
microbiome metagenomic center that probably
most people don't know about yet, and I think it's going to become more
and more common to hear this. I think you'll go to the doc
and you might end up just standardly giving a poop sample along with
peeing in a cup and something out. So we'll see how that goes. I'm curious, did anybody spend 90 bucks
an hour to have their poop analyzed? Anybody want to be honest? Yes. Okay. No wonder you look so good. That's fantastic. So I'm sure they told you,
oh, you have this lactobacillus and you have this firm liquid
or bacteria, Daddy, and you should eat blackberries, not raspberries,
and you should eat walnuts, not for corn. They ignored all OC at this point.
Some of it is a little silly. Oh, you're a forager or oh,
you're a harvester. Oh, you're a you're something else. What should you. What should I eat? Well, you should eat vegetables and whole grains and nuts
and seeds and beans. And like, that's what they told me anyway, even though I wasn't. All right, anyway,
you can spend a lot of money on this. There's a whole bunch of companies
coming out doing this. You can send in your poop and pay them. They're actually using your your data
to come up with bigger data sets
to help be predictive of what's going on. And there's quite a few of these arrival
and have it are already gone so some of them don't last a day too, which is put together around
two brilliant guy at the Weitzman Institute in Israel
is doing some great stuff with this. I hang out with some folks in the UK
who sort of have an international collaboration
called Zoe. Actually, the last time I gave this talk
somebody was doing the Zoe app. So I'll just ask this time, is
anybody in today's talk doing the Zoe app? There we go. Right there. Okay. Well, we might ask
you some questions later, Kathleen. Okay. And then
these guys got in a lot of trouble. And so it's not all going very well,
but there's some fraud. There's some good folks out
there. We'll see what's going to happen. So my background is it's exciting,
it's moving. There's companies,
there's innovation and disruption. That's why we're at the business school. But at the basis of all
this is really two categories of things because I'm a nutrition professor,
my PhD is in nutrition science
and it's prebiotics and probiotics. So maybe because you came here,
you already know this kind of stuff. But I'm going to assume
not everybody knows this prebiotics is basically fiber. So the definition of fiber
is that it's carbohydrate like molecules and long strings that we don't have
the humans enzymes to digest. And so since we can't make it small enough
to digest, it goes to our colon and then the bugs there eat it. And so this is feeding
our friends with fiber. So they love this. And the other thing is probiotics
and that's eating live bacteria. So technically, probiotics
usually means pills. So technically fermented
foods aren't probiotics, but they contain live bacteria. That's the point. You're eating it,
although not everybody does this. You can take cabbage
and then just put vinegar on it. And it might seem like it's fermented,
but it's not. I know that Costco now has some kombucha I might be making this up,
so don't quote me that somebody said they sterilize it
and they kill all the bacteria off and then they add bacteria to it,
which seems odd, but maybe from a scaling up perspective,
they they can't make it the regular way. But there are I have it at home. I make kombucha all the time. I'm I'm like my 120th batch, right now. It's super simple. It's fermenting right next to my desk
once a week. In fact, every Saturday I'll go
and I'll make six bottles of kombucha and I'll take my SCOBY,
my symbiote attack, culture of bacteria and yeast, and I'll brew up some tea
and I'll stick some sugar in there and I'll let it ferment for a week
and then I'll bottle it and I'll put some something in. I'll put cinnamon nutmeg. Oh, I should put some pumpkin spice
because it's Halloween. I've got some mango extract
and some other pomegranate extract and then I let it ferment
a week in the bottle and I have carbonated kombucha at home. It's pretty fun. Okay, so I make my own probiotics. The sonnenburg to make way more than me. They're amazing at this. And so, from my nutrition perspective,
should you eat more fiber? Yes, I'll always it's like from day
one, that's this is nothing new. Should you eat fermented food? Wait till I show you what we did
in our fee. Fi fo study fee for fermented five for fiber and fo for food. So if I feel you like that. Okay, so I actually stole
a bunch of these slides from the sonnenburg,
so I need to give a lot of credit to them. This is Justin's version
of your intestinal tract. This is a very dumbed down
idea of your intestinal tract here. So up top in the beginning
it's much smaller and at the end it's this big colon. And the idea here is that as humans, we have about 20 different enzymes
to digest carbohydrates. If you go to the colon collectively,
the bacteria living there have a thousand different enzymes
to digest and break down the fiber
like molecules that show up there. And so the idea being that if we eat the
standard American diet, SD stands for S&D. If you have the standard American diet,
which is very high in sugar and refined grain,
we are all capable of digesting that. And look at those poor bacteria in the
colon, just languishing, lethargic Lee. They're like, Please send me some food. I'm starving down here because
we've broken it all down and absorbed it. But the option is to eat vegetables and legumes and whole intact grains
and things like that, and they come with fibers
that we can't digest. And so those go down and look how happy those bacteria
are in the colon up at the top there. And while they're digesting that,
they're making small molecules. There's a fabulous colleague
on campus named Michael Fischbach, who got a $7 million grant to study
the small molecules that they generate. And I've seen his graphic
of a hundred different small molecules that get generated by the microbiome that we absorb
into our circular circulatory system. And quite a few of them, we believe, improve immune function and lower
inflammation. That's sort of the promise out there. And one of the main types is called short
chain fatty acids. So you might see that a couple of times. Today's SCAF short chain fatty acids. So altogether we have two very different metabolic
scenarios here. And the Sonnenburg have sort of jokingly suggested that not all the fibers will feed the bacteria
and it's not all just soluble or insoluble, it's mostly soluble,
but it's a bit of a mix and so what they call the right ones
and we don't actually know exactly what all the right ones are,
but they are the microbiota accessible carbohydrates,
which they coined as a Big Mac diet. Right. Is that bad? That is so bad. Okay. So now you've seen your intestinal tract,
so you don't have a screen. I love this auditorium,
but I hate that there's like no screen. So sorry. I got to try to see that one
look over my shoulder, so. Oh, Justin won a photographic award for this electron
microscopy picture. So this is a cross section of a mouse colon stain in various ways. And so if you look in the upper left,
those are your friends, the bacteria. So they stained all the different bacteria
in different colors. Isn't that cool? And on the bottom, right,
they've stained the nuclei of the intestinal cells
that line your colon. And so that's the blue is lighting up
the intestinal cells, the green that looks bright, dynamic green. They're neon
green is the mucous lining that separates the middle of your gut
from exposure to the intestinal cells. And this is a very important
mucous lining. It protects us from different things
and we want a nice, thick mucous lining. Interestingly, the main composition of the mucous lining
is carbohydrate, like substances. In the absence of eating enough fiber, the bacteria will eat your mucous lining. And so this is what they've done
in their mouse studies, looking at all the trillions of bacteria
that are in there and the way biology works, they fed a bunch of mice up or left
a whole food diet, let's say, and the poor mouse on the bottom
is getting Coca-Cola and jelly beans. And if they then track
what happens in their colon, the one on the left has
a very thick mucous lining. The one on the right has
very much of a deteriorated mucous lining. The idea being that if the bacteria keep eating that and thinning it,
it will lead to leaky gut syndrome, inflammation and a lot of problems related
to heart disease, diabetes and cancer. And so this is one of the explanations
for the importance of the microbiome
and of feeding the microbiome with fiber. So that's the background to this. And then he's got some he does some other
amazingly fascinating things. So let's go from ecological
to some mouse models. So from ecology, he actually has a whole
bunch of hoards of poop in his freezer. He went to a traditional hunter gatherer
tribe and he collected all this poop. And they've been looking at it
and it's amazingly diverse and it doesn't really look like our Western diet
microbiome. They eat they eat a lot of fiber,
so they out hunting and oftentimes they won't catch anything hunting. And so one of their staples
is just tubers. They eat a whole bunch of tubers. And so that's, I think Bobo
or something like this on the right, very, very fibrous. And so we've got a timeline
way up top there and we've got a ton of hunter gatherer,
a little bit of agrarian, and now we've got industrial French fries,
which doesn't have nearly the fiber of those folks and what they're eating. And so this is a graph I can't describe
because I am not a microbiologist. But the idea is if you go
to all the hunter gatherer tribes around the world, there's not that many,
but they're in different locations. Their microbiome is quite similar to one
another in different places on the planet. So this graphic is trying to show
how they line up from different places in the world. And then if you go to Western countries
on this side, they line up also but in a different way. And so if you look
here, here are three different species that they're quite likely
to find in a hunter gatherer tribe, but really exclusively
not in Western diets. And there's one in Western diet
that's not in the hunter gatherer tribe. So this kind of bizarre
that there's such commonality around the world for a hunter
gatherer lifestyle and a Western. But they're they're so different
in some specific ways. And the way they liken it, to make it more simplistic,
is this lush rainforest on the left and clear cut forest on the right
is what our intestinal tract looks like. Pretty sad. And so, again, timeline here, going from eating
hundreds of grams of fiber a day to 35, which is the national guidelines,
pretty much to less than half of the national guidelines,
which is about what we eat. And my concern has been lately
in the nutrition world, this weird backlash against, oh, low fat, low fat
oh is wrong, low carb, low carb, low carb. And so I got a lot of people
doing the low carb thing and eating more meat
and eating less fiber. And so I think that's even more
of a problem than we've already got. The national recommendations
are about 30 to 40 grams of fiber a day. If you look at the National Health
and Nutrition Examination Survey, Americans eat about half that. And when they complain, oh, doc, I
can't eat that much fiber, it's too much. Oh, gee, I distress. We kind of want to say, go
look at the Hadza. They eat like 100 grams a day. So you can physiologically you can
you just probably have to assimilate and adapt
and don't do it all at once. Take some time. So here's
here's something you can't do with humans. So I'm a human interventionist. I don't deal with mice
just in dealing with mice. This is super clever. So he took four generations of mice
and he tried a fiber experiment with them where one group across the four
generations kept getting a high fiber, mixed fiber diet, and the other one
would have fiber removed from the diet. And then after a while added back, as if to say, okay,
I came with this fabulous microbiome. I went on the standard American diet
and I lost my microbial diversity. Can I add fiber later and get it back? Would that help if I go back? So here's my four generations of mice. So here is pictorially. The depth of the color over here
is how abundant it is. But these are all the different species
that they're finding in the mice, if that makes sense. And then they take this first generation. So the next two bars are a low fiber diet
where you see many fewer species. And then if you can see,
I don't really have a good point or maybe I can point real quick
because this is pretty smart. See, it says low there and high there. So keep that in mind. So at the end, they give them more fiber and can you see a few more species
come back at that bottom one? Okay, now let's go to the next generation. Oh, even less diversity. But the fiber brings it back. Oh, even less diversity. But the fiber brings it back,
but not very much. And then here's the fourth generation, and that's compared to the mice
who got fiber the whole time and never lost any diversity. So you can't do this in humans, right? If I was trying to publish this,
I'd have to have my great, great, great granddaughter publish this finding for me. But he does this in mice. And the concern is that are we depleting
the microbiome irreversibly? So a lot of the grants we've been writing
lately are sort of titled, Here's our grant to recover or restore microbial diversity
like we had it and we're losing it. And so there's some urgency here. We don't want to lose it forever. Okay, so hence comes
we actually had a lot of fun. We'd been on the same campus
and heard of each other for a while and the first time we met
was at a conference, which actually happens more often
than you might think. Like we're on campus
and we don't see each other, but we're both speaking at a conference
back to back and it was like star crossed lovers
or two pieces of the amulet that matched. And I said, poop is icky. And he said, Humans are a pain in the ass. And I said, We can do this. I will get the humans,
I'll get them to poop and you analyze it and we can take all this mouse work
that you've been doing, which seems to implicate diet, diet, diet,
diet, and let's, let's do it in humans. So we got this published in cell
just a little while ago and had some great graduate students
working on this. We had diarrhea. Perlman who's the diet
whisperer? Who can get anybody to eat anything? She's so kind and empathetic. And the idea was
we would give a bunch of people fermented food
and a bunch of people high fiber food. And we would kind of compare and there's
an interesting side note to this, which is all of Justin's work
at that time had pointed toward fiber. He did make a lot of fermented food,
but he didn't have much faith in it. And he's he has said that I somehow
had to cajole him into including fermented as one of the groups and you're going
to see it proved to be very powerful. So here is the diet whisperer. Are you trying to get people
to eat more fiber or more fermented food? It wasn't a huge study. 18 people in a group for four weeks. They ramped up to
as high as they could go. And we didn't actually have a set number. We just said as much as humanly possible. Just so we can get some movement in your microbiome
and then keep that for six weeks and then we'll go back a few weeks later
and we'll see kind of what you've maintained,
if that makes sense. Okay. So here is how much fiber
they're eating on the left. They started at about 20 grams a day. That's about what Americans eat. And check it out, they got higher
and look over here for fermented food. How many of you guys think
you eat a serving a day of fermented food? I'd be curious because our group, a less
than a serving a day on average. Anybody, two servings a day. Okay. So I tell you what, we asked them to eat
was six servings a day. Does that sound ambitious? Keep in mind that a half a cup of sauerkraut
or a half a cup of kimchi is a serving. And one of those bottles of kombucha
that you buy in a store right now, that's two servings. So really all you have to do to get six servings
a day is a cup of sauerkraut for lunch, a cup of kimchi for dinner and drink,
a bottle of kombucha during the day. And it's only about three. And all the different mixtures that we put
together, it's about 300 calories. So six servings a day is not like that. That's all they ate was fermented
food all day. That was like 15% of their diet. So it's not as bad as it sounds. Okay. So very cool. Here's it. They're eating at baseline
and they ramp up and then they maintain. Bless their hearts. Oh, love this w Perlman. She got them to keep this. The really interesting thing
was at the end we said the study is over. You can do whatever you want. And I'm most impressed
with the fermented folks who are not eating anything
in the beginning on their own. They were eating three servings a day
when the study ended. They enjoyed it. Oh, my God. Okay. Unapologetically delicious fermented food
that we gave them. And the fiber folks, they're eating more
than they did at baseline, too. Something seems to be working. They keep doing it themselves. Okay, so here's the fermented food group, and they
are increasing their microbial diversity. That's great. We don't know exactly which ones are good
and which ones are bad. So increasing your diversity per
se doesn't have to mean it's good. But. But probably
especially if you're eating well. These are all the different types
of things they eat. And statistically, if we tease that apart, it looked like the yogurt in that kombucha
were making the biggest contribution. But maybe that's just because what people
have the easiest time consume thing. We didn't really find that many different
fermented foods out there. There's not a huge amount of choice. We did not try to introduce
natto to anybody here, even natto. Okay. Oh, my God. I cannot. It is so slimy. Okay. Is it fermented soybean thing
that's just not go there for now so I can eat those though? And then we found a number of species that seem to be moving in the gut,
and this is really exciting. We kind of thought,
Oh, well, that makes sense. They're eating fermented foods, so they're
getting the bacteria from those foods. So we actually started going out
and buying all the foods that they were getting. And in the Sonnenburg lab,
they characterized all the different species of bacteria
that we were finding in those fermented foods. And this is a pie
chart of how many of the new bacteria in the increased diversity was contributed
from the foods they were eating. So that very small sliver
was what they found in the foods and the rest of the pie was not in those foods
that they were looking at. And so the idea here is
maybe there's some bacterial strains that are in our gut that are just sort of waiting to bloom,
but they need the microenvironment to change. And so we were changing the environment. And so this is a hypothesis
we have to follow up on later. It wasn't just what they were eating
something else by changing that environment was opening up the possibility
of increasing diversity in other ways. This is kind of how mysterious
the microbiome is right now. Don't know exactly what we're doing,
but this was fast. Amazing. Okay. And then we have all kinds of outcomes. So we're very interested
in immune function and inflammation because this is one of the more likely things that's going to be
the clinical impact of these. And so one of the tests that we can do
looks at different inflammatory markers. Now, I'm sure you've all been to the doc
and had your blood pressure, your LDL and HDL cholesterol,
maybe your glucose. How many of you have
had your inflammation checked out? Not not yet, really. So maybe CRP. There are some docs who ask for CRP,
but there isn't. How about your IL six? How about your tumor necrosis factor? Oh, there's so many of them. It's actually a really challenging field
because there's so many different inflammatory markers and we haven't
figured out which ones are the right ones. But in the fermented food group
of 90 different inflammatory markers we looked at and we could have looked
at more of the 9020 of them went down during the course of this study. And so this is a little subtle
in this graph. So fermented food is in purple
and fiber is in green and only one change
significantly in fiber. And it was interleukin eight
and it's the last one in my list here and it's actually anti-inflammatory
and it went up. So that was good. But only one thing got better in fiber and 20 things got better in fermented
food. And Justin called me up and he said, Did
you did you mix up the coding? You handed me all the data. I, you know, humored
you and included a fermented food group because I knew
the fiber would do everything we needed. But there's one group
is not really responding here, and the other group
is responding in enormous way. Are you sure? You know, it was it was the fermented
food group that was doing so well. We actually if you go back about a year,
The New York Times, Tuesday science section ran two things. One was our study,
and then they got so many requests. The week later, they ran a whole thing on
where do you get fermented food? Because so many people were curious
how we got these results. The fiber group
is actually a little different in that and this is not my forte. But if you if you do some machine
learning type thing, you can see that there were clusters within the 18 people
that were on high fiber. And this is this is pushing
the limits of statistics a bit here. And so don't take this too seriously. If we sort of broke them up in thirds,
there was one group whose information got better
and there was another group whose inflammation got worse
on this study. Well, I went too far. And when they dug a little deeper and
this is the hypothesis we're following up on, it was the ones that have the least
biodiversity at the beginning of the study that had an adverse reaction
to all the fiber. And Justin
and Erika's interpretation of this is like a firehose of fiber
that you're not ready for. You don't actually have the bacteria ready
to process all this fiber that's coming your way. So in our new studies, we're actually
feeding them fermented food first and then fiber
to see if we could increase the diversity and then maybe they can handle more fiber. So at the end of the day,
we got this published in cell, which is a science
journal of great reputation, and we said, you know, we've got
some interesting changes in the fiber. It seemed like more of a personalized
response. The response, it's kind of based on what
your baseline diversity was, whereas as opposed to for the fermented,
it kind of worked in everybody. Everybody had this very consistent
increase in diversity and decrease in inflammation, whereas the fiber was more individualized,
which kind of makes for a nice story. There's a very generalizable result
on the one hand, and maybe there is something
to personalize nutrition, maybe there is this angle that we should follow up on that
not everybody's the same. So that's sort of our take home message from this fee
fi focused study have to give a huge shout out to studying immune
function and inflammation. So Stanford has a world
famous human immune monitoring center
run by Mark Davis and holding maker. So any time we come up with anything
like if if we have $1,000, we could spend it
$10,000, we could spend it a million. Like if if we have more money,
they can look more into immune function. So that's a good and a bad thing. The bad thing is, oh my God, we can never run out of extra things
to look at for immune function. And we don't have this simple number
to just say, Oh, you're a 46 and you're at 23,
you need to get your number up. So it's close to it
and we don't have that yet. But in I'm sure everyone's
heard of inflammation as sort of this underlying cause of chronic degenerative
disease, non-communicable disease. It's they're just got to figure out
how to work on these. There's no one better
to work with than these folks. So we feel like
we have this trifecta going. We've got a bunch of little studies going
where our group intervenes on the diet. The Sonnenburg lab characterizes
the microbiome and the Human Immune Monitoring Center
is looking what happens to inflammation. So we're really hoping
that Stanford is uniquely poised to take sort of these three fields
in an interdisciplinary, interdisciplinary way
and move the science forward. Okay. So on
another little note, here's an example. How many of you have had any of these
plant based alternative meats? There's actually a microbiome story here. Okay. So this is the study with appetizing plant food, a meat eating alternative trial. Not bad, huh? Okay. And so we we were looking at something
called trimethylamine oxide, which is something
that when you're eating meat, it has the precursors, choline
and carnitine in it. And as that goes to the intestinal tract,
the microbiome chews up those two precursors and generates
something called TMH Trimethylamine. And if that goes to the liver and gets
oxidized, you get trimethylamine oxide. Sort of an emerging cardiovascular
risk factor was discovered by Stan Hazen, a doc at the Cleveland
Clinic. It's not standard now. It might be one of those things
he would like it to be. I'm very involved in the American Heart
Association, and every year when I go, there's a whole session on TMAO
and what people found. So you may find this soon,
but it's probably related to clotting and inflammation and lower TMAO is better. Okay, so in our trial
we said, okay, let's have people eat two servings a day of fake meat
and two servings a day of real meat, and we'll have them crossover
and do the other one and we'll use beyond Meat is where I'm the industry chef,
so feel free to call me out. I didn't get any money to do this
on my own, so they gave me some money. And what should we compare it to? Should I have got McDonald's meats? I've got Safeway meat. Well, I'm a huge proponent
of not setting up a straw man. So we went to San Francisco and we got a company called Good Eggs
to give us grass fed, pasture raised, organic, regenerative,
you know, ground meat. So we did the best meat that we could versus beyond meat, and we lowered trimethylamine oxide. And we also, in a small way, lowered
weight and we lowered LDL cholesterol. So basically three things got better
when they did the alternative meat relative to the regular meat
and nothing got worse. So it was a win for the beyond meat. But what I want to focus on
is that TMAO right now and here's that thing I was talking about
where TMAO the precursors go to the gut,
the gut transforms it to TMA goes to the liver,
TMAO contributes to heart disease. That's a hypothesis. So in our study we had two orders. So let's start on this side
because half of them did the plant first and the animal second and half of we did
the animal first and the plant second. And so this is a graph of TMAO levels
and you can see at least on the second half here
when they did the animal first, not everybody but a couple of people,
their TMAO shot up right. Notice that a couple of people,
they didn't move at all. So it doesn't happen with everyone. Okay then in the other. So in a crossover study, the advantage is
everybody is their own control and so that helps to do a study
with fewer people. But what you expect is you'll get the same
thing regardless of which order it is. And if it doesn't, you are tongue tied
and you have to explain what happened. And so here's the folks
who got Plant first. You can see the black line is the average. So it goes down a little on average
and then we give them animal and it and it oh crap. It didn't shoot up. Oh no. I have to explain this
when I try to get it published and it's not as easy
as it was supposed to be. And I did it
with fewer people than I may be needed. But we went to the literature
and we found that somebody had tried to get vegans to eat meat to see
if they would make TMAO and they didn't. And so the idea was on a vegan diet,
they had transformed their microbiome to something that didn't metabolize the
choline in the carnitine in the same way. And so right now
we have swap, meet poop in the freezer and it's being thawed
so we can see if in this first phase they changed their microbiome on that diet in such a way
that they didn't make the TMAO later. So these are kind of the fun ways that
we get to work with the Sonnenburg lab on how that's happening. So we're going to take advantage of Justin
and Erica and their great book, The Good Gut. Again, I don't get any royalties,
but it's a great book. Now I do a shameless plug because here's
another thing that we're doing. How many of you let's see, probably none of you are pregnant today,
but some of, you know, pregnant people. So here's another acronym from our group, the Maternal and Offspring
Microbiome Study. We're doing in 132 pregnant women moms. And the idea is upfront
in their second and third trimester. Some of them eat more fiber,
some of them eat more fermented food. Some of them do both. We were trying to learn from that
other study do and some of them do none. So it's the control group. And then what we're going to do
is after they do that for their second and third trimester, then we check out
the microbiome of the infant and we track them both for 18 months. Because one of the issues it's a hot topic
now is the mom giving her microbiome to the child. And then how many of you
have heard of this? But there's women having C-sections
that are freaked out that their kid isn't getting their microbiome, so they're
swabbing some rags in vaginal juices and then they lay it out over the infant
born by a C-section, hoping that they'll I don't even know how it works, but
they're doing that because it seems like, oh, my God, I had a C-section
and I missed out on this thing. So we're going to have women who have gestational diabetes, C-sections
who get antibiotics. We're going to be women who breastfeed
or not wean their children on different food or not. And so the whole hypothesis here, it's
actually more discovery and exploratory. How does the kid optimize the microbiome? Are there some dietary factors
or other things? So this is another just cool thing
we won't have any results for. I actually have 65 women already
and so the moms have to give us blood and poop and vaginal swabs and breast milk
and pretty much from the infants. We just need diapers. That's that works
out pretty good, if you can tell. Okay. And so for this now, we need a clinician. So now are taking advantage of OBGYN,
OBGYN. Dr. Scarlett Carcache is fabulous at this. There is a center on our campus
called M.S., HRA, the Maternal Child
Health Research Institute, fabulous new partners, again, multidisciplinary
kind of Stanford Research, just perfect. And so now it's the trifecta
with a new population to study. Now we're taking all the same things
we've been doing before. We're specifically studying
pregnant women, so click on the QR code or if you know one, someone who's pregnant
just this is easy to remember nutrition at Stanford dot edu and we were originally recruiting women
in the Bay Area, but we've expanded it right now to all of California
and it could go beyond that. So during the pandemic, we learned more
how to do studies remotely. So we have 68 of our 132 women
and we need the other ones. So hint, hint, if you know, and it's
a recruiting plug for our moms study and then a group that I work with it's
also trying to collect data do this is Zoe and I saw someone sat down
I was doing the Zoe app. This is fabulous. So I get to work with Jose, all of us at Tufts and a whole bunch of people
at King's College, London on this Zoe app where they had
they started out over here with a thousand identical twins and then they said, Oh, let's recruit some
people in the US for practice remotely. And they came and sat me out and Jose
and some folks at Harvard and they recruited
a thousand people in the US and now they have this app and they're giving advice in the app
and they're trying to get 10,000 people on the app to sign up and give them their poop, give them poop
and blood and just learn from it. So it's a bit of a scam
here, I'll be quite honest. It's a bit of a scam
you're paying to get the app, you're contributing your data, and you need that data to figure out
what some of this some of this stuff is. So the NIH is $170 million. That's five years of 10,000 people. And all that poop
they're trying to collect so they can look at it in parallel. Zoe is trying to do the same thing, but
they're actually giving you advice as you go, as they learn they're developing
developing the app with your data, and they're trying to share that a lot of
us do with wearing glucose monitors. So you can see these continuous
glucose monitors when you're eating something
and your glucose spikes or not. So that's sort of their claim to fame. And Zoe, these
are, you know, I'm supposed to inspire you in these classes of quizzes of Stanford
is doing some super cool stuff I think. Right. So the Zoe group published a huge paper,
two papers in Nature Medicine just last year, and one was
how much of it is the microbiome versus the genome versus sleep versus
exercise versus timing of meal? And then the second paper was a huge deep
dove into the microbiome. Which bacteria seem to be the healthiest? Which bacteria seem to be
the least healthy? Which ones change? Which ones are associated with the foods? I don't possibly have time to share
all that with you, but it's very exciting. We have a lot of data and I don't have a clear for you today,
so I want you to be skeptical of it. I do. I want you to be skeptical,
but there's a lot of potential. So conclusion is, please, at least for now,
feed your friends, eat fiber. You can't go wrong. We've been telling you that for years. Here's another reason to eat fiber, right? And then the whole prebiotic
probiotic thing, they have pills for it. Don't have pills. You should eat food, eat
fiber and fermented food. Oh, my God. Have Korean kimchi, have middle Eastern vegetables,
salad, have Mediterranean roasted veggies. Make your own kombucha at home. Eva, hummus, sauerkraut, salad. All I have is a yogurt parfait. Oh, get out there and eat some fiber
in fermented foods. That's unapologetically delicious. Enjoy it. And take home these messages. The Western
microbiome is not doing so well. Dietary fiber should help feed that fermented foods looked like they'll help
increase diversity. But most of the claims out there
right now of companies that are selling
this are ahead of the science. They're saying we can do this
and we can't yet. So lots of promise. I think
I think this is where we're headed. I think we're going to be able
to diagnose some things, figure out how to support your immune function
through the microbiome. But we're not there yet. But I'm glad you came to class today
so that you can hear this and give a shout out to all the Sonnenberg
lab folks and all the folks in my lab.
