In this Biome Bite, Dr James McIlroy discusses the differences between food supplements and drugs, including their regulations and pricing. He suggests that some food supplements may be better than drugs for certain uses and indications, despite the higher standards and stringency for drugs. What are the differences between a food supplement and a drug? There are some key differences in the regulations. And those regulations govern how they're manufactured, how they're tested, the levels of quality assurance, and also the level of evidence. that has to be generated for them to be able to be put on the market. So drugs are regulated by competent authorities. In the UK, it's the Medicines and Healthcare Products Regulatory Agency. Food supplements are regulated by food standards agencies. In the US, interestingly, they're both governed and regulated by the same group, the FDA, Food and Drug Administration, but they're separate divisions within that very large organization that create the standards that the companies and the organizations that are manufacturing, distributing, and marketing have to adhere to. Now, classically, there are significant price differences between drugs and food supplements, and that's driven by the level of evidence that the companies have to generate to put the products on the market. And there's much higher stringency and standards in drugs rather than foods. Drugs often fail in clinical development as well because the standards are so high. Therefore, the drugs that are on the market are priced by the companies to be able to recoup losses from a company-wide perspective, associated with failed drugs, and also to make a significant return, typically within a patent life. of an approved drug. Back to the topic. Food supplements could be better than a drug for certain indications, and certain uses. Timestamps: 00:00:00 Intro 00:01:46 Key differences between supplement and drug 00:03:14 Lysine 00:09:54 Quercetin 00:15:19 Melatonin TRANSCRIPT: Biome Bites #11   Hi everyone, it's your host Dr. James McElroy here today for another Biome Bites. This is a solo episode so you have me and only me for the entirety of this episode. Today we're going to be speaking about three food supplements that could be better than drugs. Or rather, in a parallel universe, may in fact be regulated and distributed, marketed, and prescribed as drugs. So what are the differences between a food supplement and a drug? There are some key differences in relation to the regulations. And those regulations govern how they're manufactured, how they're tested, the levels of quality assurance, and also the level of evidence. that has to be generated for them to be able to be put on the market. So drugs are regulated by competent authorities. In the UK, it's the Medicines and Healthcare Products Regulatory Agency. Food supplements are regulated by food standards agencies. In the US, interestingly, they're both governed and regulated by the same group, the FDA, Food and Drug Administration, but they're separate divisions within that very large organization that create the standards that the companies and the organizations that are manufacturing, distributing, and marketing have to adhere to. Now, classically, there are significant price differences between drugs and food supplements, and that's driven by the level of evidence that the companies have to generate to put the products on the market. And there's much higher stringency and standards in drugs rather than foods. Drugs often fail in clinical development as well because the standards are so high. Therefore, the drugs that are on the market are priced by the companies to be able to recoup losses from a company-wide perspective, associated with failed drugs, and also to make a significant return, typically within a patent life. of an approved drug. Back to the topic. Food supplements could be better than a drug for certain indications, and certain uses. I'm going to start with something called Lysine, also known as L Lysine. Lysine is an essential amino acid. Now, there are nine essential amino acids that we're aware of for the human body. That means that they cannot be synthesized by the human body and have to be consumed, have to be generated by your diet, so you have to consume them, you have to find them through some sort of intake, whether it's through food or a supplement. High protein foods are rich sources of all the essential amino acids, red meat, poultry, fish, pork, nut, legumes, and soy products from a plant perspective, also contain a wide variety of amino acids. Typically they don't. contain the complete sets of amino acids in the case of plants. And interestingly, from a protein bioavailability perspective, animal proteins are typically more bioavailable than plant proteins. What are we talking about now in the context of lysine? We're not talking about muscle hypertrophy. We're talking about cold sores, which are generated by the herpes simplex virus. And there are two that we typically discuss, HSV1, and HSV2. Typically there are cold sores on the face, but of course, there are also cold sores that can happen elsewhere in the body, most typically the genitals, HSV 1. Impacts the face, and HSV2s typically impact the genitals, although I think there can be some vice versa in there. Now, classically, when treating a cold sore, the medical community would prescribe an antiviral medication that can be topical. Ciclovir, commonly known as Zovarax, now is an over-the-counter medication. We can get into the differences between over-the-counter medications and prescription medications a different times and on a different podcast. But it would be typically an antiviral medication, topically, or systemic. Lysine has antiviral properties, which have been most classically demonstrated in what we call in vitro experiments. So these are experiments. In a test tube, essentially, where there's no living organism or living thing like a mouse or a rat or some other different species. Now, Interestingly, there is quite a good bit of evidence for lysine as a supplement for the prevention and treatment of cold sores in particular. I think there is some evidence as well for genital herpes, but the majority of the evidence exists for oral herpes, which is essentially synonymous with the term cold sore. So what does the evidence show? The evidence shows, fascinatingly, across a range of studies, for the most part, that lysine supplementation can prevent or reduce the severity, and by severity, we're talking about how many are there across a particular defined part of the body, in this case, the face, the severity beyond just how many there are, so how deep are they, how sore are they, there are other mechanisms. and predetermined parameters that clinicians and people working in this field use. And how long are the outbreaks? So what people have found is that daily supplementation with lysine in people who are prone to cold sores can, as I said, prevent and reduce the severity. Increased use of lysine during a cold sore outbreak can accelerate the time frame in which you have cold sores, so reduce the time frame that you have cold sores and indeed make the outbreaks less severe. That's fascinating, right? Now in terms of dose typically one to three grams a day for the treatment. That's one thousand to three thousand milligrams per day for as long as you've got a cold sore. If you can feel a sort of what we call prodromal type syndrome coming on where you've got a bit of a tingle. Some people know if they're about to get one things feel a bit strange in their face or elsewhere in their body. And that would be a good opportunity to load up and from a preventative point of view, it would typically be 500 milligrams. That's 0. 5 of a gram taken every day. Wide variety of sources available. It's quite a cheap supplement. So you can get a tub of 30. Excuse me, I was just taking a drink. You can get a tub of 30 for between 5 and 15 pounds depending on the source. Now, you can take a lot more lysine than that. I had a look for the LD50, which is a pharmaceutical, clinical phrase used to describe what the lethal dose is of a medicine, and the LD50 was at an insanely high level. That means you can probably take more than three grams a day. You could maybe load up to five or 10, see how that works for you. I've certainly done that. You can also get lysine as a topical formulation. Typically in the US, it's hard to find in the UK, so if you wanted a double whammy approach, you could take lysine systemically and you could also apply it topically around your lips. It doesn't seem to interfere or cause pain. In the formulation that I've seen, it's more of an ointment rather than a gel. Or a powder. It just makes your lips a little bit shiny. Now, what about the evidence? The evidence is quite strong in some respects, but it's also mixed. The studies are not ideal insofar as they're not very large for the most part, and typically they're conducted in compliance with standards that you'd associate with a food supplement rather than a drug. As I said at the start of this podcast, the Stringency, the level of regulation and rigour in the clinical studies is less for a food supplement than it is for a drug. So you might be wondering why has the pharmaceutical industry not jumped all over this. And I have to say anecdotally, i. e. based on personal experience, but also other people's personal experiences outside the confines of a robust clinical study. The evidence for lysine is pretty awesome. Some people swear by this, absolutely swear by it. I am prone to cold sores around my lips when I'm stressed. It runs in the family. Interestingly, my dad never gets them, and has never had one, but my mum is prone to them. So there are obviously some genetic predeterminants there around how bad your outbreaks are. But I, I've been taking lysine every day for years now. I was put onto the evidence by a former colleague called Dr Michael Butler. So shout out to you, Mike. If you're listening, I'm still listening to your advice. And here we are on Inside Matters talking about it in front of other people. So if you're prone to cold sores, I would recommend you give lysine a try. In a later episode, we're going to be talking about how to select a good quality supplement so if you want to wait before buying until that episode it'll be coming out within the next week or two. So that's supplement number one, Lysine. Supplement number two is Quercetin. Quercetin spelled q u e r c e t i n and we'll have some post-show notes as well. It's a type of flavonoid Flavonoids form part of a broader category called polyphenols and if you've been listening to this podcast You will have heard of the three P's prebiotics probiotics polyphenols again and again and if you want to take care of your microbiome the broad principles are, eat real food and focus on prebiotics, probiotics, polyphenols There's a plant pigment that's found in many fruits and vegetables this is quercetin I'm talking about now. It has antioxidant, and anti-inflammatory properties, some people even say it has anti-carcinogenic properties, i.e. anti cancer. What kind of fruits and sources in the diet is it found in? Onions, apples, vegetables, grapes, tea, and Red wine. But we've talked about red wine in the past in the podcast as well. And if you want to get quercetin in high doses, I would recommend you look at a supplement. So the one key benefit, I believe, from quercetin in the context of this supplement versus drug discussion is that it has antihistamine properties. So the histamine pathways are heavily implicated in allergy and allergic reactions. And these can range from what we call atopy, so a very mild type reaction, where you maybe get some inflammation in your skin, to anaphylaxis, where you have a total. almost catastrophic systemic, so total body reaction to an allergen. Now Quercetin has antihistamine-type properties. There's a variety of evidence available to suggest that it can reduce the severity of allergy and atopy including hay fever. So for some reason, it stabilizes histamines from certain cells. I'm not 100% sure what the pathways are that can reduce allergy symptoms. Typical doses range between 250 milligrams, and 600 milligrams per day, taken in divided doses throughout the day so you're not just getting a big dump of quercetin at some point in time. Now more studies are required for a definitive conclusion. And we go back to the lysine discussion. Why are the pharmaceutical industry not all over this? They exist as food supplements already. It's hard to get a strong intellectual property position based on the studies that already exist, based on the fact that it's already ubiquitous as a food supplement. And typically the pharmaceutical industry is only interested if it can have a defined intellectual property patent position. Ideally, sometimes they're okay with know-how, but basically, they're trying to stop people from copying and eating into market share. Reversing out now, from quercetin specifically, into flavonoids, bioflavonoids more generally, forming part of the bigger polyphenol complex. The human body doesn't efficiently absorb all the flavonoids because of the complex structure that these compounds take. and the microbiota. through a series of bacterial enzymatic reactions, i.e. enzymes contained within the metabolism of bacteria can break down the bioflavonoids into smaller, more bioavailable compounds. Now, this is one of these, we feed the microbes, they feed us, type discussions. And the things they feed us are classically beneficial. So The flavonoids themselves through the actions of the microbiota have several anti-inflammatory, potentially anti-carcinogenic properties. They may strengthen gut barrier function as well and we've talked about epithelial integrity a lot on this podcast. Gut barrier integrity aka leaky gut. If you want more listen to the episode with Dr. Laura Craven on that. So there's some evidence to suggest that the flavonoids found in foods including quercetin, which is one of the best-studied flavonoids, can impact cardiovascular disease risk factors, certain cancers, and obesity-related complications, and part of that must be through their interaction with microbiota. One final point. I believe that flavonoids are synergistic with fibre. Fibre, we talk on this podcast a lot. All prebiotics are fibres, but not all fibres are prebiotics, right? Prebiotic is a type of fibre that promotes the growth of beneficial bacteria within the gut and there is absolute synergy between fibres and flavonoids. The good news is that the flavonoids that come from plants can have high fibre. There's a synergy there. So if you're eating colourful plants, You classically have a lot of flavonoids and you have a fibre content there as well in the form of cellulose, but also other prebiotic substances like, for example, pectin and inulin. So that's quercetin. If you're struggling with allergies, you're allergic to a cat, you're allergic to a dog, or you have hay fever. Maybe give quercetin a try. Also personally, based on anecdotes, based on what I've seen, and based on the people I've spoken to, quercetin can also have an impact on systemic inflammation. So if you've got achy joints, quercetin has been reported to be beneficial in some people, much like turmeric potentially has some benefits as well. Cercumin potentially has some benefits too. Now, number three on this list, and we're getting to the end of the podcast now, melatonin. Melatonin is a hormone produced by the pineal gland in the brain. The pineal gland sits close to the pituitary gland if you're more familiar with that. And it helps regulate the body's sleep-wake cycle. Just as a brief aside, I like to go a little bit off-piece sometimes. The pineal gland is also thought to be the source of something called dimethyltryptamine, also known as DMT, which has very strong psychedelic properties. Some people believe large amounts of DMT are released by the body in Death, which is why people who have near-death experiences report similar experiences to people who've taken DMT recreationally. Okay, back now to the drug versus food debate. Melatonin is not found in foods. It's quite hard to find hormones in foods. Classically to do with the stability of the compounds metabolized by whatever it is where you're getting the source from. So if it's a slice of meat, then it would not find its way into the meat that you're eating. Now melatonin potentially because it's part of what we call circadian rhythm, i. e. your sleep-wake cycle could have beneficial effects in helping you get to sleep. There's some evidence to suggest that for people who have jet lag, so people who work in shift patterns, melatonin can be a good way to reestablish a normal circadian rhythm. Now, the evidence is a little bit mixed. Some evidence suggests that it can improve sleep quality. And reducing the time taken to fall asleep. Others say that it doesn't improve sleep quality, as measured through your sleep cycles, but may indeed reduce the time that it takes to get to sleep. This is another one of these anecdotal ones, where you have to try yourself, I think, to really understand how it affects you. Anecdotally, some people who take melatonin can feel groggy in the morning, they can feel slow, they can have brain fog, they can also feel a little bit nauseous, whereas other people, it gives them an amazingly deep sleep. And our recent episode with Andy Scott, the bodybuilder, revealed that he's very big on melatonin. He takes a big dose. Classically, the recommended doses are 0. 5 to 5 milligrams. Andy was taking 10 milligrams. That's a lot, but he's also a very big guy. So if you're having trouble falling asleep. If you're doing a lot of international travelling, you should consider melatonin. I would prefer melatonin to some of the other drugs that are available for sleep. Zopiclone is a classic one, but Zopiclone has an impact on REM sleep and other sedatives like GABA, and Agonist. So for example, the Azepam. are not things you want to be taking regularly at all because they have a high risk of developing dependency and a sort of rebound withdrawal effect can occur quite easily with limited use. Interestingly with melatonin, there doesn't seem to be what they call this rebound insomnia, i. e. you stop taking it, you can't get sleep, that doesn't seem to exist based on what I've seen. And there are some people, classically people who describe themselves as naturopaths swear by melatonin for infections too. I've not done much research on this. I'd encourage you to look at it yourself, but it might be an additional benefit. Melatonin as an antioxidant across the blood-brain barrier may be effective in delaying, preventing, and being involved with the development of some neurodegenerative diseases, most notably Alzheimer's. So we're coming to the end now of this podcast. I just wanted to emphasize that none of what I've said today constitutes a practice of medicine. It does not equal the giving of medical advice. You should consult with your healthcare professional before embarking on a supplement routine.

The following is a conversation with Jordan Haworth, a gut health physiologist working at the Functional Gut Clinic who are based in Manchester and London. In this conversation, we covered probably, possibly the widest range of gut health-related topics in the history of Inside Matters, so this could become a reference episode for all things gut health in the future. Jordan is a fountain of knowledge relating to basically all things to do with the gastrointestinal tract, prebiotics, probiotics, polyphenols, everything. We covered what to eat for your microbiome, what not to eat for your microbiome, what IBS is, including how to potentially classify it in a way that's not currently widely accepted amongst the broad range of medical community specialists that currently focus on IBS. We talked about antibiotics, in particular an antibiotic called rifaximin, which counterintuitively may actually be good for gut health in specific situations. We also talked about food sweeteners, emulsifiers, and some of the really exciting research that Jordan and the team at the Functional Gut Clinic are focused on. I absolutely love this episode. I've learned a heck of a lot. I'm absolutely sure you will as well. Timestamps: 00:00:00 Intro 00:01:26 IBS: what is it? 00:03:29 Bloating 00:04:30 IBD causes & diagnosis 00:09:38 What is bile? 00:11:54 Different categories of IBS 00:18:18 Coffee a laxative? 00:19:18 What is gut health? 00:21:38 What aren’t normal gut responses? 00:23:23 Most common symptoms 00:28:53 Mr Gut Health’s journey 00:32:51 Stool sampling 00:35:46 Functional Gut Clinic 00:37:18 Definition of probiotic 00:43:46 Probiotics: what to look for 00:48:14 Tummy MOT 00:53:15 Microbiome is an orchestra 00:55:30 More on Tummy MOT 00:57:00 Prebiotics: what are they? 01:01:04 Partially hydrolyzed guar gum 01:03:59 FODMAP diet 01:07:27 Best food for microbiome 01:10:49 How to improve microbiome 01:12:52 ChatGTP for gut health tips 01:15:17 Fermented foods 01:22:08 What’s bad for the microbiome? 01:26:30 Artificial sweeteners 01:30:15 Gluten intolerance 01:34:22 Cutting out dairy for the gut 01:41:33 Testing for SIBO on the NHS 01:49:47 TikTok gut health trends 01:53:20 Things to avoid for a healthy gut 02:00:53 Colonic irrigations

Learn more about this episode's guests and the topics discussed - https://insidematters.health/ The following is a conversation with Professor Konstantinos Yerasmididis, a professor in clinical nutrition at the University of Glasgow, who has a special interest in the gut microbiome and dietary interventions to treat disease. We also had Dr Richard Hansen, consultant paediatric gastroenterologist, who was on episode number one of the podcast. This is the first time I had two guests participating in the Inside Matters podcast at the same time. It was an absolute pleasure. Given that Costas and Richard are experts in inflammatory bowel disease and that they've collaborated on several different research initiatives, we spent a lot of time talking about inflammatory bowel disease. We spoke about their work which is focused on using nutrition and personalized dietary therapy in the context of Crohn's disease in particular. So they've been involved in a program called CD-TREAT where they've tried to mimic the effects of something called exclusive internal nutrition, essentially an entirely liquid diet with a diet that contained real food. Why is that important?  Well, for four out of five children with newly diagnosed Crohn's disease, a form of inflammatory bowel disease, this exclusively liquid diet has a profound impact on Crohn's disease. So four out of five of them go into what we call remission. i. e. no clinical symptoms. However, there are challenges associated with EEN. Most notably, it's very restrictive. You can't eat any food for six to eight weeks. So what Costas and Richard have been trying to do is, can we give children and potentially even adults a diet that contains the same components? as a liquid diet. It allows people to eat real food without having to have an exclusively liquid diet. We also talked about some common myths and misconceptions associated with the microbiome. We asked the question, does the microbiota cause obesity? We also spoke about the microbiome field more generally and how it's progressed over time. and some of the challenges that both the field and the academic researchers have faced over the last decade. This is a really interesting conversation that I think should be accessible to most of the listeners. We did go quite deep on some areas but we always brought it back to well, what does that mean for the listener and what can a listener take away from it? I believe that you will particularly enjoy this podcast if you're someone with inflammatory bowel disease or if you know somebody suffering from inflammatory bowel disease. You will also enjoy this podcast if you're interested in diet, nutrition, and how the diet interplays with the microbiome and how the microbiome interplays with the rest of the body. Timestamps 00:00:00 Intro 00:04:00 Welcome to the guests 00:04:48 What is a healthy microbiome? 00:09:24 Microbial therapeutics 00:14:00 Intersection between disease and diversity in the biome 00:17:41 Insights from research 00:22:36 Should we drink milk 00:31:47 CDG 00:34:39 Mediterranean diet pt1 00:40:51 Carnivore diet 00:47:52 Personalised dietary intervention pt1 00:50:22 Microbiome testing 00:55:14 Personalised dietary intervention pt2 01:02:23 Measuring inflammatory cytokines 01:08:55 Mediterranean diet pt2 01:14:40 Fermented foods 01:18:59 Plant-based diet 01:22:10 Microbiome and obesity 01:26:50 Do the scientists take supplements? 01:30:12 Composition of microbiome 01:37:43 Treating IBD 01:43:28 Training gastroenterologists 01:47:16 Importance of hydration to the guy 01:47:57 Obesity and the gut microbiome 01:56:31 What’s next? 02:00:12 The future of research and treatment

With a wrap-up of 2023, Dr James McIlroy reflects on his journey hosting the Inside Matters Podcast so far. I have to say that I've thoroughly enjoyed the first year and a bit of the Inside Matters podcast. I'm thrilled actually that I took that step to start it. And there was an element of not sure what I'm getting into here. Can I produce content once every two weeks? And are people going to want to come on and talk to me? But fast forward to December 2023 and we've had genuinely some of the best minds in the microbiome space on the podcast. And we've got a loyal listener base who listened to most episodes. Some every single episode, there's a group of people who write into the podcast and say they're enjoying it. They've learned a lot. Some people have taken action themselves on their health and some people are reporting amazing benefits. I feel better. Some people have had an impact on their disease and that just makes me happy. Because, fundamentally, I believe that the microbiome is extremely important. I believe that gut health contributes to wider body health in a way that's currently underappreciated by the general medical community. And even specialist medical doctors who, for some reason, even with all the evidence that's available now, don't think it's as important as it is. So what it's about on Inside Matters is connecting with people on a really deep level and helping them live a better, longer, healthier life through taking steps to improve their microbiota and microbiome, in doing so improving their gut health, in doing so improving their wider body health. And this is just the start, you know, we're, we're just at the start of this journey, which is why I'm excited. And we're starting to build good traction, you know, 35 5-star reviews on Spotify, I think it's 17 or 18 on Apple podcasts, people commenting on the videos, people writing it on Instagram, stopped once on the subway in Glasgow, which is a bit of a claim to fame. And it sounds very egotistical, but it was pretty damn cool. And that just motivates me to keep going and to create. Even better content on a week-to-week basis for the listeners. None of it would have been possible without the team at the Podcast Studio Glasgow who've gone above and beyond to help build this because they believed, and believe in me as the founder and the host. They believe in the vision and the mission of the podcast and Without them, we wouldn't have built the brand. We wouldn't have been able to get it going in the way that we have, and I've learned a huge amount from Mark and more laterally cam about podcasting and creating great content and this new world of education. 21st century year education. I wanted to take this opportunity on, on record to thank Mark and Cam for their belief in the partnership that we've established. And I'm looking forward to 2024. What have you got to look forward to in 2024 as a listener? More great content. A couple of really high-profile people actually in this space booked in for the first couple of quarters in 2024, which I'm excited about. We're going to continue with the content once every two weeks. We're going to have more solo episodes where I'm talking about topics that are probably more easily accessible to the general population. Why is that? Well, we've had great top minds coming on this podcast and we get deep, really deep actually probably deeper than any other platform on the internet for microbiome. And for some people that's gold dust.

In episode 24 we once again meet up with IFBB bodybuilder Andy Scott. Hopefully, you can see for those of you who are watching the video Andy is massive. He's 130kg and there are just slabs of muscle on his body. So he knows a thing or two about how to gain muscle. If you're interested in how to gain muscle, lose fat, and get in shape, this is a podcast episode that you’ll want to listen to. You can watch this episode on YouTube. https://youtu.be/IViPBxJ8ZFE For those of you who want to connect with Andy and learn more or perhaps have him as your personal trainer, I would highly recommend him because he blasts you and teaches you the true meaning of training to failure. If you think you're training to failure, and you've not been trained by Andy Scott or someone similar, you probably actually haven't trained to failure and doing so is worthwhile to get maximum gains. Reach out to Andy on Instagram. I'm very grateful to all of you. the listener for the support that you've been giving us so far. The best way you can support the podcast is by liking, subscribing and very kindly giving us a five-star review. People are messaging that I don't know and even bumped into someone recently who I didn't know who said they were listening to the podcast, which was frankly awesome. We started this podcast over a year ago to produce high-quality gut health content for people all over the world and we've been delivering that content every second Thursday. If you know someone who’d benefit from the conversations on the Inside Matters Podcast, I’d encourage you to share the podcast with them.   Timestamps: 00:00:00 Introduction 00:02:06 How Andy got started 00:03:23 Socks and Crocs? 00:06:18 Are we in a simulation? 00:07:31 Switching rugby for bodybuilding 00:10:17 Being introduced to testosterone 00:11:58 Arnold Schwarzenegger documentary 00:13:03 Andy’s first competitive show 00:14:49 Show prepping as a living 00:17:49 The realities of pro bodybuilder physique 00:19:39 Magnesium dosing 00:21:16 Psilocybin dosing 00:23:15 Treating cachexia with CBD 00:24:47 Parkinson’s disease 00:32:52 Dealing with injuries 00:36:17 Dorian Yates and training to failure 00:43:23 TRT cycles and contest prep 00:53:51 Victor Black 00:55:01 Optimal recovery 00:56:57 Trenbolone 00:58:54 Focus on overall health 01:03:56 Drugs don’t make mass 01:08:25 Getting a pro card 01:14:44 If you’re considering a steroid cycle 01:16:50 Women aren’t interested in bodybuilders 01:22:46 Longevity 01:26:32 Creating programs for clients 01:29:20 Do women want to bulk? 01:35:35 Avoiding crash diets 01:39:01 Supplements 01:42:51 Swimming for fitness 01:47:52 Conclusion  

In episode 23 we chat with Dr. Simon Baunwall, a medical doctor and scientific researcher focused on fecal microbiota transplantation, also known as FMT. Dr. Baunwall is based at Arras University Hospital in Denmark. This conversation centred around the establishment of fecal microbiota transplantation (FMT) as a therapy in Denmark. Simon talked to us about his work which centres around establishing FMT as a standardised, scalable approach using a blood banking type model, is fascinating. We talked about his perspectives on how the field might evolve looking forward, the next indication after recurring C-difficile infection, and the progression of FMT delivered by colonoscopy to delivery by capsules. And we had some interesting philosophical discussions around what is the mechanism of action and how do you define a dose. This is important, as historically what researchers have used is the wet mass of starting material, in other words, stool, that goes into the process. But what we discussed is actually, that's probably not a good definition or metric for dose! Additionally, we talked about the regulations, which Simon's been very heavily involved with. I particularly enjoyed this episode because Simon is a self-confessed lover of the Inside Matters podcast. In fact, he has listened to pretty much all the episodes. So it was amazing to have a loyal listener on the podcast to talk about their fantastic work in the microbiome and FMT space.   Timestamps: 00:00:00 Introduction 00:02:38 How Simon got involved in the microbiome 00:04:01 We can do better 00:05:47 Low tech 00:09:21 Patient improvement 00:12:33 The metabolite perspective 00:14:18 How the process is evolving 00:19:31 Universally perfect donor? 00:23:29 Are we doing too much? 00:25:25 Likelihood of false-positives 00:30:18 Undergoing repeated screenings 00:42:02 Preparing for it going wrong 00:44:51 Safety issues 00:50:29 What is your vision? 00:57:31 Is it actually safe? 01:01:48 Building in scale 01:05:20 Accessing screening as a private company 01:10:43 Two different donor types 01:20:09 The struggle to get enough donors 01:24:15 Limitations of diet studies 01:28:07 Dr Mark Hyman 01:30:39 Regulating FMT 01:34:50 Presenting stool as a “drug”

In episode 23 we chat with Dr. Simon Bownwell, a medical doctor and scientific researcher focused on fecal microbiota transplantation, also known as FMT. Dr. Bownwell is based at Arras University Hospital in Denmark. This conversation centred around the establishment of fecal microbiota transplantation (FMT) as a therapy in Denmark. Simon talked to us about his work which centres around establishing FMT as a standardised, scalable approach using a blood banking type model, is fascinating. We talked about his perspectives on how the field might evolve looking forward, the next indication after recurring C-difficile infection, and the progression of FMT delivered by colonoscopy to delivery by capsules. And we had some interesting philosophical discussions around what is the mechanism of action and how you define a dose. This is important, as historically what researchers have used is the wet mass of starting material, in other words, stool, that goes into the process. But what we discussed is actually, that's probably not a good definition or metric for dose! Additionally, we talked about the regulations, which Simon's been very heavily involved with. I particularly enjoyed this episode because Simon is a self-confessed lover of the Inside Matters podcast. In fact, he has listened to pretty much all the episodes. So it was amazing to have a loyal listener on the podcast to talk about their fantastic work in the microbiome and FMT space. Now, the podcast has actually been starting to get some really decent traction and I'm. pretty excited to be honest with you. We started the Inside Matters podcast about a year ago with the aim of giving high-quality gut health content to all of the listeners and that's what we're doing. We've done over 20 episodes, we're pushing 35 5-star reviews on Spotify, similar traction on other podcast apps like Apple, we wouldn't be doing what we're doing if it wasn't for you, the listener. So thank you for supporting the podcast. Please keep engaging with us. Timestamps: 00:00:00 Introduction 00:02:38 How Simon got involved in the microbiome 00:04:01 We can do better 00:05:47 Low tech 00:09:21 Patient improvement 00:12:33 The metabolite perspective 00:14:18 How to process is evolving 00:19:31 Universally perfect donor? 00:23:29 Are we doing too much? 00:25:25 Likelihood of false-positives 00:30:18 Undergoing repeated screenings 00:42:02 Preparing for it going wrong 00:44:51 Safety issues 00:50:29 What is your vision? 00:57:31 Is it actually safe? 01:01:48 Building in scale 01:05:20 Accessing screening as a private company 01:10:43 Two different donor types 01:20:09 The struggle to get enough donors 01:24:15 Limitations of diet studies 01:28:07 Dr Mark Hyman 01:30:39 Regulating FMT 01:34:50 Presenting stool as a “drug”

Following is a conversation with Dr Indrani Mukhopadhyay, a lecturer at the Institute of Medical Sciences Microbiology and Immunology Group at the University of Aberdeen. Over the last ten years, we’ve started to understand more and more about why the virome is important in both health and disease. Indrani is an expert in the viral and has been involved in some of the seminal research to characterise profiles and help us understand why the virus is important. So if you're interested in that, this is a great episode for you. We also spoke about probiotics and what a next-generation probiotic might be in terms of its composition, structure and function. We spoke about Indrani's career progression. She's been all over the world involved in exciting research and setting up her new lab recently here in Aberdeen. So we covered a range of topics.  Finally, we spoke about inflammatory bowel disease, how the viral elements of the microbiome might be important and how specific depletions of bacteria might be important too.  As always, I wanted to thank you, the listener, for tuning in and for supporting the podcast. It's fantastic to get the feedback we've been getting about people enjoying it and if you are enjoying it and haven't yet liked and subscribed, please do that. Timestamps: 00:00:00 - Intro 00:01:52 - How did you get into the field of the microbiome? 00:06:32 - Research into developing vaccines 00:12:58 - Effectiveness of vaccines 00:14:24 - Complexity of the rotavirus 00:16:28 - Seasonal flu 00:20:01 - Viruses in our gut 00:24:17 - Viral metagenomics 00:33:06 - Knowledge of viruses greater than of bacteria 00:35:53 - What’s the most important part of the microbiome? 00:37:06 - Bacteriophages 00:40:15 - Enteric viruses 00:41:29 - Fungus in the gut 00:42:39 - Viruses keep bacteria in check 00:43:07 - Most exciting development in microbiome research 00:46:10 - Women in science 00:47:00 - Immunomodulator’s effects on gut viruses. 00:49:23 - Next-generation probiotics 00:52:20 - Taking probiotic supplements 00:54:28 - Manufacturing bacteria to treat patients 00:55:39 - Benefits of single strain vs consortia 00:56:34 - Universally beneficial probiotic? 01:00:25 - Thanks and conclusion

In episode 21 we chat with Professor Karen Scott of the Rowatt Institute at the University of Aberdeen. Watch the podcast on YouTube. Professor Scott is one of the world's leading researchers for gut health, gut microbiome and all things microbial.  We had a fascinating and at times humourous chat about all things microbiome and bacterium. We cover questions such as; Does Professor Scott take probiotics? What are some of the limitations of current microbiome research? What is a healthy microbiome and how can you make yours healthier through diet, nutrition and potentially supplements? We also cover the role of fibre in our diet and whether we really need to be eating 5 pieces of fruit and veg a day to get our fibre intake, or whether we can find good sources of fibre in other foods. And we chat about where Professor Scott sees the research into the gut microbiome heading in the next 5 years. You can listen to this episode as a professor with a keen interest in the subject matter of the gut microbiome and still learn things. Likewise, this could be your first ever Inside Masters podcast and you'll learn a lot. 00:00:00:00 - Intro 00:01:47:09 - Getting into the field of the microbiome 00:06:38:08 - Detriments to bacteria transfer 00:11:17:05 - The problem of antimicrobial resistance 00:18:23:01 - Restoring the microbiome post-antibiotics 00:20:53:10 - Illegal to refer to “probiotics”? 00:21:51:23 - Is it a viral or bacterial infection? 00:25:21:07 - Discussion on vancomycin 00:30:29:02 - Does the microbiome change from when people are born and as they get older? 00:32:17:23 - Understanding how bacteria “use us” 00:34:58:13 - Why fibre is so important to the gut 00:40:30:01 - The risks of too much protein 00:41:48:08 - Are some fibres better than others? 00:48:40:04 - Does our gut make us “crave” certain foods? 00:50:17:14 - What is a “healthy” gut microbiome? 00:53:02:17 - Bacteria and inflammation 01:01:59:08 - Advancements in culturing bacteria 01:06:42:13 - Taking probiotics 01:08:42:09 - Thoughts on FMT 01:12:31:07 - The importance of feeding our gut bacteria 01:15:33:08 - Where is the field heading? And conclusion

In episode 20 we chat with Kristina Campbell, microbiome science communicator, educator and author. In this episode, I had a fascinating chat with Kristina Campbell, a science writer who specialises in tiny things. In other words, all the microorganisms that live on and inside of our bodies. It was our first remote podcast with a guest, and I'm really grateful for Kristina joining me and helping me produce such amazing content for all of our listeners. We talked about what makes a good probiotic “good” and what makes a bad one “bad”. If you're somebody who consumes probiotics or is thinking about taking probiotics, you should tune into this episode because we really dig into where the field is and what are some of the key quality criteria that you should be looking for if you want to embark on a probiotics journey. We also talked about where we see the field going in the next five years and even further on from that talked about some of the recent drug approvals as well, which we're all really excited about, plus some tips for parents who want their children to health a gut-healthy diet. This was the first remote recording that we did and it went really well. As always, I would encourage you, if you're enjoying this podcast, to like and subscribe, the best thing you can possibly do to support Inside Matters is to hover your finger over the five-star reviews and kindly give us five stars. This helps bump us up the algorithm, helping the podcast reach more people who will ultimately benefit from the no-cost scientific information that we're delivering to you, the listener. Timestamps: 00:00:00:00 - Intro   00:02:01:20 - Kristina introduces herself and outlines her background   00:05:13:09 - Kristina shares some of her own health journey   00:07:18:06 - Why the interest in probiotics?   00:11:32:01 - What to look for when considering a probiotic   00:14:33:24 - Probiotics vs life beneficial microbes   00:23:09:21 - Role of microorganisms and our digestion   00:32:24:02 - Microorganisms and new drug developments   00:35:13:01 - Fecal transplantation derivatives   00:37:24:09 - Developing bugs as drugs   00:40:10:22 - Should everyone take a probiotic?   00:43:00:18 - Kristina’s books   00:47:50:08 - What about prebiotics?   00:51:58:01 - Can a dead microorganism confer a health benefit   00:53:06:15 - The future of microorganism therapeutics   00:58:15:23 - Pioneers of the microbiome space   01:01:30:15 - Distilling the best information   01:08:31:21 - What’s next for Kristina?   01:11:30:15 - Tips for parents

In this Biome Bite, Dr James McIlroy examines the findings of studies that show the potential role of microorganisms to treat cancer along with looking at the question of whether FMT can play a part. Be sure to get the Inside Matters Podcast wherever you listen to your podcasts, and as always please leave a positive review. As always, you can get in touch with Dr McIlroy via insidematters.health, and it would be appreciated if you could leave a positive review wherever you listen to the podcast if you're enjoying it. If you're enjoying the podcast, please consider leaving a 5-star review wherever you listen to it.

In episode 19 we chat with Dr Megan Eldred, Senior Policy Advisor and Dementia Mission Lead at the Office for Life Sciences. Megan walked us through her journey from PhD and potential academia, to transition into the UK Civil Service and the work she does with the Office for Life Sciences. She told us about her journey to becoming the senior policy adviser and dementia mission lead on everything that entails. More generally, the Mission aims to develop novel precision medicine tools that help boost the number and speed of clinical trials in dementia neurodegeneration. This is a much-needed and highly impactful endeavour. We all know somebody who is suffering from or who has suffered from dementia. It is devastating and still has massive unmet clinical needs and is a huge cost and burden to society that is a burden that is getting bigger because of an ageing population. Megan talked about some interesting scientific and commercial developments in this field, including the approval of two drugs to slow the progression of dementia. We spoke about cures for Alzheimer's disease and how close and how far away we are. We also spoke about psychedelics, exercise, the mind-body connection and burnout. As always, I would encourage you, if you're enjoying this podcast, to like and subscribe, the best thing you can possibly do to support Inside Matters is to hover your finger over the five star reviews and to kindly give us five stars. This helps bump us up the algorithm, helping the podcast reach more people that will ultimately benefit from the no-cost scientific information that we're delivering to you, the listener. Timestamps: 00:00:00:00 -Intro   00:01:51:04 - Dr McIlroy’s neurodegenerative family history   00:04:01:20 - Dutch care home designed for dementia   00:04:43:02 - Japanese robotic seal   00:06:35:06 - Pet dogs and our microbiome   00:07:41:10 - Link between microbiome and depression   00:09:17:07 - Mice research   00:11:44:02 - Can the microbiome cure depression longterm?   00:13:30:01 - How habits are formed   00:15:22:27 - Addictions and their cure   00:19:15:28 - Fight or flight responses   00:25:41:01 - Building resilience   00:27:57:24 - Choosing a career path   00:30:36:20 - Undertaking a physiology degree   00:33:03:02 - Unknown unknowns   00:35:50:08 - The cell fate in the retina   00:37:55:24 - Intelligent design?   00:41:55:10 - Micro-dosing   00:49:33:11 - Understanding the retina   00:55:10:29 - Starting a career in the civil service   00:59:13:24 - Scientists working for the government   01:04:59:23 - Centre for Science and Policy   01:08:59:15 - Role as lead at Office for Life Sciences   01:14:46:09 - Focus on biomarkers   01:17:52:04 - Drugs approval for treating dimensia   01:20:10:10 - Understanding the disease pathway   01:24:51:08 - Funding research   01:26:44:21 - Our Future Health   01:34:28:01 - Sharing IP with competitors   01:39:45:24 - CSF testing   01:41:51:12 - Inflammation and the disease pathway   01:43:13:15 - Vaccine for cognitive disease?   01:46:19:27 - Conclusion    

In episode 9 of Inside Matters, Biome Bites Dr James McIlroy dives into the huge world of dietary supplements. He tackles whether, if your diet is good enough, supplements are really needed, and highlights some instances where supplementing our diet could be essential for good health. He also points out some caveats and helps us understand how to plan a supplement regimen based on our health and lifestyle goals, and how to identify supplements that will actually work. As always, you can get in touch with Dr McIlroy via insidematters.health, and it would be appreciated if you could leave a positive review wherever you listen to the podcast if you're enjoying it.

What are the potential gut health benefits of drinking red wine? Is it recommended to start drinking red wine based on studies that propose gut health benefits? In this episode of Inside Matter's Biome Bites, Dr. James McIlroy references a study from lead author Professor Tim Spector, which states: "This is one of the largest ever studies to explore the effects of red wine in the guts of nearly three thousand people in three different countries and provides insights that the high levels of polyphenols in the grape skin could be responsible for much of the controversial health benefits when used in moderation." But if alcohol is often considered a toxin, where does the balance lie between the potential benefits of red wine in particular for a healthy gut? If you're enjoying the podcast, please consider leaving a 5-star review wherever you listen to it.

Learn more about this episode's guest and the topics discussed - https://insidematters.health/ As it’s been a few weeks since the last episode of the podcast, Dr James McIlroy gets in front of the microphone again to explain what he’s been up to with EnteroBiotix and what the plans are for the podcast in the coming months, including some inside into the exciting guests who’ll be joining him to discuss all things gut health, fitness and personal improvement.

Listen to Inside Matters: https://insidematters.health/biome-bites In this episode, Dr James McIlroy discusses diet tips to improve and fortify the gut microbiome. Touching upon topics such as the controversial argument surrounding artificial sugars, fermented foods and whole foods, and why some researchers believe that red wine can help to promote a healthy gut microbiome. Just as a garden can be populated with weeds if the right conditions exist, so too can your gut microbiome with unhelpful habits and cravings. The broader picture goes back to: - Reducing the number of harmful organisms in your system. - Replacing lost microorganisms that are beneficial to your microbiome. - And continuing to nourish the microbiome with a minimally processed diverse diet. Timestamps - 00:00:00 Intro 00:00:46 What is the microbiome? 00:02:18 Key Points on Why Diet is Important for Microbiome Diversity 00:04:51 The Broader Picture When it comes to Gut Microbiome and Diet 00:05:40 Avoiding Artificial Sweeteners 00:07:45 Reducing Alcohol Intake 00:10:24 The Gut-Liver Connection 00:11:31 The Impact of Smoking on the Gut Microbiome 00:12:48 Episode Recap and Important Takeaway Points

In this episode of Biome Bites, Dr James McIlroy explores some practical tips for improving your microbiome based on 3 specific areas: Probiotics: what they are, where to find them and whether you should spend money on supplements or not Prebiotics: what they are, where to find them and how to include them as part of your daily dietary intake Polyphenols James delves into how microbial imbalances occur within our bodies and what we can do to address these through diet and lifestyle. James references David Sinclair’s podcast “Lifespan”, which you can learn more about here - https://www.lifespanpodcast.com/ and also Dr Hyman’s podcast “The Doctor’s Farmacy”, which you can find here - https://drhyman.com/blog/category/podcasts/ 00:00:00 Intro 00:00:43 What is the microbiome? 00:01:54 You’re more microbial than human 00:02:12 Body’s microbial composition 00:02:41 How microbial imbalance occurs 00:03:23 How to achieve a healthy microbiome 00:04:56 Role of probiotics 00:05:57 Importance of probiotic foods 00:07:09 Role of prebiotics 00:10:10 You must stay hydrated! 00:10:32 The role of polyphenols

Dr James McIlroy shares some tips and tricks that keep him consistently productive throughout the day. Stacking up small wins, like pre-booking dentist appointments and haircuts months in advance to reduce stress. Investing in pill boxes for supplements and dried greens for on-the-go. With daily exercise, and the benefits this has on concentration and health that this naturally brings.   00:00:00 Introduction and welcome 00:00:21 - Batch Booking and Scheduling 00:01:53 - Buying the Essentials in Bulk 00:02:50 - Systems for Supplements 00:04:04 - Investing in a Pill Pack 00:05:00 - Sachets of Dried Greens 00:05:49 - Exercising Everday 00:08:08 - Episode Recap and Outro

Dr Laura Craven is Lead Research & Development Scientist at EnteroBiotix and has a  PhD in Microbiology and Immunology, specialising in gut microbiome modulation. Dr Craven’s studies include research into the gut's role in auto-immune diseases like MS. In this episode, Dr Craven joins James to discuss her journey from completing her PhD in Canada and the impact the NEMJ’s paper on Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile” had on her science career, along with her own personal health diagnosis of Type 1 diabetes. They chat about the difference between FMT and IMT, leaky gut syndrome and the factors, including stress, which play a part in us developing this challenging condition. And they broach the topics of probiotics, improving gut permeability, and whether having a morning coffee is actually a good idea. Timestamps: 00:00:00 intro 00:00:29 getting into the field of the microbiome? 00:01:45 impact of the NEMJ  paper 00:03:10 what was Dr Craven’s PhD on? 00:05:33 what’s the difference between “FMT” & “IMT”? 00:08:51 treating NAFLD with FMT 00:14:23 Enterobiotix and staff dietary provisions 00:16:18 Dr Craven discusses leaky gut syndrome 00:18:06 Wim Hof being injected with bacterial endotoxins 00:20:35 more discussion on leaky gut 00:21:22 getting a strong gut rather than a leaky one 00:22:26 How do doctors diagnose leaky gut? 00:24:06 how does FMT/IMT have an impact on leaky gut? 00:26:22 Dr Craven's study findings in relation to treating NAFLD 00:27:32 discussion around endogenous alcohol production 00:31:12 how has the public’s perception of FMT/IMT changed 00:34:14 gut permeability can be improved via FMT 00:37:41 treating MS with FMT/IMT 00:38:51 what factors cause leaky guy and what's the role of stress? 00:41:48 the connection between leaky guy and autoimmune diseases 00:44:10 what is a probiotic? 00:47:15 Dr Craven's move from Canada to Scotland 00:54:45 living with Type 1 diabetes 00:57:58 how do I improve my gut health? 01:10:32 hopes for diabetes and the role of FMT/IMT 01:20:04 is having a morning coffee a good idea? 01:21:18 where is the microbiome field heading in the future? 01:25:57 interaction between the microbiome and the host 01:26:54 what is engraftment? 01:32:13 what's FMT/IMT going to be used for next? 01:35:08 dietary challenges upon moving to Scotland 01:37:38 other scientific interests outside of the microbiome 01:39:14 the potential role of AI for health management

Professor Harry Flint is a world leader in gut microbiome science and Professor Emeritus at the Rowett Institute at the University of Aberdeen. He's known for his book, "Why Gut Microbes Matter" and has two species of gut bacteria named after him: 'HarryFlintia' and 'Flintibacter'. As part of a research collaboration, Professor Flint helped to identify a combination of six naturally occurring bacteria that work to eradicate a highly contagious form of Clostridium difficile (C. diff). The results of this research illustrated the effectiveness of utilising a mix of bacteria naturally found in the gut to displace C. diff and supershedder microbiota. The research helped develop a standardised mixture treatment for FMT. Professor Flint began studying ecology at university before switching to genetics, completing his PhD in this field. He then worked as a lecturer for 6 years and then came back to Edinburgh to start a training fellowship to learn molecular biology in 1982. His career began at the Rowett Institute in 1985, with a focus on the rumen of animals due to the complexity of the microbiology of that system of digestion. He joins James in this episode of Inside Matters, the Gut Health Podcast, to chat about his career as he nears retirement, and the ground-breaking research into the complex universe of the gut microbiome. They cover a variety of topics including the importance of the digestive system of rumens, symbiosis in living organisms and dive into the different levels founds in the gut's microbiome.   TIMESTAMPS: 00:00:00 Intro 00:00:26 How did you get into the field of the microbiome 00:04:07 What was known of the rumen in the 80s 00:08:20 The discovery of key gut bacteria 00:10:07 What's the story with termites? 00:12:23 Does every living thing have symbiosis? 00:14:31 How diverse is the rumen? 00:17:00 Transition into human gut research 00:19:29 In the 90s what was known of the gut biome? 00:22:07 The different levels of the gut microbiome 00:26:19 The importance of starch for the microbiome 00:30:08 What is a keystone species and how many? 00:35:11 What is an enterotype? 00:37:56 What is prevotella? 00:41:12 Should everyone have a fibre supplement? 00:44:58 Does going plant-based improve overall health? 00:47:29 Why are the microbes in our gut in the first place? 00:51:08 The uniqueness of each human's microbiome 00:56:27 10 functional groups found in human stool? 00:59:11 Are there disease states with all functional groups? 01:02:45 Breast-fed babies with less biome diversity? 01:07:39 Important metabolites from the biome 01:11:16 What determines ph balance in the biome? 01:13:29 What still needs to be characterised in the biome? 01:18:51 Do gut bacteria have a form of consciousness? 01:24:23 Will AI help gut biome research advance? 01:28:03 What about fungi in the gut? 01:29:38 What should a healthy microbiome look like?  

Dr James McIlroy breaks down the terminology and science surrounding the wonderful world of your gut microbiome, including explaining terms like "microbiota" and how your gut interacts with your immune system, and the ongoing research into the role your microorganisms in your gut with health and well-being. Watch the video on YouTube - https://youtu.be/_g3QGjHLC98 00:00:00 Introduction and welcome 00:00:26 What does the term “microbiome” mean? 00:01:34 Is the microbiome just limited to our guts? 00:02:27 What’s the scale and scope of our gut’s microbiome? 00:03:36 The role of genes in the microbiome and the role they can play in our health 00:04:32 What is the microbiota? 00:05:16 What is the composition of microorganisms in the microbiome? 00:06:46 Tools and techniques for understanding the components of the microbiome are improving 00:08:18 What does the microbiome actually do in terms of health? 00:09:30 How changing the microbiome may positively impact IBS 00:09:53 How might the microbes in the gut communicate with the brain? 00:10:39 Does lack of gut microbiome diversity lead to negative health outcomes? 00:12:07 How can you change your gut microbiome?

Learn more about Inside Matters - https://insidematters.health/ Professor Simon Carding is Group Leader at the Quadram Institute and is a Professor of Mucosal Immunology at the University of East Anglia. Professor Carding's research covers a broad area of gut biology including epithelial cell physiology, mucus and glycobiology, mucosal immunology, commensal microbiology, foodborne bacterial pathogens, and mathematical modelling and bioinformatics. The success of this programme has led to the establishment of the Gut Microbes and Health research programme that is integral to the research agenda of The Quadram Institute. In this episode, Dr McIlory chats with Professor Carding about his journey into the field of the gut microbiome and they discuss some of the ground-breaking ways his research is revealing the connection between gut health and debilitating conditions such as Parkinson's Disease, Alzheimer's and ME. They also cover the topics of how to ensure good gut health while debunking some popular myths on the topic.

Learn more about Inside Matters - https://insidematters.health/ In this week’s episode, James has a lively discussion with Dominic Falcão about science, new technologies, starting and securing funding for tech companies and their personal philosophies and outlooks when it comes to development. Dominic is a co-founder of Deep Science Ventures (DSV), a company that focuses on four key outcomes: restorative cultivation, scaling intelligence, reversing global heating and curative therapeutics. He previously led Imperial College London’s science startup programme: worked with over 200 student companies, and supported a fraction of these to raise over £25m in funding within 3 years. Dom admits to being obsessed with building new companies to solve the climate crisis, from carbon-neutral fuels and negative emissions technologies to market-side interventions to funnel more finance profitably into climate solutions. Via DSV, they are championing the diversity of background and vocation of focus in STEM education, starting with a global, diversity-led venture-focused science PhD programme.

In episode two of Biome Bites James provides an overview of how to master your microbiome. Often asked how you can improve your microbiome diversity and gut health, James covers a wide range of topics including microbiome-friendly eating and how the food you eat is processed by the gut, probiotics, mindset and easy lifestyle changes you can make to improve your microbiome.

Learn more about this episode's guest and the topics discussed - https://insidematters.health/   Dr Mapstone is co-founder and CEO at BoobyBiome, a biotechnology company developing live biotherapeutic products to improve and protect infant health. BoobyBiome are seeking to achieve this by rationally designing microbial therapeutics from the beast milk microbiome. Dr Mapstone holds a PhD in Synthetic Biology from UCL.

Learn more about the podcast - https://insidematters.health/   Sean Lazzerini is a professional boxer and 2022 Commonwealth Games gold medalist. He started boxing at the age of 12 and quickly started to win fights. He took a short break for a couple of years during his mid-teens while at school but restarted at age 17 and progressed from there. He became a professional boxer towards the end of 2022 in the light heavyweight category following on from his success at the Commonwealth Games. Sean trains six days a week. He has built a great team around him that includes Ricky Burns, three-time world champion. On four out of the six days, he trains twice a day, and on two of the six days, he trains three times a day. His training is predominantly boxing-specific but also includes running and weight training. Sean also undertakes hot and cold therapy using a sauna and a plunge pool most days of the week. He sees this is a fundamental aspect of his recovery programme. Sean has had setbacks including injuries and losses. One example that was discussed was a hand injury that prevented Sean from going to the Olympics. Being able to overcome adversity successfully is a key trait of a champion. Over the course of the podcast, Sean and James dug deep into the world of being a professional athlete and boxing. Topics included: the mindset of a champion, what happens before and after a fight, making weight, drugs and alcohol, sports in Scotland and creating a good diet. To learn more about Sean and/or to follow his journey see https://www.instagram.com/lazzaboy_beastmode/

Learn more about the podcast here - https://insidematters.health/episodes/dr-andrew-morgan   Dr Andrew Morgan is the former Chief Scientist of DuPont Nutrition & Health. He has forty years of experience in biosciences innovation in major global science-based companies spanning nutrition, health and agri-food. He is actively involved in supporting microbiome innovators and researchers as well as the wider industry through his role as Chair of the Innovate UK KTN Microbiome Innovation Network Advisory Board. He also serves as a Royal Society Entrepreneur in Residence at the University of Exeter.

In this episode, James provides an overview of a medical procedure called intestinal microbiota transfer (IMT), also known as a ‘stool transplant’ or ‘faecal microbiota transplantation (FMT)’ amongst other descriptive nomenclature. IMT involves the transfer of microorganisms into the intestinal tract of a recipient with the intention of modulating the microbiome in the recipient in a positive manner, and in turn, influencing disease processes and health in a positive manner. James describes a brief history of IMT, the various forms of IMT and how the procedure has evolved over time. Transcript: 00:00:00:03 - 00:21:05:48 Hello, everybody. It's James here. And this is the first Biome Bite. The Biome Bites are shorter. Podcasts hosted by me and in Biome Bites, I’m the only guest, so essentially it's just me talking to you as the listener.   Today's episode will focus on something we've talked about a lot on the podcast, something called fecal microbiota transplantation, also known as FMT.   You may have heard of it referred to as stool transplantation, poo transplantation. Intestinal microbiota transfer, intestinal microbiome transplantation and potentially even other things I may not be aware of. And you've probably thought, what is that? You may have heard of it before and you want it and want more information.   So in today's Biome Bite we're going to give an overview of FMT, also known as IMT. If you refer to it as intestinal microbiota transfer, which is my preference and I'll get on to that in this episode. In subsequent Biome Bites relating to FMT, IMT, I'll dig deeper and talk through the latest evidence as well as how the industry is developing. So let's start with the basics of the basics.   What is FMT IMT?   FMT, and I'll just refer to it from now on in this episode as FMT is a medical procedure in which microorganisms are moved into the intestinal tract of a recipient with the intention of preventing treating, curing a disease or a condition.   Now, where do the microbes come from?   The microbes come from the stool, hence the name fecal microbiota transplantation. And that stool can either be derived from the person who's receiving the FMT, as in it's coming from themselves and going into themselves. And that's called an autologous FMT.   Or it can come from a related, unrelated, healthy, some cases even unhealthy. And I'll get to that in a later episode, the donor and in this case, when it's not come from the person who's receiving the microorganisms which are derived from the stool, it's called allogeneic. And you can look up the definitions of those words, but essentially they relate to the source of the material that's been moved in to someone else.   We also see in the case of allogeneic, it can come from more than one donor, so it can be mixed. I've seen in the medical literature it coming from up to seven donors in a trial in which they administered FMT to patients suffering from ulcerative colitis, a form of inflammatory bowel disease.   So I think it's important to understand that it's a procedure and it's not a medicinal product in itself. What's medicinal about FMT is the microorganisms that are being administered as part of the procedure.   Now we can ask ourselves, when did FMT first originate? Who was the first person to do it?   And the answer to that question is, is not actually that clear. And it's probably much older than you might think. So in 2022, we're doing FMT routinely for patients suffering from nasty infections associated with a bacterium called C difficile, also known as Cdif.   There's also been a large number of clinical trials in other disease areas like ulcerative colitis, as   I just mentioned, but also irritable bowel syndrome, IBS. And patients suffering from various different types of cancer as a means of improving how they respond to cancer drugs. And that's just a very, very small segment of all the possible indications in clinical trials.   So actually, the first recorded cases of FMT seem to originate back to ancient China, probably fourth or fifth century. And they prescribed this suspension of microorganism called yellow dragon soup.   In other areas of medicine, such as the veterinary world, FMT is performed reasonably routinely as a means to treat mastitis, for example, and colitis in horses and cows. And you may also be aware of the fact that some animals perform something called coprophagia. Essentially the consumption of feces as just part of being themselves.   Why do they do that?   I think there's lots of different theories, but what I'm trying to say is it's not totally unprecedented for mammalian species, i.e. humans and others, to essentially get microbes from other sources to potentiate or improve their health and well-being. And it might be that we've actually evolved to benefit from the consumption of microorganisms in this manner.   So you might be wondering how do the microorganisms get into the patient? How is it administered? How is it prepared, so and so on?   And I'll give a high-level overview of all of that now and in later. Biome Bites will cut out sections of the whole process of finding a donor and administering the microorganisms and what happens after cut it up and then do deeper dives into each individual area so, a donor provides a stool sample.   And that donor, typically, if they're not related to the patient, would undergo a series of screening tests to make sure that they're free of disease. And there if they're related to the patient, some people, some clinicians, whoever is providing the FMT or at least providing the material that's used to manufacture and ultimately produce the microbes that are used in FMT, take the view that if they're related to the recipient, then there's less of a need to screen because they live together.   And as a result of that, they are probably carrying the same bugs. Now, that said, the more and more we understand about FMT the more and more realize that donor screening is fundamental and extremely important in the context of making sure that what's being administered is safe. And even if donors are relatives now typically they're screened in the same way as an unrelated person would be.   So what does this screening involve?   Well, it's trying to reduce the risk as far as practically possible of an objectionable organism, also known as a pathogen being present within the stool donation and reducing the risk as far as possible of the kind of global microbial community profile being pro-inflammatory or being conducive to the development of a microbiome mediated disease.   What do I mean by that? And what I mean by that is that we have observed that the microbiome changes in large numbers of patients with diseases?   I'll just name a few. Multiple sclerosis, obesity, type two diabetes. And it may be that these changes that we've observed are actually driving the disease processes. Therefore, you probably wouldn't want to transfer microorganisms from someone suffering from type two diabetes into someone suffering from something else, because you might then trigger processes that could ultimately lead to type two diabetes.   If you see what I mean and there's no easy way of characterizing that other than making sure that the donor doesn't have type two diabetes.   So there's a whole raft of questionnaire-based screening procedures and questions that exist to reduce the theoretical risk of the transfer of microbiome-mediated disease through the microorganisms that are administered as part of FMT.   The other elements relate to objectionable organisms, pathogens. And what we do is we ask people if they've traveled. We ask about their sexual history. We ask if they currently have an infection or the feeling well fit and healthy on the day of donation. So and so on. We also extensively screen their blood and extensively screen their stool.   And you might be thinking some of that sounds quite familiar. It sounds a little bit like blood transfusions and what I've done or what I've heard people do as they go to donate blood. And there's a lot of parallels actually, between donors for FMT and Donors for blood transfusion. Now, the purpose of this Biome Bite is to give a high level overview.   So I'm going to kind of stop there and not go any deeper into what kind of pathogens we look for, what kind of tests we do, how frequently do we do it. That will form the basis of a much more detailed discussion at a later date. So we've tried to make sure that the microorganisms are safe.   We've talked about it coming from a patient in the form of an autologous procedure or a donor or multiple donors in the form of an allogeneic procedure. The benefits of an allogeneic procedure, for example, over an autologous is that you might be trying to change the microbiome in a particular kind of way that possibly couldn't be achieved if you're just giving yourself your own microorganisms back.   Now, how are the microorganisms manufactured? Do they just sort of take a stool sample and do one or two things and then trying to get it into the patient? Or do we do a large number of different manipulations and processes?   So historically, we had a rather unsophisticated, quite crude methodology, and it was really just about getting the stool sample into suspension. Now you might be thinking, Well, if it's just into suspension, why do not just get runny sort of diarrhoea type stools? Well, the reason we don't do that and we have cut offs is related to something called the Bristol Stool score or the Bristol stool chart.   And the cutoffs really relate to is this person is potentially constipated or does this person have diarrhoea. And we wouldn't accept either, because constipation and diarrhoea can be proxies for infections or problems within the gut that might make the microorganisms essentially unsafe in the context of FMT.   So historically, it used to just be about creating a suspension   What we now try and do is try and remove the non-microbial components, so basically fibres from the stool sample and try to basically distil down to the microorganisms only. The stool is actually quite a complicated substance that includes undigested foods, a variety of microorganisms, bacteria, viruses, fungi and small viruses that infect bacteria called bacteriophage, as well as other components that you may have ingested. For example, in smokers, sometimes you can find ash in stools and things like mucus and antibodies, colonocytes, which are elements of the inner lining of the intestine, so and so on.   So the purpose of the processing is to try and distil down or maybe distil is the wrong word.   But what we're trying to do is remove the microbes and the microbial elements from the non-microbial elements, because it's the microbial elements that we're most particularly interested in the context of FMT, because we're trying to change the recipient's microbiome.   So how do we do that? We do a series of processing steps under typically controlled conditions. We want to, as best as possible, replicate the intestinal environment, which is anaerobic, so oxygen-free. And interestingly, we want to protect the microorganisms that have been donated as much as possible and keep them alive, which is very different to a traditional pharmaceutical manufacturing process where you don't want there to be any bacteria in there at all. Sometimes you want it to be completely sterile if you're injecting it, for example, in someone's vein.   So what we want to do is not only keep the microorganisms alive, but we also want to make sure that no microorganisms from the environment can enter into the sample. So it's quite complicated and quite challenging.   The suspension of microorganisms then goes through subsequent processing steps and typically these days is either stored frozen as a suspension or is taken through some sort of drying process where the aqueous component is removed. And we produce a powder.   Historically, and it doesn't really happen so much anymore, Processing would happen essentially on the day of donation and recipients would get the FMT the same day. And that's typically described as being fresh versus frozen. I'm not so keen on the fresh nomenclature, but you kind of get the picture.   It's done on the day and it's not stored, frozen or banked  Earlier on in the field of FMT we did a lot more on-the-day type processing rather than storing anything and then giving it at a later date. So instead of creating a bank or an inventory of processed material that could be administered, it was typically done on the day. And that's because no one had really compared to see if a frozen sample is less effective or more effective than a fresh one.   And typically what was seen in the scientific literature and research was that Frozen was pretty much as good as fresh in the context of a C difficile infection or prevention of recurrence of C difficile infection. So based on that, people started to do frozen a lot more and we started to move away from relatives to anonymous type donors. There's also benefits associated with anonymous donors as well.   What happens after we've managed to distill the microorganisms and either produce the frozen suspension or produce the powder?   Typically the powder is encapsulated and FMT as a procedure is associated with a number of medical procedures, like a colonoscopy, which is a tube that goes up the back passage like a nasal gastric nasal duodenal.   The first part of the small intestine or nasal mid-part the small intestine tubes, which go up the nose through the stomach and into these parts of the intestine. And the microorganisms are essentially pushed into the patient through these tubes. And they arrive at some point in the intestinal tract where if it's going up the back passage, it's going into the colon, the large bowl, if it's going from top to bottom, it typically goes into the bottom part of the stomach or to the small intestine.   And there's been a variety of research over the last ten years comparing upper GI delivery versus lower GI delivery. What's more effective? What's less effective? So and so on. Typically, the evolution has been from an enema or nasal duodenal through to a capsule, which is typically what we're doing now    Some clinicians prefer colonoscopy because you can also visualize the colon at the same time, and that's quite useful. In things like C difficile infection or colitis, where visualizing the inner aspect of the colon gives you an indication of how severe the patient's condition disease infection actually is.   That's the most established use case. Interestingly, in terms of history, I think that the first recorded case of FMT in modern medicine, which was published in 1958 by a gentleman called Mr. Ben Eiseman, the chief surgeon at Denver General Hospital. He administered FMT probably for patients suffering from C Diff although it wasn't really known as C Diff at the time.   And there was a little bit in the in the literature following on from that in patients with ulcerative colitis. But we didn't really see that much FMT until 2013 when there was a landmark randomised controlled clinical trial, the gold standard of medical evidence which essentially showed that FMT plus antibiotics in these patients who had an overgrowth of C difficile, a nasty hospital acquired bug. typically hospital acquired bug did much better than patients who just received antibiotics alone.   And it kind of broke the cycle of patients who were getting recurrence. So what was happening with these patients as there were too many bad bugs in the case of C difficile, too little good bugs. So there was like too many weeds in the garden. Those bad bugs were producing toxins. The toxins were inducing inflammation. Sometimes the patients were going on to die and if they were treated with antibiotics, they got the FMT, after which replenished the garden with all the healthy, with all the healthy plants. And as a result, the weeds couldn't grow and out-compete and take up all those biological niches.   So that trial spurred a huge wave of interest in FMT. It catalysed lots of funding, company formation. And since then we've seen hundreds of clinical trials, hundreds of publications and many companies and patents filed following on from them.   Okay, so why would somebody need an FMT? Why would someone benefit from an FMT? Why is it done really for anything?   So each of us has something called a microbiome, a term used to describe communities of microorganisms, their collective genomic potential through all of their genes and their theatre of functional activity and essentially what we now know is that changes to the microbiome in terms of composition and function are associated with likely contribute to and in some cases are probably the cause of development of disease, some of which are really underserved in terms of treatment options.   So the theory, the thinking is that in patients with microbiome perturbance the change and disease linked to changes to the microbiome, if we can change their microbiome back to a healthy state, then we might be able to alleviate symptoms and ideally cure the disease, which is currently incurable based on currently available medical therapies. And there's a variety of different ways we can change our microbiome.   But FMT represents one such avenue that is quite dramatic. We're taking something communities from a healthy person or from someone before they've had a disease or change in the case of autologous FMT and giving it back to them. So it's a rapid sudden change to their microbiome reversion, hopefully back to something that's healthy. The human colon is an incredibly efficient fermentor system, and within each stool that we produce, roughly 50% of it is microbial. One times 10 to the 12 bacteria.   Think about how many zeros that is per stool donation. So it's it is a really incredible, well, efficient way to capture large numbers of potentially therapeutically active bacteria before instilling them into someone else. So what have we talked about?   We've talked about what FMT is, we've talked about how the microorganisms instilled through FMT are typically prepared and stored.   We've talked about how the microorganisms are administered and we've also talked about essentially the most well-established indication for FMT in the form of C Difficile infection. We've also brushed on some of the history, which is really extremely interesting, and I think that's probably a good overview for now.   And in later Biome Bites, we're going to dig deeper in each of these key areas. I hope you've enjoyed this brief overview of what is FMT. If you have questions, please feel free to send them to me. or tweet, connect with me on social media. I'd be very happy to try and answer them on a subsequent podcast.

Emma is a fitness coach, sports scientist and researcher with a large following on social media and multiple successful online businesses.  Through structured programmes and coaching, Emma has helped thousands of people lose weight and improve their body composition. She understands the science underpinning successful diets and uses her knowledge to help other personal trainers and coaches help their respective clients. To find out more about Emma’s products and businesses, check out: https://esgfitness.co.uk This episode is full of recommendations and knowledge relating to how to improve your physique and live a longer, healthier and happier life. When asked to distil her top recommendations, Emma came up with the following advice:    Eat in accordance with your energy demands   Eat primarily whole foods, limit processed foods  Reduce snacking to a minimum  To give context to the above, Emma noted that it was challenging to figure out exactly what your energy demands are. No calorie calculator / energy demand calculator is going to be entirely accurate. Emma suggests tracking your food and body weight for a period of time and using this as a basis to make adjustments. Daily fluctuations in weight are not important due to water fluctuation and varying food intake. Weekly / monthly fluctuations in weight are important.   The concept of eating minimally processed foods has been discussed several times on Inside Matters and is sound advice for someone wanting to improve their body composition and the composition of their microbiome.  On the subject of snacking, Emma’s view is that this is one of the primary reasons for people being unable to lose weight or a reason for putting on weight. Snacking can be mindless and instinctive e.g a biscuit with coffee in the office or finishing a plate of food for the sake of finishing a plate of food and not being wasteful.  Beyond her big three tips, a lot of Emma’s advice centred around what she calls ‘showing up’, essentially, how you approach a task or your day. How you show up dictates how you perform and how others respond to your actions. Exercise helps Emma show up at her best, and the benefits of exercise for her extend beyond physical health and into performance at work and in life.  Her morning routine is as follows: Wake up at 05:45, put the kettle on Undertake 10 pull-ups and push-upsTry not to open emails until 7 - be mindful 07:30 gym 09:00 start work  On supplements, Emma recommends fish oil, vitamin D, creatine and B12. Creatine is particularly beneficial for people that do not eat animal products - most notably red meat. 

Visit our podcast's website to learn more - https://insidematters.health/ Watch the podcast on YouTube.   Expect the unexpected in space microbiology! There are microorganisms that have adapted to survive in the most extreme environments. These microbiomes are being analysed to figure out what might be happening in space, especially with those that have been found to survive up to 3 years. What would happen if a human came into contact with them on another planet?