Dynamic Dialogue with Danny Matranga - 17 - Dr. Gabrielle Fundaro PhD: "Gut Health", Antibiotics, Probiotics, and Artificial Sweeteners.

Episode Date: April 12, 2020

In today's episode, we sit down with Gabrielle Fundaro PhD to talk all things microbiome and "gut health." Dr. Gabrielle Fundaro, CISSN, CHC, is a Renaissance Periodization consultant, Monash low-FODMAP certified and ISSN-certified sports nutritionist, an ACE-certified health coach. Dr. Fundaro combines her knowledge of nutrition and motivational interviewing techniques to promote intrinsic motivation and behavior change in clients to facilitate long-term weight management and healthy lifestyles. Dr. Fundaro is a former Assistant Professor of Exercise Science at Georgia Gwinnett College and holds a PhD in Human Nutrition, Foods, and Exercise from Virginia Tech as well as a BS in Exercise, Sport, and Health Education from Radford University. She is currently completing requirements towards the Registered Dietitian credential as a participant in the Individualized Supervised Practice Pathway of the Dietetic Internship Program of the University of Oklahoma Health Sciences Center. In her free time, she enjoys hiking, reading, spending time with her dogs, and training for powerlifting.You can find out more about Dr. Fundaro and what she is working on below:Follow Dr. Fundaro on Instagram HERE:Follow Dr. Fundaro on Twitter HERE:Check out Her website HERE:Support the Show.

Hey there, everybody. Welcome back to the Dynamic Dialogue podcast. Today, we get to sit down with Dr. Gabrielle Fundaro, a world-renowned nutrition and gut health expert. We're talking everything from antibiotics to kombucha. And what I want to let you guys in on today before you hear the conversation I have with Gab is this. Remember that just like metabolism, just like some of the other topics we've talked about, there is a lot of nuance. And when you really, really know about something, it's okay for things to be unclear. And that's something that Gab does an amazing job. She speaks with tremendous confidence and expertise, but she does not speak in absolutes. And I think that that's very, very important, particularly in an emerging and new

field like gut health. So buckle up. This is going to be a really exciting interview between myself and Dr. Gabrielle Fandaro. So Gab, how's it going? absolutely as good as it possibly can be going right now all right yeah pretty crazy times and you're in arizona right yes yes i am um exploring arizona a little bit in the next several months um as much as safely possible of course um but i am looking to settle here and so i will be spending spending about a month each in a few different places so I can hit all corners of the state. I've already have been here several times. And for any Arizonans, I have to say you guys are the friendliest people that I have ever met in all of my travels. Nice. And so are you moving out there to continue kind of your practice academically or just for lifestyle stuff?

Well, really, everything that I do is remote, so I can kind of go wherever I please. My academic connections, as limited as they are, are actually back in Tennessee. So I am collaborating with a research project out there. We just actually submitted the grant. So haven't made any official announcements, but it is something that's in the works. And I just really love Arizona. So I'm like, if I can go kind of anywhere in the US and work, I would like to be someplace super sunny and a bajillion degrees. And I think while we're on the topic of academics, before we get into the main

questions, why don't you tell everybody kind of how you found yourself or how you got to where you are and kind of what ignited the fire to get into the health space? I know you have, if I'm not mistaken, some physique sport background as well. So could you let everybody know a little bit about that and then kind of how you became the person who I kind of look to as kind of the main expert in this gut health space. I wish I knew that. I have no idea how I got here. It was literally, it's been a series of like happy accidents. I think my whole career has been really serendipitous. And my dad always stresses that, you know, luck is where preparation meets opportunity. So I guess I've been very lucky in that I've been very well prepared for the opportunities that arose. So I started actually in exercise science.

So my bachelor's was in exercise, sport, and health ed. I really thought that I was going to own a gym one day. And then my junior year of undergrad, I decided that that was not my future and that I was so in love with science and with biology and anatomy and phys. And I wanted to be a professor. And I was actually tutoring for hours every week just for free because I loved it so much. And I thought, this is how I'm going to make my place in the world. This is how I'm going to affect change. I'm going to be an educator.

I'm going to empower people with knowledge because I just got so much fulfillment out of those interactions. So I went straight from bachelor's to PhD. So I did my PhD at Virginia Tech in a skeletal muscle physiology and biochemistry lab. And my initial project was looking at the effects of high fat feeding on hypertrophy. I had, there was, there was a series of unhappy accidents there. We lost a bunch of samples. And so what was my side project then became my main project. And my side project was looking at the potential protective role of probiotic supplementation during high fat feeding. And, and I was given that project because I was just, I was haranguing my PI all the time about why

aren't we looking in the gut? Because we were challenging our rodent models with lipopolysaccharide or LPS. And it's an endotoxin that can leak from the gut. It comes from certain bacteria that inhabit the gut. And when it binds to certain immune receptors on skeletal muscle, for example, it causes an inflammatory cascade that's been implicated in metabolic dysregulation. And so I said, well, why, you know, why aren't we looking at the gut? Like, why aren't we trying to prevent this from happening if it's, if it's happening because the gut is, you know, permeable in some way. So finally he, he let me have this project and went through many iterations of mouse models and I helped with the human project on my way out.

Parallel to that, I was doing a fellowship and a graduate certificate in the scholarship of teaching and learning because I wanted to learn how to help my future students learn. You know, I want to know like what's motivating them. How can I be the best educator possible? And so when I came out with my doctorate, I immediately went into a teaching focused institution. I did not expect that I was going to be a gut health anything. It was literally a means to an end. I wanted to get out and teach. And after four years in academia, I realized that at least where I was, wasn't really like my dreams for, you know, those kind of in relationship with students and that type of engagement really wasn't coming to fruition. And that's when Mike Israetel from

Renaissance Periodization found me on Facebook in the International Society of Sport Nutrition. I was like debating with someone and I guess Mike liked the way I was debating and he messaged me on Facebook like, hey, I have a business proposition for you. Then I was like, what is this? And then I realized, holy shit, this is Renaissance periodization. And so they recruited me. And so my last year teaching, I was also coaching, trying to do those, you know, kind of simultaneously full time was a huge challenge. And I knew, you know, midway through that I was going to have to make a decision at some point to go in one direction or the other, because I was going to be up for

promotion, and I had to do a lot of research. And so I decided at that point that I had enough support and enough, I think, I guess, clout in the industry that I could make the transition. And so I resigned from teaching and went into coaching full-time. And that's when Mike really had the excellent idea for me to get back to my roots because, you know, I studied the gut microbiome and start talking about that in an evidence-based way because there's so much misinformation in that area. So he had me on Steve Hall's podcast, Revive Stronger, and I spoke, you know, kind of generally about it there. And from there, it was really just a snowball effect. I think people were really desirous of more kind of advanced and evidence-based information in that field.

And it's been, I think, pretty much organic growth. I think that, you know, I can, or I hope that I communicate things in ways that make sense to people because of my background as an educator, and I try to make them applicable, but I am also incredibly skeptical. And because I have, you know, a background in that field, and I still have connections with some of the researchers, I can kind of mesh those two things together of like bringing it to the fitness industry in ways that are applicable, but also in ways that are conservative and skeptical and prudent to kind of quell some of those myths and misconceptions. And yeah, how I got here, just people are gracious and appreciate what I have to say. So I'm thankful for that.

Yeah, I think that's a fantastic story. And I think to just remind everybody who's listening, it's one thing to go out and try to find experts. It's quite difficult to find experts, particularly in this field, because it's newer. It's something that we've just recently started exploring. But for almost everybody listening, there's some degree of fitness goal you might have. And to have somebody here who's both an expert in fitness as both a practitioner and an educator, and also the microbiome, this is going to be loaded with lots of nuggets for you to take home, particularly that will help with your fitness. So buckle up because I'm just as excited as you guys are. And I think we'll start with this question because this is one I like to ask, particularly those who are super

experts in one area. What are the three biggest myths or misconceptions that you hear very regularly about gut, gut health, microbiome, microbiota, all that stuff stuff I think one of the biggest would be the idea of a healthy gut or an unhealthy gut not to say that we don't have gastrointestinal diseases of course we do but even that gets conflated so we assume that a gastrointestinal disease has a causative link to the gut microbiome or that the human gastrointestinal tract and the gut microbiome are sort of the same thing when we're talking about them. And while we do see correlations between the microbiome and certain disease states, there's so much heterogeneity, both in individuals from one person to the next,

the microbiome is quite different. It's like a fingerprint. And even just when we're looking at methodological differences from one study to the next. So even to say that we have consensus about certain things is a bit too much at this point. Because as you said, the field is so new. So when we say things like good gut health or bad gut health, it's so general, it's sort of like saying good weather versus bad weather. That's very subjective. Some people really like thunderstorms. Other people don't. Maybe at the extremes, we can say like tornadoes and hurricanes, that's considered to be bad weather. But we just don't really see in most cases, the extremes in terms of microbial changes to the gut. So I think that's one thing

that we have to be careful about because we use good gut health or bad gut health as sort of a marketing term. We use it in much the same way we sort of have this idea of creating a problem for people. So we create the problem of bad gut health and then we can sell a solution to it. We can sell a detox or we can sell some sort of gut reset. So we have to be very careful about what we actually mean when we say good gut health versus bad gut health. When we say bad gut health, I think most of the time people are talking about some symptoms like gas, bloating, bowel irregularities, constipation. That could be caused by a gastrointestinal disease. Certainly might correlate with a microbial profile that's different from someone who

doesn't have those diseases, but it's not necessarily the cause. It's not necessarily rather caused by the microbiome itself. And it's not necessarily that you have a bad microbiome. Realize that those are living organisms and they are producing gas as a byproduct of their metabolic processes. So what we sort of deem bad gut health can actually kind of just be a normal functioning of those microbes. And likewise, when we're trying to come up with idea of good gut health, do we have, you know, a healthy microbiome profile? No, because quote unquote, good and bad, or, you know, the disease causing potential of these microbes

really depends on their relative abundance to one another. And just like we, you know, we would be very problematic if we were to eradicate all mosquitoes, even though mosquitoes are really super annoying, like they're just assholes, but we still need them as part of the ecosystem. We really wouldn't want to completely eradicate any one of these microbes. And a lot of them just get a bad rep because of the media. We look at yeast and we talk about how yeast overgrowth is so damaging. And it's really just a pseudo diagnosis. And there are strains of yeast that are actually probiotic. So I think we really have to be careful about sort of that black and white thinking of good gut health versus bad gut health. And even some of the terms that we use like dysbiosis in the literature, really that's researchers are

moving away from using that because dysbiosis just means altered compared to the controls. But when we don't have the idea of this is one specific, this is what a healthy gut quote unquote should look like. We don't have that. So we can't say that we know, okay, this, then this is what dysbiosis is. So that's sort of the second myth, I think, that maybe a sub-myth to the good gut health and bad gut health are the way that we're using some of these terms. And again, it's quite often used as marketing. And then the final one I think would be, as I mentioned, this idea of the gut reset, as I mentioned, you know, this idea of the gut reset or, you know, I've heard it used in different ways. And I know it's sort of a functional medicine thing that they talk about, like the

4R protocol. But it sort of flies in the face of physiology. I mean, what do we mean by a reset? What is actually being reset? Are we turning it off and back on again? Are we claiming that we're clearing out all of the microbial contents? We've got a few kilos in there worth of biomass. I don't think that that's happening. Are we reprogramming them in some way? I mean, we really have such a rudimentary understanding of who's there and what they're doing and how they're interacting, not just with each other, but with our own cells, that I think it's kind of silly. It's science fiction to think that we can reset all of it and then start fresh with some protocol or specifically starve out the bad bugs and only feed the good bugs, when in reality, they're all competing for relatively

the same nutrients. So those are probably the big three. And because it's such a, like you said, a new area and one that has a lot of gray area and just a lack of knowing better because we don't have the information, then it's very easy for people to sort of insert things that seem to make sense. No, I think that's fantastic. And I think what you've done there by promoting some degree of skepticism around these things is you've laid a really solid foundation for us to kind of build upon as this conversation moves forward. Because when you think about what the average individual is probably familiar with when it comes to the gut, they're very familiar with the term gut health. They think it's perhaps black and white, cut and dry, that if you have any type of gastrointestinal pathology, it's indicative of a dysbiosis, right?

Another big time buzzword. to use terms like reset or the various different forms of gut health detoxes that people might be selling or even gut health supplementation that people might be selling. And so this kind of puts a pause on that and says, hey, a lot of kind of what you've been hearing may well be coming from the wrong people or may be coming from people who have perhaps an ax to grind rather than somebody who's trying to educate. So I think that's a really solid foundation. And as somebody who knows so much about this stuff, what are some of the real issues, right? Like pathologies, perhaps that people see in the gut that a lot of people are dealing with. And then maybe we'll move

into talking perhaps more about the actual microbiome itself, but it sounds like those are very distinct things. Yeah, they absolutely are. Because when we're talking about a gastrointestinal disease, we may have an organic disease where we actually can see that there is damage to the tissues or that there is some dysfunction in that organ due to changes in the anatomy. Maybe a functional disease where the anatomy and physiology of that organ system are normal, but the physiology might be a little bit dysregulated, we should say. So it looks normal. The tests come back within normal ranges, but it's not functioning in a normal way. So when we look at some of the diseases like inflammatory bowel disease, so ulcerative colitis, Crohn's, or if we look at celiac disease, which is an autoimmune response to

gluten, we see tissue damage there. That also correlates with obvious symptoms and dysfunction. That may also correlate with some form of dysbiosis, meaning that the microbial profile of individuals with one of those diseases is consistently different from individuals without those diseases. But when we compare them to one another, they're still going to be distinctly different. So we still don't have one profile. That's why we're not able to draw causative relationships between specific microbes in these disease states. It's a chicken versus the egg problem, which came first, the change in the microbiome or the change to the gastrointestinal tract. When we look at something like irritable bowel syndrome, in this case, the anatomy of the gut is normal,

but the individual might experience chronic diarrhea or constipation or alternating symptoms. They could have some visceral hypersensitivity. So that means that the nervous system of the gastrointestinal tract is really sensitive, can cause some aberrant pain signaling. is really sensitive, can cause some aberrant pain signaling. They may have a lot of gas and bloating. They may be really sensitive to certain types of carbohydrates that are highly fermentable because as they're fermented, they create a lot of gas that creates stretching in the GI tract, and that sends off those pain signals. They, again, we might see correlations in those individuals where they have a different microbial profile from people without irritable bowel syndrome. But again, we don't see that it's exactly the same or even very similar in individuals with IBS versus controls.

So again, we can't see that there's one IBS profile. Not to say that it doesn't exist because research is emerging now to say, hey, we seem to see that certain taxa, certain groups of microbes are underrepresented or overrepresented in these individuals. But again, it's a chicken versus egg problem. We don't know what came first, so we can't draw causation there. Now, inflammatory bowel disease and celiac disease are extremely rare, but irritable bowel syndrome is actually fairly common. And we see it worldwide. It seems to affect females more so than males, but it's really one of the most prevalent gastrointestinal disorders that we see.

And some of this could potentially be due to changes in the way that we sort of you know diagnose it that we're measuring you know what do we consider to be chronic constipation versus chronic diarrhea so in some of in some of that you know it's just sort of our record-keeping so we don't we can't say with certainty that yes this is increasing because of you know changes in lifestyle or something like that. But it does appear to be fairly prevalent. But again, we don't know the cause. And so what we can really look at are, you know, what are the ways that we can manage it or what are sort of,

you know, potential exacerbatory factors. And then finally, you know, to kind of touch on the idea of dysbiosis and and one of the things that I think is not really you know disease or anything that people are talking about but a theory of what could be going on is sort of a an overall loss in microbial diversity from generation to generation so this happens in rodents that if you rear subsequent litters with a fiber deficiency, you see reduced diversity transferred from mother to offspring to offspring to offspring, which is really kind of interesting. And we do know that in humans, vaginal birth is the first inoculation with microbial bacteria. And it's not probably from the vaginal canal. It's actually probably from the proximity to the rectum because we don't really see huge blooms of vaginal bacteria. We see

more fecal bacteria, gastrointestinal bacteria blooming in those areas. So what might be potentially happening, and this is just sort of an interesting theory, is that it's very hard for us to determine what is healthy versus unhealthy gut because we see overall reduced microbial diversity in developed nations versus less developed nations. Now, some of that could be hygiene, some of that could be certainly diet, but we see sort of these differences based on location, which is something that's really interesting and sort of gives rise to the idea that potentially we're losing diversity based on, you know, the changes in our lifestyle, in our sanitation practices, and certainly in our diet, because most of us are fiber deficient. In a lot of developed countries,

we're seeing an average of about 15 to 19 grams of fiber per day. And we want, you know, upwards of 25 to 40. So I think that, you know, probably some of the biggest issues that we're facing would be that, you know, we're, I think we're, we're adding problems where there aren't any, we're like creating some of these problems like, oh, good versus bad gut health. But then the solutions that we're looking for are like supplements or protocols and detoxes. And we're missing the basics of adequate fiber intake and regular physical activity and a diverse array of, you know, plant matter in the diets. You have microbe accessible carbohydrates.

So I think those are, you know, probably the low-hanging fruit that we could really easily address and, you know, have some tangible benefit to some potential problems. You know, not to say that that's going to be helpful necessarily for people with IBS to just wholesale, oh, increase your fiber intake. No, definitely not. Or to say that that's going to be, you know, curative of anything, but it's just a place, I think, toative of anything, but it's just a place, I think, to start. No, I think there was a lot of kind of gold nuggets in there. One thing that you said that I quite, I hadn't really thought about was that there aren't unique kind of categorizable bacterial profiles that align with each gut-related abnormality. So you can't say this

is a profile that's indicative of IBS, vice versa. There might be some things we could highlight, but it's certainly not always correlation between X gut profile and X disease. And then another thing that I found quite interesting was you keep hitting on fiber. Now I have somewhat of an understanding as to why fiber is so important for the gut, but I think in the general communication of nutrition principles, we spend so much time talking about lipids, proteins, and carbohydrates that we often forget that fiber, even though it falls under that carbohydrate umbrella, has a particularly valuable role for the microbiome. Why is it so valuable? What does it do for our gut? And again,

are there things people should be aiming for? You kind of hit on some targets already with regards to fiber intake. Yeah. So you can think of food moving along the gastrointestinal tract like it's on a conveyor belt with stops. So the first stop really in terms of absorption is the small intestine. That's when all of the human accessible carbohydrates are going to be sequestered by the human host. So if it's something that we have a digestive enzyme for and we have a transporter for, we're going to be breaking it down to its smallest monomer and absorbing that. And also because the, so between that, so there's not a lot of nutrient availability and it's a little bit of an aerobic environment and it's a little bit acidic there in the

small intestine. It's fairly low microbial diversity and number in the small intestine. Where we really see the greatest number and diversity of microbes is in the large intestine, especially in the more distal portion. And that's where everything that we've kind of taken up that we can take up is gone by the time that food mass or feces enters the large intestine. What's really getting to the large intestine are those microbe accessible carbohydrates. So they're the fibers and the resistant starches that weren't broken down by our digestive enzymes. So that means that they're available for those microbes and the microbes use those to make energy. So their process of making ATP is fermentation.

So people think of it like making alcohol, not exactly the same way, but that's what they're doing. So they're making their own ATP, their own energy by fermenting those carbohydrates. So if we don't leave, if we're eating a diet that's extremely low in fiber, that means that there's less nutrition available for those microbes. They can use other things. So they can use amino acids. Some of them also process cholesterol and lipids, but to a much lower extent. They really do rely heavily on carbohydrates. So what happens then is that you may lose microbial diversity. Now, diversity is another word that we kind of have to be careful with as well, because more is not necessarily better.

You can have, so diversity is talking about species evenness and richness. So how many are there and then what's their relative abundance to one another. And sometimes you can have a change in diversity. You may have a loss or a gain of diversity. That doesn't necessarily mean that something bad or something good is happening. It's just a change to the population. There are also two different ways to look at diversity in terms of looking at taxonomy. So who's there? And then functionality, what are they doing? You may have changes to who's there with no change to what they're doing. So the functional capacity of the microbiome stays fairly stable kind of regardless of who's there or not. And a lot of early studies were looking more at who's there rather than what they're doing. So that's another area that I think I just want to side note that to say we have to be

kind of careful talking about diversity. But generally speaking, I think that I could say in one consensus is that to have a fiber deficient diet probably isn't a great idea because we can lose diversity to the point where now we don't have as much resistance to pathogens and we may then end up with abundances of certain bacteria that might not be beneficial to us. Perhaps they don't do anything for us. There are some that just aren't neutral. Or perhaps they may have a potential pathogenic effect. So as I mentioned earlier, that relative abundance is important because they're all competing for nutrients and for real estate. And they're interacting not just with us, but with one another. And so one of the ways that they can resist pathogenic growth is really just through

sheer numbers. So if that pathogen is sensing its other brethren via quorum sensing and saying like, who else is here? Ooh, our numbers are pretty low. I don't think we're going to be able to overcome this host's immune system. We're just going to hang out. Whereas if we allow their numbers to really expand, then they might say, oh, okay, there's enough of us now. We're going to mount an attack. And so that's what we're kind of trying to control for as well. And then there are just some other obvious, perhaps non-microbiome associated, but things like finding excess cholesterol, creating bulk in the stool to aid in transit of fecal matter. And then when those microbes are fermenting these fibers, they make not just gases, but also short-chain fatty acids. Two of them that have come into the limelight,

butyrate actually has been kind of popular for a while, but butyrate is associated with a number of metabolic outcomes like insulin sensitivity. And then propionate, which is kind of a recent player on the field that was just highlighted in some studies on elite marathon runners. So at least those two short-chain fatty acids seem to be pretty beneficial. Acetate kind of remains to be seen whether that's going to have any effect or not. But those serve as energy sources for the host and the host intestinal cells. So those microbes are playing a role in kind of energy harvesting for us as well.

So they take something that is not digestible to us and then potentially ferment it to something that is absorbable to us. So as food moves further along our digestive tract, essentially the closer it gets to exiting, the more microbes it comes in contact with. We kind of take earlier precedents. We grab what we can grab as humans from the small intestine. But as we get further through the large intestine, that's when we start feeding all those little guys that exist. social media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. Now, approximately do we know how many different species of microorganisms might live in the gut? And have we identified any that are particularly valuable? Not to say that any are not, because again, we went over the fact

there's tons of different ones and they all compete to do perhaps very different or very similar jobs, but about how many are there? And do we know of a few that are particularly of benefit to the human microbiome so when we're looking at bacteria specifically now now within the microbiome so microbiome refers to the microbes and all their genetic material so all the microbes that we have present we have bacteria we have archaea we have we have viruses, we have viruses that infect bacteria, which are bacteriophages. And within those fungi, people are probably pretty familiar with yeasts. So there's actually a fairly wide array of microorganisms specifically. Now about 99% of the organisms there will be bacteria bacteria aren't cleanly um organizable into species but like people who study them are kind of like yeah I know what you mean when you say species and

there are potentially thousands the problem is that really early you know for a long time like our early models were using just like culturing to try and identify who was there. And you can't count what you can't culture. So we missed out on a lot of who was there. And then even, you know, the more recent methods using things like looking at DNA or RNA, that comes with some shortcomings as well, because if you have bacteria with a cell wall, it might be hard to break that cell wall and access that genetic information and kind of read that barcode. And, you know, and then even that, like you can kind of look at who's there, but you can't see what they're doing. Now we can see what they're doing with something called metagenomic shotgun sequencing. So now you can look at who's there, like all of the genes,

who's there, what are they doing? And you can look at some functional capacity as well. who's there, what are they doing? And you can look at some functional capacity as well. But again, you know, there are, we rely on libraries of, you can think of it like barcodes. So imagine you're at the grocery store, right? And you've got, they're ringing up all of your items and then something doesn't have a barcode. They're like, we have to do a price check. Well, if that happens with microbes, depending on what you're using, you might not be able to identify who that was at all. It could be someone brand new. And so we kind of are just counting based on what we know right now. So potentially thousands of species. Now with bacteria, we have to look not just at the species, but the subspecies level to look at what they're actually doing.

And an example of a subspecies and things that we might know about would be comparing a dog to a dingo. Dogs, family pets, dingoes, eat babies, obviously like two very different functions. And it's the same thing with bacteria. So one thing that people, one that people might be familiar with would be E. coli. So there's an E. coli nissile that is probiotic. And then there's an E. coli nissile that is probiotic and then there's an E. coli that produces Shiga toxin that will make you poop your brains out so same species but we have to look at the strain level so one even when we're thinking about like okay there are potentially hundreds or thousands of species bacteria of bacteria each one of those species might have some sub strains and each subspecies rather in each of those strains might have a different behavior in the gut. So it's really difficult for us to say, even when we're just looking at, you know, the species

level that all species, all bacteria within one species will behave the same. They really won't. But most of the data really is looking at the genus level, which is a couple steps up. And when I really started to get into the field back in, you know, before 2014, they were looking at the phylum level, which is like looking at vertebrates versus invertebrates, super, super general. And they came up with this B to F ratio, this bifidobacteroides to formicutes ratio. And so they thought, well, if you have like, you know, a high level of formicutes, that might be more obesogenic. And that's really not the case. Like lactobacilli are formicutes. And then, you know, saying, okay, well, it was a, uh, uh, uh, for Mickey D's and then, you know, saying, okay, well it was a, okay, well maybe bacteria DDS are, you know, lean promoting, but then there are taxa within that group that

could potentially be, um, increasing energy harvesting from the diet. So all that is to say, we don't have a really clear picture of who's always a good guy versus who's always a bad guy. But based on probiotic studies, we have an idea that there are some taxa that generally speaking have a bunch of species that are probably beneficial to us. And there are some that are more potentially disease-causing. But we can't necessarily affect those through diet and lifestyle. We kind of want to think that we can do that, that we can feed the good guys and starve the bad guys, and that really just doesn't appear to be the case because we don't know which of these microbes feeds on specific types of fiber. They've tried

to do these studies where they, you know, feed a variety of fibers and then see like, oh, can we, you know, just feed one guy or the other? And they're like, oh, not really. So it's probably best to just eat a wide variety of fiber. And, you know, I think researchers also might sort of spin things in certain ways to make microbes look like something that will fit a narrative. You know, like Lachnospiraceae is one that I've seen be kind of a good guy and kind of a bad guy, or some methanogens can be good guys or bad guys, because is it a good thing to increase energy harvesting from the diet? Like if you are eating a bunch of fiber and not accounting for the extra, you know, 200 calories that you might be absorbing from that. It could be a good thing. It could be a bad thing, I think, in context. And so it's very easy to say like,

oh, this is an obesogenic microbe, or this is a lean-promoting microbe. Very interesting stuff. And it's a nice segue kind of into my next question, because I think if you just ask the general person or general layman, you know, what do you do to increase your gut health? They would probably say like, oh, you just got to drink kombucha and do a detox and you'll be good. Because there's this idea that one can simply introduce bacteria through fermented foods or foods that contain bacteria. So I'd love to know, is there any utility to the implementation of fermented foods in the diet? Does that have value? Or should people primarily just be focused on get the prebiotic fiber, maybe explain what

prebiotic is, right? Because there's probiotic and prebiotic is the best approach to eat probiotic rich fermented foods, prebiotic fiber, or some type of combination of the two from a nutritional standpoint? Yeah. To define prebiotic, that's just basically a substrate for the bacteria. It's an energy source for the bacteria. And quite often, we're talking about fermentable fibers in that case. So you don't have to supplement necessarily with prebiotics. You could just eat foods that are high in soluble fiber and you'll be getting plenty of prebiotics. As far as the utility of fermented foods, there are a couple of problems. There are a couple of problems with trying to sort of enrich the gut with fermented foods. So for one thing, for an item to be considered a probiotic,

it has to contain strains that have been shown to confer a benefit to the host. It's not enough just to contain microbes. It has to be something that has been shown in the literature to confer some benefit. has been shown in the literature to confer some benefit. The other thing is that while we don't have a clear consensus on the dose required or whether the probiotic really has to be alive, we have to be very transparent about the fact that we don't know how many microbes are in a given fermented food. So when we're looking at probiotics supplements, those are usually going to be labeled with a CFU,

so colony forming units, or it's kind of a metric for like what's the dose of bacteria in here. But that's not the case with fermented foods. And so A, you don't know if you're going to get one that's actually considered a probiotic, that's actually conferred benefit to the host. Could be just a microbe that ferments stuff and then ends up in a food. That doesn't necessarily mean it's going to enrich the gut. And then second, you don't know what the dose of that bacteria is going to be. Third, this goes for fermented foods and for probiotics that we have a large body of evidence that shows that probiotics, even if they show enrichment in the feces, don't necessarily do anything to the microbiome itself. So the fecal microbiome, the profile of microbes in a person's feces,

is not a very good surrogate for the profile of the gastrointestinal microbiome. Because the gastrointestinal microbiome, we're looking at stomach, small intestine, and large intestine. It's many, many feet of intestine. And within that, we can break it down even further to look at the microbes that are luminal or in the center of the intestine versus those that are mucosal or in the mucus layer covering the intestinal cells. So it's one huge caveat to looking at probiotics literature. If you're looking at fecal samples, you really don't know if that probiotic has actually enriched the gut. All you can determine is that it's present in the feces. And maybe if you're looking at just DNA, you don't even know

if it's alive or not. So depending on the method that you're using, if you're looking at DNA, you're going to get live and dead microbes. If you're looking at 16S, you're going to be seeing who's alive. So that's a little bit more functional. But yeah, so there's a possibility that you might have sort of a resistant GI tract, that your microbiome doesn't allow those external microbes to come in and take root and thrive, which could arguably be sort of a good thing. You know, we don't necessarily want our microbiome to be so fickle that it's very rapidly, you know, modified by things that we're eating because part of what it's doing is defending

us against pathogens. And in most cases, we find that it is actually quite stable over, you know, from about three years of age up until, you know, we're in our 60s or 70s that it's fairly stable. It's resilient and that's actually desirable. Not to say that probiotics don't have some applications, but again, it's going to be strain specific and the applications are relatively few and not anything really cool like weight loss like people hope for. Dr. Very cool. So it kind of sounds like just supplementing with fermented foods or even probiotic, potentially

probiotic enriched foods or probiotic supplements doesn't guarantee that these new guys that we're ingesting get to sit down at the cool kid table in the cafeteria with the guys who have already populated the gut. Yeah. Because for every supplemental bacteria, we try to give a seat at that table. They've evolved to keep hundreds of potentially pathogenic bacteria out. Is that kind of what I'm hearing?

So there's, there's some mechanisms in place to prevent the bad guys that might make it a little bit harder for us to say with certainty that this food or this supplement, if you take it, it's going to stick around. You also brought up fecal bacteria, which might be a conversation for another podcast, but I've seen that fecal transplantation has particular value in, in certain pathologies for certain people. Is that related to the gut microbiome? And could you perhaps briefly just touch on if that has a kind of bright

future in the same way that the gut sciences and the gut health stuff does? Yeah, this is a really interesting one. And I'm sad to say that the outcomes have not been really promising outside of C. diff. So C. difficile is a really common hospital associated infection. It's definitely one of those that I, that, you know, like these guys are pathogenic. C. diff certainly is. And, and. C. diff is a bacteria. Yes. Yes. And it's a, it's a bad bacteria. Yes. Okay, cool. Absolutely. Yeah. So it causes just chronic diarrhea and can, it can be deadly. So fecal

transplants are really one of the most effective treatments for C. diff because C. diff quite often it just is resistant to antimicrobials. People have to go on just really nasty antibiotics to try and knock it out. And it's actually brought on by antibiotic use in the first place. So like I mentioned, when we have a big die off of bacteria that allows for pathogenic overgrowth. So C. diff that might be just a, you know, he's hanging out normally in very low amounts, all of a sudden has this opportunity to grow, it will do so and then cause disease in the host. So a fecal transplant is the donation of fecal matter from a healthy individual to a person who's infected with C. diff. And in the trials for this,

it was so effective that it was actually unethical for them not to give it to the control group. Wow. Yes, absolutely. So effective. Now, unfortunately, in the US, I believe there was a death from an individual who was immunocompromised that received a fecal transplant because it's still sort of an experimental treatment. It's possible that they had in an individual who is immunocompromised that received a fecal transplant. Because, you know, it's still sort of an experimental treatment. It's possible that they had potentially been infected with a pathogenic bacteria in the healthy donor. Because, again, these guys hang out. I mean, you know, at low numbers, they just are there.

And then in other applications, looking at using it in inflammatory bowel disease, it's not as consistently effective. And actually in a small percentage of cases, it actually exacerbated the disease. And I believe that there are even some cases where it was brought on, like a person received a fecal transplant and then, you know, they had, you know, sort of an acute bout of colitis. So not necessarily an infallible treatment. And it really doesn't seem like it has many applications outside of C. diff because it's really not helping with IBD. It doesn't help with irritable bowel syndrome. Looking at weight management and metabolic syndrome, there have been a couple studies transplanting from healthy individuals to individuals with obesity or metabolic syndrome does not appear to be an effective intervention in that either. And then there's also one that

I'm aware of in children with autism, but there was no control group. And so it was a two-year follow up and they found that they improved without a control group. You really can't say that that was due to the fecal transplant. So this fecal transplant idea came about really from early rodent studies. So they took fecal transplants from rodents with diet-induced obesity, transplanted them into germ-free rodents or rodents that didn't have any bacteria. And those germ-free rodents then became obese either through increased food intake or increased energy harvesting. And they've been able to recapitulate that across a number of different diseases like models of colitis or even with behavior. So they do find that they're able to

identify some mechanisms between the gut microbiome and behavior in rodents. But I want to stress that that is not a surrogate for human behavior. We can't extrapolate that directly to human behavior. Obviously, the rodent brain is very different from the human brain. So it's interesting for mechanisms and to identify that there is a link there, but not to be able to say, you know, the microbiome is to blame for our mood, you know, or all health. I mean, that's probably the myth number four that, you know, the microbiome has become the scapegoat for absolutely everything. Mm-hmm. You know, it really has. I've heard quite a bit about it. And that's actually a great

segue into a question I have about the disrupting impact of antibiotic use. And one of the things that I've seen, I've even felt this, I'll tell a story. Last year, my girlfriend and I both unfortunately contracted strep throat. And we were somewhat apprehensive about taking the antibiotics because there was some degree of awareness as to how these impact the gut. And we were like, well, we can beat it without it. Long story short, we took the antibiotics, our digestive system seemed to be fine. But there's a tremendous amount of alarm around antibiotic utilization, whether it be for medicinal purposes or to treat something acute like an infection. How disruptive are your traditional antibiotics that might be given for something like a strep throat or a secondary

infection on the gut? Do they cause damage that can be fixed? And is it kind of just relegated to simply eat a relatively healthy diet, get your fiber in, and give this stuff time? It really depends on the antibiotic. And it's not even just antibiotics that have a potentially disruptive effect on the gut. Looking at what's most disruptive and in thinking term, you know, long term as well. So an antibiotic treatment might last, you know, one to two weeks, maybe longer. If you're looking at, you know, like I said, it depends on the antibiotics. So some of them are a little bit weaker or they're more, it depends on the antibiotics. So some of them are a little bit weaker or they're more, they're only going to act on specific types of bacteria. So it might be a relatively small perturbation versus others are going to affect far, you know, in far greater numbers and cause

much more die off. And, you know, the length of time as well. But when we're looking at other types of medications, metformin is incredibly disruptive. Looking at PPIs, proton pump inhibitors used for controlling reflux, also extremely disruptive. So in those cases, we're changing the pH. We're changing nutrient availability. That has a hugely disruptive effect on the gut microbiome. And the microbiome likewise also metabolizes certain drugs as well. So there are a number of different drugs that we might take, and especially those that are sort of long-term,

or we think of antacids sort of being like, oh, that's just an over-the-counter thing. It can't be causing any problems. And potentially it does and could actually, does seem to correlate with increased risk of small intestinal bacterial overgrowth because of reducing the acidity there, allowing for greater growth of those bacteria. So when we're looking at the effects of antibiotics, it might actually be fairly minimal. And we do seem to rebound relatively quickly. There was a really interesting study that compared post-antibiotic use, whether, you know, who would fare better, individuals who had an autologous fecal transplant, so their own fecal transplant from before the antibiotics,

those who did nothing, just watch and wait, get back to normal, or those who took a probiotic. And it was sort of the, you know, the long held belief, oh, you take a probiotic during or after your antibiotics to help prevent the loss of those beneficial microbes. Interestingly, they found that individuals who took that probiotic, which was really high in lactobacilli, actually had delayed reestablishment of the native gut microbiome. So they had some version of dysbiosis in terms of very low species richness. Diversity. Yeah, exactly. The people who did the best had the, those were those who did the autologous fecal transplant, but most of us are not going to do that. So I would say we go for second best and do the nothing,

just go back to normal. So absolutely, as you were saying, you know, just have adequate fiber, regular physical activity, and, you know, just get back to normal. Obviously, finish the entire dose of antibiotics, you know, as directed by your doctor. Cause that's how we end up with antibiotic resistant microbes is that people don't finish them. But yeah, then just get back to your normal habits or if beforehand you were not eating adequate fiber, that's a good time to start. Somewhere, somebody heard that and is saving their feces for veggie caps next time they have to take an antidepressant. Oh, please do not do that. You can get really, really sick. People have tried to do that. There was one guy I heard, there was like a podcast that I was listening to about this and he used his wife's and his newborn, or not newborn, but they had like an infant who'd been in daycare

and he used their fecal transplants for himself and ended up with some insane infection because little kids just have some really weird stuff in their guts. You know, they haven't fully established a mature gastrointestinal tract. So he got super sick from that. And yeah, it's not to be messed around with. I wonder if it's the same guy who drank fish tank cleaner to try to prevent COVID-19. They must at least know each other. So it sounds like there's obviously an impact of antibiotics on the gut. We can do some things. They're just not practical. The best thing is a return to normal. The only thing I've seen recently that's been more demonized in how it impacts gut bacteria than antibiotics are non-nutritive sweeteners

or artificial sweeteners. Now, the reason I bring this up is because I think it's incredibly valuable because there is certainly a utility for using non-nutritive sweeteners for things like weight management, weight reduction. They're probably not the healthiest thing to eat or ingest long-term in high doses, but they're certainly not unhealthy when we consider the amount of obesity we are dealing with and the amount of people who could use them as a tool. And I found more recently, a lot of people are saying, no, no, no, because even if they might help you reduce weight, they're horrible for the microbiome. So is this true? Does this actually show up in evidence or is this kind of just another

unsubstantiated claim? I think this is such a great example of looking at sort of the hierarchy of evidence and how we need to add more weight to certain types of studies. So if we look at cell culture data and we're looking at the research of non-nutritive sweeteners and cell culture data, it looks like they're extremely problematic. You know, we're looking at, you know, inflammatory responses and cell death and things like that. You know, we're looking at, you know, inflammatory responses and cell death and things like that. If we take it up a notch and we look in a rodent model, it looks like they could still be potentially problematic if we, you know, ignore completely the super physiological doses that no human could ever ingest. But, you know, oh, we might be able to induce some insulin resistance in a rodent model. When we look at human studies done with controls, and I'm saying this to throw shade on like a specific study that didn't use controls and it was just replicated with controls and they didn't replicate those findings because go figure, when you have a control group, you tend to elucidate things with more clarity. to elucidate things with more clarity.

But in human models, and I will say that the data is still in its infancy. We still only have a handful of studies looking at the human microbiome specifically. It doesn't seem to be doing anything. So for anyone listening who's not perhaps as educated on the way in which studies are constructed, could you perhaps tell them what a control is and why it's so important? Yes. So a control is a group that does not receive whatever treatment you're giving. And that's how you determine whether your treatment actually caused the effects or whether it was just effect of time or just an, yes. So, um, that's why it's very problematic to run a study without a control because you can't then say, oh, well, this group

didn't get the treatment and they also didn't see the effect. If, if one group gets a, an intervention and the other gets nothing and they both have the same outcome, you know, it wasn't the intervention that got them to that outcome. Yeah, so that was problematic. But yeah, you know, and I think the one that we have, the one that's I think most vilified but has the most studies, I want to say there are four studies on the human microbiome on aspartame and it doesn't seem to do anything. It just doesn't bother the microbes, goes in one end and out the other. Perhaps they, you know, if they can't metabolize

it and it's not affecting them in any way, it's just something that's in their environment and it just doesn't affect them. When we look at the effects of sugar alcohols, which are another form of artificial sweetener, not really artificial, but a sweetener that we consider to be non-nutritive because we can't readily absorb it and extract energy from it. Those in some cases can actually be prebiotic. So if they're fermentable, something like sorbitol, that could potentially have a beneficial effect on the microbiome in terms of being an energy substrate for them, but it can cause a laxative, it can induce a laxative effect in us and cause gas and bloating. So that's something to look out

for with sugar alcohols, erythritol being the exception because it's not fermentable. So that's one that really goes completely in one end and out the other. But I think we just, we kind of have this idea of, you know, because things like aspartame and sucralose are man-made, that they are more chemical than the naturally occurring chemicals that make up our food. And there's a certain level, I think, like distrust and whatnot. And some of the older studies using rodent models, you know, saw that those rodents had like larger, rodent models saw that those rodents had larger, developed tumors and had larger incidences of cancer. But again, we have to look at the human equivalent dose. So if you give a mouse four mg per kilogram of something, it's not the same as seeing four mg per kilogram in a human. And when we actually do those calculations and determine like, how much are they actually feeding these mice? Well, it's the equivalent of, you know, oh, 22 liters in a human in one day. There's just really no way that we can feasibly ingest that. And so, you know, looking at,

you know, if we want to be really prudent and say like, let's stick within the ADI, the acceptable daily intake of these artificial sweeteners, even that is very high. We're looking at maybe like 13 cans of diet soda in one day for a 150 pound individual. So if you're encroaching upon that, know that there's still a huge buffer zone because they calculate those based on something like 10 times less than what you would need to actually see any detrimental effects. But you know, if we want to be very black and white about it, the extremes of anything can potentially be problematic. But like you said, it can be a tool that can help us, you know, adhere to an enjoyable diet that allows us to, you know, meet and not exceed our energy needs.

Yeah. And I think for any coaches listening, and I know many of you are coaches, if you remember that that non-nutritive sweetener, whatever it may be in, whatever product it may be as a tool that may help your client live a healthier life, and we know that for a fact, live a healthier life, and we know that for a fact, it's probably better to lean on that side than to continue to parrot that the non-nutritive sweeteners are incredibly disruptive to the gut when we don't know that for sure. Additionally, if I'm not mistaken, the majority of these man-made compounds are exponentially sweeter than sugar, so we're able to use them in incredibly small dosages that might be all but innocuous for the average person in the amount that they take them in. So I'm glad that you shed some light on that because I think it makes sense because to the

point you made earlier, there is a fundamental distrust of anything that's quote unquote, not natural or manmade. But if I'm not mistaken, aspartame is simply just an aggregate of a few amino acids that when you toss them together, tastes pretty sweet. So if you're, you know, if you're comfortable taking in free form amino acids, I don't see why a aspartame sweetened beverage would be particularly of any problem. So as far as best practices for those who just want to say, hey, I've listened to the podcast. I know there's no such thing as definitively bad guts or good guts. It's very much a gray area.

There's certain species that I want and they're going to compete with maybe some that I don't want, but by and large, they all do a lot of the same stuff. But I want to do something. What are like two or three things people could do from a lifestyle standpoint, be that nutrition, exercise, whatever, to make sure that their microbiome and those millions and billions, even if little guys living in there, have the care that they need to help them live a healthy life. Oh, I love that. The care that they need. So I had an attendee at a seminar in New York last year put it succinctly. He said, so basically eat vegan, but with meat. And so to that, I say,

but with meat. And so to that, I say, yes, if you want to eat meat, you can absolutely do this in an omnivorous way. And I encourage people to eat plants at every meal. So plants include fruits, vegetables, whole grains, legumes, tubers. So anything that's not an animal, eat that at every meal. If you want to add animal proteins, you can do that. So there's nothing that's intrinsically better about a vegan versus omnivorous diet when it comes to the microbiome. And to that, and I say, you know, ensure that with that plant-centric diet, that you're aiming for your 25 to 40 grams of fiber per day of a variety of different fiber types. The other thing that seems to be associated with a robust microbial community is regular physical activity. And that is kind of, you know, more is not better in this case. So kind of steering clear

or being careful about doing a lot of high intensity, long endurance exercise in the heat, very arduous, but aiming for a lot of recreational physical activity, moderate intensity cardiovascular activity seems to be super beneficial. We don't really know much about resistance training yet, but those are really the two big take-homes. To eat plants at every meal, engage in physical activity, those seem to be time and again correlated with a diverse, robust microbial community and the production of the beneficial short-chain fatty acids. serendipitous that that's probably the blanket health advice that we would give 90% of people who just wanted to live a healthier life, regardless of what they were trying to optimize or what condition they might be trying to manage, um, to just up your plant matter, do what you can to feed those guys, support them, give them what they need, because it seems that we kind of are symbiotic. If they're not happy, we're not happy, vice versa. But if we

take care of them, we've got a pretty good shot at this. So is there anything else that you think people should know or things that you find to be fascinating about the gut that most people just don't know that might be a fun fact? Well, I will say, because people are probably curious when it comes to probiotic supplementation, that if you're experiencing diarrhea, that a probiotic might actually be beneficial for you. The one that I see consistently supported would be Esbulardi, which is actually a yeast, which I think is pretty cool because people are always like, oh, bacteria, yeast are bad. Not in this case. And individuals with inflammatory bowel disease also might see some similar benefits from specific strains of bacteria.

So I would say that there are some good resources out there for looking at whether you might want to take a probiotic. USprobioticsguide.com, even though I'm not really usually big on dot coms, it's actually just a neat little consortium of literature to say, here's what we recommend. And then the level of evidence, sort of like examine.com does for their supplements. So it's similar to that. So I would say, you know, that can potentially have an effect.

And there's emerging research looking at their role in reducing the incidence of upper respiratory tract infections, which is really interesting. And that's more of an athletic population. And the one area that I think is super fascinating, only because like nothing is known about it yet, would be resistance training. So there's been like one study looking at the microbiome and bodybuilders, and it looks like eating more than 100 grams of fat per day is probably not a great idea for supporting microbial diversity. But that's an area that I think we're going to be seeing more literature coming out and looking at the effects of resistance training because everything has been so focused on endurance training. It does look like there is kind of a dose-dependent effect of exercise and microbial diversity and butyrate production up to a certain point at which you start to see some deleterious effects from overtraining.

So those are some of the kind of cool little areas that I think are going to grow hopefully in the near future. hopefully in the near future. Yeah, very interesting. And even with debunking some of these perhaps more pseudoscientific claims about the gut, for most of 2017, 2018, the gut is everything. If your gut's off, your whole body's off, that seemed to be parroted, but it does sound like there's still certainly reason to be pragmatic about how long-term maintenance of a balanced, if you will, gut microbe that's well taken care of would be aligned with staying healthy and fit for a long time. So a lot of reason to be pragmatic, especially right now where everybody's looking for something to be positive about. So just to wrap it up, Yab, if you could give the audience one piece of advice that's helped you achieve the platform that you have because you're clearly intelligent, you're well-spoken, and you're passionate, which are things that we all strive to be in one way or another, what piece of advice could you give them? that if you have a passion for doing something,

go ahead and pursue that and just keep doing your best, trying not to compare your best to what someone else's best might be. You know, like go out there and do the thing that you feel like you're really good at doing. And I think that's incredibly valuable, especially in a culture that's so comparison driven and everybody wants to kind of be like somebody above them or however that may end up panning out. So, Gab, where can they find more of your work? Where can they connect with you and what's the best way for them to reach you or, you know, kind of get a hold of more of your content if they're kind of hungry for more gut stuff. Yeah, so vitamin PhD, that's my handle on Instagram and Facebook. I have a website, vitaminphdnutrition.com. But it's really just kind of a list of the podcasts that I've been on.

I'm really bad at social media. But they can message me on Instagram, I answer every DM. but they can message me on Instagram. I answer every DM, um, and, uh, or if they want to shoot me an email, vitaminphdnutritionatgmail.com. I do provide telehealth coaching. So if they want to work with me, um, and have some fun little video chats, I am down for that. I do low FODMAP coaching as well. And I'm also a coach and consultant with renaissanceperiodization.com. So they can find me. They want to just Google RP Strength, Gabrielle Fundaro. They'll be able to find me there and work with more weight-focused template-style coaching for weight management and performance. Well, Gab, thank you.

I want to say thank you for coming on. I'm sure the guests want to say thank you. And then all of our trillions of microbiome bacteria and organisms want to say thank you for coming on. I'm sure the guests want to say thank you. And then all of our trillions of microbiome, bacteria and organisms want to say thank you too. So appreciate you coming on and you have a good day. You too. You're very welcome. And thank you. So there you have it. That's Dr. Gabrielle Fundaro and myself talking all things gut health. Thank you guys so much for tuning in. It really means a lot that you listen. I hope you got value from this. I know I did. Gab is somebody who I respect tremendously,

and I thought she delivered a really impactful educational podcast. So if you want to thank me and Gab, you can do us a huge favor. Share this episode. Please be sure to tag both of us so that we can pick your brain about what you like, didn't like, answer any questions. Again, we both respond to almost every DM and we really want to create a space for deepening what you're able to take from all of these podcasts. So thanks so much for listening to Dynamic Dialogues. And if you haven't already, share, give me a five-star rating and review on iTunes and enjoy the rest of your day. Remember, it's always a good day to be a good person.