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Stool testing has been a staple in the arsenal of functional medicine practitioners since the beginning. Unfortunately, there are many problems which lead to extremely limited functional use. As we’ve discussed on many microbiome and GI-related webinars over the years – we have hesitated to recommend and/or use stool testing personally because of these issues.

Problems with Stool Testing

  • Most tests use 16s (or even earlier) technology, which has a host of drawbacks (see below)
  • Many reports use arbitrary ranges which haven’t been well-established using healthy populations
  • Most don’t afford much practical, useful information
  • People often end up confused and unsure how to proceed based on their results
  • Look at individual microbes, not the larger context of microbiome community or function

Drawbacks of 16s Sequencing

  • Inaccurate on the species level – unable to effectively identify specific species of bacteria
  • Cheap to run – but the tests often have high price tags
  • High rate of false positives

Our friends over at Microbiome Labs have been sent hundreds (probably thousands) of stool test reports over the years, from people looking for guidance on what to do with their results – only to disappoint them by sharing the above information about inaccuracies, arbitrary reference ranges, and a general lack of actionable data provided.

For this reason, they never endorsed or recommended a specific stool test to use in clinical practice.

But the calls for help and nudges to create something better grew louder, so they started investigating any other potential technologies or testing methods that might yield more useful results.

Whole Genome Sequencing is a much more effective testing technology than 16s, but has always been rather cost prohibitive/too expensive to use in most cases. Tests using whole genome sequencing had usually cost upwards of $1000+, well out of the range for most individuals. When exploring options for an affordable way to create a test using whole genome sequencing, they found CosmosID and knew they’d found their partner on this endeavor.

Why CosmosID?

  • Their whole genome sequencing has 98-99% accuracy in species identification
  • Ability to create a customized test that would be within a reasonable price range
  • Industry leaders in microbiome testing and data analysis
  • Founder, Rita Colwell, is the most qualified scientist in the world when it comes to sequencing and building & creating interpretive data

For any baseball aficionados out there, Rita Colwell is the Babe Ruth of microbiome sequencing and data interpretation. Here’s a brief synopsis of her career and credentials:

  • Professor at the University of Maryland & Johns Hopkins University
  • The 11th Director of the National Science Foundation (1998-2004)
  • The President of the American Society of Microbiology (1984-1985)
  • Member of the National Academy of Science, the Royal Swedish Academy of Sciences, the Royal Society of Canada, and The American Academy of Arts & Sciences
  • Has Authored or co-authored more than 800 scientific reports and publications along with 19 books
  • Holds 64 honorary degrees
  • Awards include: National Medal of Science (2006), Stockholm Water Prize (2010), The Order of the Rising Sun-Gold and Silver Star (2005), National Women’s Hall of Fame (2005), Vannevar Bush Award (2017)

Once a partner was established, the work began to determine the goals of the test and subsequent reports created from the results. Using whole genome sequencing, the problem of accuracy was solved. Due to the incredible amount of data they now had access to with CosmosID, it would also be possible to GI map the entire community in context and compare the results with good data of healthy populations. This would provide the ability to understand interactions, correlate the results to disease prevalence, and give customized, actionable steps people can take – relevant to their own microbiome ecology.

There are still limits to even the best stool testing – and even this test is not a diagnostic tool… but it can be helpful in determining a successful course of action for each individual.

Why Biome FX?

The customized report is divided into several main sections which look at/provide the following:

  • A Microbiome Index Score which looks at trends in your microbiome compared to a database of healthy individuals with no chronic disease.
  • Alpha Diversity looks at the overall diversity of your microbiome (# of species found vs. healthy average)
  • Beta Diversity looks at the composition of your bacteria based on your specific geographical location (healthy individuals in US look different than those in Africa, Asia, Europe, etc…)
  • Resistome – The measures ecological forces within the microbiome that create competition within the population. A high number here indicates low vulnerability in microbial population.
  • Pathogen Control Index looks at the abundance of pathogenic organisms in relation to the overall microbiome. This score would indicate your microbiome’s ability to control pathogens.
  • A specific look at over 20 different common pathogens
  • Big picture/Phylum level ratios – We know certain proportions are important when it comes to health outcomes. Ex- One ratio is known to contribute to metabolic dysfunctions when dysbiotic/out of balance.
  • 30+ Function Groups – Another unique feature explores specific groups of microbes which perform specific functions. This may help determine what your microbiome is doing well (or not-so-well) and help create an optimal regimen for yourself when it comes to actionable steps to improve function.
  • Analyze Keystone Strain Levels – Strains that are known to be very important for maintaining health & structure of the microbiome.

This and much more is included with the 40+ page customized results report.

Also, in addition to the PDF/printable report – if ordered through Rebel Health Tribe, your report will be accompanied with an additional customized video breakdown of your results from a trained professional who has been educated in interpretation of the BiomeFx reports.

In summary, here are the unique features of the BiomeFx Test & Report:

  • Whole Genome Sequencing with 98+% accuracy
  • Partnered with CosmosID, the industry leader in microbiome testing & analysis
  • Compare results to a diverse database of healthy individuals
  • Resistome and Pathobiome Assessments to determine the resilience of your microbiome
  • Over 30+ Function Groups to explore how efficiently and effectively your microbiome is performing its functions
  • Keystone Strain Levels – known to be important for maintaining health & structure of microbiome
  • Tests for over 20 different common pathogens and overall pathogenic load
  • Personalized diet, nutrition, and supplementation recommendations based on your individual results
  • 20+ Page Report with all this information and much more!

Plus, a customized professional video review of your results to make sure everything is crystal clear regarding the report and actionable steps you can take moving forward to improve the health, diversity, and function of your microbiome!

Biome FX Webinar Transcript

Michael Roesslein:

Hello? Zoom recording. We are now recording. Welcome. We are going to talk about poop testing today, and once again, Kiran Krishnan is here to join us to answer some questions about the BiomeFx functional stool analysis. It’s interesting that we’re doing a webinar on this because there was a lot of webinars and years and conversations where we didn’t really talk a lot about stool testing and thought of it as an afterthought or something that really wasn’t that useful. So we’ll get into that, too. There’s a lot of responses in the emails that I sent out, and I have some questions from those emails, and then I have a couple questions, so we can cover those.

                So, first, I just wanted to get into … For anybody that found this through the email, I sent a link to a video and a blog post that we recorded a few months ago that explained the limitations of stool testing, how it came about that you guys created this, why, and why you partnered with the people you did and with the lab you did, and a bit about it. So if you want to just give a very brief overview of that because I’m sure there’s a lot of people that are going to be on this webinar that have heard you in the past not speak very highly of stool testing as a thing.

Kiran Krishnan:

Yeah, absolutely. That’s really important. And, really, I’ve hated stool tests, to be completely blunt and honest about it, right? And the reason is when I started looking at stool tests that were out there in the market and what people would send me as their reports, it just drove me crazy because it’s all nonsensical information. So let me highlight first a few major problems with some of the ways that stool tests are done.

                The first part is all the companies for the most part doing stool testing, with the exception of maybe one, are using a type of sequencing technology called 16S ribosomal RNA testing, right? And I don’t expect anyone who’s listening to this to know what the hell that means, so let me explain it to you in an analogy that hopefully will help, and you’ll see why that 16S technology is not adequate to identify bacteria down to the species level. Right? Because to get any sort of useful data within the microbiome, you really need to be able to get down to the species level for bacteria. Now, you can get some decent data at the larger phylum level. You can look at different phyla of bacteria to get certain ideas about what may be going wrong in the microbiome, but, really, to understand what the function or dysfunction of the microbiome is, you need to get down to the species level, right? So that’s point number one.

                Now, here’s how 16S works in a simplified manner to look at bacteria, to try to identify bacteria using genetic material. Now, all bacteria in the world have these hypervariable regions called these 16S regions within their genome. So imagine a bacteria’s entire genome. There’s thousands of genes stretched out in one long line. Within those thousands of genes, there are six, seven, eight, or so hypervariable regions. When all of them are together, it can represent a particular bacterial species, right? So these hypervariable regions, if they’re all together, can represent that bacterial species. Now, however, many bacterial species share multiple of these kinds of regions. So if you get five out of seven of these regions or four out of six of these regions, you cannot necessarily guess exactly what bacteria it is.

                So let me give you an analogy to understand that. Imagine we’re trying to identify people in particular. Let’s say we’re trying to identify Michael, and you’ve got four or five snapshots of various parts of his body. So you’ve got a snapshot of the lower half of his face, one of the back of his head, you’ve got one of his shoulder, you got one of his wrist, and one of his knee. You got good pictures of those components. Now, you might be able to look at those pictures and narrow down what kind of person it is. You would say, “Okay, this is a guy with a beard.” You can clearly tell that from the lower half of the face picture. You can tell it’s somebody with darker hair, maybe with long hair. You can tell it’s a man from the frame of his body when you look at a picture of part of his body. So you can start narrowing it down to the type of person it is, but you can’t definitively say it’s Michael, right?

                So that’s where 16S is. 16S is looking at these snapshots of genetic elements of a bacteria, and then it’s making a guess as to what bacteria that is. Right? So that is where inherently the errors come about. There are some papers that show that 16S sequencing is upwards of 60% erroneous when you’re looking to identify bacteria down to the species level. So that in itself was very problematic. 16S is the original sequencing technology that started the human microbiome project, so this is now 15-year-old technology, and there’s been some improvements, but it really is not adequate to identify bacteria to the species level. And that’s not my language, that’s language from the head of the American Gut Project. The Human Microbiome Project and all have come out and said, “Okay, 16S, not really giving us accurate species-level identification.” So that’s problem number one.

                Problem number two, many of the tests I saw, especially when they look at the pathogens … And that seems to be the big focus of many of the tests, right? They’re looking at a handful of other bacteria, but then they’re really focusing on pathogens. Now, one of the problems when you focus on pathogens is they use PCR methodology to amplify the genome of the pathogen. Right? So then they’re going into the gene pool, where there’s all this chunks of DNA, right, and then they’re using PCR technology to try to amplify the volume of certain genes, and then they’ll sequence and look for those genes. They try to give you an absolute concentration of particular pathogens.

                Now, the problem with that is when it comes to pathogens, the presence of the pathogen is not that important. It is what is the relative abundance of that pathogen to everything else, right? Having C. diff in the gut is not an issue necessarily. Having overgrown C. diff with relative abundance much higher than where it should be is where you end up with a problem, right? That’s the same thing with virtually every pathogen in the gut, unless it’s a direct pathogen that you got from a foodborne illness or something like that. Everybody’s gut has lots of pathogens in it. They’re a normal part of the microbiome. So going in, amplifying the pathogen’s DNA, and then giving you a number that this pathogen is at this level is pretty inaccurate, right? The focus becomes pathogen-centric. Then what is the result of doing that? Most people end up on antimicrobials for long periods of time because they’re just seeing these high pathogens and trying to kill them. Right?

                So just those two things alone really always irked me about stool testing, the inaccuracies, the poor way of sequencing, and then this huge on focus on this pathogen-centric approach, and then they’re amplifying the pathogen DNA using PCR. So it’s just not a good, accurate way of doing stool testing. I still stand by my position that all of those tests aren’t really giving you the value that you should be able to get through microbiome analysis, right?

                And then, most recently, about a year, year and a half ago, we kept getting approached by clinicians who wanted some way of understanding what’s going on in the microbiome. So then we took on the project and said, “Okay. If people are going to continue to do microbiome testing, can we provide them with something of good value or at least of decent value or something that’s really going to provide insight into how their microbiome functions?” Right? Because ultimately that’s the most important thing, is how does your microbiome function? How does it respond to the foods that you put in there? How does it respond to the lifestyles that you have? What are the functions within the microbiome that are making you feel the way you feel? How does it relate to your symptomology? Those are the key things that we think are really important and provide actionable steps, or like what Reed Davis would say, gives you healing opportunities, right? So that’s the focus we had.

                And so we said, “Okay. In order to be able to really understand what is going on in the microbiome, you need really good mapping of the microbiome, right?” You need to understand what microbes are there with a high degree of accuracy, but you also need to understand the relative abundance of each individual strain within your microbiome and then also groupings of bacteria by function, right? So you have each individual strain, you know what the relative abundance of each individual strain is in this large population of microbes, and then each strain can also be grouped under functional taxonomy units, and so how many of those functional units are also present, and what is their relative abundance to one another, right? That’s an area that I understand but I’m not an expert in, so we went with the expert who has probably the most published papers in that area, who’s got the most honorary degrees and so on, and that’s Rita Colwell, right? So Rita Colwell, she just-

Michael Roesslein:

I put her resume in the blog post. It’s silly.

Kiran Krishnan:

It’s just silliness. 60 or so honorary degrees. She has over 600 publications in this area. She is by far the world leader in understanding microbial ecosystems and mapping it accurately, right, to give you an understanding of how your microbial ecology affects function. That’s what she does. She’s absolutely brilliant at that. There’s nobody else in the world that comes close. She just has a book out, and she’s in fact speaking at our microbiome keynote event. There was just this great article on her at the Wall Street Journal, so if you Google Rita Colwell, I’m sure you’ll see that article.

                So we partnered with the best, right, and we went to her team and said, “Okay, here are the functionalities within the microbiome that we think are really important that have good studies behind them that show that these functionalities have health effects for the individual. How can we map these functionalities? How can we understand what is the healthy range of these functional characteristics within the microbiome? So how we can give people an idea if this function within their microbiome is leaning too far to this end or too far to the other end?” And I’ll give you specifics later on as we keep talking. But that was really the idea behind it because people are using stool testing in functional medicine, right? The whole idea is functionality. The whole idea is understanding cause and effect and really understanding root cause when the test that they’re using is one-dimensional and is providing no functional insights at all.

                So that’s why we took on the project. We went to the best of the best to work with, and we partnered with them. It took almost a year to develop this test using their expertise and our expertise, and we’re super excited to be able to bring it because we believe very strongly that it’s going to provide you insights into what’s going on inside your body that you would never be able to get without it.

Michael Roesslein:

Yeah, and I think that the functionality and what’s actually happening … One thing that you said in the video that I posted that I found interesting was that one of the functional, I don’t remember what you call them on the report, but the function groups, was that these microbes are responsible for or involved in the digestion and breakdown of a certain food group and that … I think it was ammonia-related organisms and that some people who score a certain range there, a high-protein, high-meat diet might not feel awesome for them, yet they would see this paleo or this carnivore or this thing great for this other person and then they do it and they feel like hell, and that could be one of reasons why. So it can help shape dietary things that haven’t made sense to you. You could do a food sensitivity test, and broccoli might not show up or other types of sulfurous … Brussels sprouts, I’m sure there’s a category with those types of foods, too.

Kiran Krishnan:

Yeah, that’s the sulfate-reducing category, right? There’s that.

Michael Roesslein:

Yeah, and it wouldn’t show up on a food sensitivity test per se because you don’t necessarily have a sensitivity to it. It’s just you don’t have the right microbe diversity and population that would be adequate for breaking it down properly, right?

Kiran Krishnan:

Yeah, so high sulfate foods is a great example, right? There are lots of foods that are really healthy foods that tend to be high in sulfates, like fish, for example, lots of different types of fish, or leeks and garlic and Brussels sprouts and so on, so lots of good stuff that tends to be high in sulfate. And if you happen to have high levels of sulfate-reducing bacteria, what tends to happen is when you eat these healthy foods, the sulfate in the food is converted by the bacteria to hydrogen sulfite. The problem with that is hydrogen sulfite is very inflammatory and starts breaking down the lining of your digestive tract, right? In fact, elevated hydrogen sulfite is associated with things like Crohn’s and colitis. So you may be eating foods that are presumably healthy and generally healthy to people, but because of your elevated levels of hydrogen sulfite or sulfate-reducing bacteria, those foods are actually inflammatory to you.

                Now, the beauty of it is you can change things up, right? So you don’t have to just go, “Okay, I’m going to eliminate all of these foods forever.” We show you in the report, there are dietary, lifestyle, and supplement recommendations on how to modulate every single one of the things that we test. So if your sulfate reducers are high, there are dietary recommendations, and these are all referenced recommendations, not just things we made up, on how to modulate down the sulfate-reducing bacteria so you can enjoy all those kinds of foods without the production of hydrogen sulfite.

                That’s just an example of the functionality that’s really key because we see that all the time in the docs we work with, right? I’ll get friends of mine that are practitioners that say, “Hey, can you talk to me about a patient?” “Sure, let’s talk about it,” and then they’ve got them on a healthy diet and they’re doing the right things, giving them the right products, but for some reason, they’re just not getting better or not getting over a certain point, and they don’t have any sensitivities and all that. But then when you look in their microbiome, you get an insight as to how their gut is responding to the food that you’re sending in there. And, again, there’s modulatory opportunities with all of it.

Michael Roesslein:

Yeah, it was interesting. And you didn’t get into tons of the details on the video about, what are they called, the sections. I have that right here. The function groups.

Kiran Krishnan:

[inaudible 00:16:07].

Michael Roesslein:

But there’s over 30 of them. And then I learned two new terms, resistome. Did you invent that term?

Kiran Krishnan:

No, no. That fortunately is a term in the research world with microbial-

Michael Roesslein:

Okay. I had written down, “Ask what is resistome,” because that was mentioned earlier in the video. But then later in the video, you explained it’s kind of like the ability of the microbiome to be resilient in the face of invaders or antibiotics or things like that, right?

Kiran Krishnan:

Exactly, yeah. So what we tend to see and part of what’s exciting for me for this is since we’re running so many tests now, we’re getting lots of good collective data on what’s going on in people’s guts in the US, right? We’re tending to see that a lot of people have pretty decent diversity. Now, mind you, that in the US, the level of what the diversity is in the healthy population, and I can explain where that healthy population comes from, the level of diversity there in itself is not great. But when you look at a lot of people, they are typically within the range of where the healthy curve is.

                So when you look at their diversity, let’s say you have 180 species in there, and that’s pretty decent on the curve, but your resistome is really low. What that means is your microbiome is pretty tenuous, meaning you’ve got lots of different bacteria, right, but many of those bacteria are likely at such low levels that they’re not really providing a whole lot of functionality or stability of the microbiome. So resistome directly measures the ecological resistance forces that maintain that ecosystem, right? So when you look at a really healthy ecosystem, a well-balanced ecosystem, there’s a lot of competitive forces within that ecosystem. It’s those competitive forces that maintain stability in the ecosystem. So we measure that same thing in bacteria. We look at the whole bacterial environment, and we measure all of the resistance factors within that ecosystem. If your resistance factors are low, that means that the population is tenuous.

Michael Roesslein:

Okay. The other-

Kiran Krishnan:

Oh, excuse me.

Michael Roesslein:

Bless you. The other one that was new to me was this pathogen control index that looks at your microbiome’s ability to control pathogens. That was new, and interesting that you mentioned if this is really high, the odds are that your problems or symptoms or issues that you’re looking at are likely not due to the effect of pathogens.

Kiran Krishnan:

Exactly, yeah. So we call it the pathobiome or pathogen control index. The idea there is that, again, the research is very clear that pathogens are a normal part of our microbiome. If you’re going to go into the microbiome, amplify artificially the genes and pathogens, and then put up this arbitrary high number for each pathogen, it’s going to freak people out and more than likely cause them more problems because they’re just going to treat the presence of the pathogen when they don’t have to.

                What’s important about pathogens is what is their relative abundance to each other, and then what is their relative abundance to the rest of the commensal species that surround them, right? So the rest of your commensal species keep those pathogens in check. So when you look at your pathobiome index, the pathogen control index, what it does is it tells you what is the relative abundance of the rest of the commensal bacteria to the pathogens that have been identified within your microbiome. If the index is high, meaning you’ve got lots of control mechanisms, then pathogens are probably not at all an issue for you. If the pathobiome or pathogen control index is low, that means you likely have pathogens that are causing issues within your microbiome and that should be looked at deeper.

                Now, we then also go further and identify the pathogens that tend to be outside of the relative abundance range. And remember, if you see a microbiome report … And this is another thing just as a microbiologist drove me crazy. If you see a microbiome report that gives you a CFU count, right, that is absolute nonsense because it’s meaningless, right? It’s like saying, “Hey, in my city, I have 100 police officers, is that enough?” Right? It’s meaningless. It depends on how many people you have within your city, right? If you have 500 people, that is way too many police officers. If you have five million people, that’s probably not enough. So that absolute number of the number of that one bacteria is meaningless. It’s relative to what else is around it. So when you look at a report and it says, “10 to the fourth CFUs per gram for Pseudomonas,” or, “This particularly bacteria is at 10 to the sixth and it’s high,” it’s absolutely meaningless because it’s not considering at all the most important part, and that’s the context, right?

                So what we show you is something called relative abundance. Relative abundance tells you exactly what is the proportion of that bacteria to the other microbes that surround it and that affect it. That’s the key thing, right? With any community, you’ve got certain number of police to population that is defined as the right ratio. That’s what we’re telling you. So you can ask us the question as, “Hey, if I have this ratio of police to citizens, is that the right ratio?” That question can be answered. Just saying, “I have 500 police, is that enough,” it’s meaningless because you don’t know the rest of the context, right? So hopefully that makes sense. That’s the same thing with the pathobiome index. We look at the relative abundance of all of the pathogens, compare it to the rest of the commensal microbes that will control the pathogens, and then if any of them are high, we also show you the relative abundance of that pathogen by itself and tell you, comparing it to healthy normal population, is that out of range, right? And that’s one of the questions we get, is a healthy normal population-

Michael Roesslein:

Even comparing labs to healthy normal populations is a thing that never happens. That’s why I used to get so many even blood tests that people would send me and say, “My doctor said this is all normal,” and it is normal compared to the range of the sick people who go into that lab to do blood tests because that’s the range. Then I would send them back with some functional interpretation of it. They’d be like, “Well, why don’t they make the range this?” I was like, “Well, healthy people don’t go to the lab a lot.” You know?

Kiran Krishnan:

Yeah.

Michael Roesslein:

So that’s part of why you guys teamed with Cosmos, right, they have the database of the healthy populations?

Kiran Krishnan:

They do. So that’s another important part. Now, when the other tests, when they do show you the high and low, as you already know, number one, is that number even accurate? They’re showing you this absolute number, which is kind of meaningless, and then their high and low targets are based on all the tests they’ve run, right?

Michael Roesslein:

Okay. Okay. [inaudible 00:23:10].

Kiran Krishnan:

Which is basically a concentration of messed-up guts, right? So it’s meaningless. Now, what Cosmos has is they have access to all of the data from the Human Microbiome Project, when we were first sequencing hundreds and hundreds and hundreds of people just in different demographics, right? They also have all of the data access to the American Gut Project. Basically, through those big two research projects, they’ve been sequencing the microbiome of people that are categorized by research standards as healthy normals. This means people who are in that small percentage of US adults that don’t have a chronic illness, right, that don’t have one or any chronic illness, have never been diagnosed, aren’t obese, aren’t pre-diabetic, aren’t taking any medications, any of that stuff, and then it’s an average of the distribution of all of those people.

                So what those big microbiome research projects have done and Cosmos themselves have done is they have gathered huge amounts of data on where all of these kind of functionalities and characteristics seem to fall in range in terms of relative abundance in this kind of healthy population that does not have any sort of chronic illness. Right? Like the sulfate-reducing bacteria, for example, the range shows you that in a healthy population that doesn’t have any chronic illness, this is the range in which they tend to have in terms of amount of sulfate-reducing bacteria. And that range is given almost a bell curve, right, so it’s like here’s the two extremes of the range and then here’s the middle where everyone falls in, and if you are outside of the two extremes, then it means that your microbiome has a dysfunctional tendency, whether too high or too low, in that particular function. If you’re in that range, then it’s likely not that big of an issue for you, unless then your symptomology corroborates well with that function.

Michael Roesslein:

That makes sense. Now, if we could just get everybody else to start using healthy databases for their-

Kiran Krishnan:

Yeah, and that’s the crazy thing because when you come up with a lab test, you don’t go out and do thousands of healthy people and with a defined measure of what healthy is and get regular people’s ranges, right? So they just don’t do that. We are fortunate in that because of the Human Microbiome Project and the American Gut Project, their whole initial years were about sequencing what the normal microbiome looks like, right? So they accumulated so much data, and then companies that have the right type of mapping technology have access to that data and can actually make sense of it.

Michael Roesslein:

Cool. Yeah, it’s refreshing to see. I used to get really frustrated with almost all labs because it’s like, “Where does this range come from? Who are these people? Why does it matter?” And I could never really get answers to most of those questions. I think that’s the questions that I had. Oh, the cost. I didn’t know this until I watched that video, that 16S is really cheap to do?

Kiran Krishnan:

Oh my god, yeah. [crosstalk 00:26:26]-

Michael Roesslein:

Because I wouldn’t know that because the tests costs $500.

Kiran Krishnan:

Right, it costs nothing. This is not definitive on what their costs are, but I can tell you, I could probably get 16S sequencing done maybe for 20 bucks or that about.

Michael Roesslein:

Yeah. I’m not going to name names, but a lot of popular 16S stool tests are between $350 and $700.

Kiran Krishnan:

Yeah.

Michael Roesslein:

Cool. All right.

Kiran Krishnan:

Okay. Oh, and then let me just mention, what is the difference? So we’re not using 16S. What are we using, right? Because I didn’t mention-

Michael Roesslein:

Yeah, yeah, yeah. I thought you covered that, but I guess you didn’t, so go ahead.

Kiran Krishnan:

Yeah, I totally forgot to mention it. So we are doing what you call whole genome sequencing, right? Remember the analogy of taking snapshot of different parts of Michael to try to identify who he is. You can make a guess of the category of person that he fits, but you can’t definitively say it’s him. Whole genome sequencing actually measures the entire sequence from beginning to end of the genome of the bacteria, so you get every gene read in there and that’s how you identify the presence of the bacteria. Using that previous analogy, it’s like taking a high-definition photograph of Michael right from the front, and so there’s no mistaking who it is, right? So that whole genome sequencing is a painstaking process of identifying bacterial DNA and sequencing it end-to-end. It’s called shotgun end-to-end sequencing. That means you are getting the entire genome of the bacteria to definitively say what type of microbe it is.

                And as you can imagine, taking four, five snapshots versus reading an entire genome end-to-end, reading the entire genome is more expensive and takes more time, but it’s important, it’s necessary. And that was the part that really drove me crazy because the technology exists for doing it better and companies are just not doing it. There’s cost advantage to not doing it. There is time advantage to not doing it. You can turn around a test in eight, nine days when you’re using 16S, right? That’s because it’s inadequate and it’s incomplete. So you can get something incomplete in a short period of time. Whole genome sequencing is going to take a few weeks.

Michael Roesslein:

Okay, yeah, that was one of the questions, how long, and it’s about four weeks, right?

Kiran Krishnan:

Mm-hmm (affirmative).

Michael Roesslein:

Okay.

Kiran Krishnan:

Yeah, four weeks from when you mail your sample. We’ve had some practitioners say, “Hey, it’s been taking a little bit longer.” Then we track it back and go, “Oh yeah, the patient took the kit home and sat on it for two weeks,” right, and so that adds to their time. So what-

Michael Roesslein:

Yeah, yeah. But the time from when they get it till its report is given is usually about four weeks?

Kiran Krishnan:

Yeah.

Michael Roesslein:

Let’s see. And then the report itself, we kind of went through it. It’s got an overall microbiome index score, which compares trends in your microbiome to a database of healthy individuals. What you called an alpha diversity looks at the overall diversity of the microbiome, which is number of species found versus a healthy average. There’s a beta diversity, looks at that based on specific geographical location, like in the United States would look different than people in Africa and Asia. There’s the resistome, the pathogen control index, over 20 pathogens, if they’re relevant to mention. You don’t just put levels on the test if they’re not over a certain level.

                Big picture phylum level ratios, which phylum is above species and so that can look at … It said, “Example, one is known to contribute to metabolic dysfunctions when dysbiotic or out of balance.” So it can relate to a lot of different functions in the body. 30-plus function groups, I think last email I got, in the practitioner emails, said there was 35 of those, but I didn’t want to put an exact number. And then you analyze-

Kiran Krishnan:

And we’re changing some of those here and there, really dependent on when the data is available to support them. But, yeah, you’ll get somewhere around close to 30 functionalities, which is important. And the way the test is laid out, what we want to do is give you a 30,000-foot view of what’s going on in your microbiome because there may be some real obvious things that are problematic even at the 30,000-foot view, right? So that is something that you could get an overall picture that, “Okay, here’s a whole section of my microbiome characteristics that’s off, that I need to work on.”

                Then the next part of the report goes to the 15,000-foot view. That’s the phylum level. And then we go a little bit deeper into the more on-the-ground view with some of the family differences. The phylum is a bigger grouping, families smaller grouping, and then we go all the way into the species specificity and functionality, and that gives you more of the microscopic look. So it’s broken down that way so that you can see, “Okay, is there trouble in the big picture,” and when you do find trouble in the big picture, then when you look through the report, you’ll start understanding why you’re seeing problems in the big picture when you get to the more finer points.

                So let me give you an example of that. Let’s say you’ve got pretty good species diversity, but your resistome, those resistance forces tend to be really low, which means that your microbiome is unstable and kind of tenuous, which means a trip overseas somewhere, a single course of antibiotics, a few weeks of just eating poorly and drinking and doing all kinds of stuff. Those kind of things can really throw off your microbiome, right? You don’t have the resilience you should have. So then you see that, okay, that’s a big picture issue. We already give you some recommendations on what to do and what to think about when your resistome is low. But then as you go through the report, you’ll start seeing more specifically what are the things that are causing this lower resistome, right? So you’ll get to one section and you might see in the phylum comparisons that there’s an entire phylum that’s not even present. You have such low levels of bacteria at that phylum level that when you look at the ratio to other phylums, their levels are so low the test can barely detect them, right? So that then gives you an idea, “Okay, I got to bring this phylum back up,” and here are some dietary recommendations and supplements and all that that can help with that adjustment of the phylum.

                So you’ll get deeper and deeper into your microbiome, and it’ll give you more and more specifics on areas that you can take action on. That’s, again, another thing that really drove me crazy about the other microbiome tests, is that nothing is clearly actionable. You get this test, and what does it mean? I’ve had so many people send me their tests going, “Can you help me understand this test? Can you help me figure out what to do?” And I look at it and go, “There’s nothing really to do with this information.” So we wanted to make sure that everything we tested was actionable and it’s something that you could follow up with and do to help.

Michael Roesslein:

Yeah, there was a lot on the sample report, which I think we can … If those exist to see. But there’s a lot of actionable stuff there that you can look at there and then it’ll lead you to here and it gets a little more specific. I’m looking forward to learning it better. We talked before we came on the air that I’m going to go through your practitioner training because with the report, we are going to do interpretation videos for everybody. So anybody that orders the kits through us is going to get the 40+ page report, but I’m also going to be doing interpretation videos for them based on a little bit more extensive knowledge than just somebody looking at it so that you can have some professional guidance. And I’m going to bring in at least one, probably two other FDN practitioners that we’re also going to train to do those as well.

                So let’s get to a couple questions. How come 16RS sequencing completely missed serious E. coli infection plus other pathogens detected in a cultured stool test? Might it also be because 16RS needs only one tiny sample instead of sampling on three spots as with cultured stool testing? I think you answered that in that they only use little snippets of information to try to form a bigger picture, so that’s why it’s inaccurate.

Kiran Krishnan:

Yeah.

Michael Roesslein:

It says, “How many samples do you need for Biome Fx tests?”

Kiran Krishnan:

So you really need one sample, but the way you sample also matters, right? One of the other things we realize is problematic with the way microbiome testing is done is a lot of them … And we had a case show, which many of you know. She ordered every single microbiome test, she did them all to herself, and went through the experience and the process to get an understanding. Most of them had you either swab the stool or take a tiny scoop off the top of the stool and put it in the tube and send it. The problem with that is the stool is a three-dimensional object and the distribution of bacteria throughout that object is not uniform, right? Stool is not homogenous in terms of the bacterial distribution. So we find that at the top of the stool, the microbial prevalence and distribution may be different than inside the stool compared to the other side of the stool.

                What we’re trying to do is get the best sampling of the stool, so we came up with this simple concept that we call this high-contact coring brush. So we thought about, “Okay, if you get a scoop, you’re getting just one layer of contact with a single small part of the stool.” If we use a brush that has lots and lots of bristles on it and you core through the sample, right? So what you do is you have the stool sample sitting there in the flushable catching device, which I’ll talk about in a second. Then you take this coring brush, which has a long little stick to it, and then you core through one part of the sample, you dip it in the tube, and you clean it off with … The tube has this neutralizing buffer. Then you core it again through another part, you do it again. We recommend coring it through four, five different locations through the stool. So you finish it up, and then you just wrap the brush in toilet paper and you can throw it out. It’s a small, tiny brush with lots of bristles.

                Now, the capturing device is this flushable paper that we give you that you actually stick on your toilet. You lift up the seat, you stick it on the side of the toilet, you put the seat down, and it has this cup in it, and you take the first void in it and then you stop, you sample, and then once you’re done sampling, you just unstick it and just flush the whole thing. So you don’t actually have to touch any sort of poop or anything. That process in itself we’ve found gives us more accurate data because we’re getting better sampling and picking up more and more DNA in the stool itself rather than a swab of the top of the stool or a tiny little scoop, right?

Michael Roesslein:

Yeah, because the microorganisms in the middle are different than the ones on the outside.

Kiran Krishnan:

Mm-hmm (affirmative). Yeah.

Michael Roesslein:

Yeah. Okay. How quickly and for what reasons … For what reasons would be an entire nother webinar. But how quickly and for what reasons can the microbiome population shift, and how could that affect the timing of when you should do the test to get actionable results?

Kiran Krishnan:

Yeah, so a lot of the other microbiome tests tell you to stop your probiotics and stop this and stop that before you do the test. To me, that makes no sense at all. You should do your test based on what your microbiome looks like on a regular basis. If you typically drink kombucha and eat yogurt in the morning and take this probiotic or that probiotic, that’s the normal state of your gut, that’s when you should be testing it, right? Because we want to know, what does your microbiome look like under the influence of all the things that you normally do? So stopping normal behavior to get a test done doesn’t give you any good data because then when you start that other behavior again, your microbiome’s going to shift. So we want to look at your microbiome in the natural state that it’s in, which means including all the behaviors that you typically do. So that’s another thing that didn’t make sense to me.

                Now, one of the reasons why it doesn’t make sense to me is because of the crude way of sequencing microbes in those samples used from the other tests. If you’ve got a bunch of Lactobacillus and Bifidobacteria going in through probiotics, those sequences will pick up that Lacto and Bifido as well, and you can’t tell the difference between the probiotic version of Lacto and Bifido and your endogenous version because it doesn’t have the accuracy. So it throws off those tests quite a bit. But since we’re doing highly accurate whole genome sequencing, you wouldn’t have that problem with our test.

                So we say just the normal state of your microbiome. Unless you’re, of course, on a course of antibiotics right now, you may want to do it as soon as the antibiotic ends so that you could see, “Okay, here’s where I am now, this is my baseline,” and then understand what you can do to fix it and get back normal. Then all of the things we talk about can help shift the microbiome in as little as three, four, five weeks, depending on how off it is. In some cases, it may be three months. But, in many cases, you can make significant shift to the microbiome in three, four weeks, and you should be able to test that again to get a sense of how you’re improving.

Michael Roesslein:

Okay. That makes sense. Could Europeans’ microbiome be compared to the microbiome of Americans, or Europeans would need their own microbiome database?

Kiran Krishnan:

So Europeans and North Americans are relatively close in terms of their relative abundance of different species, different families, different orders, different phylum. When you start going to places like Southeast Asia and you start going to Africa, that’s when you start to see significant difference. And a lot of it is diet and climate driven. Europeans live in equally sterile environments as Americans do. They live mostly indoors. They don’t spend that much more time outdoors than Americans do. Their diets are very similar when it comes to just the general staples that they consume. So, for the most part, you see a lot of similarities between Europeans and North Americans. But then if you moved here from Africa, then you’re going to see a difference in your microbiome.

                But what’s interesting is then your microbiome will adapt to the geographic region that you’re in, right? So that’s part of the beta diversity that we look at, is we look at where does your microbiome map in terms of degrees of difference from other people, the healthy, normal individuals that live within the United States. If your microbiome maps right smack dab in the middle or within the cluster, it means your microbiome is well-adapted to this ecosystem. If your microbiome is way off, it means that maybe you spent some time in the Amazon and picked up a bunch of bacteria that now are causing dysfunctional responses now that you’re back here in the States. Right? So it gives you a little bit of a clue of how off is your microbiome to your environment.

Michael Roesslein:

I’m not going to give this one tons of time, but I want to answer it. You answered this in the Q&A of the original video when we talked about this. How does this test differ from Viome? I’m going to just give my own personal response to that before you do. I kind of view Viome overall as a fraud, and that’s my word. Those aren’t his words. That’s mine, so if anybody wants to attack anyone, attack me. I’m going to leave my opinion at that, and you can respond with what yours is.

Kiran Krishnan:

Yeah, just Google it and see. You’ll find a number of very prominent microbiome scientists and researchers that have written entire blogs against the technology, questioning the technology that is used in that particular product. Number one, they use RNA, right, not DNA, and RNA is really unstable. I’ve been at many conferences where people from Viome are speaking, same conferences that I’m speaking, research conferences, where the researchers in this field are really questioning them very aggressively about how do they come up with the data that they come up with. They’re doing things that, claim to be doing, that the technology doesn’t seem to exist for or is not quite possible with RNA. So there’s a lot of questions around it, right? It’s a lot of black box technology. I wish they would publish more so they can disclose more of how they do some of the miraculous things that they do. So, because of that, it puts just a lot of questions and a lot of doubt on what is the validity behind what they’re doing

                With what we’re doing, all of it is verifiable, right? All of it is documentable. You can look at the workflow, the substantiation. You can look at just even the sequencing technology. What are all the control measures that are used? How are the standards prepared? What does the process look like? All of that stuff is all disclosed and available for review and scrutiny. So that is a really important part of this kind of stuff because Viome, which comes out of Silicon Valley, we all know Silicon Valley things that are almost too good to be true, right? You can look up a number of documentaries-

Michael Roesslein:

Like that finger stick blood test?

Kiran Krishnan:

Yeah, the Theranos.

Michael Roesslein:

That finger stick blood test that was going to give you every marker ever for-

Kiran Krishnan:

One drop.

Michael Roesslein:

… $40 or one drop of blood, yeah.

Kiran Krishnan:

And then, by the end of that, I think they defrauded something like $400 million from investors or something like that. That kind of black box technology is suspicious. So do your research. Dig into it a little bit. It makes me uncomfortable. I wish they would disclose more. And we’ll see. I don’t know. I don’t know definitively what’s going on there. I just wish they would disclose more and publish more because if they have the science to do what they’re doing, then they should be sharing it and they should be making the scientific world aware of it because it would be awesome. So do some Googling, and you’ll form your own opinion.

Michael Roesslein:

All right. Does it show what metabolites like B12 and other metabolites bacteria produce? I think that would be in the function groups, and it wouldn’t measure B12 per se, but it would look at the function groups of bacteria that do produce certain things, right?

Kiran Krishnan:

Exactly, yeah. Some of the vitamins that are well-documented to be produced by functional groups of bacteria, we do look at those, and we do tell you whether your relative abundance of those microbes are good or seem to be pretty low or right within range. That gives you an idea that, “Okay, do I really need to supplement a huge amount of B12, or is my microbiome really delivering a good amount?” It gives you opportunities to tweak your lifestyle and behavior around what your microbiome has the capability of doing.

Michael Roesslein:

Same would go for a test that shows how well one can absorb nutrients. That would be other function groups and phylums and other things that are known to break down certain types of food, like I mentioned before.

Kiran Krishnan:

Yep, exactly. Yeah. And, again, those things all give you insights onto why your microbiome responds the way it does, why certain foods may bother you, why certain diets you’ve tried don’t seem to have the effect on you that it does on other people. And, again, healing opportunities. It gives you that insight on healing opportunities.

Michael Roesslein:

All right. I’m using grapefruit seed extract right now to address a few gut issues. Do I need to stop that before this test?

Kiran Krishnan:

The way I would think about that is if you plan on using grapefruit seed extract as an ongoing thing, then you should do the test now. If you have in your mind that, “I’m going to just do this grapefruit seed extract for two weeks and then I was planning on stopping anyway,” then you might as well just do it after you’re planning on stopping. So if it’s an acute thing that you plan on stopping anyway, then you should just do the test right after you think about stopping it. But what you may find is that when you really get some insight into your microbiome that the grapefruit seed plan may not be the right plan for you. Depending on what you’ve been suffering from, it’s a good time to see if maybe you can get some better insight and maybe there’s something else that actually is what you need rather than the grapefruit seed extract.

Michael Roesslein:

Can we be able to review the report and take actions on our own, or do we need to take inputs from our doctors? So to have some professional contact here, what we are doing … And doctors are using these tests as well, so if you have a functional doctor, integrative doctor you’re working with and you want them to order it, just let them know and they can get an account and order the test kits directly, and they can guide you. They can get educated and guide you.

                What my plan is is to get more educated on it myself. They have a team of doctors that educate the practitioners. I’m going to get educated on it, I’m going to bring in an FDN or two, and we’re going to create customized personal review videos of your reports. So we’ll record a video that goes through your report and goes through the recommendations and goes through all of that type of stuff, and you can email with questions after that. So that’s how we’re going to operate it.

                The sections have recommendations, this is another question, recommendations as far as dietary recommendations for each section, really, each function group and section and area, and lifestyle type things to think about and consider and supplemental recommendations that might be useful there. So it’s a pretty wide-ranging recommendation approach.

Kiran Krishnan:

Yeah. What’s interesting is we went through a lot of the available research on how do you modulate certain functionalities within the microbiome from a diet perspective, from a supplement perspective, or even lifestyle perspective. We found a lot of overlapping areas, which is interesting, right? When you look at these few things being off in your report and three out of the four recommendations overlap for each of them, it gives you some simplistic approaches to making a number of functional changes within your microbiome. That was one of the interesting things that we came across and we learned from the available research out there, is that certain simple things can really make a big difference in a number of dysfunctions within the microbiome.

Michael Roesslein:

How long would it take to adapt to a new region if one were to move? That’s not really related to the test, but I’m curious what you think about that. If somebody moves from the US to … That’s part of the reason why the whole “don’t drink the water” thing about going to Mexico or Central America … Well, those people are drinking the water and they’re just fine, so that’s probably a big reason why. And I would guess people in Central America and less developed areas have much more diverse microbiomes than we do, which is why we get sick from their water. But about how long does it take a gringo to drink the water in Mexico? No, how long does it take to adapt to a new region? Is there any research on that or evidence or anything?

Kiran Krishnan:

There is some. So there have been some studies where some really awesome, brave microbiologists have gone and lived with the Hadza tribe in Tanzania and eaten the food they eat, slept the way they slept, and so on. They find that their microbiome does change and adapt to that ecosystem. And some of these studies are now 10, 12 years old. If I recall, some of those adaptations could be as quick as two or three months. In some cases, it was four, five, six months to see real big changes in phylum levels of bacteria. But then what’s interesting is the moment they come back … Oh, well, and actually one of the microbiologists actually did a fecal transplant with a local Hadza tribe person and saw massive changes, obviously, in their microbiome. But the moment he came back to the US, within weeks, all of those microbes disappeared because they’re not adapted well for this area, right?

                So if you’re going from your native area, where your microbiome is evolved to exist, to a new area, the transition time’s going to be much longer. It’s likely months before your microbiome starts to change and adapt to that area. If you’re going from your native area to a new area, there’s some changes that happen, and then you come back to your native area, when you come back to your native area, your native microbiome comes back much faster than that adaptive change. So that’s an interesting aspect of the microbiome.

Michael Roesslein:

I already contacted the microbiome.co.uk in order to purchase a test. They still don’t offer it in Europe. Do you have any time table of when it might be available in Europe?

Kiran Krishnan:

Yeah. We’re really hoping to have it by spring or so of next year. It requires some registration and things that we have to go through. The big problem we’re having is all of the regulatory agencies are working half the speed that they used to work at and-

Michael Roesslein:

With twice as much demand.

Kiran Krishnan:

Exactly, with twice as much demand, and they were slow to begin with, right? So with COVID, it’s all gone so slow. We’re trying to do it in Canada as well. We’re trying to get it registered in Canada, and we’ve been waiting on just a response from Health Canada as to what do we need to do to register this or does it need to be registered. Those questions were submitted, I’d say, eight, nine weeks ago and we don’t even have a response yet. So it’s going slow. Unfortunately, I think it’s going to take time. I’m hoping it’ll be end of spring next year.

Michael Roesslein:

As far as trying to get one from the US and use it and ship it back, I don’t think that would be viable due to the length of time the shipping would take, right?

Kiran Krishnan:

The DNA is perfectly stable in the solution, so we are looking at that as an option. We’re looking at assembling the kits in the UK and then shipping it around to the UK and Europe.

Michael Roesslein:

And shipping them here.

Kiran Krishnan:

Yep. And then the consumer themselves, once they do the sample … It’s just a tiny tube is what you’re sending back. It’s probably about this big. It goes in a little envelope. You can put it in, and we’ll either do it a prepaid DHL or something like that, and you’d send it back. If we get it back within two or three weeks, we can still run the report. There’s no issue. I think it’s pretty stable for a month or more. And so we are working actively on that. Doing it that way, we may not need to get it all officially registered, but we’re working on that.

Michael Roesslein:

Do you suggest taking NAC for a week prior to test to help break down biofilms that may be hiding pathogens? We’ve talked about biofilms a lot before in that we’re not really advocates for a lot of biofilm attacking because healthy organisms in them just as much as pathogenic organisms do. So I’m guessing your answer to that is no but-

Kiran Krishnan:

Absolutely, yeah.

Michael Roesslein:

Yeah. Okay.

Kiran Krishnan:

Yeah, you don’t want to do anything unusual or egregious to your microbiome just before you do a test, right? Yeah. And, again, biofilms aren’t really the enemy here. Biofilms are critically important for your commensal bacteria, too.

Michael Roesslein:

Intestinal methanogen overgrowth. I’ve never heard of methanogen, the term. But there’s no reference in your test. Is it desirable to completely eradicate it, even from the colon? If it’s an organism that lives in your gut, I would guess that’s impossible. The doctors talk about it as something negative.

Kiran Krishnan:

No, we do have … One of the functional groups that we test for are methane producers.

Michael Roesslein:

Okay.

Kiran Krishnan:

So it’s in the test. These are methane-producing bacteria, and often they work antagonistically against hydrogen sulfate-reducing bacteria. So sometimes what you’ll find, if one of those is really high, the other one may be low. And one of the ways of bringing balance is to actually feed food that feeds the other group of bacteria. So if your methanogens are high, the sulfate-reducing bacteria will actually compete against them and bring about balance, so you then want to eat foods that tend to be high in sulfates. So you might go off and eat a bunch of salmon and other things, leeks and onions and mushrooms and all that kind of stuff, and we list all of those things in the test to bring back balance. So we do have methanogens as part of it. And, again, it’s normal for methanogens to exist. It’s just what is their relative abundance to everything else?

Michael Roesslein:

So your test is going to tell me to eat more salmon?

Kiran Krishnan:

It depends on your gut. Oh, we’ll find out when you do yours, too.

Michael Roesslein:

Yeah. Oh, we’re going to do that. We haven’t announced that yet. 54-year-old, suffer colitis … Is there any … I’m trying to decipher this down to a direct question. Do any of the function groups relate to anything around mental, emotional, mind, anxiety, neurotransmitters, hormones?

Kiran Krishnan:

Yes. So one of the functional groups I have to recall if we are picking up much of this at all are serotonin producers. That’s in there. Some of the other, like the proteolytic versus saccharolytic fermentation, that has an impact on the gut-brain axis as well. So there is some leads into that. Now, one of the things that can be really telling when it comes to mental health is what pathogens may be present, right? There are pathogens that are known to produce toxins that actually have an impact on your mental health, creating panic disorders, anxiety, and so on. One of the things that you may pick up is that, “Wow, this pathogen tends to be really overgrown looking at relative abundance to everything else and certainly compared to healthy, normal individuals.” So that may give you some clues as well.

Michael Roesslein:

Okay. I think I got to all the questions. There’s no marker specifically for elastase, calprotectin, SigA, short-chain fatty acids, but you do look at groups of microbiome that produce these things or inflammatory state type things, right?

Kiran Krishnan:

Exactly, yeah. We look at microbes that produce things like short-chain fatty acids. But things like calprotectin, zonulin, and all that tell you that something’s wrong with your gut, right, but it doesn’t tell you what is wrong with your gut. So our whole idea here is about giving you a little bit more insight as to what may be wrong. You can have high zonulin or elevated calprotectin. Basically, that says, “Okay, your gut is leaky and your gut is messed up.” But what do you do about it? What is actually wrong? That part doesn’t get answered by those metabolites. Not to say that they’re not useful. They can be quite useful, but we wanted to give you more insight as to what may be wrong.

Michael Roesslein:

That makes sense. It’s kind of like a functional medicine approach to stool testing versus … Like, looking at the root and the issue that’s caused and the function versus what’s here. It’s more like what’s it doing or not doing, or is there enough of it to do this, or why am I …

                Yeah, it’s really interesting because I’ve run a bunch of stool tests in the past with clients and then I kind of just stare at the stool test, and then nine times out of 10, I tell them the same thing to do that I would’ve told them without the stool test. There’s that time where a super high level of a specific parasite shows up or something like that, which only certain tests do I even trust that on. But then there might be a specific approach related to that. Other than that, nine out of 10, it’s the same recommendations, and it didn’t tell me anything about why they’re reacting to these certain foods or don’t tolerate them well but it doesn’t show up on the also very expensive food sensitivity test that I just ran. So it seems like it could answer a lot of questions all in one spot.

Kiran Krishnan:

Yeah, we’re seeing that it’s acting as a really important piece of the puzzle for many people. In many cases, it provides that insight that people have been really looking for and, again, the opportunities to modulate. So it’s pretty exciting. We actually officially launched this, a 1.0 version of it, in January, and so since then, we’ve been gathering feedback and data on the types of things we’re reporting and so and trying to improve the test. What we have right now is the new, improved version that has additional functionalities to it. But I think people start seeing some interesting insights into what’s going on in their gut.

Michael Roesslein:

Cool. Candida albicans is not one of the pathogens, right?

Kiran Krishnan:

It is, yeah.

Michael Roesslein:

Oh, it is? Okay.

Kiran Krishnan:

Yep.

Michael Roesslein:

I wasn’t sure because I know Candida testing in stool is tricky. It’s hit or miss sometimes, but that was also with ciphering just a little bit off the top of a stool and running really poor analysis on it.

Kiran Krishnan:

Yeah. If you’re running 16S, 16S is relatively specific to bacteria the way they’re running it, and so they’re not going to pick up fungus very well, right? But since we’re doing whole genome, we can pick up viruses, we can pick up fungus, we can pick up protozoa, we can pick up anything.

                Oh, and here’s the other thing, which really is not mentioned much. One of the problems in the research world, in the scientific world, is the issue of human DNA, right? When you have human DNA in the sample, it’s going to confuse the sequencing machines because it’s trying to decipher the difference between human DNA and bacterial DNA. We share similar genes in certain cases. And so when you get that stool sampling and then they extract all the DNA, there’s a percentage of that DNA that’s actually human DNA, and some of those, when they’re looking at snapshots, they may confuse some of your own genes with some of the bacterial snapshots, right? So it becomes messy. The background gets contaminated.

                When we’re doing the whole genome sequencing, we never confuse human DNA for any part of bacterial DNA because the only way you identify bacteria is by reading the entire genome end-to-end, right? So the human DNA is not that much of a factor as a contaminant, hence giving you some inaccurate data. For example, that one question, why wouldn’t the sequencing test not pick up the E. coli but then a culture test does? It’s because the sequencing test just missed those regions of DNA or mistook them for something else, and that just illustrates the inaccuracy.

Michael Roesslein:

Perfect. That makes sense. The last question and then I’m going to stop and offer … I just put a link in the chat. I had to call Kiran about a half-hour before we came on to try to get more test kits because just from the emails that I had sent out the last couple days, we had all the test kits that we have reserved, and that was before anybody knew anything of the details of the offer or anything else. So I said, “Hey, dude, we’re out of test kits. We need some more test kits.” So we’re going to get some more test kits, and so we do have enough. I was going to have to do this whole webinar and then be like, “Yeah, and sorry, none of you can order this. High five.” We got more on the way. So I put a link there.

                For the test itself, the kit and the running the test and all of that, and the 40-page report, it’s at least 40,  I think, that you get, it’s very thorough, and the professional interpretation video that we are going to create for you, the regular price for that that we’re going to charge is $429. Right now, for this week, for the last week of August, it’s going to be $379 for the lab test, the report, and the interpretation video, which is actually cheaper than the most-used 16S stool test is by itself, with which you get a four or five-page report and no video or guidance or anything like that.

Kiran Krishnan:

And zero functionality. You know? Yeah.

Michael Roesslein:

And, yes, it’s not available in Europe yet. Yeah, and zero functionality. So it’s less than the cost of a normal stool test and you get the whole report and the video, so it’s a pretty solid deal. And there’s the link there in the chat. We did get some more. I don’t know how many we’re going to have. But I was stunned to open my email about two hours ago and then scroll through them all and it’s like, “I want a test. I want two tests. I want a test.” I’m doing numbers on my hands, and I’m like, “Oh, we’re out of tests.” So we have some more. That’s the link. It’s there in the chat, and we’ll send this out with the recording. I’ll send the recording. I’ll put it on that same blog post with the other videos on, and then we’ll send you a link to that. That offer is going to run through the end of the weekend, so we will have that.

                Now, here’s an important note, and I’m going to email everybody who emailed me and tell them this. We need your birthday because that’s on the registration for the test, and I tried to get it put into the checkout on the website when you buy the test kit as a field with your name and your address and everything else. That is surprisingly difficult to do, and WooCommerce, who we use on our website to do that, it’s a strange field that confuses the system and we were getting a bunch of errors. So what we’re going to do is either in the special instructions area on the bottom of the order, you can put your birthday. I’m going to respond to all of those emails and personally ask you for your birthday. And if neither of those happen and you place an order and we don’t have your birthday, keep an eye on your inbox because we’re going to be emailing you probably daily until we get it. That is required for the lab for us to give to them to run your test.

                Cool. I think that’s everything, and if there’s errors with it, we’ll get it fixed. Just send me an email, michael@rebelhealthtribe.com, if there’s any issues with the pricing or the checkout or any of the tech stuff. I think we’re good. Thank you. We only went nine minutes over the target hour, so that’s really impressive for us.

Kiran Krishnan:

This might be the shortest one we’ve ever done together.

Michael Roesslein:

All right. I got one more. Then I said one more and … Understand this more functionality of a test for the microbiome. Since it does not perform a culture and sensitivity for pathogens, would you suggest pairing it another test if a pathogen is highly likely, in parentheses, from travel to another country?

Kiran Krishnan:

So I would do the BiomeFx test first because a Biome Fx will really give you an idea if there is a pathogen out of range. Then if it does provide you a pathogen that’s out of range, then if you want to further verify that information, you can do a culture. Now, if you feel like you have an infection going on, then go to your doctor and get whatever culture it is that they think is the most appropriate. I don’t want to provide you with advice if you’re not feeling well and you’re sick right now. So if you’re sick and you just came back from overseas, that could be an infection. Go see your doctor. They’ll recommend something. If you’re just somebody working on your health and trying to get healthier and you want to see if a pathogen or groups of pathogens are problematic, then it’s a perfect thing to take a look at it. But if you feel like there’s an acute issue going on, you should go get it checked out.

Michael Roesslein:

Yeah, that can get really serious really fast. I actually know a few people in this field that are in this field because they got super sick in a situation like that and then they couldn’t get better. It took them doing tons of research and tons of time and tons of stuff to get better. Then they were like, “Oh, I’m a doctor now.”

Kiran Krishnan:

Right.

Michael Roesslein:

Like Michael McEvoy, who we work with quite a bit. He got sick in India and then was sick for two years and did thousands of hours of research and then you’re a professional. So cool. Yeah, the link is there. I’ll send it out in the email as well. Thank you for doing this and for doing the Q&A.

Kiran Krishnan:

Of course.

Michael Roesslein:

I am going to run one, and then we’re going to do another one of these, and Kiran is going to analyze my test results live on the Internet. So you’re going to get to know me inside and out on a webinar.

Kiran Krishnan:

Yep, and from every angle.

Michael Roesslein:

We’ll do it in a month or two or something, so that will be fun.

Kiran Krishnan:

That’ll be fun. I look forward to that. It’ll help explain a few things that we’ve all noticed.

Michael Roesslein:

Yeah, for sure. Yeah, they’re already laughing and everything, so that will be fun. Thanks, everyone. Great questions. Tons of questions.

Kiran Krishnan:

Thank you.

Michael Roesslein:

Really good stuff. Thank you, Kiran. We’ll talk soon. And thanks, everyone.

Kiran Krishnan:

Bye, guys.

Michael Roesslein:

Bye.

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2 Comments

  1. Does a sample from one bowel movement really represent the whole Microbiome? Different poops from the same person look different, so wouldn’t a sampling of more than one poop be better? And if a person tends to be constipated, would one sample be less accurate than if someone isn’t constipated?

    • Hi Lisa! This was actually answered specifically in the Q&A video on this post. First off, no stool test is perfect/able to be completely accurate. That said, they use a unique sample-gathering method with this test which is likely to be far more accurate than a standard single sample taken via conventional means. (Explained in video) I don’t believe that constipation would make a sample any less accurate. If anything, it would have an increase of microbes discovered due to being in the colon for a longer period of time. Hope this helps!

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