Ep. #1105: Elisa Marroquin on Gut Health and Body Composition – Fitnessnacks

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Mike: Hello and welcome to Muscle for Life. I am Mike Matthews. Thank you for joining me today for another episode on gut health, but on an angle of gut health that I haven’t written or spoken much about and that I have not covered in previous interviews, at least not in the amount of detail that this interview is going to cover it.

And that angle is body composition. How our gut health influences our body composition, and how poor gut health can lead us to gain body fat, retain more body fat, maybe even gain less muscle, and how better gut health can bring about the opposite conditions, faster fat loss, easier fat loss maintenance, easier body composition, maintenance generally staying leaner, and possibly more muscle and more muscle gain.

And in today’s episode, you’re going to be learning from my guest, Dr. Elisa Quinn, who is an assistant professor and the Director of Graduate Studies in the Department of Nutritional Sciences at T C U, and who has conducted a number of studies on today’s topic, specifically how the gut microbiome can affect obesity and body composition.

Hello, Elisa. It’s nice to meet you.

Elisa: Nice meeting you, Mike.

Mike: Thanks for taking your time to come and talk to us about microbiome and body composition, which is, uh, something that I have not written or spoken about. I’m always looking for, after doing this for many years, what’s some interesting angle that I haven’t already beaten to death?

And this is one of them. So I’m excited to talk to you about this.

Elisa: Thank you for the invitation. I appreciate it.

Mike: Um, so maybe we should just start, I have written and spoken about the microbiome a bit in the past. I have had one or two other guests on the show to talk about it more in the context of general health and general gut health.

But in case people listening have not heard any of that previous content, let’s just start with maybe a brief explanation of what the word means. What, what is our gut microbiome?

Elisa: Um, the go microbiota involves different microorganisms, not only bacteria. So we have, in addition to bacteria, we have viruses, we have archaea, we have parasites and fungi.

So we have a lot of different microorganisms, although we have focused more on bacteria. And so we have around the same number of bacteria cells per each of our human cells. So we have three trillions of human cells and we have around 3.8 trillion, uh, bacterial cells. We are as bacteria, as we are humans, but if we consider the number of genes we have versus the number of genes bacteria have, they have around a hundred times, uh, our genetic information.

Mike: And how does that influence different aspects of our physiology and our health?

Elisa: Yeah, so the gut microgram has many functions among them. We have, for example, it helps with the education and activation of the immune system. So when we are born, it’s really important for our immune system to get in touch with bacteria because it, it helps with the activation, the correct activation of the immune system.

Another function is a production of vitamins from the B complex and vitamin K. It helps also to produce fatty acids such as propionate, butyrate, acetate, and these ones have, uh, metabolic impact in, in the host, in, in our metabolism, and helps with digestions of. Complex polys cries that our human enzymes cannot digest.

And by doing so, it provides around 10% of the calories that we consume each day. Um, so it has a lot many other functions. It, for example, it converts the primary biliary acids into secondary biliary acids, which have a function. Um, we have specific receptors for these biliary acids called fxr amongst others, and, and they take care of insulin and sensitivity, et cetera.

So they have so many functions.

Mike: Very symbiotic relationship. I guess they need us to, to keep them healthy and we need them to keep us healthy.

Elisa: Yes, we, we do. In fact, there’s a new term called holobiome and that term is now being used to refer to the human plus the microbiome. And so, um, why, because we cannot really be healthy without them.

We need them to exist. We have co-evolve together for so many years that we need each other to, to live.

Mike: And if people listening have looked into the microbiome at all, they’ve probably come across some of what you just explained, but something that they might not have come across is this element of body composition and how the microbiome can influence body composition.

Uh, can you help explain a bit of how that relationship works?

Elisa: So, This is actually the area that got me interested into study the gold microbiome. Uh, so when I was doing my, um, my PhD, there was a professor that gave a talk about the gold microbiome and how it could change body weight. And this is, uh, animal research.

So basically what the, the study she presented to us was, was talking about is basically they perform a fecal transplant from an animal model of obesity. It was genetic obesity. It’s called the O B B M. So they have a mutation in, uh, the production of leptin. So they don’t, they don’t produce leptin, they have hyperphagia release energy expenditure, so they develop obesity and.

Basically what the study did is they took fecal samples from this animal and they transplanted those fecal samples into a germ-free mice, a germ-free mice or mice that they are put into spatial cases since the moment they are born and they are free from bacteria inside and outside. And so these germ-free M started gaining weight without changing their caloric intake.

So they continue to consume the same calories, yet they wore gaining weight. And to me that was very shocking and very. It sounds, it sounds blasphemous. Yes. Yes. Because, you know, I, I am a dietician. Uh, I have a master’s and PhD, but I, I am a dietician, so to me, I was like, wait a minute. And that changes everything because it means that you continue consuming the same calories, but just because you have a different gold microbiome that is gonna change how your body respond to it.

Mike: And, and I assume it wasn’t related to activity levels, something simple like that couldn’t explain the.

Elisa: Um, I don’t remember if they measure energy expenditure in that sense, even if it was caused by gen, by energy expenditure. Just the fact that the actual, uh, fecal transplant changed the energy expenditure is, is something concerning because it’s a factor that we have been ignoring all this time.

And so there has been a lot more research, particularly the research that has shown stronger effects is in animal labs. In humans, these effects have not been 100% fully replicated. And there are some reasons why I think that has happened. The go microbiome is affected for so many different things. So diet, consumption of medication, uh, sleeping patterns, exercise, uh, your ethnicity, your location.

So many, many things. We don’t have all those confounding variables in laboratory animals. So even when a small sample, you can detect significant differences between groups. However, in human samples, you have all these different variables, and if you don’t have sample size that is high enough, you are not gonna have enough statistical power to detect significant differences between groups.

And so, uh, a lot of the studies are having done in humans have small sample sizes. And it could be one of the reasons why we’re not seeing the same in humans in, in some of these studies. I think a lot needs to be done before we get to any conclusions.

Mike: And if there are. These mechanisms in play and is my understanding is there is some evidence in humans that suggests that there is something more to be learned here, but I, I’ll defer to you.

And, and how might that look, it’s, it’s obviously a new line of research and there are probably way more questions than, than answers. But with the evidence, the current evidence, are some of those questions kind of looming larger than others where it looks like, Hmm, it, there are some, some potential mechanisms here.

Here’s what we have seen.

Elisa: Yeah, so definitely the gold microbiome, what we have seen in humans is that it affects our metabolism. And so for example, Our response to a diet is gonna depend on the gold microbiome, more so than it would depend on our genetics. Uh, and this has been proven, uh, using twin studies.

Basically, when you provide the same dietetic intervention, humans don respond differently. Just to give you an example, there was a study in which the scientists were providing either white bread or sourdough. And so, you know, the systemic in index exist different, 70 versus 40, and the recommendation always has been to consume whole grains and, and sourdough over white.

Refine. However, what scientists discovered is that not everyone responded the statement. There were a lot of people that responded actually better to the white bread, and that depended on the gold microbiome composition. So after seeing that response in, in the glucose, that’s that glycemic response. What the authors did is go back the gold microbiome.

A baseline and try to predict if the gold microbiome could give us an idea of who was gonna respond better to each of these breadth. And they discover, I, I think it was like 82, 80 3% of certainty just by using the gold microbiome composition, what person was gonna respond better to each of these types of threats.

And, and that’s give us an idea of how individualized microbiome is. And the same happens with exercise interventions. We know that in studies, for example, that prescribe the same exercise, there’s a huge variability. There’s people that are gonna respond like crazy. There’s people that are not gonna respond like if they hadn’t worked out.

And a lot of that variability depends on the gold microbiome. And so what we have seen, for example, is that there are responders and nonresponders and you can classify the person before starting the workout. You can classify just by taking a look at the composition of the gold microbiome, whether they’re gonna be responders or not, responders of data, exercise intervention.

Mike: And when you say exercise response, sorry to interject, I just wanna follow up on that point before we talk about something else. ’cause that’s very interesting. Can you speak a little bit more about what type of exercise and what you mean by response? ’cause if people are thinking in weight loss terms, they’re probably just thinking in.

Caloric expenditure versus maybe if we’re talking about some sort of resistance training now there, there’s a more complex response that we’re trying to elicit than just, you know, maybe inverting some calories and improving cardiovascular endurance To some degree,

Elisa: yes, it was, I’m talking about body composition and, uh, glucose response, like insulin resistance.

Mike: So, so we are talking about fat loss and

Elisa: Yes. So what I foresee happening in the future is that before receiving a nutrition intervention and before receiving an exercise intervention, we’re gonna have to analyze a gold microbiome, and then we’re gonna receive a personalized nutrition intervention that is gonna work for us because the same that happens with bread will happen with different foods.

Uh, and that is gonna depend on whether we have the bacteria that have the enzymes necessary to digest and metabolize on a specific food. And the same for for exercise. The composition of the gum microbiome can change your performance in the exercise as well, which has been shown.

Mike: Do you think that’s why?

What, what the, what the difference is in the, in the response. Do you think it’s, okay, so let’s just say it’s a simple exercise intervention of doing 30 minutes of zone two cardio every day, and you have certain people responding very well to that, and you’re seeing market changes in their body composition, whereas other people not responding well.

Minor changes in body composition. Why might that be? Is it, is it a point of maybe performance, the people who respond well are exerting themselves more vigorously and therefore burning more calories in those workouts or

Elisa: No, no, no. It had nothing to do with that. And so basically when the baseline gold microbiome wasn’t alive, We couldn’t detect today human eye basically.

Significant differences between them. But then after the workout was done, they say, I can’t remember if the intervention was like 12 weeks or something like that. You can see that there was a, uh, significant difference in the gold microbiome composition between responders and nonresponders and nonresponders, and these are people that also worked out the 12 weeks behaved basically and had a similar go micro composition than the group, like if they hadn’t worked out at all.

And so by using machine learning algorithms is that they were able to analyze, again, the gold microbiome composition at baseline and detect very subtle differences in the gold microbiome that we’re able to predict high degree of certainty whether a person was gonna respond or not. So I think that we are gonna head to that direction, and perhaps in the future we can, before we start an exercise intervention, we can either take a specific probiotic or do something to change the composition of the gold microbiome to make sure that we’re gonna respond to the exercise intervention before we even spend the time working out.

Mike: And, and, um, this might be just my ignorance of why I keep coming back to this, but it, how do you square that with something like energy balance, which would be considered at least some, a, a fundamental mechanism that would dictate, right? Like whether somebody is going to lose fat with a, if we take into account what they’re eating as well.

It’s just, I, I, maybe I’m missing something, but some people listening might be like, does this, wait a minute. So energy balance, it might just be that, you know, my gut is the reason why, uh, it’s, it’s not that I drink three bottles of wine every weekend.

Elisa: No, no, no. I do believe that the energy balance equation, is it still happening?

So basically what I’m trying to say here is there’s some people have a gold microbiome that is able to extract more energy. You know, in the calories you’re consuming, you, you think it’s the same calories. Your GI tract, your gold microbiome has capacity to absorb more calories. So still, you know, there is an increased energy intake just by having a different gold microbiome.

And also the gold microbiome has been shown to you change energy expenditure. So I do believe that the question is still respected.

Mike: And when, when you talk about extracting energy from food, can you explain a little bit what is extracting more energy from food? Is that a good thing? Is that a bad thing?

Because if people hear, oh, extracting less energy, so I just like poop out the rest. Isn’t that a good thing? Can I eat more food then?

Elisa: Well, the thing is, in evolutionary periods that would have been awesome because it would have allowed us to survive in periods in which we probably didn’t have enough food.

So that was a good thing,

Mike: being able to extract a lot of energy from the food, right? Like getting the most we can out of it.

Elisa: Yeah, so, so bacteria are gonna help us to extract around 10% of the calories that we ingest each day. So that much in, in, you know, it doesn’t sound a lot in a day, but in a month, in a year is a lot.

And so, Bacteria basically are, they have specific enzymes that humans do not have, and they are able to ferment and to metabolize complex polysaccharides that we humans cannot even touch. And so by doing so, it provides molecules that can provide energy, so like cho and fatty acids or other oligosaccharides, and can now be digested by, by human enzymes.

And so, uh, that is how it can affect with our body weight. Now there are other mechanisms that have been proposed. For example, certain bacteria have shown to have the potential to alter the delivery of hunger hormones such as GLP one, Y Y C K. And so in doing so, it can also change our appetite.

Mike: That makes sense.

Just to follow up one, one more question on that energy extraction point. So could you just explain quickly how variability in that can influence energy balance, thereby influence body composition? If somebody’s microbiome, it sounds like you’d say it’s working efficiently, it’s extracting a large amount, maybe it’s it’s maximum 10%, but then you could have somebody else’s microbiome is working less efficiently, which is.

Better and worse for body composition?

Elisa: Well, for body composition, perhaps it would be not to extract as much energy from the the diet you’re eating, just because that will mean that you’ll need to consume less calories in your diet in order to keep the same body composition. But yeah, so, so basically, let’s say to people are consuming the same calories.

So let’s say you and I are consuming 2000 calories in a day, but my gold microbiome can extract, I don’t know, let’s say 1800, whereas your gold microbiome can extract 1900. So that’s a hundred calories more than you are capable of extracting that. I am not, and in a day probably that’s not a lot, but in a week, in a month and a year, that accumulates.

Mike: That makes sense. Thanks for clarifying that. And you had mentioned also with the bread, the study with the D, with the different types of bread and how there was a different glycemic response to the types of bread. And could you just explain briefly to people listening how that could influence body composition?

’cause it would be an indirect influence. Right. Many, many people have heard if they kind of are just new to all of this, like, oh, high GI is is bad, and that just makes you gain fat. Well, of course that’s not exactly true. But

Elisa: yeah. So this effect of the brain on glucose, it’s mostly important for people who have insulin resistance and people who have some sort of, uh, either pre-diabetes or.

Mike: Which is a lot of people who are overweight and, you know, trying to get fit.

Elisa: Yes. But also it has been suggested that perhaps if you wanna keep a healthy b m i, you wanna try to keep your glucose as constant as possible just because every spike you have, you have to have a contract regulatory response of insulin.

And insulin is anabolic hormone of excellence. So it activates lipogenesis protein synthesis, uh, glucogenesis, it activates all the synthesis of the different micromolecules we need in our body. So, in doing so, yeah, it can cause lipogenesis, it can activate lipogenesis also, it would mean to me, it would mean that if you have a high glycemic response, for example, may, it would mean that your gold microbiome is able to extract more glucose molecules from the, you’re consuming.

And perhaps that could relate into. Higher chlor can take. This was a short term study, so they only consume the bread for one week was period. And then the other bread for a week, it was a construction study. So basically the group, some it was 20 participants that were randomly assigned to one of the two groups, and then they had a washup period, two weeks, and then they were assigned to the alpha side.

Um, so it was a very short intervention. I cannot tell you with certainty if that would affect their body composition, but what we know is that you wanna try to keep your glucose level in a, you, you wanna try to avoid spikes.

Mike: And are there potential effects, um, on the appetite as well where if somebody, if somebody’s having, uh, spikes and then dips?

Elisa: It could be, I mean, particularly when you have a spike of glucose and then you have a spike of insulin to contrast the, the glucose, right? Sometimes the insulin makes the, the glucose drop and then a person has like a, a desire to eat or a desire to get more glucose. And, and so, Translating to hunger and, and is one of the mechanisms that could help us explain why it’s recommended to consume a diet that doesn’t have those spikes.

Mike: Yeah, anecdotally, of course. I mean, I’m sure you’ve heard that from many people. I’ve heard that from many people over the years. They’ve just learned that certain foods or certain amounts of certain types of foods leave them feeling hungrier than they should be, or hungry sooner than they should be.

Elisa: And, and it’s just very, very important for us to understand that complexity because for decades we have been prescribed this nutrition guidelines by the government and, and they’re trying to do their best.

And that’s the best we can do right now. This is gonna look like in the future is we are not gonna have a one size fits all diet. We’re gonna have the need to do a personalized diet because obviously what we have right now is not working because perhaps something that is beneficial for me is harmful for you.

And so we are hoping that by doing so we have, we can have more success with dietetic and exercise interventions. And the evidence says that by doing these like microbiome prescribed diets, the success is higher compared to following the general guidelines.

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Lower quality protein cookies, but not with mine. Check out my protein cookie by legion.com, b legion.com/cookie. I I want to ask a few more questions about body composition and microbiome, but since you mentioned the microbiome diet, which there’s a book coming for sure. Someone’s gonna, in fact, if it isn’t already written, it’s, it’s, it’s coming.

But that already, I’m sure you’ve seen. The marketers are already there. There already are services that purport to test your microbiome and then give you very detailed do’s and don’ts for eating and exercising. And what are your thoughts about, if you’ve looked into any of these, the state of these services and just the state of the research are we at that point, we can confidently and honestly tell people, Hey, just take this test, get your result, and here’s your personalized plan.

That’s gonna be far superior to any cookie cutter thing anybody wants to give to you.

Elisa: I personally think that we’re not there yet. I think the results in research are very exciting, very, very interesting. And I think in the following years, probably within five, 10 years, hopefully we are gonna get there.

But right now, I cannot say with certainty that we are there, and I cannot say that the benefits are gonna be enough to compensate the cost. And I, I do know that there all, there’s at least a company that does this, that analyzes the code microbiome and based on these machine learning algorithm that was created, uh, by a scientist, they prescribe some sort of diet.

But I personally think that there’s a lot that needs to be done before we get to the point of personalized nutrition.

Mike: And based on where we’re at right now, are there any I. Interesting piece of advice that you could share to people to help ’cause where this discussion kind of the the next phase of it is, alright, so we understand now some direct and indirect ways that our microbiome can influence our body composition.

Most people listening now are probably wondering, okay, so how do I influence my microbiome? A, that positively influences my body composition. And so this concept of the microbiome diet, does there appear to be some universals that like these things tend to always work well from what we’re seeing and then different categories of things with certain types of people and so forth.

Elisa: Yeah, so as you mentioned, there is a bidirectional communication between the gut and the human body, and so we want to keep our gold microbiome healthy so that it can keep us healthy. The reason why I say healthy is because is because we have not yet defined what a healthy gold microbiome looks like.

We have been able to show that an a high alpha diversity is related with positive health outcomes, and we have been able to identify several probiotic bacteria and several potential next generation probiotics. However, there are still a lot of unknowns and probably a healthy gold microbiome is not gonna look in one way, but in hundreds,

extremely complex.

Mike: I mean, ultimately, it’s probably gonna result in similar. Bottom line results that are maybe more traditionally associated with good health, right. That you could detect in blood tests and so forth.

Elisa: Yes, exactly. And, and so exactly what you’re saying, a lot of the recommendations to have healthy goal microbiome is, are the same recommendations that we already knew we needed for our health.

So for, for example, have high variety in your diet. That’s extremely important to have a healthy gold microbiome. And I know that’s extremely difficult for people who do meal prep, but somehow we need to be creative into adding variety into our diet so that we can feed different bacteria, different species of bacteria.

Mike: And can you speak a little bit more to that point? Because people hear that, you know, maybe they’ve heard like, oh, eat the rainbow, or just eat a variety of foods. But I, I, I just know because people have reached out to me asking for something a bit more prescriptive, you know, like, okay, what does that mean exactly?

Elisa: Yeah. So we just wanna have a high variety and, and that is just what it sounds. I mean, you don’t wanna have either a vo diet or genic diet. You wanna have all the groups and you wanna have a high variety, not always in the same vegetable or the same fruit. Um, you wanna vary because all of these different fruits and vegetables have different molecules.

Yeah, you call it fiber, but not all the fibers are created equal. And they have, they feed different bacteria in our gut, depending on the molecular configuration. And so you need to vary. So there’s no need for us to stress about which, and enzyme and which bacteria species digests every molecule. But you can assure that just by having high variety in your diet and don’t eliminate any macronutrient, I would say.

Mike: And so, uh, if I’m hearing you, then you’re referring to not just a variety of fruits and vegetables, which is what people have often heard, but also a variety of foods, different types of proteins, so have some dairy and have legumes and seeds and have different types of whole grains.

Elisa: Yes, and I have liked on, on process because there has been very new research showing how emulsifiers per sample have a very determinable effect in our gut.

Emulsifiers are used to, to basically create a solution from a liquid and a solid state, if that makes sense. So like it is used in myON in butter and ice cream,

Mike: isn’t it, to like suspend molecules in or am I, am I wrong in my definition?

Elisa: Yeah, so you, you want to prevent the separation of the liquid and the solid face and it, and, and this emulsifier helps the kind of, the, the merging of both, if that makes sense because there are like phospholipids and whatnot.

So they have a polar and a lipid part basically. So that helps with the dissolving in colorants for example, also have a negative effect in the gut microbiome. And so you, you wanna try to consume unprocessed foods and, and just add high variety. Now with regards to other things we can do to help the gut microbiome or physical activity, we still dunno, with certainty there’s a difference in the effect of doing strength exercise versus cardio.

So I think a lot more research needs to be done in that area so that we can better understand if they influence the go microbiome differently. But doing exercise as a whole and sleeping is important as well. Just trying to keep, uh, And by that I mean not only your sleep, but also your meals. You wanna try to keep your meals in the day, not all night, and try to prevent the consumption of antibiotics unless it’s really necessary.

Because antibiotics are gonna delete not only the bad bacteria, but also the good bacteria. And that is gonna allow for the arrival of and colonization of potential pathogenic bacteria. So the way how it works in our intestine is that we, let’s think at the as intestine as a community, right? So every bacteria has their own house, and when pathogenic bacteria comes there, They cannot get into a house that is occupied and so they cannot infect.

Maybe they find a house or two, they can stay there, but that doesn’t mean that it’s gonna cause an infection. That’s why you hear, oh yeah, that, I mean, you can have, for example, a leak factor, uh, pylori or to certain light, yet not have an infection because you have it in very small amounts, and that is because you have all the houses occupied.

But when you consume antibiotics, you eradicate right? The, the good bacteria, you empty the houses and so now they can grow, they can cause infection. So yeah, you’re probably treating an infection, but you might end up with a worse infection. So you just wanna be careful when, when you take an antibiotic, not take it just because there’s a little cough.

Mike: Yeah. Many people over the years have been a little bit alarmed at how eager they are to just take an antibiotic or give an an antibiotic to their kid when the kid just has a cold. Even like, oh, take ’em to the doctor. The doctor says antibiotic. Give ’em the antibiotic. It’s a cold. Kids get cold. Whatcha doing?

Elisa: Yeah, exactly. And what is very concerning right now is that we are presenting every time more antibiotic resistance. So the bacteria are creating mechanisms to prevent being killed by our antibiotics and we’re not developing new antibiotics. And so that is extremely concerning for humans. There is, however, the development certain.

Several labs around the world are working in development of phages. So bacteria phages, which are viruses that can target specific bacteria. And this is great because what that means is that they’re gonna create viruses that are gonna attack a specifically Clostridium deli or a specific strain of the Leer Pary rather than attacking your whole commensal bacteria.

And, and so we are gonna get there hopefully within the following years. But going back to, to what I was telling you, so other things that can affect the composition of your gut microbiome is hygiene. So I know for many years, infections were, you know, one of the first three ca causes of that, and it still is in some countries.

And so we have been moving slowly into being every time more hygienic. And that is a problem because both extremes are a problem. You wanna stay somewhere in the middle

Mike: that’s like, it’s like a plot twist. People are thinking like, okay, very hygienic, very good. Like, wait, what? Did I just hear you right?

Elisa: Yeah. Unfortunately that is not the case. So you don’t wanna be very hygienic to the extent that it’s gonna affect the composition of bacteria and the number of bacteria you have in your skin, in your lungs, in the gut, et cetera.

Mike: Can you explain a little bit more what that means? Like practically speaking?

Because also when people think of hygiene, they just think of cleaning themselves and not being stinky and gross.

Elisa: So for example, a lot of parents are very, very careful with their kids. They don’t want the kids to get and play with the third, or they don’t want the kids to touch pets. And that is actually very helpful for the kids, not only for the gold microbiome, but for the correct activation of the immune system.

And so I’m not a person that has pets inside the house. I don’t like it, but if I ever have a kid, you bet I’m gonna find a way to, to get him or her in contact with, with a pet, and to allow them, you know, to play in the third and whatnot, because that helps them with the correct activation of the immune system and the correct colonization of the gut microbiome.

So those things is, is what I’m talking about. Maybe not being crazy about having the, cleaning them every second.

Mike: And that applied to adults too. Like one of the guys who works with me, he, he has a, a, a compulsion to clean it. He probably washes his hands like 30 times a day probably.

Elisa: Yeah. So, you know, it’s very difficult for me to come here and after Covid say, oh, don’t, don’t use, you know, alcohol or don’t use, uh, antibacterial or whatever, wash your hands, but, You just wanna be mindful of when you actually need it and when, when you don’t, when you’re being a little bit too extreme.

So that is gonna look different for different people and we don’t know how that middle ground looks like, but we do know that being too Titanic is detrimental and potentially all these hygiene that we just went through in this last years is gonna have an effect, particularly in those, uh, those kids younger than three years old.

Uh, because that’s when you are basically setting up your gold microbiome that is gonna live with you the rest of your life. Uh, so yeah, you can do small changes to it, but around 60% if not more of the gold microbiome. With that, you establishing those first three years of age is gonna remain with you the rest of your life.

Mike: Wow, I didn’t know that. Can you speak briefly to what are some of the negative consequences of excessive hygiene in the context of what you just explained?

Elisa: Yeah, so excessive hygiene would just mean that you are not in touch with different bacteria, and so perhaps that can either keep a low level of bacteria in your skin, in your gut, and a lot of the bacteria, most of the bacteria are not harmful.

They can just get and colonize our gut and have some sort of function. And it also helps with the correct activation of the immune system. So what we know, for example, is that, just to give you an example with, with babies, when babies are born through C-section, everything’s extremely hygienic. And so the babies don’t get in touch with the bacteria that moms have, for example, in, in the, uh, for example in, in the vagina, or I don’t know, it’s just very hygienic, right?

And so when it’s the natural delivery, the baby’s get in touch with all those bacteria and, and that helps with the setting up the microbiome of the baby. And even when what has shown, even when babies are breasted, For six months to a year, if that baby was born through C-section, breastfeeding them is not gonna fully correct the damage created by C-section.

So you wanna do both. You wanna try to have natural delivery and then breasted. However, it’s important to know that doing breastfeeding is not gonna fully the damage created by C-section. And that’s a way for me to explain to you, okay, this is a very hygienic condition and this is, uh, not so hygienic condition.

Yet we need it in order for our immune system to be active. What we have seen in research is that babies that are born through C-section, they are more likely to have, for example, obesity, diabetes, autism, and even uh, psychological problems and autoimmune diseases.

Mike: Yeah, I was gonna ask that because you have so many more problems now, allergies and so forth in young kids.

Elisa: Yes. Yes. And that is because either one of these things that I just mentioned were, did not happen when we were born or extremely hygienic mom. You know, that you think you are doing the best for your kid, but you’re really harming them.

Mike: What are your thoughts on, I’ll let you decide how extensively you want to, you want to answer it, but there’s this ongoing controversy about artificial sweeteners and the microbiome.

What are your thoughts based on your understanding?

Elisa: Look, up to, one or two years ago, the evidence in non artificial sweeteners was mostly based on animal research and using very high doses. So it was not really something applicable to humans.

Mike: Yep. And that’s often what you, what you saw on social media.

You people dismissing it for that reason, saying, oh yeah, well that’s the equivalent of drinking like a dump truck worth of diet Coke a day. So who cares?

Elisa: Yes. There was recently a study humas using a smaller dose, or I’ll say a real life dose, which it was basically six packages of either sine Splenda, Stevia, aspartame, or glucose.

They had another country group. So they had 20 participants per each of these groups, and they provided the non artificial sweeteners, six of those packages. So like two in the morning, two the afternoon, two at night for two weeks. It was just for two weeks. And what they measured was it was postprandial glucose tolerance test and insulin concentration.

And they also made sure they got microbiome. So basically what they were able to see is that Splenda and saccharin, these two increase the test. The the glucose tolerance test. However, they did not increase insulin. The ones that increased insulin was stevia and glucose, which was. A little bit off. ’cause usually what you see is an increase in glucose and an increase insulin in, in the same ones.

But, but it was a little bit weird that this happened and they were able to see that not everyone responded in the same way. So again, there are differences in these differences are based in the gold microbiome. So there were some people, and I, I think it was like percent or something like that, that responded.

In a favorable and unfavorable way to the same artificial sweetener. And again, by analyzing the baseline gold microbiome, they were able to predict how a person was gonna respond, whether that artificial sweetener was gonna be neutral for them, or whether it was gonna have some sort of effect. So we cannot do a generalist statement again, because for some people it might be detrimental, for some people it might not.

Also, perhaps eating one or two or three even per day might not be a problem. But we don’t know that for sure. And there’s a big limitation though in this study that I would like to address, and that is that. Usually artificial sweeteners are very sweet, like several hundreds or thousands of times sweetener that glucose.

And so companies have to use a very small amount and they use another powder to dissolve it. So usually the other powder they use to dissolve it is some sort of carbohydrate. And so the packages that you see of the Splenda is like a very small percentage of actual Splenda. And there’s, I’m sorry, I’m using a brand sucralose.

Um, so there’s a very small amount of sucralose and the majority of the other powder is actually maltodextrin, for example. And one of the big limitations is that you don’t know if that increasing, for example, postpartum glucose is caused by the carbohydrate itself and not the actual non artificial sweetener, because there’s evidence showing that when that non artificial sweetener is not dissolvent with a carbohydrate, it doesn’t cause that glycemic response.

To me, that is concerning. And I wouldn’t do a statement until. We see that that effect without dissolving the non artificial sweetener in, in some sort of carbohydrate, if that makes sense. Now, that’s the way how we find it in the supermarket. So I, I can see how they just went ahead and did experiment that way.

But it is true as well that we can just see that non artificial sweetener are added to, for example, salt drinks or bubble gums or something like that without the need of having to add carbohydrates. Because not always we consume non artificial sweeteners in these packages. Uh, presentation.

Mike: Yeah. Yeah.

And that would though be separate from potential impacts on the microbiome, right? Meaning the, the glucose response and the insulin response is, is one thing, but then how it may impact or not impact the microbiome would be another consideration.

Elisa: Yes. It does seem to impact the gold microbiome and basing the gold microbiome.

We can predict what person.

Mike: And in the cases where it has a negative impact is, is there something else happening in the microbiome? Like some people will say, for example, that it can kill good bacteria or it can help bad bacteria gain more purchase in your microbiome. Some people make these claims,

Elisa: I believe, That this study is when they found a significant increment in flavonoid consuming bacteria.

And, and didi, uh, it has a different name, but basically what they do is degrade flavonoids. And so by supplementing with flavonoids, you can potentially reverse that effect. But I, I, I’m not a hundred percent sure this is a study or if it’s a different one. It’s from the same research group.

Mike: Yeah, I understand.

And you’re going off memory, so

Elisa: I, I can’t remember with hundred percent certainty, but more than likely it’s an effect in the gold microbiome. And if we are seeing, for example, changing a bacteria, potentially we can supplement either the bacteria or we can use, for example, bacteria phases to kill a specific bacteria that potentially could be causing that glucose intolerance

Mike: or skip the energy drink or diet soda.

That’s also an option.

Elisa: As well. But you know whether that is better than consuming sugar. I don’t know. I mean, if you are gonna stop consuming the Diet Coke to drink water, go for it. If you can do that change, go for it. But if you’re gonna stop consuming the Diet Coke to go into regular sugar, like, I don’t know, I don’t think we have evidence to support that action.

Mike: Agreed. Agreed. I wanna come back briefly to, uh, the different types of foods eating a variety of foods. I just curious, are there any foods that in your opinion, do appear to be especially beneficial for most people or likely all people if people want to, if they’re just wondering like, are there a couple things I could just make sure I’m eating every day that seem to pack a lot of microbiome punch to, so to speak?

Elisa: So we do know that, for example, fruit oligosaccharide oligosaccharide are pretty good for the gold microbiome. And you can find them, for example, in onions and garlic and s asparagus, bananas, green bananas, particularly ris in, for example, in yogurt, fermented yogurt. I mean, that has the, the, uh,

Mike: Keifer, if I’m pronouncing that correctly.

Elisa: Yes, fermented foods are also extremely good for the gold microbiome, and they actually, there are some studies showing that they actually have a stronger effect than consuming high amounts of fiber. So you do wanna include fermented foods in your diet. And there are different presentations, so you can just try to choose the one you like.

Not everyone likes fermented foods, but you can just try different, want different presentations.

Mike: I mean, you can also, so my brother, uh, he gets this fer on my, yeah, I think I’m pronouncing it correctly. And, and I think he only has, I think it’s like four ounces a day or something like that. And I’ve tried it and it doesn’t taste good, but who cares?

It’s four ounces. You just drink it just like,

Elisa: yeah, exactly. So there are different presentations of these products, and I hope that in the future we can have more presentations of fermented foods. But ideally you wanna do a combination of high fiber diet plus, uh, fermented foods.

Mike: Great. And can you, um, comment on probiotics and other just controversial topic whenever microbiome is discussed?

Elisa: Yes. So a lot of people ask me they should consume probiotic just because, um, or to keep a healthy, uh, diet or a healthy state. And the reality is that if you have a healthy gut microbiome, there might not be a need for you to consume any probiotic and probably you don’t want to consume it because that can change the composition of your gut microbiome.

Now, something that is, is quite concerning and a lot of people don’t know is that probiotics. Have a very transient effect in the gut microbiome. And what I mean by that is that usually the, the small benefits you’ll see are usually present only while you’re taking the probiotic and you stop seeing the benefit once you stop taking the probiotic.

And in part that is because a lot of people are not thinking about consuming a healthy diet that will nourish that probiotic. And so they just take the probiotic and continue with their Western diet and, and they, they don’t see that that is not gonna fit the probiotic.

Mike: Just dump it into the, into the cess pit, and then it gets eliminated.

Elisa: Exactly, and so you wanna be mindful of that. But also, as I was telling you with the houses for each bacteria, what we have learned in science is that perhaps we need to do a little bit of an antibiotic intervention and then a probiotic in order to have a spaces for the probiotic to get there and colonize.

Because otherwise this niche or niches, however you wanna pronounce it of, of spaces for each bacteria are gonna be occupied and the probiotic is not gonna be able to stay there. Basically, ESAL bacteria are not very welcoming, even if you are probiotic. And so what we have seen, even for fecal microbial transplants, when when we do fecal microbial transplants, you have to do an antibiotic first to get rid of the bacteria that is there because it’s casting a disease or because the person has a very bad infection and then you wanna give the fecal microbial transplant so that.

The houses are pretty much empty and, and then you can colonize, so this is called colonization resistance. So colonization resistance is present because the houses are occupied. So the space is occupied. And by that I not only mean the physical space, but the nutrients they get, the metals they are utilizing ’cause they utilize metals, the oxygen.

So all of that is like occupied already. There’s no enough of that for other new bacteria that get there. But also the bacteria that are there, they produce bacteria sins. So molecules that attack the other bacteria that are coming. And they also get in touch with immune system so that immune system attack these bacteria.

So there are different ways how they don’t allow all their bacteria coming just to get there. And colonize, we’re learning that if we. Perhaps we want probiotics or FMTs to be more successful. And to have engraftment, we need to provide a little bit of antibiotics at beginning. Now I’m not telling you take, go ahead and take antibiotics and then taking a probiotic and there’s still a lot of research that needs to be done before we can get to that point.

But when there’s a disease, for example, Clostridium the fist, I don’t know if you have heard about it, but it causes around 15,000 deaths in the United States alone every year. So it’s a bacterial infection that causes very bad diarrhea and sometimes it is antibiotic resistant. And so it is the only clinical condition for which fecal transplants are approved by the F D A to be perform a clinical setting.

And they have a success is 90 something percent. So it’s a a crazy success that you cannot get with a combination of antibiotics. And that is caused because. They, you give antibiotics first and then the, the D transplant from a healthy human and, and then the person recovers. But going back to the probiotics, I think there’s a lot that we need to do in order to improve the current probiotics we have.

’cause usually in the market we have either one species, two 12 species per probiotic, and we have hundreds of the species in our gut. So considering that the stronger indicator we have of a healthy gold microbiome is high diversity, you wanna have also high diversity in the probiotic you’re taking and also high concentration.

1 million is gonna cut it and it’s not gonna do anything to your gut. So there is, there was actually a couple of months probiotic approved by the F D A and this probiotic is based on fecal microbial transplant. So basically healthy donors provided bacteria and the capsules are now, I believe they are already on sale, but it’s the first one approved by the F D A and that is where I can see the future going.

It would be gross to receive a fecal transplant like NASA gastric having to be, you know, anesthesia and everything to be able to receive a fecal transplant that way, or colonoscopy or something.

Mike: That’s why. So these are poop pills, I’m hearing you right, right.

Elisa: Oh yeah. But it has to be from the right donor.

It has to be from the right person. I know he is very gross and I hope people are not eating while they are listening the podcast. But.

Mike: Eat your vegetables or you might have to be taking poop, poop pills one day. So you can choose, you can have the, the spinach or you can swallow poop pills.

Elisa: Yeah. So. Now discovering what, what we call next generation probiotics.

And next generation probiotics are probiotics that have shown to have either a stronger role than the probiotics we have identified so far. So the probiotics we usually hear about are different species from lactobacillus or bifidobacteria. Now, next generation probiotics are none of these, and they have shown stronger effects in our body.

For example, Akerman, ula, or FOB Bacterium Persit. These are aerobic bacterial species that have shown very positive effects in very strong effects in the human body. And for example, Kerman. ULA has been associated with better body composition. And so for example, when a person has higher akerman signif at baseline before a diet, they lose more weight and higher concentration of Akerman signif protects animals from high fat diet induced obesity.

And supplementation in humus also has shown some benefits. Benefits at the body composition level. So in other words, we, I think we’re moving there, but to my knowledge, there’s only one supplement that has ula. There’s none that has pelo bacteria, prosy. Why? Because there are an aerobic bacteria, so they get in contact with oxygen, they die.

So they need to be produced in a quite complex way. They have to be, I think, the process called ization. And, and so they need a different process in order for them to be, to be produced. And also next generation probiotics involve microorganisms and bacteria that have been modified, genetically modified to exert a specific action.

And I think that is gonna be very beneficial for us, for example, If you’re lactose intolerant, well, we can just create a bacteria that can help you break down lactose and problem solved. Or if you are not capable of activating, for example, a specific molecule in chemotherapy, for example, well, you can have a specific bacteria that can help us process that.

And so the current probiotics, they can be used, but there are limited effects that have been shown. Of the transient effect and the the need to continue taking it to see the effect. And I think we’re moving in the right direction, uh, with next generation probiotics. Now, can they make you lose weight? The evidence says that, no, apparently not.

I mean, you are gonna see probably one or two studies that show a small effect, one or two studies that show weight gain and a couple of studies that show nothing. And so as you can see, the evidence is pointing in all directions because different effects are gonna be noticed based on the strains and species used, based on the concentration, based on the person receiving it.

And what we know is just like it happens with diet and exercise, your baseline called microbiome is gonna predict whether you reject or not the probiotic you are consuming. So in the future, that also will have to be personalized.

Mike: Yeah, your friend, possibly colleague, actually, Dr. Grant Tinsley worked on a, a probiotic supplement for my sports attrition company Legion.

And so he went through and it was interesting to learn about a lot of what you explained and getting very specific on the strains. And so there are several patented strains that, um, I, I give him all the credit that he wanted for very specific reasons and similar strains. It had to be this specific patented strain and this is why, and it had to be this combination together, and this is why if we can’t do that, it doesn’t work.

Now, fortunately, we, we were able to do it, but I knew going into it that your typical off the shelf probiotic that you might just pick up at Whole Foods is, in my opinion, almost certainly not going to help. Most people with With anything,

Elisa: yes. And you wanna be very specific. So like if you see in a scientific study that a specific supplement was good for chronic constipation or for I B s or I b D or colitis, you wanna prescribe the same specific species and try to provide the same dose, the same length of intervention because otherwise, I mean they perform different actions.

So it’s just like taking a medication for cholesterol when what you have is high blood pressure. You know, it’s, it’s just like that. You have to be very specific imitating what you can see in the scientific article. And I, I’m curious, has Grant finished the, the study, they found something interesting?

Mike: Oh, so this was more desk research, so he was formulating, so he was going through existing research and the formulation.

Yeah. I’ll send, I’ll send it to you. Uh, you, you can, you can check it out. Would love to hear your thoughts. And, uh, but I just, it was very much that process of what you’re describing as being very specific, very specific amounts, like you said, like it needs to have billions of these little guys in here, uh, not millions.

And there needs to be a certain, you know, where there are three and then, yeah, so three specific ones that were, were chosen and they were chosen for specific reasons and they go together and so forth. Well, this was, was very informative. Those were all the, the main questions that I had. Is there anything that I should have asked or anything that is, is still kind in the back of your mind?

You feel you should mention before we wrap up? I don’t think so. I thought of something, actually, I thought of one thing, one final question actually that occurs to me is, so if somebody, um, has through just poor lifestyle, bad diet, have not been exercising, they have not been healthy, they haven’t taken care of themselves, their microbiome is not in a, in a great state either.

You had mentioned that you can get into a situation where most of the houses are occupied and they’re occupied by, in, in this case, delinquents, uh, by bacteria that are, are having negative effects. So practically speaking, to get them to a better state, obviously you said like don’t just go take an antibiotic and then, and then take probiotics.

That’s not what you’re recommending. Of course. I’m assuming though that. Through consistency of the things you’ve talked about, that in time your body will be able to modify your microbiome positively. You just have to stick with it. Or do you have something else to to say about that?

Elisa: Yeah, probably. And, and we don’t know these research because usually we, we try to, well, not always, but either we recruit a, a person with a healthy person or a person with obesity and other comorbidities and whatnot.

So it’s, it’s difficult for me to do a generalization, but perhaps if they have low diversity, low richness, that there are empty houses, perhaps it would be good for them to consume, for example, a, a probiotic that would have those spaces colonized by bacteria that we know are not going to be harmful for them, instead of having the empty spots that can be occupied by potential pathogenic bacteria.

Now, there’s debate as to whether or not we should consume a probiotic when taking an antibiotic. And my personal point of view, and not everyone agrees on this, is that. You should take an probiotic when you are taking an antibiotic, even when this can slightly modify or delay the gold microbiome, going back to where it was pre antibiotic.

And the reason for that is that, as I mentioned, when you consume the antibiotic, you eradicate good and bad bacteria. So you can have a potential pathogenic bacteria, um, causing an infection after whatever infection you are fighting, and you wanna try to avoid that. So probiotic when taking and antibiotics has shown to reduce most of the symptomatology, such as diarrhea induced, antiotic induced diarrhea, bloating and gases, nausea, all of that.

But also when you consume both probiotics and antibiotics simultaneously to fight an infection, the success of eradication is higher. So like if you are dealing against clo fist infection or iact pylori or some sort some other. Sort of infection. If you’re consuming both simultaneously, the success rate is higher.

And there are also studies that have shown that by consuming the probiotic while taking antibiotic, the potential development of antibiotic resistant bacteria is gonna be also lower. I, I would say that in those cases, I would personally recommend to consume a probiotic when taking the antibiotic, especially considering that, as you mentioned, 74% of the population has in the United States has either overweight or obesity.

Even when, when you are eradicating a good part of the bacteria, it, it would be probably a good idea to try to replace them with healthier versions.

Mike: Yeah, yeah. Yeah. That’s interesting and kind of counterintuitive because you could assume, well, isn’t the antibiotic just gonna kill all the good bacteria as well?

But clearly it doesn’t work exactly like that.

Elisa: It, it doesn’t kill all of them. And so what you’re trying to do is just trying to. Replenish as many houses as possible while the antibiotic is doing its action. And you might kill as well, some of the probiotics you’re taking. But that’s why usually when you take the probiotic, you continue taking it for at least two weeks after you stop the antibiotic.

Mike: Yep, that makes sense. And um, I don’t think I asked my question clearly enough. What I was referring to is, okay, so you have somebody and they’re overweight and they’ve done various things that have put their microbiome into a not so great place. They wanna make some changes. So they start following the various advice that you’ve shared in this podcast.

So they’re eating better now and they’re doing their exercise and so forth. They’re getting better sleep. And how much can those things influence the microbiome? To what degree? ’cause you had mentioned earlier that, you know, the first couple of years are very important and there, there seems to be an immutability to the microbiome to some degree.

So do those people have a. A generally positive, uh, prognosis, so to speak, where if they’re doing the right lifestyle things for long enough, then can that significantly improve the makeup of their microbiome or, or not? Or if you, if you screw it up too much, it, it actually is very difficult to fix.

Elisa: I don’t think we have a very concrete answer to your question, which is a very good question, but I can tell you that based on research, it takes a lot longer.

To recover the gold microbiome composition than what it took to get you there. And this is based on, on animal research, but I think my hypothesis is that pretty much the same will apply to humans, although it needs to be replicated in humans. So basically when you have mice in diet induc obesity, the gold microbiome changes negatively, right?

And then when you put the diet, the mox into a hypocaloric diet, the gold microbiome get affected, but a little bit. So basically everything goes back to normal. All the glucose, insulin, cholesterol, to release rise pressure, everything goes back to normal. But the gold microbiome is not comparable to the group.

And, and, and it’s also not comparable to what they had when they had obesity. It remains in something called like intermediate state. Um, so in the middle. And so when that person is exposed to, uh, an epigenic environment, That microbiome is gonna make the person gain more weight than what they had initially.

You can cure that gold microbiome. Basically you can treat that gold microbiome once you have lost weight, but it takes five times longer than what it took you to change your gold microbiome during the hypo caloric diet. So basically for the mice it took two weeks. Well multiply that by five and that is what you are supposed to continue keeping the healthy habits in order for the gold macarro to go back and be similar to the contour group, if that makes sense.

So I would say for humans, it, it might be something similar in which you wanna keep for a long period of time, your healthy habits, hopefully for the rest of your life, so that you can enjoy of, of the benefits.

Mike: That’s uh, that’s just a good point because body composition you can change quickly if you know.

What you’re doing, if you just understand how to manage your calories and get on with it, you can gain a lot of weight and then you can just lose a lot of weight. But then, if I’m hearing you correctly, with yo-yo dieting or also the, the quality of the diet where it’s really good for a little bit and then it’s really bad for a period of time, that unfortunately, if I’m hearing you right, that the things that we do that negatively impact our microbiome can take a lot longer to undo.

Elisa: Yes. So precisely this study was made to analyze the effect of UO dieting. So the mice were put into like hyper caloric diets and hyper caloric diets, and what they sow is that, It was, they were worse than the group that was taking just hypocaloric diets all continuously. And so we know, metabolically speaking that some things happen when you’re in a hypocaloric diet.

Um, you lose muscle mass, your base metabolic rate decreases, need decreases. T three T four decreases. So all of those things happen. But also it seems that some changes in your gold microbiome also help you with the weight regain. It’s important for us to consider all those things and also consider that you don’t wanna be doing a diet that you cannot follow for a long period of time, because that might be detrimental.

Mike: Yeah, yeah. I think of some research on settling points, and I’m sure that this, there’s some interaction here, I’m sure with, with people, you know, with just body weights and body, well, it’s ranges of body weights that they just tend to be drawn to or tend to settle in. And,

Elisa: and I, I do believe that that tends to happen.

And one of the things that has shown to, to reset that body weight set point or bariatric surgeries, and that’s why they are a lot more successful. So when you do a diet alone, usually people tend, 80% of people that lose weight tend to regain it back in five years, whereas a bariatric surgery is, you have 20% of weight loss still present at 20 years after the bariatric surgery, and that’s because there’s a reset in the body weight performed by, you know, changes in absorption and also in the production of, uh, hunger, sat tight hormones, et cetera.

Yeah.

Mike: Yeah. Unfortunately, it’s uh, a very invasive intervention and so, you know,

Elisa: yes, yes, it is. It’s, and obviously you want the person first to try to do lifestyle intervention and to stick with it. Yeah.

Mike: Yeah. Well, this was, this was a great discussion, Elis, I really appreciate, again, you taking the time. And why don’t we wrap up with if people, if they want to, Maybe learn about your work or read some of your research or, I actually, I didn’t look if, uh, if you’re on social media, I don’t If you wanna share

Elisa: Yeah, I, I try sometimes to, I’m not super active, but I try to I understand.

Yeah. Uh, I have an ITHER Instagram account. I believe it’s Elisa Makin PhD. So you’ll spell it E L i S A M A R R O Q U I N PhD. So it’s a long one, sorry.

Mike: And there will be, uh, a link also in the show notes, but for people who are listening

Elisa: and Twitter as well. And Twitter is Elisa pc.

Mike: Okay, great. Well, uh, thanks again for taking the time.

This was a, this was a fun discussion. I enjoyed it.

Elisa: Thank you. Thank you for inviting me.

Mike: Well, I hope you liked this episode. I hope you found it helpful, and if you did subscribe to the show because it makes sure that you don’t miss new episodes. And it also helps me because it increases the rankings of the show a little bit, which of course then makes it a little bit more easily found by other people who may like it just as much as you.

And if you didn’t like something about this episode or about the show in general, or if you have, uh, ideas or suggestions or just feedback to share, shoot me an email, [email protected], muscle f o r life.com, and let me know what I could do better or just, uh, what your thoughts are about maybe what you’d like to see me do in the future.

I read everything myself. I’m always looking for new ideas and constructive feedback. So thanks again for listening to this episode, and I hope to hear from you soon.

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