OneMedicine Podcast

Rob Lutz 00:00
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader. Some you'll know, and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:21
Welcome to the OneMedicine Podcast. I'm your host, Rob Lutz, and the editorial director for Today's Practitioner. Today, we're going to dive into the microbiome. We're going to look at the gut-X axis and go a little bit deeper into the gut-lung axis, and maybe as well, some talk about metabolic health and how the microbiome can impact that. I've got two guests today. They're from ResBiotic. They are the sponsor of the Microbiome Resource Center on Today's Practitioner. I've got Kara Siedman and Dr. Vivek Lal. And thank you both for coming on the podcast today. I'm really looking forward to this topic. There's so much that's evolved over the last few years around the microbiome. You know, originally it was, "You take an antibiotic and you've got to go eat some yogurt." So it's so much more sophisticated and targeted now, I think. So, looking forward to diving into this, but before we get into the topic, I'd love for you guys both to just introduce yourselves to the audience and share a little bit about your background and what got you here. Kara, do you want to go first?

Kara Siedman, RDN 01:23
Sure. I'm happy to. So, I'm a registered dietitian. I came through pretty conventionally and worked in various demographics in patient ICU and loved, you know, the hustle and bustle, and found myself in outpatient counseling. Landed, long way to get to, but landed in gastroenterology, and that's just where my love of the microbiome--I was always, I think, subconsciously, without knowing so much about the microbiome, I got into food fermentation very early on in my college life. My apartment was like an experiment, and so I think it was just something I was always attracted to, and so ending up in GI felt very natural, and that's just really where I honed in on my skills and love of understanding and really utilizing the microbiome as a means for benefiting health, improving health, beyond just the gut itself. And so, I moved into the industry, worked for some other microbiome companies. I met Dr. Lal organically, and just loved so much of what Res was doing, and so now I'm here and really excited to be on the show to talk about all things microbiome-related.

Rob Lutz 02:28
Thank you. Dr. Lal?

Dr. C. Vivek Lal 02:31
Yeah, you can call me Vivek. So, my name is Vivek Lal. I'm a physician and a scientist, and also the founder and CEO of ResBiotic Nutrition. So by clinical background, I'm an ICU physician, double board-certified ICU physician--neonatology, believe it or not, so I used to see patients in the neonatal ICU, but while doing it, we started doing a lot of research on lung health and microbiome health. So I'm an NIH-funded scientist too. I was the director of the microbiome and discovery labs at the University of Alabama at Birmingham, also an executive in residence still at the University, and a tenured professor at the University, but I wanted to convert all of the science and the research that we were doing into actual products or consumables for the consumer. Many a time, we realize in academia, as things get stuck in citations and papers--and just to please the dean or the chair, Right? Like, but how do you bring it all back to the consumer? So that's where entrepreneurship, or translation, or, you know, for lack of a better, better word, commercialization, comes into play. So I took the whole-circle approach, took those scientific discoveries out of the university, and started ResBiotic Nutrition, where we try to restore chronic health issues with science-backed solutions.

Rob Lutz 03:54
Mm hm, So really looking at specific strains of what they do in the body, yeah?

Dr. C. Vivek Lal 03:59
Yeah. So you know, as you know--it's a good segue--the microbiome is a plethora of organisms that inhabit different parts of the body. Right? Every organ pretty much has a different microbiome. Right? The NIH came up with the Human Microbiome Project, I think, in the late 2000s, and they had specified some specific organs to study the microbiome from. And our lab started studying some of the organs which were not listed in the original NIH Microbiome Project, such as the lungs. We--the lungs also have a microbiome. Right? But the gut has trillions of bacteria. It's the most immune mode, you know, the richest source of microbes for the whole body. So we have a concept of the gut-X axis, wherein the gut microbiome communicates with different parts of the body. As in algebra, we used to say X is any unknown. So our concept is, we can target most of the unknown parts of the body, or organs of the body, or systems of the body, gut, using the microbiome through the gut-X axis. A sample would be the gut-lung axis, or the gut-brain axis, or the gut metabolism axis. Right?

Rob Lutz 05:14
Mm hm.

Kara Siedman, RDN 05:15
I love this, because so much of microbiome research--there's not one condition now that's not linked back to what's happening in the gut microbiome. It's the eyes and ears of our immune system, and so, I always think of it as the foundation. We go and we look for this home that's got everything we've ever wanted. But what do we wait so patiently for is that inspection report to come back saying, "Oh, you don't have any cracks in your foundation, because if you do, then when those winds and earthquakes and hurricanes and everything come through, your home, your structure, is not as stable or resilient." And that's how we like to think of the microbiome. Building resiliency in the gut supports resiliency beyond.

Rob Lutz 05:53
Because I guess things that we, you know, might ingest or stresses on our body can impact the microbiome and then all these other impacts through other systems in the body. So that sounds like you focused on the gut-lung axis. It was one of those areas that hadn't received a lot of study, from what you said. Tell me how you went about doing that. What was the process?

Dr. C. Vivek Lal 06:16
Yeah. So initially, when we started studying the lungs, we started looking at individual molecules, right, the anti-angiogenic molecules or anti-inflammatory molecules, et cetera. Many people, many scientists, have made careers out of studying an individual molecule for different organs, right, in the academia world. But what we realized was lungs, like many other organs--our human body is so complex that a single molecule or single pathway study doesn't lead to therapies. So we started studying systems biology. It started with transcriptomics, metabolomics, microbiomics, and several other -omics. That's when we got unbiased results from human samples. We started at the bedside. Being physician-scientists, we had the privilege of having physician or patient samples, right, from the bedside, both from adults and from the pediatric population. We took those samples into the lab setting, studied all these -omic analyses, and then, and consistently found that the microbiomics of these patients was different than the healthy patients.

Rob Lutz 07:29
Mm hm.

Dr. C. Vivek Lal 07:29
Or healthy, you know, consumers. Right?

Rob Lutz 07:32
Mm hm.

Dr. C. Vivek Lal 07:33
That triggered the question, "is the microbiome affecting lung inflammation?" We took those findings into in vitro and in vivo. In vitro models are all these cellular models, right, and even organoid models of lung diseases and lung inflammation, and then, in vivo models--that is, animal models--of lung inflammation, and then found the same results. This was really fascinating. We found specific bacteria which could make you either resilient to a second hit or make you susceptible to a second hit, even if you adjust for all of the factors around it. So that was the "A-ha" moment. Oh, so we can, you know, put a particular kind of bacteria in the body and you could be resilient to a second hit, like COVID or a smoke injury or an oxygen injury or an infection. Right? So that's the--that's where the story started. And this is 12 years ago.

Rob Lutz 08:19
Mm hm.

Dr. C. Vivek Lal 08:27
Since then, we created several gnotobiotic models, or germ-free models, and started doing monocolonization--individual, you know--introducing one bacteria at a time, second bacteria at a time. But the initial findings of what to put and what not to put, or what was harmful or what was beneficial, came from the patient population.

Dr. C. Vivek Lal 08:39
And then, over the course of the next 8 to 10 years, we identified specific species which would be beneficial, and then, out of those species, also what combination of those bacteria, right, in what ratio would be beneficial. And how they will be beneficial was the mechanistic aspect of it later, and Kara could also point towards that. Right? So that's how we came about identifying specific species which benefited the lung. And then once we had the template of how to do this, we started going to different organs.

Rob Lutz 08:50
Mm hm.

Rob Lutz 09:22
So who might be a patient that a practitioner--maybe a typical patient that might benefit from this? I always find that interesting.

Dr. C. Vivek Lal 09:30
Yeah.

Rob Lutz 09:30
How do you identify that patient?

Dr. C. Vivek Lal 09:32
So my running joke is, "Anyone who breathes is a customer."

Kara Siedman, RDN 09:36
I've taken that joke now and have run with it.

Rob Lutz 09:39
Yeah.

Dr. C. Vivek Lal 09:40
Yeah. So I think it comes down to the concept of, "Why do we need to reduce lung inflammation?" COVID, or the pandemic, taught us a big thing here. What we see is not really true. We have endorsed the idea of food as medicine. Right? And we eat three times a day. But think of it, we breathe 30 times a minute.

Rob Lutz 10:02
Mm hm.

Dr. C. Vivek Lal 10:03
What we breathe in at every minute is important in triggering or reducing the lung inflammation. At this time, you or I could have inflamed lungs, but we will never realize until we have a second hit. That is why, you know, two similar-looking people could end up with COVID, and one would be in the ICU; the other one would be walking absolutely fine. That is why someone who never smokes could end up with lung cancer. Someone who's smoked two packs a day could be absolutely fine. So at baseline, your lungs could be resilient to or susceptible to a second hit or a third hit. Right?

Rob Lutz 10:37
What do you mean by a second hit or a third hit? I'm not familiar with that term.

Dr. C. Vivek Lal 10:40
Yeah. So a second hit would be at baseline, like, if you get an infection, that's a second hit. The first hit is your lung inflammation at baseline.

Rob Lutz 10:50
I see.

Dr. C. Vivek Lal 10:50
So now, if you get an infection, whether you fall sick from that or not will depend on how susceptible your lungs are. So your lung microbiome and your innate immunity determines how susceptible or how resilient you could be to a second hit, whether it could be an infection or what we breathe in, like smoke, or the infection, the viral infection is going on, or you know, any other pathology that your body could have.

Rob Lutz 11:18
That makes sense. Yeah.

Kara Siedman, RDN 11:19
There's even been some interesting studies that have come out, you know, now that we understand the lung, the gut-lung axis. I mean, Vivek, you were really early on in the research. Now it's become more known and better understood. There's been studies that have come out this past year looking at human studies that have looked at the impact of air pollution, what we're breathing in, and how that's changing the composition within the gut microbiome, and so really highlighting this gut-lung axis. And it's really great to see now more of these models. I've read, you know, even animal studies, which now I wonder if you actually did them, Vivek, where they've taken the microbiome from a COPD patient and they transplanted it into healthy mice, and those mice then developed emphysema. So really interesting to see, and we know this relationship exists, that people who suffer from chronic conditions or chronic respiratory issues have dysbiosis, or imbalance, within their microbiome. But if you have imbalance, or dysbiosis, because of our diet, because of the air we're breathing, because of all these other insults, that that is something that can then link back to less resiliency in the lungs. And we saw that with COVID. They've done studies now looking at worse COVID outcomes were related to--the worst COVID outcomes were linked back to how dysbiotic, or how imbalanced, the gut microbiome was.

Dr. C. Vivek Lal 12:33
Absolutely. And you're right, Kara, we did several studies in mice, even gnotobiotic mice. Gnotobiotic are germ-free mice which don't have any germs or any bacteria. We introduce specific bacteria into them and then give some infection or some, you know, smoke injury or oxygen injury, and the ones who had a specific kind of bacteria were, you know, more likely to develop the injury, or were protected. So this is fascinating, that what our bodies have as a microbiome could make you resilient or susceptible, which was not a concept until very recently. Right? So who is the customer? Why do I say everyone who breathes is a customer? Because at baseline, you will want your lung health to be solid, so that you avoid that second or third hit. Right? Of course as, when you talk about the customer segmentation, we have four big categories which people just endorse. It's a concept of vitamin and painkillers. Right? Unless someone has a pain, no one tries to think about these things. It's all these people with chronic inflammation or chronic lung issues, although at ResBiotic, we make science-backed supplements. These are still supplements. These are not drugs that we can make disease claims, but anyone with chronic lung issues--we have several customers with chronic lung diseases who are, who swear by the product. But again, we don't claim to be a magic bullet for any disease. Right? We are a supplement. In addition, athletes who want to improve their vital capacity of the lungs are a great cohort of customers that we have. We have--we did not know this was a category, but a lot of young people who smoke or who consume weed are not customers, because they think that there's nothing proactively available on the market to reduce their lung inflammation. You know, so these are cohorts which consume resB Lung Support, and we get great customer feedback. But again, the big disclaimer, we don't claim to treat any disease. We don't aim to reduce, you know, any lung injury from smoking, et cetera. It says that these cohorts do endorse it, and our customers are our biggest PR machinery.

Rob Lutz 13:19
It supports healthy function, right? That's the--that's how we talk about it, and which is what probably everybody wants.

Kara Siedman, RDN 14:45
I--

Rob Lutz 14:45
I'm sorry, Kara. Go ahead.

Kara Siedman, RDN 14:51
Oh, I was gonna say, like, as a clinician, you know, we're looking at people who are obviously suffering from, but then on the flip side, we're also looking at, how do we prevent. And I think that's where the microbiome becomes an essential piece, and more importantly, these targeted strains and these targeted functions, because then you can better suit the patient that you're working with. And so when we look at lung health and lung resiliency, I mean, this is a hallmark of aging. I mean, everyone's talking about longevity, and how do we age and increase our health span along with our lifespan, and lungs are a big part of that. And so, when I think about, you know, who is this for, as a clinician, when you're working with patients, well, obviously, someone who's suffering from, and we know then that they probably have a dysbiotic microbiome. We want to improve the health. We want to incorporate these strains back in, but also looking ahead at, what are we trying to improve upon to prevent something from taking place even in the first place?

Rob Lutz 15:47
Yeah. It's something that you touched on as an example early on. It sounds very foundational to me. You're really reinforcing a foundational piece to your overall health and wellness. In this case, we're talking about the lung, or lungs. But yeah, I'm curious. So let's say there's a patient that doesn't have some kind of a chronic lung issue. Is this something that they would take over a long period of time? Is it something that you kind of repopulate some of these strains in the microbiome, and that's what you need, or both, kind of, in a way?

Dr. C. Vivek Lal 16:18
Absolutely. So before even looking at the lung function, these are pretty good digestive probiotics, right, so they help digestive function. They help the immunity. And then the added benefit is lung or allergies or--so everyone, Kara will tell you, all of our team members, all our kids, all our parents, everyone is on resB. And we have heard from our customers that--there's a concept called LTV, or lifetime value of a product, you know.

Rob Lutz 16:48
Right.

Dr. C. Vivek Lal 16:48
You can sell a pill with water, right, by marketing.

Rob Lutz 16:52
Sure.

Dr. C. Vivek Lal 16:53
But what is success for a product? The lifetime value. Do people come back and keep taking it, right? So that's what we have seen with this product that people don't give it up. People swear by it. Like, you know, even when they're doing well, they just are afraid to give it up, because they're--

Rob Lutz 17:09
Right. Yeah.

Dr. C. Vivek Lal 17:09
Going back or something. So, yeah, people do take it chronically. We do recommend, you know, taking it at least three months. Right? Because these are natural products.

Rob Lutz 17:18
Mm hm.

Dr. C. Vivek Lal 17:18
The products do take time.

Dr. C. Vivek Lal 17:20
The metabolites, which have to go through the lymphatics and blood vessels to different parts of the body. It's not a peptide or a drug which would reduce your symptoms immediately. It does take time.

Rob Lutz 17:20
Sure.

Rob Lutz 17:33
Yeah. And it does have added benefits, right, that you're talking about, side benefits, which--I love that term. You know, you're going to take something and have to deal with the side effect to get the effect. This sounds like, over time, you get all the benefits for your lungs, but also other parts of your body as well.

Dr. C. Vivek Lal 17:51
These are natural bacteria which already exist in the body.

Rob Lutz 17:53
Yeah. So how did you figure out which strains? What was the process there? Is it really just looking at the patients and trial and error?

Dr. C. Vivek Lal 17:53
Hopefully without the side effects, because these are natural solutions.

Rob Lutz 17:54
Right.

Dr. C. Vivek Lal 18:03
Yeah, absolutely. So we started taking samples from patients with lung diseases, and then healthy population, and started doing microbiome analysis. So there's something called 16S analysis, and there's something called metabolomics, right, oh, metagenomics, where you identify the genus and the phylum of all the bacteria which exist in a sample. So we started comparing those between healthy and diseased over a big cohort of population. And then on statistical analysis, we found that there was a difference in specific bacteria, and the genus, and we didn't believe it, so we did a validation cohort to confirm that, and even on validation cohort found specific bacteria which were beneficial. Right? Those were extracted from humans and then cultured in a manufacturing facility to produce these strains. Yeah. So these are proprietary strains, which we isolated from humans.

Rob Lutz 19:10
I got it. How did those humans get it into their system to start with, right? I mean, these--they didn't take a supplement to get that. Where did they--where did it come? I'm curious, you know, where those strains came from.

Dr. C. Vivek Lal 19:22
So these are--that's the concept of dysbiosis. Everyone has a lot of bacteria in their body.

Rob Lutz 19:27
Right.

Dr. C. Vivek Lal 19:27
And Kara, you might want to talk about dysbiosis a little bit before I forget.

Kara Siedman, RDN 19:31
Yeah, and it's a good question. So, you know, we have this sort of healthy consortium. And actually, that's something that the microbiome research is really trying to understand. What are the very specific species and strains that are really profiled or signatured in the healthy? But what we do know is that we have diversity. We've got more of these beneficial, these probiotics, that are producing these really important compounds known as short-chain fatty acids, which are key signaling molecules that impact just about every aspect of health. And that reinforces this gut barrier and the integrity, which is what protects your microbiome from your immune system. And so we understand that this consortium of bacteria that are there: there's commensals; you've got opportunistic; you've got pathogens; you've got good--it's like a neighborhood, right, where everyone's living harmoniously together. But then, as we get exposed to certain things, like medications, antibiotics, proton pump inhibitors, our diet, right, the lack of fiber, the more ultra-processed foods, you know, traveling, poor sleep, chronic stress, all these things--we actually call it the exposome--all these things that we know impact the microbiome, start to shift that neighborhood, right, where you start to have less of those friendly neighbors, and you have more of those neighbors that you're like, "I really don't want to live next to you. You're throwing wild parties, you're inviting all your friends, and you've changed the entire integrity of the neighborhood." And so that's essentially what's happening in your microbiome, and you start to lose that diversity. Your rainforest is starting to become more of a desert, which--what that really, in turn, translates to is less functionality. Because the reason we have these good bugs, these probiotics, there is to function and do the jobs that they're supposed to. And that's where even probiotic therapy and microbiome therapies have really advanced to is, we're better able to understand these exact functions so that we can create these very targeted therapeutics.

Rob Lutz 21:27
Mm hm.

Kara Siedman, RDN 21:27
But as you start to lose the functionality in the microbiome, that's where we start to see then the negative impact of how the gut microbiome impacts, not just obviously digestive health, but how you start to then see less resiliency beyond.

Rob Lutz 21:40
Great explanation. Thank you. That was great.

Kara Siedman, RDN 21:43
A lot of analogies.

Rob Lutz 21:44
Yeah. I like that.

Dr. C. Vivek Lal 21:45
Yeah. Kara is an expert in analogies.

Rob Lutz 21:49
Absolutely.

Kara Siedman, RDN 21:49
No lie, you haven't even heard half of them. I've got so many.

Rob Lutz 21:55
So what else do we want to talk about as far as the gut-lung axis? What other topics do you think a practitioner should know about or be thinking about?

Dr. C. Vivek Lal 22:03
Yeah, especially for the practitioners, I think it's important to understand how this works. Right? It's very easy to say the gut affects the lungs, but how exactly? So the gut-lung axis is the connection between the gut and the lung, but it all is based on a couple of things. Right? One is the connection through the lymphatics and the blood vessels between the gut and the lungs and, similarly, the gut and the brain and different organs. So these bacteria produce specific metabolites, enter the bloodstream or the lymphatics, and travel to the lungs and decrease inflammation in the roots. So that's the concept, which is, you know, important to understand.

Rob Lutz 22:45
Mm hm.

Dr. C. Vivek Lal 22:45
In addition, every moment we are aspirating, you know, our gut content. The younger you are, you aspirate more. But every moment, you do aspirate things from the gut into the lungs. That does change your lung microbiome also. The lungs innately have a microbiome, irrespective of the gut-lung connection.

Rob Lutz 23:04
Mm hm.

Dr. C. Vivek Lal 23:05
So your gut microbiome does enter the lungs also, although the lungs do have a skill set of clearing these bacteria, because of our immune system, so they clear and the low--and the biomass of this lung microbiome in the lung is extremely low, but just being small doesn't mean it's not important. So what that small biomass is does affect lung inflammation directly, also. But these are the main mechanisms by which the gut-lung axis works.

Rob Lutz 23:33
What, I'm--just made me think about a patient that might have acid reflux. Is that--does that have an impact on inflammation in the gut?

Dr. C. Vivek Lal 23:41
Absolutely. Anything which is aspirated into the lungs would have an impact. Right? So acid reflux, although I'm not aware of a clinical trial which has proven that, right, but based on physiological plausibility, it is absolutely possible. So we are scientists. We talk about the level of evidence. You can't make a definitive claim unless it's a randomized control trial or a meta-analysis that is showing it. But below that comes the animal experiments. Right? Below that comes expert opinion, like what I'm telling you, but all of the expert opinion, et cetera, needs to be grounded into physiological possibility. Is this possible physiologically? So it is possible physiologically. Has an RCT, or randomized control trial, been done on reflux and lung microbiome? I'm not sure of that.

Rob Lutz 24:30
Not yet, but maybe someday. Yeah.

Dr. C. Vivek Lal 24:32
Absolutely.

Kara Siedman, RDN 24:33
Well, and even if we just think, you know, anatomically, we're sharing, you know--everything's coming through one tube, which is why, when we think about digestive health, it's from mouth all the way down. And so if we're constantly aspirating, if we're refluxing things up, if we're coughing, there's going to be constant transmission or translocation. And it comes down to that base neighborhood and that base resiliency. And if you lose that resiliency, then when you're doing these things, it's harder to clear out. It's harder to say, "Okay, let's get rid of these bad guys." And I think that's why you--we look at the lens, and a lot of people say, "Oh, a lung probiotic, you know, that you're consuming orally, that's getting into the gut." You're having this transitory effect, and it's because of what these beneficial bacteria produce that can then enter systemically into the body to start reducing inflammation, start improving the immune system, these short-chain fatty acids. And so I think that's really unique behind the mechanism. And I also think the fact, when we look at the strains we're using, we're combining it with herbs that we're clinically studying at that finished product level, and that's really unique. We've done more than--you know, we've got more than three published studies alone on our lung probiotic, ResB. And I think that's really important, because we're not just taking these clinically validated strains or these clinically researched ingredients, but we're actually putting it together. And in the probiotic space, that's actually really important, because what we've learned is that microbes compete for space. They compete for nutrients. And so you can have probiotics and beneficial bacteria that individually have benefits, but then you combine them together, and they wipe each other out.

Rob Lutz 24:33
Yeah.

Dr. C. Vivek Lal 26:08
Yeah.

Rob Lutz 26:08
That's interesting.

Dr. C. Vivek Lal 26:08
That's an excellent point here, Kara. So we come from the drug development background, and although we are not making drugs, but we use the drug development rigor because we have the structure for it. Right?

Kara Siedman, RDN 26:08
That's so important in probiotic studies, and we looked at that. We saw strain survival, we saw modulation, but we actually saw the blend of our strains outcompete any individual strain in terms of their benefit.

Rob Lutz 26:33
Love that.

Dr. C. Vivek Lal 26:33
If you would have asked me 10 years ago, I would have never done a supplement company. Right? I would've said it's all snake oil. But that's where the opportunity was. How do we bring rigor into the space? How do we scientify the supplement industry? That's our thesis. So all our supplements that come into the market go through the preclinical work, go through the clinical trial at the product level. This is an extremely important concept which people don't relate to. People can claim anything in a supplement just based on the ingredients, but an ingredient can totally inhibit another ingredient, totally exaggerate another ingredient effect. We don't know what happens if you mix that. Right? So product level preclinical work and product level clinical trials are the need of the hour, and that's what the industry should move to, although there is no rigor, and they still do it.

Rob Lutz 27:23
Yeah, I mean, so many times you'll see a formula. It's got, you know--it's like everything under the sun. It's supposed to help you, and you don't know how they're going to work together.

Dr. C. Vivek Lal 27:31
Absolutely.

Rob Lutz 27:32
Right. It may not work at all.

Kara Siedman, RDN 27:33
And that's exactly why I joined the company, because in--I'm an evidence-based practitioner, and I want to see the evidence, and I think we're trying to change that narrative here in what quality supplements look like. And I think, given the day and age we're in, we should be doing that. And I think it's really powerful, and why we talk about it so much is because, of course, there's a lot of money that goes behind, and we want to do that because we want to make sure that we're bringing clinically efficacious products to the market. We're all, you know--Vivek and I and our other scientists, you know--we're nerds at heart. We love the science, but when it comes down to it, we want people taking something that actually works.

Rob Lutz 28:07
Yeah. And that's also a good business strategy, lifetime value. If the stuff works, their friends are going to hear about it, their other patients are going to hear about it, and that patient's going to continue to use it.

Dr. C. Vivek Lal 28:16
Yeah and, you know, it's an education piece, right, which is extremely difficult to cut through the noise. And people have been brainwashed for years by legacy, you know, companies just based on ingredient benefits. It's important to understand that a single herb with a probiotic could totally kill the probiotic on day one. Right? Or even the acid in the stomach could totally kill the probiotic, unless you have a delayed release capsule, et cetera. So there are several bells and whistles which need to fall in place to make a clinically validated, robust supplement which has benefits at the product level. And that's the rigor we bring.

Rob Lutz 28:57
So we've talked a lot about the strains and how that was figured out, but there are also botanicals, right, that we're talking about. So let's spend a little time talking about those and how they work and how they work synergistically.

Dr. C. Vivek Lal 29:09
Absolutely. So I'll give you a high level and then Kara can break it down. But the high level is, there are several botanicals in ancient medicine that have been studied for several benefits, but have not been published in western medicine.

Dr. C. Vivek Lal 29:29
We started looking at what could be synergistic with our strains, and at the same time, what is a botanical which can have additive effects, right, more than what we have right now. So that's when we identified these three botanicals after, you know--at that time, it was not AI, but based on RI, real intelligence, analysis.

Rob Lutz 29:39
Mm hm.

Rob Lutz 29:47
I like that.

Kara Siedman, RDN 29:57
Love that.

Rob Lutz 29:59
I'm writing that one down.

Dr. C. Vivek Lal 30:02
So we shortlisted 12, out of which we tested seven or eight, and then came up with these three. And then at the botanical level, individual botanical level also, we started testing inhibition studies or synergistic studies with our strains.

Rob Lutz 30:17
Mm hm.

Dr. C. Vivek Lal 30:18
Because the first question was, "Are these botanicals inhibiting our strain?" Right? So we did that and then found that a specific combination potentiated the respiratory benefits, and that's the combination which is in the product right now, and which is patented. And that's our intellectual property there.

Rob Lutz 30:35
Mm hm. Thank you.

Kara Siedman, RDN 30:37
So, and for those that are new to us, so we have our three lactobacillus, our three lactobacillus strains, that we combine with vasaka, which is an Ayurvedic herb that's got, obviously, its own immune-enhancing and respiratory benefits. But it was the blend, as Vivek said, but we also had turmeric and holy basil, and that's why, when we look at the mechanism of immunoregulation, but also really targeting the respiratory benefits. And that's that pharmaceutical-level rigor, going from individual testing to then looking at the combination to then putting it together as a product, to make sure that everything worked synergistically, to make sure that the amounts we were putting in were producing the results. So I get that question a lot.

Rob Lutz 31:17
Yeah.

Kara Siedman, RDN 31:18
It's, "How do you know you're using--there's enough of the vasaka or enough of turmeric or enough of your strains?" That's why finished-product testing and at the finished level is so important. We don't have to necessarily give more. That's a myth out there in the probiotic space. "You've got to take more to achieve the benefits." That's not true. You should take what's being clinically studied, because more only means that you're potentially paying more money for it. And so that's important. We're testing different dose. We're testing different levels to make sure that that combination isn't just working together, but we're giving that efficacious dose as well.

Rob Lutz 31:41
Yeah. You guys are focused on the result, the desired result, and formulating for that, rather than, it's going to look good on a label to have eight, whatever, trillion--whatever the number is now.

Dr. C. Vivek Lal 32:02
And this is not easy. Right? Like, we are talking about it casually, but a lot of money and effort goes behind the scientific rigor, because science is not cheap. So the only way we were able to achieve this is by vertically integrating our supply chain and science. Essentially we have an in-house R&D team of PhDs, MDs, RDs, who work day in and out doing the pre clinical work, doing the clinical trials in-house, and also the supply chain. We control our supply chain very carefully. That's why we were able to reduce our prices. And we want this to be accessible, because we really believe creating a $100 product, we could charge people $80 based on the research we're doing.

Rob Lutz 32:50
Yeah.

Dr. C. Vivek Lal 32:50
If it doesn't reach the people we are aiming to reach, it doesn't serve our purpose. Right? So accessibility is an important concept we are trying to achieve, while keeping the rigor superior than most of the other brands.

Kara Siedman, RDN 33:02
And I'm just going to add, because this is something--we talked about this, I think, one night at dinner, and I'm, you know, I'm not a doctor. I'm a nerd, you know, with a capital RD. But I think it's also important to highlight, when you look at pharmacological agents that are used in the lung space--you know, if we just dissect that, not only is it hard for newer medications to come to the market, which, I had no idea what it took for new pulmonary medications. I mean, it's mind-blowing. I have my mother who suffers from terrible asthma, and she's actually taking resB and has had significant benefits. I keep asking her to maybe make a video. But there's not, and then we're taking steroids, which actually have impact, long-term steroid use, on--but that's the problem is, you know, there's medications that are necessary and needed, but there's not a lot of options. So to be able to have something that's natural, no side effects, that's actually improving the health of the microbiome, while also improving symptoms and lung resiliency, is really exciting, especially in, like, the larger realm of pharmacological agents, and what's happening even in that area. And so it's a really--I always say when, when we talk about innovation, like, this to me just really is at the the top of, like, what's so innovative in this microbiome space.

Rob Lutz 34:16
Yeah, and it's--I do applaud you guys for doing it the right way, because you're right. You could launch a supplement company tomorrow, put together a bunch of ingredients, make some quasi-claims, and get distribution, get it on the shelf, and sell a product, and probably make a lot of money. But to take the time to develop a product that you know is working, the actual product itself, in an area that we're not hearing a whole lot about. Right? I have not heard a lot about different products for for lung health. I'm guessing, with pollution and all the other things that are going on these days, most people could benefit from something like this.

Dr. C. Vivek Lal 34:50
Absolutely. You're totally right. Like, the specialized precision space, as we call it, we could launch 20 products, if we want to. Right? But we are targeting one or two specialized axises, the gut-X axis, the lung axis. And every year we launched, like, one or two very specialized products after rigor, after intentionally creating the product.

Rob Lutz 35:16
Yeah. Was there anything else that you guys wanted to talk about as far as microbiome and the lung, gut-lung axis? I know we talked about me going into some metabolic topics. I don't know if we'll have time. We may have to come back and do another one of these, because this was great. But anything else about the gut-lung axis that you guys wanted to mention?

Dr. C. Vivek Lal 35:36
I think we've covered a lot. And of course, we can--you know, I love talking about this. We can talk all day, all night, but we have hit the high points.

Rob Lutz 35:41
Yeah.

Kara Siedman, RDN 35:42
Well, and I'll just, and I'll add, just as from a biotech and development standpoint, you know, the rigor that we put behind the strains that we're using, obviously, in our lung probiotic has just launched now, our development of exactly what we were just mentioning, this targeted and precision therapy. And I think that's what's so exciting about the microbiome space is continuing to better understand these targeted functions. And so we've launched into focusing on postbiotics, and that's one of the products that we launched, which is our resM GLP-1 postbiotic, which--most people don't even know what postbiotics are. And I think this is truly the next generation of what we're going to see in the microbiome space. Postbiotics, we used to only think of them as the bioactive compounds, or the bioactive components, like butyrate. Many practitioners are used to using butyrate supplementation. I used it in my practice, especially with GI patients. But it's actually--the term has changed to be purposely heat-treated, or heat-inactivated, or dead probiotics that still actually contain and maintain targeted function. And so, one of my my previous roles, we used to call them ghostbiotics, right, which I think explains them perfectly, because they're not quite in the other world, not quite in this world, living in between, but still having an impact on everything around us. And I love that. And so we're really excited about our postbiotic, because postbiotics, it doesn't matter what's happening in your digestive tract. It doesn't matter if you've got something going on that's creating a lot of inflammation or your stomach acid, or what's going on in the environment. Like, it's really, really hot out, or you left that probiotic sitting outside in the 100 degree weather. They're very stable. And so we have a postbiotic that we're using, which is a heat-treated, that we've done a lot of preclinical development to really focus on the metabolic aspects, and we found that it supports the natural production of GLP-1, which obviously is big.

Rob Lutz 37:32
Yeah. That's great. Vivek, was there anything else that you wanted to share on that?

Rob Lutz 37:32
Right.

Kara Siedman, RDN 37:32
And everyone's talking about GLP-1, and I think it's really incredible what GLP-1 medications have done. It's really--given the popularity of it--has really just given increased awareness around our metabolic problem that we have in our country, and so to have natural metabolic support for people on whatever metabolic journey, whether it's prior or before or during, whatever the case is, your microbiome is still at the root of it. And so this is a postbiotic that targets natural GLP-1 production that we also combine with other bioactive, synergistic vitamins and herbs and minerals to enhance the metabolic benefits. And this is really kind of launching again, as Vivek mentioned, this gut-X axis. You know, what are these areas, these problems, these real-world issues that need natural solutions? Whether or not you're on a medication or whether or not you can't be, or--it doesn't matter. We still have to get to the root of it.

Dr. C. Vivek Lal 38:26
No, I think it's another episode.

Rob Lutz 38:29
I agree. I agree.

Dr. C. Vivek Lal 38:30
To enter the GLP-1 metabolic space. But what I'll end with is that there are several different chronic illnesses and chronic issues that could be addressed by the microbiome. It's just the tip of the iceberg. Right? And yes, we are one of the pioneers in many of these, but by no way do we claim that, you know, we are the only ones. There are several others moving in the space, and we welcome that. Right? Collectively, what we do need to encourage the industry is to move towards science.

Rob Lutz 39:02
Mm hm.

Dr. C. Vivek Lal 39:02
I think we've seen enough of snake oil out there in the market. There has to be a collective brainwash of the brainwash people, as I said. Right? That unless--making the consumers understand the importance of rigor, the importance of testing, the importance of science, and the long-term benefits. You could have a short-term benefit from something, and you can sell anything, you know, for that. But I think because consumer education is extremely important, and that only ResBiotic cannot do. Everyone in the industry will have to collectively join hands and do that.

Rob Lutz 39:40
Yeah. Now is there one pearl that you want to share with the audience, you know, one kind of last thought you want them to take away from our conversation today?

Kara Siedman, RDN 39:49
Yeah, I always love that, because I'm like, "Oh, my God! Do I have another 20 minutes? No." But I think as a practitioner, and especially practitioners in this functional-medicine space, and for many of us that are really starting to look outside of systems. Right? When we look at traditional medicine, it's you have your cardiologists, you have your neurologists, your neonatologists, and a lot of times no one's talking to each other. And I think that's where the microbiome becomes this central hub of an area that really links everything together. And as a practitioner, it's important for us to consider that. It's almost that third leg of the stool. Right? We think of genetics, we think of our environment, and the microbiome is that other piece. So when we're working with patients that have very complex conditions, that are dealing with multiple systems that are involved, I think the microbiome offers that anchor or, as I previously mentioned, that foundation. And that's where we then need to look to very targeted and precision solutions. You know, as a company that's creating those--and there's a lot of other supplements out there--we're not a one-size fits all. It's, how do you fit these things together so that you're putting together a personalized intervention? And I think that's--I challenge practitioners to do that now. I really challenge the space to look outside of just a brand, to say, "Okay, what's best for my patient? What's clinically validated? But how do I create this whole-person plan, really keeping in mind the microbiome as that centerpiece?"

Dr. C. Vivek Lal 41:09
Absolutely. Just for context, we have more than 10 microbial cells in the body compared to every human cell, so we are nothing but a bunch of bacteria. Right?

Kara Siedman, RDN 41:20
Or a hollow bion--

Rob Lutz 41:22
What'd she call me?

Kara Siedman, RDN 41:22
Can I use that as an excuse now? Oh, it's just my microbes, my mind, that's what--I really do want to coin a term for a company. My microbiome made me do it. Right? Can I, like, start doing that now?

Dr. C. Vivek Lal 41:26
It's another organ, essentially--think of the whole body--and which affects every other organ.

Kara Siedman, RDN 41:41
Yeah, right. I think I heard someone say it's the forgotten organ, which I think now, we actually more often hear it called an organ, so there's a lot of power there.

Rob Lutz 41:50
Yeah. Well, thank you both. This was fantastic. I really enjoyed it. I know our audience did as well. In the show notes, I'll have contact information for you guys, a link back to your company's website for some more information, and we do have the Microbiome Resource Center, with a lot of great content about gut-lung axis, as well. So thank you both so much, and I'll definitely have you back on. We've got a lot more to talk about. This is such an interesting topic for me. I really appreciate it. So thank you again.

Dr. C. Vivek Lal 42:16
Thank you, Rob.

Kara Siedman, RDN 42:18
Thank you, Rob.

Rob Lutz 42:19
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic, or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.