I’m a digestive health researcher working on IBD, IBS, and the gut microbiome. Ask me about all things gut health!

Why does your app collect location data?

Hi u/Zazenp!

The truth is that today we don't do much with location data. It really just allows us to know which country someone is in. This is important to us from a cybersecurity and privacy angle as we need to maintain regulated standards based on the geography of users. For this reason, our app is only available in the US and Canada.

Looking towards the future, we have included this capability in the app as a means of future proofing features we may want to integrate down the road. For example, many of the patients we have spoken to are interested in having their location tracked so they can identify how frequent travel impacts their symptoms. Another request we've had is using location data to help users find the closest bathroom to them. These might seem a bit random, but for those experiencing symptoms as a result of IBD or IBS, features like these can save a lot of headache and actually provide some immediate benefit.

Hope this answers your question :)

How many poops a day is too many poops?

This is a very common question!

So there actually isn't a specific clinical definition of frequent bowel movements. For a healthy individual a normal number of bowel movements can be anywhere from once every three days to three times daily. Anywhere within this range is considered normal.

That being said, the main thing to be aware of is when your personal pattern changes. For example if you are normally someone who 'goes' once a day, but over the course of a few weeks see your pattern become more or less frequent, this might be something to look into. However, unless you find yourself experiencing very loose stools, pain, or even blood in your stool, it's unlikely the change in pattern is due to an illness. Your lifestyle and diet are most likely to blame.

Is intermediate fasting (only eating every 16 hours) good for your gut/digestive track?

Very interesting question. In short, I've seen that intermittent fasting can help the gut microbiome by reducing the leakiness of the gut and regulating inflammation, which both have important roles for the microbiota. This is because of reduced meal frequency; if you're eating meals at a consistent time (in your 'normal eating phase') maintains your internal clock, which partly regulates your microbiota!

What is the best way to maintain optimal gut health?

It's such a complex topic that there is no single perfect way to go about this. It is super important to personalize the approach to gut health, because every person is different and their bodies will react differently! Some main things include eating whole foods (fresh produce, whole grains, nuts and seeds), getting regular exercise, maintaining a consistent and healthy sleep schedule, enjoying fermented foods (the gut microbiome loves this!), and taking care of your mental health (reduce stress, get the support you need for mental health disorders/issues, and practice mindfulness!). It all sounds a bit cliche, I know, but it's truly incredible how these simple things can promote gut health!

And on that note, Phyla provides personalized recommendations for optimizing intestinal health through the app that tracks symptoms, sleep, diet, etc and pairs it with microbiome testing to get a full picture of what's going on inside!

Do you think the credibility of your medical advice is limited by the fact that you're advertising your startup here?

I understand where you're coming from.

Although I myself am not a clinician, my team is composed of researchers such as myself, patients, and doctors. In addition we are developing clinical studies with hospitals in the US and Canada to validate much of the work we are doing. That being said, even today everything we do is done with validation in mind. The gut health community has been overwhelmed by far to many companies and products that make a lot of claims, but in reality have very little proof and end up being unable to make an impact on people's lives.

My team and I understand this and want to be a source of truth people can go to for advice and health tracking.

We definitely have plenty more validation and work to do in the coming years. but today we want to share what we're working on so we can get feedback and hear from people, such as those in this thread, so we can build a better digestive health solution for all.

If you ever want to chat more feel free to send me an email at [[email protected]](mailto:[email protected]) :)

I understand where you're coming from.

Although I myself am not a clinician, my team is composed of researchers such as myself, patients, and doctors. In addition we are developing clinical studies with hospitals in the US and Canada to validate much of the work we are doing. That being said, even today everything we do is done with validation in mind. The gut health community has been overwhelmed by far to many companies and products that make a lot of claims, but in reality have very little proof and end up being unable to make an impact on people's lives.

My team and I understand this and want to be a source of truth people can go to for advice and health tracking.

We definitely have plenty more validation and work to do in the coming years. but today we want to share what we're working on so we can get feedback and hear from people, such as those in this thread, so we can build a better digestive health solution for all.

If you ever want to chat more feel free to send me an email at [[email protected]](mailto:[email protected]) :)

Are there ways to regain tolerance to lactose once it is already lost? Does exposure therapy work in this case?

Great question. I'll share my understanding of the current literature on this topic below :)

In short, lactose intolerance can develop at any age. For some this can be caused be a medical condition, but for many it develops without any specific cause (as unsatisfying of an answer as it is).

That being said, many people with this intolerance are able to find a level of lactose-containing foods that they can consume without discomfort. So although there is currently no 'cure' for regaining total tolerance, there are some great guidelines on how to reintroduce lactose foods in a safe way. I will include some tips from the Cleveland Clinic below!

-Gradually add small amounts of food and drinks that contain lactose to determine your tolerance level. You may be able to tolerate up to 1/2 cup of milk or the equivalent with each meal.

-Drink milk in servings of one cup or less.

-Try hard cheeses that are low in lactose, like cheddar.

-Drink milk with a meal or with other foods.

-Try yogurt or Greek yogurt with active cultures. You may be able to digest yogurt better than milk. Your own tolerance may vary depending on the brand. Frozen yogurt may not be tolerated as well as yogurt.

-Substitute lactose-reduced dairy products and 100 percent lactose-free milk for regular dairy products. These products are located in the dairy section of most supermarkets.

-The lactase enzyme is also available in liquid, tablet or chewable form. No prescription is needed and it can help you tolerate foods containing lactose. Take the enzyme with the lactose-containing food. Lactase will help you digest the lactose so your body can absorb it. Some over-the-counter enzyme products that are available include Lactaid®, Lactrace®, Dairy Ease®, and Sure-Lac®.

-Many canned nutritional supplements (such as Ensure®, Boost®) are lactose-free. Product labels should be checked.

​

https://my.clevelandclinic.org/health/diseases/7317-lactose-intolerance

Do probiotic supplements work after you take antibiotics in terms of restoring the microbiome and how?
What are the top three things anyone can do to enhance their gut health?

What is one cool thing about the gut most people do not know?

1. That's such a great question, and a difficult one to answer. The benefit of probiotics in this case is still being debated and researched heavily. For example, C. difficile infection, there are a few types of probiotics (Lactobacillus Rhamnosus GG and Saccharomyces boulardii) emerging as potentially useful post-antibiotic treatment, but the evidence for this is not yet overwhelming enough. It also really depends on the person; what works for one may not be what someone else needs, because everyone's gut microbiome is a bit different. The general idea behind probiotics to restore the microbiome is that antibiotics are affecting the relative abundance and balance of gut bacteria, and that these supplements will reintroduce or promote the population of affected bacteria! Hope that helps.
2. I answered this earlier, but it's really standard! Eat whole foods (whole grains, fresh produce, nuts and seeds, etc), make sure you have a consistent and healthy sleep schedule, and get regular exercise! It's remarkable how much these things can help :)
3. Oh gosh, there's so much! Something random that I think most people wouldn't think about is that the colon doesn't feel pain with intense temperatures, because its pain metric is distension (which is why it hurts to be constipated or be passing a big bowel movement)

Where did you receive medical training?

Fair question. I tried to be transparent in my description, but it seems I could have done a better job.

I myself am a scientific researcher. My academic background is specifically in pharmacology research which focuses on understanding how drugs interact with the systems and mechanisms within our bodies. However, over the past few years my focus has transitioned to GI conditions and gaining a deeper understanding of the microbiome.

When it comes to Phyla and the rest of my team. We are a group of patients, machine learning/microbiome researchers, and doctors/specialists. This is extremely important to us as it helps us make sure we are addressing the needs of those we intend to serve (the GI community) and doing so in a way that respects medical practice and holds a rigorous standard of validation.

We also work with hospitals and patient focus groups in the US and Canada as well as research collaborators across the globe.

If you're curious about some of the research we do, I'll include a link to a pre-print we recently submitted for our work. This is just a placeholder as our main publication is reviewed by a peer-reviewed journal.

Hope this answers your question!

https://www.biorxiv.org/content/10.1101/2021.05.03.442488v1

What's the latest in FODMAP?

FODMAPs are quite an interesting topic. They are tiny indigestible carbs that lead to fermentation and processing in your intestines, which can increase distension, leading to bloating, cramps, and flatulence. That's why the low-FODMAP diet has been supported for people with IBS; these individuals tend to already have an
overly sensitive gut and possibly even more of these bacteria that eat away at FODMAPs and lead to more of these unpleasant symptoms. Reducing the intake of FODMAPs has been shown to relieve symptoms in 75% of IBS participants, which is quite intriguing. More work certainly needs to be done on this, and still it isn't a cure-all, so it's important to be mindful of that. Another thing that is difficult about this diet is that it takes a lot of time and patience, because you have to personalize it to your needs and food reactions, but if it works, it is a great option. I've actually recently written a blog post about the low-FODMAP diet if you'd like to consult that :) Thanks!

I don't know if this is at all related to your work but I thought I'd ask. Why do some of us get stomach aches in nervous situations? I remember getting them bad when I was on these situations and have dealt with stomach problems since being a child. Can this lead to stomach problems in later life?

Great question! I actually experience this too. It has a lot to do with the brain-gut axis, which is like a two-way highway that connects your mind to your gastrointestinal tract and microbiome. It is an incredibly complex relationship that we are still trying to understand better, but mental health and stress certainly impact the gut. When you're nervous, your body essentially goes on alert, and alters the activity of your organs, including your stomach and intestines. That's actually part of the problem with IBS; we think it's a disruption in the normal functioning of the brain-gut axis that can be improved through mindfulness and reducing stress (easier said than done for sure!). I would say that it can lead to stomach problems later in life because your body becomes accustomed to this unhealthy response to nervousness and anxiety, which is why it is incredibly vital to manage your mental health and stay grounded in the present moment in order to keep your nerves and gut activity in check!

What’s the relation between brain fog and gut health? And how can one fix it?

I've recently read an interesting study on this. They found that brain fog and depressive-like symptoms are related to inflammation. How it works (in theory) is that the gut lining is more permeable (known as leaky gut), meaning it can be penetrated and compromised more easily, which can expose the immune system 'around' the intestines to be exposed to triggers such as bacteria and dietary elements. This leads to more immune system activation--> more inflammation--> more symptoms like brain fog and other "sickness behaviour". To fix this, their suggestion was to check for leaky gut through antibody tests (IgM and IgA in case you're curious) and then treat for leaky gut accordingly, which could involve immune modulators including medication and dietary changes!

Is kombucha actually good for gut health?

Like many fermented products, kombucha is great for the gut because it promotes healthy bacteria and intestinal cells. This supports both healthy digestion and controlled immune activity because of all the probiotics (live bacteria) in the beverage. It's also full of antioxidants to encourage these benefits. There's still tons of research to be done on this topic, but the nutrients and components of kombucha such as polyphenols, acetic acid, and more, can help protect against cancer and fight the bad microorganisms in your gut that cause problems with digestion and other gastrointestinal processes. Overall, fermented products such as kombucha, kefir, and sourdough are commonly recommended for people looking to promote or maintain healthy gut activity!

An ex of mine once told me that couples end up having the same gut microbiome after spending a good amount of time together. Is there truth to this?

This is a fun one!

u/Specific_Ingenuity84 said it well that 'you'd expect your microbiomes to become more similar when you live together.'

The main distinction I would make is that the gut microbiome is not nearly as impacted as the skin microbiome. Which again makes sense because you skin is in more direct contact with you environment.

There was a study a few years back where researchers in Canada were able to identify if people were couples with an 86% accuracy by analyzing their skin microbiomes. However there were some interesting findings related to this that I will share below.

https://www.sciencedaily.com/releases/2017/07/170719113300.htm

orginal study - https://journals.asm.org/doi/10.1128/mSystems.00043-17

"Neufeld says the study is the first to identify regions of skin with the most similar microbiomes between partners. They found the strongest similarities on partners' feet.

"In hindsight, it makes sense," says Neufeld. "You shower and walk on the same floor barefoot. This process likely serves as a form of microbial exchange with your partner, and also with your home itself." As a result, partners end up with the same mix.

The analyses revealed stronger correlations in some sites than in others. For example, microbial communities on the inner thigh were more similar among people of the same biological sex than between cohabiting partners. Computer algorithms could differentiate between men and women with 100 percent accuracy by analyzing inner thigh samples alone, suggesting that a person's biological sex can be determined based on that region, but not others."

So as you can see while it's interesting to say that couples have similar microbiomes, the true reason for this might simply be due to the environments these couples find themselves in.

Thanks for you question :)

What affect does diabetes have on digestive health?

That is quite the question! Diabetes is of course a very complex condition that scientists and doctors are still working hard at understanding fully. One cool thing that has been coming up quite a bit in the literature is the link between type 2 diabetes mellitus and gut flora, so I'll focus on that, but there is for sure tons more to say on this topic.

There's a relationship between an imbalanced gut microbiota and diabetes, which can affect metabolism, compromise the intestinal barrier (risks causing inappropriate immune activity). There's some research that shows that supplementing with probiotics (which promote a healthy microbiome) can improve fasting blood glucose and glycosylated hemoglobin levels for diabetes patients, which can help keep symptoms in check. This is a very brief response because the complicated nature of this interaction makes it difficult to get into the details without causing confusion! Hope this provided some insight :)

Does your gut bacteria "flush" and reset when you travel to a new region in the world?

How can Kefir help the body/mind (effectively)?

1. Your gut microbiome is incredibly dynamic and influenced by environment, diet, genetics, and immune function, so there is certainly an impact that travel poses (think travelers' diarrhea!), but to say it gets flushed is maybe not the right term. A lot of your gut microbiome is already dictated at birth and largely set by the end of your toddler years, and while it can vary from this with infections and other things, traveling may introduce new bacteria or impact the balance of your microbiota, but the change of location shouldn't wipe and reset this system!
2. A cool paper published last year asked this exact question! Check it out if you're interested :) Essentially, they found that kefir promotes healthy behaviour in the 'microbiota-gut-brain axis' (an important bidirectional relationship) because of the fermented bacteria present in the drink. It helped change the composition and activity of the gut microbiome to improve immune system and behavioural activity (i.e mental health and stress responses), which is pretty interesting. This is probably because of changes in reward-seeking behaviour, serotonin signalling (known link to depression), and much more. Hope that made sense!

How long does it take to improve gut health after changing my eating habits? All of a sudden I've gotten some gut issues and feel like i need to make a change now.

It really depends on the changes and how you go about them. I always encourage people to seek support and guidance from a dietitian in order to ensure that they are receiving adequate nutrition and safely and responsibly making dietary changes, but I also recognize that this isn't always feasible or accessible for people. There are a number of factors that can affect gut health in a really complex way, and the amount of time (at what frequency and amount) that you've been consuming a type of food or compound like caffeine also has an impact on how you rebound from a change in diet. I'm sorry that's kind of a general answer, but diet and gut health is so personal and it is difficult to provide an accurate response for everyone!

Are there clear pros and cons to maintaining and keeping the same diet for your entire life vs. mixing up your gut biome with different foods?

I guess it would depend on how restrictive said diet is! If you are consuming a variety of fruits and vegetables, whole grains, legumes, nuts, seeds, and so on, you've probably fostered healthy habits and eating patterns, but if there isn't enough variety to what you are having every day/week, you could be deficient in key nutrients without realizing. If you're having the exact same meals/snacks each day, chances are you don't have enough 'dietary diversity' to promote a rich, diverse composition of microbiota. So I wouldn't necessarily say there are clear pros and cons, but more that it is important to consider how variable the 'diet' is, which is certainly a benefit of mixing it up every once in a while to introduce new types of foods that can support gut health. Of course, main things are staying away from sugar-sweetened beverages and other highly-processed foods.

Have you heard of any research on gut health and former soldiers exposed to burn pits? Especially acid reflux or gastritis?

I'll be honest, I haven't really looked into burn pits until you mentioned it, so thanks for giving me the chance to investigate something new! Air pollution is a known trigger for acid reflux, and burn pits definitely take the fact that poor air quality is bad for the gastrointestinal tract to the extreme.

I think more specific research should be done on this, but toxic pollutants like what comes out in high amounts from burn pits certainly impact gut health, including gastroesophageal reflux disease and gastritis. Toxic gases can affect movement of the stomach and whatever goes through it.

What’s best for normal bowl movements in elderly adults over 85? Probiotics, stool softeners and linzess don’t seem to help. Can you guide me in the right direction?

I cannot offer anything concrete, but I would encourage you to reevaluate your diet and consult a registered dietitian possible! There is evidence that resistance training (paired with bifidobacteria probiotic supplementation) can improve bowel habits (this is the study), if that guides you in the right direction, but this is definitely a question for your medical team :)

Is there a link between duodenal issues and panic/anxiety? I've had recurrent serious duodenal issues most of my life and every damn time it comes on, panic and anxiety at sunset comes with it

Absolutely. I see u/Specific_Ingenuity84 already provided a brief response that touches on the brain-gut axis, which really is the main link here! It's a two-way relationship, where stress, anxiety, panic, etc. can induce symptoms and vice versa (worrying about experiencing symptoms can actually bring them on, essentially). It's a very complex relationship with lots of 'moving parts', which is why it is so important to find ways to manage that anxiety. Mindfulness-based strategies are one common way to deal with an abnormal mind-gut relationship because this can help you come to terms with your feelings, emotions, and experiences, and process them in a healthy, non-jugdemental way!

I just got diagnosed with Crohns at the ripe old age of 27 a couple weeks ago. I'm still learning a bunch about it obviously.

Do you have an homeopathic treatments I can do like eat certain foods or avoid other foods or whatever that will help me reduce inflammation?

Please don't tell me to avoid peaches. I think I'd choose diarrhea.

Hi u/Alpha-Trion

Happy to guide you towards some resources. I have friends and family with Crohn's and know how difficult it can be right after a diagnosis. My colleague always shares the story of how after his initial diagnosis with Crohn's he was pretty much just given a few pamphlets, medication, and told to come back in a few months...which I think we can all agree is far from ideal.

First things first, homeopathy. Homeopathy is definitely a controversial subject considering it lives in the realm of pseudoscience and alternative therapy. In short, homeopathic treatments have been around since the late 1700s and include the use of highly diluted 'natural' substances to treat various symptoms people might experience. The other detail
to note is that homeopathic treatments are not regulated by bodies like the FDA and lack evidence of their benefit when put through the gold standard for validation, randomized controlled studies. What this means is that homeopathy has not been proven to provide health benefits in a statistically significant manner when compared to placebo. So while they most likely won't do you any harm themselves, they also won't provide any benefit, which is where the potential danger arises. The main issue with homeopathy or any 'natural' products becomes apparent when they are used as a substitute for care/medication and accompanied by the avoidance or disregard for professional care. So just be mindful of these details in your decision process.

In terms of products that do have some evidence behind them, Omega-3 oils have been shown to lower inflammation and be beneficial to the intestinal microbiota. Early research shows that omega-3 fatty acids might be beneficial in maintaining remission in CD however these findings are limited by variability in trials to date. Additionally, curcumin supplements have been shown to be effective in helping with UC alongside standard medical treatments. However, always speak with your doctor first prior to making any major adjustments.

I'll leave some excellent resources below to aid in your own personal research related to IBD and diet.

https://www.crohnscolitisfoundation.org/diet-and-nutrition/special-ibd-diets

https://www.health.harvard.edu/blog/i-have-inflammatory-bowel-disease-ibd-what-should-i-eat-2020051819799

As a side note our medical team has approved and included these resources and plenty more in our free app, so be sure to check it out if you're curious to learn more. Hope it helps :)