I am thrilled to have the amazing Kiran Krishnan joining me on the podcast today.
Kiran is a research microbiologist and health and wellness expert who aims to make complex information understandable for everyone. He has founded several successful health and supplement companies over the last 20 years, including Microbiome Labs, the preeminent microbiome therapeutics-focused brand amongst healthcare professionals. Kiran has also conducted many research studies and published chapters in scientific textbooks. He has global patents and has become a sought-after speaker on human health and the microbiome.
In our discussion, we dive into leaky gut, its contributing factors, and the roles of endotoxins and lipopolysaccharides. We clarify postprandial endotoxemia, exploring how perimenopause and menopause affect the microbiome and the impact of oral contraceptives and synthetic hormones. We highlight common symptoms of gastrointestinal issues, including problems associated with bloating, and explain how the immune system- innate and adaptive, impacts gut health. We also discuss the significance of keystone species like akkermansia, the importance of diversity, the role of stool testing, and the value of fiber, touching on the polarizing nature of dietary dogma and improving gut health through supplementation and lifestyle changes.
This conversation is the first in a series on the gut microbiome, and I am confident you will enjoy it.
IN THIS EPISODE YOU WILL LEARN:
Why leaky gut has specific significance for women in perimenopause and menopause
Why it is essential to understand and address a leaky gut
How intestinal permeability lies at the root of most chronic diseases
The factors that contribute to a leaky gut
What postprandial endotoxemia is
The symptoms of a leaky gut
The difference between innate and adaptive immune responses
How chronic conditions like diabetes and obesity impact the immune system
The role of the microbiome in disease susceptibility
Bacterial that are beneficial for gut health
Why it is essential to have a diverse diet comprised of whole foods
Supplements and lifestyle practices that support gut health
Bio:
Kiran is a research microbiologist and a health and wellness expert who aims to make complex information understandable to all. He has founded a number of successful health and supplement companies over the last 20 years including co-founding and leading Microbiome Labs, the preeminent, microbiome therapeutics-focused brand among healthcare professionals. He is currently a co-founder and partner in 3other companies that aim to revolutionize wellness care. He has conducted and published several research studies in scientific journals, has published chapters in scientific textbooks/reference books, has global patents, and is a sought-after speaker on human health and the microbiome
“Intestinal permeability is the root cause of most chronic diseases.”
-Kiran Krishnan
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Connect with Kiran Krishnan
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with the amazing, Kiran Krishnan. He's a research microbiologist, health and wellness expert and he aims to make complex information understandable to all. He has founded a number of successful health and supplement companies over the last 20 years, including co-founding and leading Microbiome Labs, the preeminent microbiome therapeutics focused brand amongst healthcare professionals.
[00:00:54] He has conducted several research studies, published chapters in scientific textbooks, has global patents and is a sought-after speaker on human health and the microbiome. With good reason, I was delighted to bring him on the podcast. We spoke at length about leaky gut, what contributes to leaky gut, the role of endotoxins and lipopolysaccharides, what is postprandial endotoxemia, the impact of perimenopause and menopause on the microbiome, the impact of oral contraceptives as well as synthetic hormones, the most common symptoms that point to gastrointestinal issues, why bloating is so problematic, the impact of the immune system, including innate and adaptive immunity, the importance of keystone species and diversity, including Akkermansia, the role of stool testing, why fiber is truly important and why dietary dogma is polarizing and lastly, how to improve gut health, including specific supplements and lifestyle? This is the first of a series on the gut microbiome. I know you will love this conversation as much as I did recording it.
[00:02:07] I would love to really start our conversation today around the significance of leaky gut. I think that traditional allopathic medicine in many ways doesn't acknowledge that this happens.
Kiran Krishnan: [00:02:18] Yeah.
Cynthia Thurlow: [00:02:19] But let's start talking about why this is so significant, especially for women that are in these transitional periods in their lives of perimenopause and menopause.
Kiran Krishnan: [00:02:27] Yeah, absolutely. So, there's a few different aspects of this to think about-- Okay, so leaky gut is really-- to explain it to people, if they're not familiar, it's really intestinal permeability. What does that actually mean? Well, the intestines are a really interesting dynamic barrier. Meaning, that they are supposed to be selectively permeable, because there's lots of things that we want to get through, food items, for example, nutrition and so on. But then there's lots of things that we're constantly exposed to that we don't want to allow through, like toxins and microbes and so on. And of course, we have a lot of microbes in the gut lining itself. So, that dynamic capability of the intestines to allow certain things through and not allow other things through is a really tightly controlled mechanism.
[00:03:11] As it turns out, that mechanism is largely influenced by the microbes that live in the region. That's one of those amazing examples of, what we call, symbiogenesis, which is the development of a symbiotic or mutualistic benefit between different organisms, humans being one of them, and bacteria, where they function in a favorable manner to help the whole system.
[00:03:37] So, there are bacteria in the region that control the dynamic function of the intestinal lining and its permeability. If those microbes start to become disarrayed, let's say you've had courses of antibiotics, you're eating a lot of processed foods, you're heavily stressed, you're not exercising, you've put on excess weight, all of those things that can impact the microbiome in a significant way, then you start losing the selectivity and the dynamic component of the intestinal barrier. So, now the barriers may be still allowing through some of the things it's supposed to, but it's also allowing through a lot of things it's not supposed to, including toxins that are being produced in the lining of the gut.
[00:04:23] And toxins, it's a dirty word. People use it quite a bit for almost everything. But in this case, it's really well understood and profoundly defined as endotoxin. Meaning, there are toxins that are produced by microbes in the lining of your gut. The microbes that make up almost 50% of the microbes that exist there, these endotoxins, and they're called endo because they're produced from with, then allowed to leak through when you lose a dynamic component.
[00:04:53] So, there's a few different effects of this. Number one, the fact that the gut became leaky means that your microbiome is in disarray. That means you've got overgrowth of things that shouldn't be overrepresented, you've got low levels of beneficial bacteria, which means that not only is the dynamic permeability component of it compromised, but so is the other functions of the microbiome. So, in the case of perimenopause, hormone balance. Or, at any age, really for women, once you start producing sex hormones at viable levels, estrogen recycling, for example, is heavily influenced by the microbiome. You can easily become estrogen dominant or deficient in estrogen, estradiol, especially if your gut microbiome is dysfunctional.
[00:05:42] Testosterone levels are also implicated by the microbiome. Progesterone levels are influenced heavily by the microbiome. And then, you've got all whole slew of metabolic hormones, like GLP-1, and PYY, and all these things that impact-- satiety and weight gain and how much food you're eating and energy homeostasis in the system. So, all of these things are going out of sorts while your gut is leaky.
[00:06:09] Now, the consequence of the gut being leaky is that you end up with chronic low-grade inflammation, because those endotoxins that leak through end up in circulation and your immune system sees that as almost like a bacterial invasion. They use the presence of the endotoxin as a way of identifying the potential for sepsis or bacteremia. So, then your immune system goes haywire because it goes, "Oh, my God, we've got trillions of bacteria that are going to flow through into the blood system," which can make you very sick and die within 48 hours.
[00:06:44] So, the immune system is heavily geared towards sensing for risks of bacteremia. One of the ways it does that is through measuring this endotoxin that migrates through. And so, now your immune system's going haywire, so a lot of the other systems I talked about are getting dysfunctional and your immune system is going haywire, which means you have chronic low-grade inflammation.
[00:07:07] Chronic low-grade inflammation throughout the body becomes the foundation for chronic disease. The vast majority of chronic diseases. So, if we look at things like metabolic disease, or diabetes, cardiovascular disease, obesity, immune dysfunctions like autoimmune conditions, lupus, eczema, psoriasis, thyroiditis and so on, all of those conditions have an underlying effect or have an underlying driver in chronic low-grade inflammation. Even brain related disorders. So, if you think about Alzheimer's, Parkinson's, dementia, anxiety, depression, all of these are driven in part by chronic low-grade inflammation.
[00:07:49] So, why leaky gut is so important is because it both signals that your microbiome is in disarray. So, all the important functions of the microbiome are no longer functioning the way they should. And B, because it also means that you're going to end up with chronic low-grade inflammation, which then becomes the foundation of most chronic diseases.
[00:08:10] This is why in 2015, there was a publication in the Frontiers of Immunology, where the researchers did a meta-analysis, which means that they studied a lot of studies on this topic, and they concluded that intestinal permeability-- and in this case, they attributed intestinal permeability to chronic stress. We could talk about how stress causes intestinal permeability. But intestinal permeability and the resulting chronic low-grade inflammation was the number one cause of mortality and morbidity worldwide. It's the number one killer. Why is it the number one killer? Because it's at the root cause of most chronic diseases. So, we cannot underscore how important it is to understand and deal with leaky gut.
Cynthia Thurlow: [00:08:56] It's such a beautiful explanation. I think for people that are listening, there can be a lot of contributors. You've identified some of them. I think a great deal about the opportunistic things that happen-- I'm thinking about you-- We think of food poisoning as not being a big deal.
Kiran Krishnan: [00:09:14] Mm-hmm.
Cynthia Thurlow: [00:09:14] I'm one of those people that my husband jokingly says, "If it had been 100,000 years ago, you would have died off long ago," because I seem to be one of those people that's a little bit more susceptible. It's not at all surprising, because I've had a couple autoimmune conditions, so we're constantly working on gut health.
[00:09:30] When you're thinking about the biggest drivers, you mentioned stress. I'm sure we'll probably touch on levels of exercise, life stages. Where do oral contraceptives fall in the interplay with the net impact on leaky gut, vis à vis the microbiome? Is there any research lending itself? Because we do still have listeners that are on oral contraceptives. They're not yet menopausal, but we're always trying to shed some perspectives, different lights on what these things are doing based on research on our own health.
Kiran Krishnan: [00:10:02] Yeah. So, oral contraceptives can have a very significant impact on the microbiome for a couple reasons. Number one is that hormones are a food source for bacteria. Majority of hormones are dumped into the gut at some point. There are microbes that metabolize them. As part of that metabolic process, they recycle the hormone, or they actually create regulatory mechanisms that help control the release of the hormones. And so, when you unusually alter the amount of certain hormones in your system, it will have a direct impact on your gut microbiome.
[00:10:40] So, we do know that. We do know that birth control pills can create significant dysbiosis in women. It's the same way in which menopause creates dysbiosis in women. So, there's a reason why women tend to have-- If you have a balanced hormonal system, you tend to have protection against things like cardiovascular disease, osteoporosis, some of the things that men have a much higher risk for up to a certain age. But then, once women hit menopausal and then they become postmenopausal, their risks for osteoporosis and cardiovascular disease and all go way up. Well, why is that? Well, that's because of the shift in the cycling of hormones in the system.
[00:11:21] One of the results of the changes in hormone levels is that you lose diversity in the gut microbiome. Your gut becomes more leaky, which leads to more endotoxemia, which is that description of chronic low-grade inflammation. So, anytime you alter hormone function or hormone cycling in the body using synthetic alternatives and so on, you can absolutely disrupt the gut microbiome. So, that's one way.
[00:11:47] The second way is, as a secondary effect to things like weight gain or secondary effect to things like anxiety and chronic stress. So, depending on the oral contraceptive that you're on, it can create a side effect of having more anxiety and so on, that stress can create more dysbiosis in the gut when stress is one of the most potent dysbiotic agents in the gut So, absolutely.
[00:12:15] People will often ask me, "Does this impact the microbiome, or does that impact the microbiome?" One of the things I want people to understand is that it's easy to think about the answer if you think about how natural that substance or behavior or therapy is and how your system functions. Because keep in mind that the microbes in our system evolve with us. So, they evolve to learn and work within our functionality. The balance that the microbes strike is driven in part by how our systems function, our cycles, our circadian rhythms, our dietary habits, and all of those things. The microbes achieve a certain degree of balance and resilience based on our natural systems.
[00:13:01] Anytime we alter those natural systems, like we don't sleep enough, or too stressed, or we're eating too much of the wrong thing or we're not exercising, we're not getting any movement, all of these things that alter the normal, healthy function of the human system creates dysbiosis and alterations in the microbiome, because the microbiome has co-evolved with our normal systems. So, that becomes an easy way for people to answer that question for themselves is, "What I'm doing, how my ancestors did it, how we evolved, because that's how my microbiome evolved to function within my system." And if it's not, then you're likely causing an alteration in your ecosystem, and that alteration will make all kinds of problems much worse.
Cynthia Thurlow: [00:13:47] Well, and I think for so many people, because they cannot see the microbiome like they can see their arm, they can see their hand, it seems much less tangible. And yet, what you're really speaking to is that any choices that we're making really do have a positive or a negative net impact on the gut microbiome.
Kiran Krishnan: [00:14:03] Yeah.
Cynthia Thurlow: [00:14:04] One thing that I thought was interesting as I was preparing for this discussion with you today, we talked about this endotoxin, and so we're talking about lipopolysaccharides. What's interesting is we know that the exposure to these endotoxins in and of themselves can impact healthy neurotransmitters, and can impact mood and anxiety and depression, but also can put us at risk for things like dementia, Alzheimer's.
[00:14:30] Now, I know my listeners, in particular, are very, very proactive about maintaining good cognition. As we were making these transitions from perimenopause and menopause, the hormone conversation is so important. When we're looking at the gut microbiome, when we're looking at the net impact of these endotoxins and lipopolysaccharides, which is just one component of these endotoxins, how do you like to think about this? When we're talking about whether it's a meal where we were exposed and we developed food poisoning or developed this postprandial endotoxemia, how do you like to think about it? How do you like to describe it, so that it makes it a little bit more accessible for people to understand?
Kiran Krishnan: [00:15:10] Yeah. So, the key to that is in the term that you just described. It's called postprandial endotoxemia for a reason. Postprandial, for people who aren't familiar, means after a meal. So, postprandial endotoxemia basically describes what tends to happen in your system after you eat a meal.
[00:15:30] Now, if your gut is not resilient, it's dysbiotic, it's leaky, the lining of your gut is dismantled and leaky, then what tends to happen is, every time you eat a meal, you get a massive rise in these endotoxins in circulation. They can end up in all parts of the body. They can end up in your heart, they can end up in your joints, in your brain and so on. And they often do end up in most of those regions.
[00:15:53] So, if you think about a tsunami of inflammation that occurs in your system after every meal, and it doesn't matter as much what the meal looks like-- Yes, more unhealthy meals will create a higher amount of endotoxins, but even healthy meals will create endotoxins just as a result of your gut being dysfunctional. You get this massive tsunami that goes to all different parts of your body. It's very pervasive, including deep recesses of the brain, and it creates inflammation and the inflammation creates damage to those tissues.
[00:16:28] So, every time you eat a meal, you're going through a sepsis, because a mechanism of action is exactly the same as what happens when people become septic. It's like a mini sepsis in your body. And if that continues to happen in your brain day after day, meal after meal, then you end up with enough damage to your brain where your body can't fix the damage overnight when you're resting, and then you start to see cognitive decline. You start to see function in the brain reduce.
[00:16:56] If it starts to happen in the enteric nervous system and then up the vagus nerve and so on, then you have the risk of issues like Parkinson's or chronic constipation. Your bowels just stop moving. It can happen in your skin, it can create acne and it can create eczema rosacea. It can happen in your joints. This is a big driver of things like osteoarthritis and why those conditions are very common. It can happen in your thyroid and create thyroiditis in your heart and create a pericardium, inflammation.
[00:17:26] So, this little tsunami of endotoxins ends up in all different parts of your body and creates inflammatory damage. That has a cumulative effect, meal after meal after meal. You can't stop eating food. That's not a corrective measure. So, you do have to go back to figuring out how to reseal the gut and stop this influx of endotoxins after each meal.
[00:17:50] When we did our first study on postprandial endotoxemia, and we published it in 2017, what we saw-- and at least the researchers that were doing this model before we did our study, what they saw was that in people with severe leaky gut and dysbiosis, they would give them a meal, and then they could measure the amount of inflammation in these individuals' bodies, two to three hours after the meal. In some cases, it took those individuals upwards of two weeks to normalize the inflammation from a single meal.
[00:18:21] So, imagine every meal makes you sick, effectively from a metabolic and immunological standpoint in your body. You may not necessarily feel it at the time, but know that there's all kinds of damage happening throughout the system. Your system is being bombarded by it. So that's, to me, the primary way to think about it and to visualize it, you’re losing your resilience, your ability to be resilient against these negative effects.
Cynthia Thurlow: [00:18:50] It's so interesting to me, because I think that the more I understand about small intestinal hyperpermeability, which is really what we're speaking to, the more humbled I am that we plod along in life, in many instances, not even realize that we're dealing with these issues. Our bodies do such a beautiful job of trying to do some degree of self-repair.
[00:19:11] In your clinical experience, what are the most common symptoms someone will experience if they are having a fairly new issue related to this permeability? Is it bloating, is it nausea, is it dyspepsia? What are some of the most common things that you're seeing reported, self-reported by patients, that give them clues that this maybe becoming problematic? They may not be yet diagnosed with metabolic disease, etc., but little clues that maybe their bodies are trying to identify that there's something going on that's a problem.
Kiran Krishnan: [00:19:47] Yeah, any primary GI symptom. So, even things as simple as indigestion, where frequently you experience stasis of the bowel. Meaning, it's not really moving, you feel like a big heavy lump there after you've eaten, you're not getting proper gastric emptying, you're not experiencing regular bowel movements that are fairly well formed. If you do have regular bowel movements, you've got all kinds of consistencies with your movement. Sometimes it's really watery, sometimes it's well formed, sometimes it's constipated and you're struggling to get it out. So, if you're going through those changes on a regular basis, then you know that something's disrupted there.
[00:20:28] Bloating, gas absolutely is an early-stage indicator of dysbiosis happening. But also things that you may not directly connect to the gut, like for example, sleeping issues or stress issues. If you feel like you're waking up and you're stressed out, or midday, you've got this brain fog going on and you're like, "Ah." You can't put thoughts together, you're getting really sleepy, but then at night, you have a hard time sleeping. All these things are indicative of dysbiosis happening in the gut that leads to leaky gut.
[00:21:00] Metabolic issues, if you find yourself putting on weight more. Metabolic issues are a great sign of loss of diversity, keystone species and then, thereby leaky gut, that's starting to happen. And then, other issues are like immunological issues. So, if you have allergies or asthma or sensitivities to things, if you develop rashes, if you have acne, if you get dermatitis or some sort of eczema in different parts of your body, especially in response to eating food. If you have intolerances to lots of different foods. If you used to say, "Well, I used to be able to eat this, I can't now." Anything that indicates a loss of tolerance is a part of leaky gut.
[00:21:42] When we did our first study, what was so interesting about it, if you really deep dive into what you're feeling, what you're experiencing, a lot of things that you might just chalk off to age or, "Ah, I just haven't been working out, so I feel more like this," or whatever it's going on in your life, if you really dig deeper into it, lots of them are probably driven by this early onset of leaky gut, or at least are driving early onset of leaky gut.
[00:22:11] But when we did our first study, the average age individual in our leaky gut study was-- These were college students with the most part. It was around 23, 24 years old. We were doing a study on healthy normals. There's such a thing as a healthy, normal college kid, but by FDA standards, they're healthy normal. Meaning, that they have no diagnosed chronic diseases, they're not on any medication, they have normal body weight, all of that stuff. You would consider them, physically, at least, to be in the prime of their lives if you look at them. 55% of them had profound leaky gut. Meaning, a single meal would cause just the most massive increase inflammation throughout their body. They wouldn't necessarily feel it, because their systems can kind of repair and rejuvenate that a little bit. But as you get older, you keep experiencing that, you will feel the difference.
[00:23:00] It even comes down to areas like your mitochondria. It can really affect how your cells at a cellular level functions, and thereby create things like lethargy and being tired all the time and so on so. So, that's a lot of things we just described. But believe it or not, and this is without hyperbole, those things are all signs of a dysbiotic gut and likely early stages of leaky gut.
[00:23:27] Just to explain for people what that looks like, we mentioned the small intestine, that's where a lot of this hyper permeability exists. The small intestines are really long organ. We've got like almost 20ft of small intestine. So, you can have about six, seven inches of it being leaky, or you could have 15ft of it being leaky. It progresses from that few inches onto the vast majority of your small intestine being leaky, and there's very different feelings throughout that process. The good news is you can recover it and repair it. Your intestines are designed to rebuild, and recover and repair if you make the right moves.
Cynthia Thurlow: [00:24:04] It's so interesting to me that the 20 somethings are the ones that did have evidence of leaky gut but are less symptomatic, because their bodies are younger, more able to rebound. I just dropped our oldest child off at college. Based on what he shared with us for his first week of college, there's a lot that goes on. They're not necessarily getting good night sleep, they may not be eating the right foods, they may be indulging some things like occasional alcohol use, which we know have a profound net impact on the gut microbiome versus someone north of 35 or 40, where it's more common to see some degree of mitochondrial dysfunction, it's much more common to perhaps be more symptomatic.
[00:24:43] Now, before we pivot away from the bloating piece, I do want to talk a little bit more about this, because in many ways, differentiating as a clinician trying to differentiate bloating is as ambiguous sometimes as a patient telling you they're nauseous. It's like that can be from a myriad of different reasons. But when you're looking at the research trying to differentiate, you alluded to sometimes it can be related to an immune response, it can be related to underlying food sensitivities.
[00:25:10] But when we're talking about bloating in terms of the fermentation process, that should not be going on but is, obviously, we do expect some degree of fermentation in the large intestine, not in the small intestine. When do you feel like bloating becomes more problematic? Is it the individual that says, "I eat a meal and two hours later, I'm bloated,” or is that the individual that says, "Anything I eat, I become bloated. Anything I drink, that's my de facto go to symptom that I can't seem to get rid of"?
Kiran Krishnan: [00:25:41] Yeah. So, the individual that bloats no matter what they eat or drink-- I've met individuals that bloat from a glass of water. That indicates a very different thing to me than the fermentation issue. But the fermentation issue probably preceded this result. So, to me, this is what is happening in these individuals. The fermentation issue means that the small intestine, where you really shouldn't have any fermentation happening, you're supposed to break down the macronutrients that are coming in through food and then absorb the things that the body's designed to absorb and then the rest of it goes down to the large intestine for actual fermentation. You don't really have fermentive bacteria in a natural, healthy small intestine.
[00:26:26] In fact, you have very low levels of bacteria in the small intestine. You have less bacteria in the small intestine from a concentration perspective than you do on your skin even. So, the small intestine is not designed to have a huge amount of bacteria, because when you do have a large amount of bacteria in any given space, they're going to ferment things. And so, it's designed and as many checks and balances, like bile acids and antimicrobials that are secreted by the lining and pancreatic enzymes, HCL, all of these things that prevent an overgrowth of bacteria.
[00:27:00] So, if you start to get bloating about two hours after you eat food, it means that you're eating food, it's probably being dealt with in the right way in the mouth, maybe dealt in the right way in the stomach, but then once it drops into the small intestine, you've got too much bacteria there, so it starts to do the fermentation and then you feel the bloat and the distention and the discomfort.
[00:27:23] The small intestine is not designed to expand as much as a large intestine is. It doesn't have as thick of a lining as a large intestine. So, you will feel a lot of discomfort from the bloating. But that has to be something that takes a couple hours after eating, because it takes that much time for the food to even get to the small intestine and fermentation to kick off. But if that is happening all the time, what happens is it damages the lining of the small intestine, and it creates more and more dysbiosis and more overgrowth of microbes.
[00:27:53] So now, when you have this situation where you have an overgrowth of microbes, often called SIBO, and you have dysbiosis in the small intestine and the small intestine is leaky, you've got an overtly active immune system in the lining of the small intestine. The reason for that is the immune system is constantly waiting for things to rush through, so it can try to protect the host, which means that anything that now touches the digestive tract, starting in the mouth, which is the first part of the digestive tract, and it sends signals all the way down the moment something's in the mouth. Anything that touches the digestive tract recruits immune cells immediately, because the immune system is highly nervous, that the barrier is not functioning the way it should, that things are in disarray, and so the immune system is going to be prepared and going to attack virtually everything.
[00:28:43] So, the moment you drink water, you chew something that sends signals down, that's a very normal part. So, chewing and all that has send signals to the gastric system and then the intestines. So, now, the immune system gets recruited to the lining of the intestines, the lining of the intestines inflame a little bit. So, imagine your small intestines are all folded up in this small area right here. You've got 20 or so feet of a small intestine all folded up. If the lining of that folded up system swells just a little bit, all of it balloons out together. This is how you can drink something that doesn't get fermented and it still creates this bloat.
[00:29:25] So, it's not a gas related bloat. It's massive amounts of inflammation. So, that concerns me more, because that's a farther stage of dysfunction now than it was where two hours later, you're starting to get bloat. That's a gas fermentive bloat, and you haven't gone to the stage yet where everything is causing inflammation, even just something touching your mouth.
Cynthia Thurlow: [00:29:49] It's so interesting to me, because until probably 5 or 10 years ago, the concept of small intestinal bacterial overgrowth was not on my radar or even SIBO small intestinal fungal overgrowth. But whether it's greater awareness, it seems like it has much more-- We're much more cognizant of it as a medical community. It seems to be notoriously challenging to address, because I remind people, “We don't develop SIBO overnight. It's not going to be gone overnight. It takes time.” I think anything related to improving the quality of the gut microbiome vis à vis different, both lifestyle medication, supplements, etc. It's not a one and done. It's like running a marathon. I always tell people, "It's not a race. It's a marathon."
[00:30:33] I'd love to briefly touch on-- You talk about the immune system. I think it's helpful to perhaps differentiate between what happens in a couple of hours versus what happens over a couple of days. So, we have the innate versus the adaptive immune response. I promise this is relevant to the conversation as we're evolving, because I think it's very helpful for people to understand we have different heroes in our body that are helping us fight against things that do not belong to, but helping understand a bit about this physiology.
Kiran Krishnan: [00:31:04] Yeah, absolutely. So, with the immune system, which can be esoteric for a lot of people, I always like to use analogies to help explain it. So, there is a significant difference between the innate and the adaptive immune response. Both are very important, but there's a process in which your immune system is normally supposed to function. If it doesn't flow through that process, then in many cases, your immune system can be the bigger problem than whatever it is trying to protect you from.
[00:31:30] So, let me give you analogy to help understand this. So, imagine your body is a large home, and the home has hundreds and hundreds of windows and most of those windows are open. Through those windows could come bugs, stingers and things like that that we don't want in the household. And in the household, you've got these insect guarding people that are supposed to protect the home from things coming through the window.
[00:31:56] And so, you've got two groups though, however. One group is very young, nimble and fast. The other group is much smarter, and more learned and understands better the etymology, if you will, of the bugs, but they're slower to respond. So, then, let's say there's bugs entering into the window on the third floor. The ones that are going to get there first, based on the signals that we get as the bugs enter on the third floor are the young, virile, super-fast people. So, they run up the stairs very quickly, they get to the site of action.
[00:32:27] The problem is they don't understand the bugs well. They're not specialists in this. They just understand something's coming through. We're not sure what it is exactly, but we're just going to defend the home. And as a result, the tool that they use to defend the home is a blowtorch, because they just want to burn everything in the region. And so, then, yes, they start blowtorching the area, and they are likely going to kill or contain the bug. But if they're continuing to blowtorch, they're going to burn down part of the house as well.
[00:32:57] And so, in order for that to not happen, then what happens is the older, more learned individuals show up and they take a little longer than the young individuals. They show up, and they know exactly what bug that is that has come in, and they have an intervention specific to that bug. So, it doesn't harm anything else, and it very effectively gets rid of that bug. And then they tap the younger individuals on the shoulder and say, "You know what? I got it from here. We don't need your blowtorch anymore. Go off and patrol other areas, and we'll take care of the bugs." They do so in a way that doesn't damage the system.
[00:33:32] Keep in mind, that every time they do this, they become a little smarter and they understand that bug a little bit better and they can respond a little bit faster each time. So, that is the difference between the innate and adaptive immune system. The innate are the fast acting, but blowtorching type of immune response, and there's numerous players there. And then, the adaptive immune system are the T cells and B cells that we typically hear about, and they usually use antibodies in order to go after something very specifically.
[00:34:04] But the progression is important. So, when something enters into your system that shouldn't be there, whether it's through the gut or the skin or any other place, the innate immune system shows up very quickly. We'll talk a second about how they show up. This is a very important part of the whole conversation. But they show up first, they start blowtorching the area, because they don't know exactly what's causing a problem. They're just going to try to control everything in that area. And then they're only supposed to be functioning in that manner for a short period of time.
[00:34:34] It can be as little as 12 hours, 24 hours, even less than that sometimes or sometimes a little bit longer. The adaptive immune system shows up, and then they take over and they go, "Okay, we don't need to blowtorch and damage everything anymore. We're going to go after this thing very specifically."
[00:34:50] Now, what's really interesting and why the microbiome is so important here, is that the microbiome is what signals to the immune system to show up to where it's supposed to show up. Because keep in mind the difficult tasks that your immune system has. Your immune system is outnumbered inside of the body 200,000 to 1 to microbes. There are 200,000 more microbes for every one immune cell that is patrolling any given area.
[00:35:21] So, your immune system is supposed to defend you against microbes, all the while covered in a sea of microbes. How are they going to tell the difference between good microbes and bad microbes and what to attack and what not to attack? The only way they can do that and the only way they can show up at the right place at the right time is if the microbes in that local region are acting as a neighborhood watch.
[00:35:46] So, the microbes are actually the eyes and ears of the immune system. In your lungs, for example, you take in a virus, let's say the flu virus, and you get exposed and it goes into your lungs, the virus starts infecting your lung cells. The first things that notice that present to that infection are the local microbes in that area. They send signals to recruit the immune system, then goes, that tells the immune system, "Hey, there's something going on here that you need to pay attention to." Then the immune system shows up. It's the innate immune system, so they start bombarding stuff.
[00:36:19] Now, there are other microbes who also then help facilitate the recruitment of the adaptive immune system and shifting from the innate to the adaptive, so that now the more precision mechanism can take over and stop the damage. So, this is why during COVID people who were obese, people who were diabetic, people who had other chronic conditions were far more susceptible to dying from COVID than individuals who were relatively healthy.
[00:36:49] For example, if you were 48 years old and you had diabetes compared to a 48-year-old who did not have diabetes, you were 10 times more likely to die from this virus than the same age individual who did not have diabetes. Why is that? It's not because the diabetes is causing some additional problem, it's because you were likely significantly dysbiotic, and as a result, you ended up with diabetes. So, leaky gut is the precursor to diabetes. This has been well established and confirmed. So, these individuals tend to already be severely dysbiotic, which means they don't have the friendly microbes in the needed regions to alert the immune system when a new virus or something comes in.
[00:37:33] So, with the individuals with diabetes, what tended to happen was they get exposed to the virus, it comes in, it enters the lungs, it's allowed to infect the lung tissue longer, because all the opportunistic microbes they have in that region, rather than the commensals, aren't willing to alert the immune system, because they themselves are trying to hide from the immune system. And so, they don't alert the immune system. The infection gets bigger and bigger and bigger. When the immune system does finally come across it, then the infection is so big. Immune system brings out the biggest blow tortures they have, because they see the problems at such scale and they start bombarding the region with a massive amount of blowtorching, in this case in the lungs, and it would create this condition called a cytokine storm that a lot of people heard about.
[00:38:20] And then, again, because they don't have a functioning microbiome as well, it doesn't recruit the adaptive immune system. So, now, the cytokine storm blowtorching goes on for longer, which eventually damages the lung tissue and puts these people in respiratory distress. That's the reason why-- The same thing with long COVID. Great research done at University College Cork by a professor called Liam O'Mahony, who was able to characterize the microbiomes of individuals that either died from COVID or ended up with really bad infections. And then, long COVID, and he was able to predict whether or not an individual is likely going to be severely sick and maybe even die or have long COVID just by looking at their microbiome, because they had a very high levels of pathogens and low levels of commensals. So, their whole immune response gets skewed.
[00:39:14] Now, this is super relevant to hormones and gut and everything else, because your microbiome is in all of these regions. Your microbiome is constantly training, and talking to and modulating your immune response, and your gut is where the vast majority of your immune tissue is. So, if you have a dysfunctional microbiome, you have a dysfunctional immune system that is negatively responding to everything that enters into your gut, all the food, all the things you drink, all the stuff that you get exposed to in the environment. And that negative response creates massive inflammation throughout your gut, and you can end up with conditions like inflammatory bowel disease, so, Crohn's, colitis, microcolitis. You can end up with all kinds of IBS and all kinds of damage to the lining, a lot of it driven by the immune system itself.
Cynthia Thurlow: [00:40:04] It's so interesting, because the more I understand about the gut microbiome, this complex in a relationship with the immune system and also sex hormones. This is where women will say, "You know, I'm in perimenopause. My menopause, I feel good. I don't need hormone replacement therapy." But then, you start bringing in the complex interrelationship with just estrogen. If we talk just about estradiol and how critically important it is for supporting immune function, you start to understand there's so much more to this.
[00:40:34] Now, we touched around keystone species, diversity of the gut microbiome. Let's talk specifically-- I know there’s been a lot of research, a lot of information that's come out around Akkermansia in particular. What are some of the other beneficial you feel like are beneficial, not just for diversity of the keystone species, but also key signaling bacteria that are there that are very important for helping to support a robust immune system?
Kiran Krishnan: [00:41:06] So, the other one would be Faecalibacterium prausnitzii. So, F prausnitzii, often abbreviated that way. Bifidobacterium longum, which is really important. Bifidobacterium adolescentis, it's another really important one. A number of different Ruminococcus species. They also tend to be very critical. Most of them function in very simple ways that have profound effects.
[00:41:33] So, for example, take both Akkermansia and Faecalibacterium prausnitzii. One of the most important things that they do is they produce high levels of short chain fatty acids, butyrate, propionate and acetate. And then, Ruminococcus, for example, produces a lot of acetate. A number of these ketone species will produce propionate. Why these are so important is because they control all kinds of aspects of your metabolic health and your immune health and inflammation. So, they're all anti-inflammatory, which is great, which is very important to have, and they're anti-inflammatory both in the gut in the case of butyrate, or outside of the gut in the case of acetate, and to some degree, propionate.
[00:42:14] You'll even find acetate in the skin, reducing inflammation in the sebaceous glands and so on, which is one way in which a healthy microbiome can reduce acne, for example, or redness associated with the skin. So, these keystone species, a lot of short chain fatty acids are really important.
[00:42:32] The other thing that the short chain fatty acids do, besides modulating immune response and activating the metabolic response-- So, butyrate, for example, activates satiety signaling. It manages energy, homeostasis, increases fat burn, causes insulin sensitivity, which is good rather than insulin resistant. So, you've got all your energy components balanced well. They're also are really important for repair of the lining of the gut. So, the mucosal system, which is that thick mucus level that protects the lining of the gut requires butyrate in order to be produced. So, without adequate butyrate, you're not going to produce enough of a mucosa.
[00:43:12] Then the second part of it, the cells that make up the lining of the intestine, also predominantly consume short chain fatty acids as a primary fuel, so that they can be repaired, because they're constantly going through damage. The lining of the intestines, it's a one cell thick layer. These cells are sitting shoulder to shoulder like this. So, if any one of those cells get damaged through either normal processes of digestion and things like that, or oxidative stress, inflammation, all the crazy things that happen during the digestion process, if that cell gets damaged and gets knocked off, then you've got a gap in between these cells.
[00:43:49] So, in order to be able to repair and replace that cell quickly, you need short chain fatty acids. So, it's really through some of those simple mechanisms that these really, really important species called keystone species, exert this resilience and balanced function in the gut microbiome and then the immune system as well.
Cynthia Thurlow: [00:44:10] Where is the role for you, per se, for stool testing, diagnostic testing? I know I use quite a bit of stool testing within my programs. But from your perspective, as a researcher, do you have favorite tests? What's the yield from good diagnostic stool testing? I'm not just talking about the ova and parasites that you get from the garden variety lab, but actual labs that are very focused on either PCR testing or some of these diagnostics that are looking a little bit deeper beyond the basics.
Kiran Krishnan: [00:44:45] Yeah. I think there is a really interesting role for stool testing, especially the commercial stool tests. I think in order for you to modulate lifestyle, diet and all that to favor a healthy microbiome, you need a stool test that gives you the proper context of what the total microbiome looks like. Because it's not just a singular absence or presence of microbes. It's really the entire system, what the entire system looks like, because everybody's microbiome at the species level can be quite a bit different. And as a result, we may look at a microbiome and go, "Is that the healthy, ideal microbiome? I don't know, because it looks so different from this individual's microbiome at the species level."
[00:45:28] Well, what's important is not just the individual species, it's the functionality that those species offer. For example, I might have much higher Akkermansia than Faecalibacterium prausnitzii, and you might have more Faecalibacterium prausnitzii than akkermansia, but they balance each other out in that they both produce lots of short chain fatty acids. So, our net short chain fatty acid production may be the same. And so, then it doesn't really matter. It's not like I have to try to get to your level or you have to try to get to mine.
[00:46:02] So, the context is really important. But understanding the context means really accurate mapping at the species and subspecies level, and then being able to identify microbes that have specific features and functions. So, the type of microbiome test I like is one that does whole genome sequencing. So, rather than 16S or even PCR, because that's the most accurate way to identify microbes at a species level and subspecies. And then, also micro tests that focus on functionality.
[00:46:36] We mentioned like estrogen, for example. You want to look at the constellation of bacteria called estrobolome. It's made up of lots of different microbes in there. That's a feature and a function of the microbiome. You could look at the presence of each of those individual bacteria that make up estrobolome, but what you really need to know is what's the constellation of estrobolome relative to the rest of the microbiome. Because it tells you then how prevalent is its function compared to the rest of the microbiome.
[00:47:07] Same thing with saccharolytic fermentation versus proteolytic, which one are you? So, saccharolytic are the microbes that have the capability of taking fiber, for example, and converting them to important things like lactic acid and short chain fatty acids. Proteolytic fermentation are ones that actually break it down and create a lot of byproducts that may be dysfunctional like p-Cresol or ammonia or things that aren't really great. But there are dozens of organisms involved in both of those. You need to be able to group them and go, "Okay, you have a higher prevalence of saccharolytic than proteolytic, which is a good feature,” or you have the reverse and you want to go, "Okay, you got to make some alterations to bring the favor back to the psychopathic." So, that's the thing. So, use a biome effects test from microbiome labs, because it gives you those particular features, which makes it easier then to think about lifestyle changes and all that.
[00:48:07] The PCR testing, to me, can be very misleading, because it is very pathogen centric and it artificially amplifies the relative abundance of that pathogen in the microbiome. What that ends up leading to is a lot of use of antimicrobials all the time, because the test is screaming like, "Oh, my God, this person's infected with all these pathogens," when the relative abundance of that pathogen to the rest of the microbiome may actually not be a problem. But because PCR can take a single small gene and amplify it, that's what it stands for preliminary chain reaction, it amplifies a gene to a point where you can read it, it artificially makes that pathogen look to be very prevalent. And then a lot of times, we go after it too aggressively with antimicrobials. And of course, antimicrobials will kill good stuff as well as bad stuff.
[00:48:57] So, that's some of the pitfalls I see with the stool testing. I don't think stool testing is diagnostic. Even if you're using whole genome sequencing or not, it's primarily way of helping you understand the potential areas of adjusting your lifestyle and all that to favor a more balanced system. You can't necessarily look at a stool test and go, "Aha, this is IBD, or aha, this is estrogen dominance,” or whatever it may be. It gives you a clue as to what may be driving an IBD diagnostic or estrogen dominance diagnostic, and it may tell you what you could adjust in your diet, lifestyle and so on in order to help the system. But I wouldn't use it as a diagnostic, because it's not definitive in that same way.
Cynthia Thurlow: [00:49:43] Well, and I think that's such an important point and one that I would echo, that's why a history is so important. That's why getting information-- I can't tell you how many women that have come to me that they've worked with someone else-- I don't know, five different stool tests. There's Genova, there's Diagnostic Solution, there's so many different companies. They've just been hit hard and for a long-protracted period of time. I've learned a tincture of time is helpful.
[00:50:12] I agree with you that more often than not, when we have those conversations where I can incentivize someone to clean up their act, there's no other way to put it, or maybe we need to back off on the quantity of fat, because you have so much fecal fat in your stool, which you shouldn't have, can be very helpful, and really starting with the basics.
[00:50:30] I'd love to briefly touch on a couple other subjects. What are your thoughts on dietary dogma? Your probably not surprised, whether it's being an omnivore, being carnivore, being vegan is probably less important versus avoidance of ultra-processed foods.
[00:50:48] From your experiences, do you lean in one direction or are you more about educating consumers about how ultra-processed foods are, not only are they poorly regulated, there's been little research done on the net impact of the food additives and chemicals, let alone the net impact on our gut microbiomes.
Kiran Krishnan: [00:51:10] Yeah. For some reason, the world of diet has become so polarizing. Its very tribalistic. I don't quite understand that. People don't do that with a lot of things in the world of nutrition, but they do that with diet so aggressively. Meaning, anytime you see somebody's profile name and the profile name is their diet, like I'm Carnivore Joe or I'm Vegan Tim, that's your whole identity is your diet, then you know that, okay, they are an activist for whatever the diet movement is and they're likely ignoring a lot of important information just to support the narrative.
[00:51:50] So, I think there's a few issues with any extreme dieting. I don't agree with the carnivore side, I don't agree with the vegan side, I don't agree with the keto side. Now, keto can have some benefits in research studies. There are showing some benefits with some certain conditions, but it should be temporary. It should be four or five weeks or something like that done under care, and then you go back to a normal diet. So, what is a normal diet? In my view, it's an omnivorous diet. Humans are really designed to be omnivores. That's one of the reasons why we have the diversity of microbiome that we do. I think anytime you go into a restrictive diet, you're going to compromise the diversity of your microbiome, which then has a huge impact on your long-term health.
[00:52:34] I think the key thing here, as you said, is the avoidance of ultra-processed foods. The moment you start telling people that kale is bad for you, that eating fruits is the same as drinking a Coca-Cola, or people on the vegan side saying eating meat is going to give you cancer, all of the extremism, you start to confuse people to a point where it's hard to take any reasonable action. That to me is a disservice to empowering people to take care of themselves in a proper way.
[00:53:08] I think diet can be extremely simple. The extreme simplicity of it comes from avoid ultra processed foods, stuff that's in packages and processed and have massive labels on them with all kinds of ingredients that you don't really understand. Try to eat as much real food as possible. Try to diversify the number of foods you eat.
[00:53:30] Our ancestors ate upwards of 600 different foods annually. They were hunters, gatherers, foragers. They ate whatever they could. They didn't have the luxury of being a carnivore, luxury of being a vegan. They had to eat to survive. The system evolved that way. They were nomadic, they roamed. So, if you look at the animal kingdom, which animals actually have the closest microbiomes to humans. It's not our genetic cousins, which are chimpanzees, which are nearly 99% similar genes. It's actually baboons. The reason its baboons is because baboons live in tribes and they roam, then they forage, and they gather and they hunt. They eat a huge variety of things. As it turns out, their microbiomes look much more similar to ours than most other animals do.
[00:54:20] And so, I think people need to just diversify their diet as much as they can. They need to avoid as much as they can ultra-processed foods. I don't think anybody should feel ashamed or stressed and all that if they have something once in a while, like the purity and the piousness that a lot of diet gurus have out there is just to me damaging to people, because you're showing them unrealistic behaviors.
[00:54:51] There was this one guy, I can't remember his name, but I think he's a paleo-ish kind of guy. He had a thing where on the airplane he's flying somewhere, and he had a duffel bag full of coconuts, And the whole thing was—
Cynthia Thurlow: [00:55:04] What? [laughs]
Kiran Krishnan: [00:55:07] He has like a one and a half million followers. The whole thing was like, "Oh, I don't drink water in plastic bottles and all that," given you should avoid plastics as much as you can. “And so, because of that, I bring my own coconuts with me. It's the most pure form of water.” That's ridiculous. [Cynthia laughs] Nobody's going to do that. And then, any people follow that when they go, and they are thirsty, and they have to go get a thing of water and they buy a bottle of water, they're going to feel really bad about themselves, because they're drinking a bottle of water that's a plastic bottle. And so, that's the unrealistic, crazy thing to me that just doesn't help people at all. It may create followers and sensationalism online, but it’s not helpful at all.
[00:55:51] So, I think stick to a diverse diet, eat within a reasonable caloric range. Meaning, try to eat fewer calories than you burn, and then stay away from ultra processed foods and I think diet is taken care of. The most important part of a diet, in my view, is fiber. It's the most well studied macronutrient. In fact, some of the meta-analysis studies that have come out there was a recent one of nearly a million patients, and they showed that for every 10 grams of fiber you add to your daily diet, you reduce your mortality risk by 10%. It's huge. Fiber is huge.
[00:56:31] So, getting enough, adequate, versatile fiber, to me, is a nutrient goal that most people should try to set, and try to get 50 grams or more of fiber from various sources throughout your diet. You do that, you're reducing ultra-processed foods, you're eating fewer calories and you burn, you're doing just fine when it comes to diet well.
Cynthia Thurlow: [00:56:51] Well, I think it's so important. It's interesting. I do quite a bit of travel. I have a little bit of mild dysautonomia. So, when I'm traveling, I'm drinking a lot of water and electrolytes. Someone tried to shame me on Instagram in my DMs. They're like, "I can't believe you're drinking out of a plastic water bottle." I thought to myself, “It was my option. It was either that or I'm going to be dehydrated.”
Kiran Krishnan: [00:57:14] Right. [laughs]
Cynthia Thurlow: [00:57:14] So, instead of shaming one another, we should be saying "Great." I always say the good, better, best mentality is so important.
Kiran Krishnan: [00:57:21] Yes.
Cynthia Thurlow: [00:57:22] I'd love to finish up our conversation today. You've mentioned some of the things that we know can improve gut health. But I would also love touch on, are there some emerging supplements that you're enjoying learning about, talking about? I know psychobiotics seem to be having a moment. Those are really interesting and compelling. I would love to end the conversation giving people additional actionable steps that they can take.
Kiran Krishnan: [00:57:44] Yeah. So, psychobiotics are amazing. Psychobiotics will start to help arrest the cycle of constant reactivation of the HPA axis. So, this is an hour-long conversation that its own, but ill summarize it in this way. If your gut is dysbiotic and you're missing certain types of organisms, what tends to happen when you experience stress is your HPA axis gets activated, it puts you in fight or flight. That cortisol response as a result of the fight or flight makes your gut permeable. The permeability increases, the cytokine called IL-6. IL-6 goes up and reactivates your HPA axis. This is why people find themselves in a constant state of anxiousness throughout the day. It's really hard to come down from it.
[00:58:32] The way the fight or flight system is designed is you're supposed to be able to activate it, run away or fight whatever the danger is that's making you more alert, and then come down from it. The not coming down from is a part of modern society that we suffer from. As it turns out, microbes have a lot to do with how you come down from it. So, psychobiotics play that role, in that they allow your HPA axis to downregulate, so that you can come back to a normal, healthy state. So, psychobiotics are really fantastic.
[00:59:04] I think when it comes to the gut microbiome, the other area that people should be paying attention to is polyphenols. Polyphenols are fantastic nutrients, whether it's eating directly colored fruits and vegetables, which is fantastic for you, or polyphenol extracts from things like berries, and pomegranate and all that can be really important. As it turns out, polyphenols seem to be more like prebiotics for really important bacteria within your system.
[00:59:32] We mentioned Akkermansia. Akkermansia does a great job with polyphenols. You can feed Akkermansia specifically with polyphenols that is really quite beneficial. And then, they convert the polyphenols into all of these important compounds like urolithins that have a reparative function of your mitochondria and your cells and all that.
[00:59:53] The other area of fermented foods have always been great. You want to test out and see if there's any sensitivities you might have to fermented foods. They're not probiotics, but they are more like prebiotics is where the power of fermented foods lie. And then, fasting, if you can do some degree of intermittent fasting, as it turns out, fasting in itself does improve the diversity of the gut microbiome.
[01:00:19] Ultimately, the biggest and most well understood feature of a healthy microbiome is a diverse microbiome. So, diversity is key. So, you constantly want to be engaging in behaviors that diversify your microbiome. So, those are diverse diets, getting outside, getting interaction with the natural environment, interaction with other people, close contact, so releasing oxytocin and battling stress hormones, those all increase diversity and getting a pet.
[01:00:49] So, households with dogs tend to have individuals, the higher diversity in their microbiome. Eliminating those processed foods as much as you can, because the pesticides, herbicides, all of that in them do have an impact on your diversity. Cleaning up your personal care products as much as you can. So, the lotions and soaps and things that you put on, you try to go as clean as you can with some of those products with the fewest ingredients and so on that has an impact on your diversity as well. And then, sleep and stress management. So, both of those things have a measured impact on your diversity. So, if you're just adding in all those things and you're doing those behaviors 80% of the time.
[01:01:29] I follow an 80-20 rule. I don't want to be healthy by having to make 100% the right decisions. I want to have a little bit of resilience and make 20% bad decisions and still be okay, because there's a lot of living that happens in that 20% which is important. So, I don't want people to feel like it's so hard to achieve health and wellness like, you have to be like these influences online, you have to walk around the grocery store with the shirt off and like [Cynthia laughs] chuck kale, because it's terrible and it's killing you, all these crazy things. That's not about health. That's a sensationalism. That's online. That's social media.
[01:02:08] Health is about making 80% the right decisions. The decisions aren't actually that hard. You're going to go to a birthday and you're going to have some birthday cake. Don't feel bad about that. That's probably fine. You're going to go out with your friends and have a glass of wine or two. That's probably fine. 80% right decisions and you should be okay.
Cynthia Thurlow: [01:02:29] Well, I think that's such a one of those ways of looking at our lifestyle and making it sustainable is not being in this polarizing zone, which as you mentioned, is the way that things have evolved.
[01:02:43] I would love for listeners to be able to connect with you outside of social media. Obviously, we will put links to your products. I'd love to have you back if you're open to coming back, because I love to talk more about psychobiotics. I was down a rabbit hole preparing for the podcast, but I knew that we wouldn't have enough time to talk solely about that. So, I'm glad were at least able touch on it.
Kiran Krishnan: [01:03:03] Yeah, I'd welcome the opportunity to come back. I think psychobiotics are so important because of the epidemic of cognitive issues that are going on, anxiety, mood disorders and so on. It becomes more prevalent, especially for women as they go through perimenopause, post menopause. So, I think that's a very important topic to address. So, I'd welcome the option to come on board and talk about that again.
[01:03:26] And then, yeah, on social, I try to interact with people as much as I can as many messages and all that I get, I still do respond to people as much as I can, both on Instagram and on Facebook as well. On Instagram, my handle is @kiranbiome, -K-I-R-A-N-B-I-O-M-E I think on Facebook, it's just my name, Kiran Krishnan. And then, if you go on YouTube, lots of wonderful hosts have uploaded interviews like this on YouTube. So, you can actually type in almost any issue like microbiome, and autoimmune and then you'll probably find an interview or two or presentation I've done that's on YouTube on that specific topic. So, lots of different ways. If you reach out on social media, I promise to try to engage as much as I can.
Cynthia Thurlow: [01:04:10] Thank you so much for the work that you do. It's really a pleasure connecting with you.
Kiran Krishnan: [01:04:14] My pleasure. Thank you for having me.
Cynthia Thurlow: [01:04:17] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
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