Achieving Gut + Skin Balance with Dr. Mahmoud Ghannoum

Transcript for Achieving Gut + Skin Balance

Dr. Cates: Hi there. I’m Dr. Trevor Cates. Welcome to The Spa Dr. Podcast. On today’s podcast we’re talking about how to achieve gut balance and how this impacts your skin. My guest is Dr. Mahmoud Ghannoum and he is the scientist that named the mycobiome. The mycobiome is the fungal community in the body. Well, why is this important well, stay tuned, I’m going to explain that as well. The Washington Post actually called him the scientist who is now known as the leading microbiome researcher in the world. He has published over 450 peer reviewed papers. His work has been cited over 21,000 times in literature he has been actively funded by the NIH, the NIH, the National Institutes for Health continuously since 1991 for his work on the fungal and bacterial communities in our body with over $25 million in NIH funding to date. Dr. Ghannoum lectures around the world on the microbiome and he is the founder of the antifungal clinical testing company, Next Trillion Sciences and has been involved in the development of 95% of antifungals that have come to market since the 1990s and I actually ask him about antifungals at the end of this interview. On today’s podcast, we discussed the difference between the microbiome and the mycobiome and how these play a role in your health, very important role in your gut, brain and skin health. Dr. Ghannoum shares best foods and lifestyle habits that help support the microbiome and mycobiome for optimal health and longevity. He’s got a book that’s now out about this as well, and he talks about about this new book and he’s just a wealth of knowledge, so I hope you enjoy this interview.

Dr. Cates: Mahmoud it’s so great to have you on The Spa Dr. Podcast. Welcome.

Dr. Ghannoum: Thank you. Thank you for having me. It’s great pleasure to be with you.

Dr. Cates: I’m so excited to have you on because you have been doing a lot of interesting research on something that I find completely fascinating and I myself have looked into a lot and that is having to do with the microbiome and the mycobiome and you have a, you’ve also done a paper publish a paper on the gut skin brain connection. And so let’s start with that. Let’s start about that connection because I think for so many years people thought of the skin as just being the superficial thing that’s not really connected to the gut and you know, the brain, like how is this all connected? So tell everybody how this comes together.

Dr. Ghannoum: Sure. You know a lot of the time people think of the gut brain access, but in fact there is gut skin brain access. We published a paper as you mentioned, inform theory of microbiology. Okay, well we showed that if you have an imbalance in the microbiome in the gut with respect to the micro organisms, what happens, it could affect your skin. Also because of the communication between the brain, the gut, also reflects in the skin. So really in a way we have communication between gut, skin and brain and there are evidence to show that people who, for example, there was a good study where people had acne and they took a probiotic in fact not prebiotic, probiotic, uh, bifidobacterium. And what they found that when they, the balanced their gut microbiome, the acne really got to reduce.

Dr. Ghannoum: Another very interesting study was, you know, people when they have UV exposure of the skin, how we lose some elasticity and this sort of thing, and a study was done where they showed that if you take probiotics to ensure that your gut microbiome balanced, you skin elasticity is maintained, even when you have some UV exposure. You know, so that, that’s really very interesting. You know, the other thing from the scientific point of view, I am as you know, professor at Case Western Reserve University, and what we have, we have a grant to look at psoriasis and we looked at the skin psoriasis and what we found that we compare affected versus unaffected areas. This is where you have the plaque and the lesions versus those that are not. And we found that there is imbalance in both the bacteria and fungal communities in the skin, in these psoriasis patients. So definitely there is a clear link between our gut skin as well as the brain.

Dr. Cates: Yeah, it’s amazing the, the information that’s coming out about the gut microbiome and the skin microbiome. And can you explain to everyone what the differences between the microbiome and the mycobiome and for some people that sounds like the exact same thing, but it is very, well not very different, but it is different.

Dr. Ghannoum: It’s different. You know, I completely understand why people sometimes think of the microbiome without thinking about the community except bacteria. Everybody used to talk about bacteria as being the main member of the microbiome and they really use the term microbiome and bacterium, in the same way. Okay. But research is showing that in addition to the bacterial community that live, let’s say in the gut, since we are talking a lot about the gut or the skin for that matter, it’s not only bacteria. We have bacteria, we have viruses, we have fungus as well. And the difference between them, we call it the mycobiome because mycology is the study of fungus. So I came out with this coined this term of mycobiome to describe the fungal community. Yeah. Yeah. To contrast with bacteria.

Dr. Cates: M Y. yeah. So that helps the spelling is different. So what, what led you to be so interested in the mycobiome?

Dr. Ghannoum: Well, you know, for years, I direct the center for medical mycology and I’ve been studying fungus for over 40 years, you know, and it took me back to when I first went to England to do my a doctorate where I was given a paper by my mentor You know, our advisor they come and tell you, what you are going to do, your doctorate on. So I looked at it and what it was, it was about a rabbit which was treated with an antibiotic. And lo and behold, that rabbit became more susceptible to fungal infections, especially candida and that taught me, you know that in our body, we have both communities living together and if one becomes imbalance, let’s say we use antibiotic, we kill all the bacteria, the fungus take the opportunity and they start to grow and causing carbon.

Dr. Ghannoum: So that was in 19, believe it or not, 74 up to 78 that’s what I spent my life studying. And then let’s, let’s come fast forward to around early 2000, 2008 I used to go to all these meetings and people talking about microbiome, meaning really bacteria. And then I tried to bring attention that we really need to look at these two communities because they work together in good and in bad. They could be helpful, but at the same time, when they are imbalanced or what we call this biosis, they will cause harm to us. That’s really what led me to uh, go into the study of not only the bacteria but the fungi of course, which is my specialty in 2000 and then I published the first paper on the mycobiome.

Dr. Cates: Right. Right. That’s so great. And I think we are shifting away from this idea that microorganisms are bad, right then that we understand now there’s so much research that we need balance that there are good ones, there are bad ones, there are ones that just are, they just exist. The commensal ones that need to be in the right balance and that there is this synergy that we need, and so how does the mycobiome play a role in our health?

Dr. Ghannoum: Which is very, very good question. And I really agree with you. We really need the balance. Now people, when they talk about candida, as you said, they always think, Oh it’s bad than use. This can be, that could cause candidiasis. It could cause, you know, various diseases. In fact, 50% of the people, the population have candida as a colonizer, which means it’s at low level. When it is present at low level it can help us, you know, it kind of breakdown the food ferment food, which gives food to the beneficial bacteria and that will really help our immune system and make us. So that’s if we have it at low level, the problem starts when we encourage the growth of this fungus and overgrows by getting rid of the beneficial organism. Then we are going to start to have digestive issues and other issues so it’s two sides of the story. They could be good when they are in balance, but when they go out of whack then it becomes bad.

Dr. Cates: So what are some of the symptoms that people should look for that could indicate that, there is an imbalance?

Dr. Ghannoum: You know, simply the constipation, bloating. You may have some time blood in the, the stool. If you have some inflammation you feel sometimes you have some pain for example. And there are studies to show that like for example, Crohn’s disease patients with their symptoms, inflammatory symptoms there is imbalance. So if you have any bad feeling, any of these symptoms, which are what as we said, we call them inflammatory symptoms, then you know there is something not right there and you need to try to adjust it.

Dr. Cates: Right, right. So and this does play a role on the skin cause we already talked about the gut skin connection. So if some, if the digestive system is off, if the microbiome of the gut is off then that could impact the skin as well. And this includes the mycobiome, the fungal.

Dr. Ghannoum: Hundred percent really. We actually completed a study as I mentioned in psoriasis and we look not only at the skin, a microbiota, but also we looked at the gut microbiota to see whether there is a relation and we showed that in cases of disease you have imbalance in both bacteria and fungus. Yeah. So it’s definitely the right way to look at it. Our gut could affect not only our digestive symptoms, but also our skin. Sometimes also some, sort of autism, Alzheimer, all of these diseases which are related to our brain. You know, degenerative diseases also are affected. So it’s really fantastic what’s happening now with our understanding of the microbiome. Because as you said, when you look at it, it’s not all bad. There is bad, but there is good. And we need to learn how we can keep, our gut balanced because that’s going to help us overall.

Dr. Cates: Right.

Dr. Ghannoum: Yeah.

Dr. Cates: So let’s talk about that. What, how does food play a role? The foods that we eat, how do they play a role and the mycobiome?

Dr. Ghannoum: Well, as you know our body requires carbohydrates, requires the proteins it requires as well as fat for, you know, our cells are made of this. So in a way you need to select the type of food. Like if we decide we want to go after carbohydrates, we need to select resistant starch because the resistant starch has these fibers which can be broken down by the microorganism in our gut, which are beneficial organism. And by doing this they are going to help our immune system on our wellness. However, if you eat something, let’s say red meat, okay, especially high fat red meat, what happens, you are feeding the bacteria that are pro-inflammatory, which means they increase our inflammation. So by selecting which food we eat, you are able to go some way to balancing the gut. You know, and I say some way because in addition to diet we really need to select some good lifestyle which we may be able to talk about because that also influenced our gut.

Dr. Ghannoum: Now with respect to the fungus can be that for example, how can we make sure it stays a colonizer and it’s helping us instead of working against us. Number one is that candida loves sugar, refined sugars are the best friend for candida, so we need to limit those low carb and that’s choose the right carb like as we said, the resistance stash for example. Now in addition, we need to have some lean proteins, good proteins from plants, from fish. This would really help us a lot as well as some poultry as well. Chicken and the sort of thing are beneficial. So by selecting the right type of food, it’s like a garden. You are feeding your garden and you are going to grow the nice, beautiful roses rather than all the weeds.

Dr. Cates: Right. So with the carbohydrates that are beneficial, would those be more of like the high fiber carbohydrates? Yeah. Yeah. Okay. And so when you look at things like, the carbohydrates, high fiber carbohydrates, are we looking, you know, legumes and what are some of the best ones for us to eat?

Dr. Ghannoum: Yeah, legumes is one of them. There is also, you have resistance starch you’ll find that in bananas. Unripened bananas in Bali for example, it is there, you know, the other good fibers. Believe it or not, in pumpkin’s pumpkin’s they have real, they are rich in fiber. So these are good to feed our good micro-organisms or good microbiome in our gut, which again is going to help us balance.

Dr. Cates: Oh, that’s great. That’s great to hear about pumpkin, it seems to be really popular right now. Not pumpkin spice but actual pumpkin.

New Speaker: Yes. Yeah. I was looking at pumpkin recently because you know, we are near Thanksgiving and I looked at it has good fibers, had a lot of minerals as well as vitamins. So it’s really good, good stuff. It’s not just to have as decoration in the front of our houses.

Dr. Cates: Right, right. Absolutely. Okay. And so when we look at the microbiome and, um, and, and the impact it plays, it plays a role in our digestion, our immune system, our mood, all of that as well as our weight, too right?.

Dr. Ghannoum: Definitely. Oh, the way. You know, there was a study done in Spain of all places, and they looked at people who are obese compared them to people who are lean. And they found that there’s differences between them. People who are obese they tended to have high levels of ascomycota this is one of the phylum of fungi. As people who are lean, they have more zygomycota, you know, so there are different sort of different phylum, different members of the fungi and these, they tend to be different in obese versus those who are lean. And there was a study in the same study actually, where they looked at people who lost weight, they became lean. They really had an increase in one of the genus, in one of the a genus of the fungi like muka. So definitely we have a change and to be clear, it’s not the only change in the fungi, but also we see in obese patients they tend to have for example, high firmicutes which is a bacterial phylum. So definitely, there is a relation, as you said, between the gut microbiome and obesity and weight control.

Dr. Cates: And do you think that, and I’ve been reading that research as well, and do you think that that’s due to people’s diet? Do you think it’s a genetic factor or maybe a combination of the two?

Dr. Ghannoum: I really think a lot of the time our diet plays a really central role in controlling the, what you call our weight. Okay. In fact, in our diet, which is in the book, Total Gut Balance, which is going to come, we, and you mentioned, uh, we did this study where we put people in this diet and at the end of it they lost weight between two to 10 pounds in four weeks time. Now, this is one factor. The other factor, as we mentioned, lifestyle. Lifestyle is very, very important because you know, for example, it’s good to exercise because there are studies to show that if you exercise you are going to have better balance of your microbiome. Okay. So the other thing which is very, very critical is we need to take care of our stress. And you know very much, very well. We are all so stressed out. We work hard and the ladies, when they go and take care of, they work hard, they take care of the kids. They have to do all of this. I tell you, I once, maybe I’m going a side a little bit. I was once, the responsibility to take care of my kids and I told my wife, Oh my God, this is really hard. So we need to lessen the stress, on us because if we have stress because of the gut brain connection, we are going to have bad imbalance.

Dr. Cates: Yeah. Yeah. And by the way, I know your son. So I think that’s probably what the stress was about. We’re all stressed and certainly this time of the year too, we’ve gone through the holidays and that is an additional stress on the body and that can really, so now is the time to do kind of a reset right and get back on track. And so what are some of the things that you recommend as far as lifestyle changes in addition to diet? What are some of the things you think are particularly important?

Dr. Ghannoum: I mean, one of the first one is, as, as I mentioned, is exercise. We need to exercise. You don’t have to be really kill yourself. You know, people, sometimes they go from one, you know, a side of the pendulum to another. No, moderation say maybe 50 minutes, three times a week. If you don’t even go on to run, just go out and walk. This is really very important. So exercise is very important.

Dr. Ghannoum: Number two is we need to have to reduce stress. Some meditation, I started to do yoga about one and a half years ago because you know, I loved it. I never done before a yoga but now I go and the one and the half hour you are in the yoga class, you are just thinking about the move you are trying to meditate. I’m not thinking of where on the surface thing. And I find that to be very, very relaxed. I see. And my wife laughs at me because I’m the only male in there with all the woman. I gave a talk the other day, I said, at the big meeting, I said I am talking to the male audience, please take up yoga is very important. So these are the other thing which is very important. Sleep, you know, you need to try to have you know, seven to eight hours of sleep because this is also a good time to rejuvenate as you know better than me.

Dr. Ghannoum: Yeah. So all in all, if we try to take these moderate activities, it’s going to, with our diet you are going to have a really gut balance and therefore better GI symptoms or gastrointestinal symptoms that are going to be better, you can control your weight and also you will be happier all around.

Dr. Cates: And it’s so amazing that, that this concept of sleep and movement and meditation, yoga, that this plays a role in our microbiome and the mycobiome. But it’s true and there’s, I mean there’s a lot of good evidence to support it.

Dr. Ghannoum: I’ll tell you something, an evidence we had, we had a lady take our tests with biome test where it’s, your gut to report to look at the profile of your mycobiome, basically bacteria and fungi. And what we found that her profile was greatly imbalanced. So the other thing we do is we look at questionnaire to see what is she doing. We just spoke to diet. She eats a great food food that supports the balance of the gut. But when we look deeply into does she have stress? And she was extremely, severely stressed. So we figured that out. This is really what’s leading to her imbalance and we advise that, you know, all nutritionist advise it to try to, you know, relax, do meditation as we mentioned you know. So definitely there is evidence that this is what happens.

Dr. Cates: Yeah. And thank you for looking at this and writing your book on this important information. One of the things that you talk about is the, the gut biofilms and for people who aren’t familiar with this, can you explain what that is and how it builds up and what we can do about it?

Dr. Ghannoum: Sure. The best way to explain what is a biofilm is when we look on our teeth, the plaque in our teeth is a biofilm. So basically bacteria sticks to our teeth and gum and then they form what you call this biofilm. So what it is, organisms or micro-organisms, they come together and they bind together, they adhere together and they start producing these sugars or polysaccharides to cover them. It’s like as if they are, undercover, like you have jello and inside the jello you have a little m and m’s or raisins, the raisins are the organisms and the jello is the matrix which covers them and protect them. So we know about the mouth but until our publication in 2016 we did not know that there is really biofilm in the gut, especially formed by the pathogenic organism or organisms, micro-organisms that can cause disease. So what can we found that candida which is one of the fungus with ecoli and serratia marcescens two bacteria. They come together, they adhere, they start producing this protective layer and guess what? They are on our gut lining and they start to cause damage to that. And that’s where it becomes a problem where inflammation increase and this sort of thing. So that’s why we really need to have a way to try to eliminate this biofilm or what we call to make it simpler digestive plaque. It’s like the plaque in our teeth but instead its in our gut.

Dr. Cates: Right. And so they’re both bacteria and fungi that are involved in this biofilm, right? That, yeah. So it’s really like, it’s a combination approach that we need for, addressing these. Right. So a lot of times people focus on the bacteria but not on the fungi.

Dr. Ghannoum: Absolutely. Absolutely. And that’s why we really want it in the diet. To put some elements, like for example, apple cider vinegar is fantastic has been shown to get, eliminate the biofilm. Also you have garlic is fantastic. I know sometimes because of the smell, but it doesn’t matter, just have it and brush your teeth, it’s a great for our health. You know, coconut oil is another, a fact that that have been shown to work against biofilms. So we recommend these in the diet. In addition, I published a paper in April of this year, 2019, where we look at these organisms coming together. How can we break this biofilm and that paper, which was published, in 2019 showed that we select a probiotic we selected that has both bacteria and fungal probiotic strains like Saccharomyces for example. Saccharomyces is a good fungus. So again, which stresses that point, not all fungus, is bad.

Dr. Ghannoum:                   Fungi is really good sometimes. But in this case we found that Saccharomyces lactobacillus as well as bifidobacterium, they work together and they are able to break these pathogenic biofilms. And we showed that, really both in-vitro as well as enviable. So this is really a great way to eat the right to get rid of this biofilm, eat the right food, which has anti-biofilm activity and also enzymes, which is also part of the provider, which we have amylase which is also shown to break these biofilms. So a good combination.

Dr. Cates: So can I ask you, when it comes to, I know some doctors will treat with antifungals, the antifungal medications. And I know with antibiotics, we’ve seen that over use of antibiotics as medications has created dysbiosis imbalances. You’re killing off not only the harmful bacteria, but you’re killing off the good bacteria too. So it’s created some issues. And of course we know antibiotics still can be, helpful when indicated, but we need to be mindful of when we prescribe them. What about antifungal medications, are there concerns about those as well?

Dr. Ghannoum: You know, usually in general, a lot of medications now the studies are starting to show that they affect our they kill certain colonizer. So, so in the case of fungi, using an anti-fungal that is a broad spectrum. It may kill the beneficial organisms such as saccharomyces That’s why I think if you take an anti fungal agent, it’s good idea to try to take a probiotic to try to rebuild the beneficial fungi and bacteria in our gut. So yes.

Dr. Cates: Right. So, and that might include Saccharomyces boulardii something, something along those lines along with a probiotic. Okay. Yes. Great. So now I know with your diet, there are foods that you recommend to help improve the microbiome that, um, that maybe, you know, some people haven’t really that maybe I’ve got a little bit of a bad rep. So what are some of those foods?

Dr. Ghannoum: Yeah, I mean some of it is like, Oh, as you said with carbohydrates for example, people say, Oh, you should stop all carbohydrates, which is not true. I mean, low sugar is good, but it does not mean that you have low carbohydrate because you know, to make it simple and we have different types of carbohydrates, some of the carbohydrates, simple sugars, glucose, when we eat it, it goes into our intestine and our body is able to break it down and then it give us some energy, but also good could change into fat. Now instead of having these specialty, taking too much carbohydrate in one setting because your body cannot get rid of it and it’s going to go and change into fat, try to lower the amount of these. But take carbohydrates such as resistance starch, which we mentioned before, which will go through our intestine they are not broken down by us, but when they reach to the colon where all these good bacteria is there, they start to break it down. They are able to break it down. That’s why they call it resistance starch okay. But when they break it down, they produce all these small molecules or compounds, small compounds that are like, that are beneficial, such as short chain fatty acids. These are very good because they support our immune system. So it’s a matter of selecting the right food, which not eliminating all type of food. You cannot eat this, you cannot eat that, no just be selective, and that would be good.

Dr. Cates: Right. And you know, I’ve had some people tell me that when they eat carbohydrates or when they eat beans, for example, that they just don’t agree with them that they can’t eat them. So what do you think about talking to people about transition? Because for some people there dysbiosis, it takes a while to rebalance. So initially eating more of these carbohydrates, you know, high fiber foods might not feel that great as they’re rebalancing, as we’re rebalancing and getting a healthy gut microbiome. Right?

Dr. Ghannoum: You are absolutely right. That’s why when you start with any diet in that to be fair, you really need to take a time to transition. And we, for example, in the book, we give people a one week plan and then so that they can get used to the food and then after that they can adopt the diet for life. And the nice thing is the diet is flexible they kind of change and it’s not too restrictive. And I really agree with you. We need to give them this period. In fact, and we did the clinical trial where we had people, take a stool sample at baseline before they started up the diet so that we can look at the microbiome, both bacteria and fungi. And then we took another sample after two weeks and then a sample at the very end, but at the same time, and we looked at this, the profile, but at the same time we capture the gastrointestinal issues which you are referring to. For example, bloating. Okay. People go direct on fiber they feel really bloated. They don’t like it or they produce gas. So that’s why we noticed in this study, like the first week, people don’t feel, you know, some members they said, yeah, you know, we need some time. It’s not perfect. But then you start seeing this slight changes by two weeks and then by three and four weeks, they really reported great improvement. So it’s very, very important what suggested is you need to really ease into something new and not just jump like people tend to be too, you know, they are keen, they want to get better so they go all in. No try to transition slowly and you’ll be fine.

Dr. Cates: It’s, it’s so true. I’ve been seeing patients for almost 20 years now and there’s definitely, it’s, it’s so variable how people react to foods and that we need to be patient, but, but we do know the research continues to support things like these, you know, the high fiber, foods and beans and legumes and vegetables and how beneficial they are to our health. It sometimes it just takes them a while to adjust depending and everybody’s different. So, yeah, it takes a little while to, accommodate. And so is there anything that you suggest during that transition time to help people?

Dr. Ghannoum: I would start by don’t change completely your diet. Let’s start to use a little bit of fiber let’s say. Let’s start, if you are eating, a lot of people eating westernized diet. A lot of meat, invariably maybe every night or all at least four times, four nights a week or four days a week. Try to supplement it, take a little bit better food at the same time. Continue doing that and slowly, slowly what you are going think about it. It’s what we are going to do is again, we start to feed the good organisms in our gut, which is going to help us. So transition, I would say is the best way really too to ease on. Don’t like for example, if you will, haven’t had fruits and vegetables. I come from the Mediterranean, I love fruit and vegetables because it’s all over the place.

Dr. Ghannoum: But if you haven’t had this for a long time and then suddenly you start to take it in, it’s going to cause some loose, maybe stool and this sort of thing. So moderation, slowly, slowly go and start to adjust. And that’s why you have the first one or two weeks to ease into the diet and that will help you. And the good thing is you will, you’ll be able to change the fungus in your gut very fast. It is starting to show that’s fungi can change in a short term diet, where as the bacteria, it takes longer, longer. So this, by easing in, I think it’s going to help you.

Dr. Cates: Excellent. All right, well it’s been so great having you on the podcast. Thank you for all of your information. Will you tell everybody where they can find your book and learn more about you?

Dr. Ghannoum: Yeah. The book is called Total Gut Balance. You can find it on, Amazon as well as Barnes and Noble. There is also totalgutbook.com. I would like to have people to go to Dr. Microbiome drmicrobiome.com because I started a site where people can learn a lot different aspects, how to balance their gut, what type of food to have, what type of recipes. I think this would help them a lot.

Dr. Cates: All right. Fantastic. Well, thanks again for coming on and, and good luck with the new book.

Dr. Ghannoum: Thank you very much. It’s a great pleasure.

Dr. Cates: I hope you enjoyed this interview today with Dr. Ghannoum. To learn more about him you can go to thespadr.com go to the podcast page with his interview and you’ll find all the information and links there, including how you can get a copy of his book. And speaking of which, if you are on The Spa Dr. email list, if receive our emails we’re going to look check your email inbox because we’re going to be giving an opportunity for you to have a possibility of winning a copy, a free copy of his book.

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