 Okay we're live and welcome everybody for another episode of Dr. Jill Live. I am super excited about our topic as you know I love gut health and everything to do with the microbiome and we're going to dive deep today on fecal microbiota transplant and why it might be for more than just C. diff which is the current indication. What else might this be for? Where's the research? Where's the status? And I've got an excerpt here today. Shaina is a neuroscientist with an interest in alternative medicine that utilizes the body's innate systems. Love that. She received her doctoral degree in neuroscience from University of British Columbia. Her research studies have focused on brain development and the impact of biological sex, exercise, and aging on the brain. She has a passion for medical education and scientific communication that is accessible, accurate, and digestible. Shaina is the director of medical communications and affairs at novel biome and is focused on spreading educational and scientific information about the microbiome and FMT. Shaina is so glad to have you here today. Thank you so much for having me. You're welcome. So I always like to start with story and especially like how did you get into this field? You're obviously a neuroscientist, microbiome. Now you and I know they're totally connected. But tell us like how did you get into just your study in neuroscience and then how did you get into the uh the microbiome research? Yeah so um I always found away somehow in my academic research to kind of find weird niches that like connected my interest in brain development and brain aging with like areas that we didn't seem to always put together. So my master's work looked at ghrelin which is a feeding hormone and how that actually changes as we age and how that might be tied to some of the dysfunctions in the brain and memory. And so after leaving doing my PhD, I went into the world of medical affairs and mostly my interest came there from wanting to be able to translate my kind of passion for science and education to actually how we can utilize that and allow people every day to kind of be able to consume these large amounts of information. And that's kind of what my focus has been on where I don't expect everybody to be able to read the 100 papers but that's my job and then how do we get that down to something that someone can understand and use that information. And that kind of led me to fecal microbiota transplantation because it's an area where there's a lot of research but that research hasn't really been connecting together as seamlessly as I think it could be. And it's an area where I think we're going to see a lot more interest as well as a lot more use for it and I felt like that was the right place to kind of settle myself in to kind of figure out how can we educate people on it and in terms of that how do we increase the research so that you know it can be utilized more widely. Brilliantly said and I love it because I remember 20 years ago in the beginning of one of my functional master practice I have a college could come in with depression or anxiety and I'm like okay we need to do a stool profile. And as you know back 20 years ago the status what we've seen I'm sure you could speak to this far more clearly than me but the exponential increase if you start to search microbiome it is exponentially exploding and showing you know what I've been doing for 20 years and anyone in functional medicine has known about the microbiome in the brain and aging and memory and so I'm sure you know again even more than I do about how much is really coming out. And the great thing I love this foundation because you're a researcher and I'm a scientist at heart and what's true about our topic today is there is so much science and it's literally exploding. You want to comment on like what you've seen in your career as far as how much it's really increasing in the amount of data that's coming out on microbiome and medications and all these things. Yeah I think the way that I always highlight it for people is the first understanding is that clinical trials are really expensive. They're not easy to run and a lot of them fail. The growth in clinical research in the application of fecal microbiota transplants outside of C. diff in the last 10 years has went from about 30 trials 10 years ago to about 300 trials in 2020. So that's a huge kind of explosion of resources to understanding how this works. But to get to doing a clinical trial the amount of work that goes in both pre-clinically and early clinical studies are exponential. So this research is growing kind of every day and in a really interesting way that we don't see a lot in research anymore where we're learning about the basics at the same time we're learning how it applies to disease. And so I find my day can be like reading a study about how FMT could be used for something like multiple sclerosis at the same time as we're learning about like the basics of like oh we should always pre-treat the gut before we do FMT. So it's very interesting that these two kind of facets are happening at the same time and it's both a blessing and a curse. Because I think for learning how it works and then we're going to have to augment how we apply it as we're doing it. But I think the ability to tie into what our body can actually do already I think will kind of highlight you know maybe not cure everything but I think it could really help get us move us forward in diseases where we're kind of at a stagnant pace. Love that and it couldn't agree more it's interesting because in my realm of course I'm medically trained as an MD but then I do this functional integrative realm where a lot of the things if we take the research and the way things go in classical medicine it's there's research there's maybe an idea and then you know a couple of clinical you know case studies and then of course the research and it gets bigger in the randomized control trials but usually that can take 20-30 years till some idea or some say vitamin has some efficacy till it shows enough with the large trials to put it into clinical practice right you and I know this and what you're describing is the pace of some of these things that are so helpful with less potential side effects like a new drug there might be some toxicity and stuff and I feel like those sometimes carry more potential risk and less benefit or the benefit is just with the risk you have to be more careful of implementing it. All this to say what I've done for 20 years is take stuff that's on the cutting edge coming out maybe doesn't yet have clinical application but I know like okay dosing vitamin C at 2000 a day pretty darn safe there's not a lot of people except for g6pd you know issues that could have problems with that and so I'd say okay if there's safety and there's potential efficacy I will often start to implement before that 30 year curve because my patients don't have time to wait and I think that's what you're describing here is we're doing we're in the trenches we're doing the stuff cutting edge which means we have to take what we get and try to apply it in real time and not wait for those 30 years because we don't want no patients to wait does that make sense or does that feel yeah and I mean at Noble Biom we're focused in in autism spectrum disorder which is really like right right at the beginning when I when I talk about it I'm like you know the groundbreaking trials were you know 2017 2019 like this is recent but there's no other options yes and I think we've had an understanding for a very long time how the gut ties into a lot of diseases but we haven't really put together the importance of okay so the gut is dysfunctional what happens if we reset it yes and I think that's where we're getting is this idea that you know you know FMT at the kind of the more extreme end but it's it's a hard reset on your gut and we're just now really getting to understand you know things that are bad for our overall health also bad for our gut yes yes and so how kind of resetting some of our things that are happening in our life can make changes in our gut but in some cases a full reset is necessary but then when we make those changes the cascade that happens after that and I think you know from your perspective in functional medicine you know you have an understanding that like the whole body is connected and I think one of the issues in traditional medicine and especially you know 20 15 20 years ago it was like the brain does this yeah stomach does this the heart does this silence yeah but we're in a place and we're like oh wait everything is connected so change one thing you change many things yeah and I think that's where gut health I think is getting more appreciation because when we look at the gut it's not only communicating you know in the basics of breaking down our food but it's creating neurotransmitters which are what communicate for the brain but it's also you know dictating the immune system yes and so these far-reaching systems are being impacted by the gut and I mean now that we know it it kind of makes sense you're like oh it processes all of our course you know breaks down the molecules it's very interconnected but it really does it's talking everywhere so okay so what does that happen when it does it right when the gut is functioning properly what else happens yes and that's where we're starting to fully undersea and to see how far and the number of disorders that are being researched you know ranging from gastrointestinal diseases like you know inflammatory bowel disease or irritable bowel syndrome but things like Parkinson's disease, autism spectrum disorder, multiple sclerosis, treatments outside of cancer so like to mitigate some of the negative effects of cancer treatments are all being targeted for possible you know diseases where you know FMT and in gut restoration can play a role. That makes so much sense I just finished the chapter in an integrative cardiology textbook it's the second edition and the chapter I wrote was on Get in Heart right in the connection of the microbiome so people would think like what does that have to do with it so pretty much any system you could talk about there's a relation it all talks so let's go a little backwards you and I know what FMT is but maybe those listening are like okay what is this I've kind of maybe heard about it that's kind of the very basics what is FMT what does that mean what does it encompass I know there's several ways to do it let's start with definition and then we can talk about application yeah so people microbiota transplantation or FMT is the idea of taking a healthy person's gut microbiome from their stool and so these people are highly screened it's very selective for people who could even act as a donor I could not be a donor I am not healthy enough and I'm generally healthy so we take these well-screened donors and so their stool is broken down so it's just basically the parts of the gut microbiome the bacteria the fungi the you know the the different viruses that are in there that make up this colony are purified and then someone who has gut dihobiosis and we're talking about a gut that's dysfunctional that cannot easily be changed so something like probiotics or a change in diet is not going to reset their gut they are going to take FMT which is from this donor material and so that ranges from colonoscopy and retention enemas to these new new ways of doing things like oral FMT capsules and then then what we're seeing is you're re-educating the gut microbiome teaching it how to be the best version of itself and so it re-colonizes the gut the gut starts to look more like the donor gut microbiome so you get a healthy gut and then we see these huge secondary changes not just in GI symptoms but across the board in for us with autism structural disorder secondary changes but as well in another other disorders we see changes that aren't just gut related yeah that makes so much sense because again it goes all over the neurotransmitters and all this so practically speaking say someone visited your clinic what would that look like would it be an intake would it be then a visit would it be follow-up what's the process look like for the average person and what's the time frame on that and then we'll talk about indication yeah so the way that we approach treatment with FMT is the first thing we always do is have a call with whoever is interested and that breaks down like what it is what the research says what the person's looking for and what kind of symptoms they have and if it would be a good fit so that's the beginning of the journey um our journey kind of focuses like our standard protocol is focused on and someone who has autism spectrum disorder of course you know in the call if that's not what you're looking for we kind of augment our process based on that but what we do is we have three checkpoints throughout the process with a physician's assistant and that starts with looking at what medications you're taking what your diet looks like what symptoms you have and creating a pretreatment to prep your gut to be able to kind of allow for this new gut to come in and get cozy in there um and so they'll come to our treatment center after their pretreatment and they spend a week there and pretreatment would you ideally like a month or three months or what kind of pretreatment timeframe pretreatment um three to four weeks normally um and that's normally based in like some kind of antibiotics we know antibiotics just kind of wipe out the gut microbiome so we take advantage of something we know is negative to kind of prep the gut so it's able to engraft new bacteria um and then they spend a week at one of our treatment centers and we have four right now um we have one in Mexico one in Hungary one in Australia and one in Panama um and that allows basically to kind of reduce the stress to getting to a treatment center so we pair with uh facilities that are able to do it have like-minded physicians and then we provide them with product and a protocol um and then once they go home we do uh 15 weeks of treatment after that first initial week and that's normally either um oral capsules or for someone who can't swallow capsules because we work with a lot of children we have an oral powder that they can just mix with juice and water um and they do that for 15 weeks and then over that period they meet with the physician's assistant again to check in um as well as we do uh different behavioral measurements and gastrointestinal measurements to kind of measure improvements to see what we're seeing change-wise um and then you know we kind of we're basically looking right now up to two years after uh monitoring changes and seeing what kind of impacts we see I'm guessing do you do stool testing of course I'm assuming is that part of it or not we don't do stool testing unless it's it's often parents will have a lot of that information we only we're working with kids with autism so parents have a lot of information coming in they've kind of got a plethora of kind of every health aspect um but we do kind of everything individual it depends on where someone is in their health dirty and so all of those things are are dependent on that person and that's why it always starts with a call because everybody kind of comes in at a different point um and you know if FMT is the correct treatment option where they're starting is dependent on where they'll end up okay that makes perfect sense so we know with uh at least in the united states the FDA has approved this for C. diff colitis because there's not a lot of other options I think that's one of the reasons again you could speak to the research on that but you and I know there's so many more likely applications um what are you seeing the research trend to besides I mean what you're doing obviously brand new research in this realm because there's and I think what happens is things that don't have a lot of other options right those are the ones that are first allowed to be able to do this in an experimental way why don't you talk through like where we came from C. diff and what other indications are now being studied yeah so in C. diff um it's it's mostly targeted people who don't respond to typical treatment or have recurrent C. diff so you know I've had multiple you know incidences and FMT treatment shows a 90 efficacy rate which is huge we 90 just doesn't happen in a lot of things um but on top of that compared to what our standard treatment is which is um C. diff comes about most cases because of antibiotic treatment unfortunately the first line treatment for C. diff is antibiotic treatment and heavy duty ones because they have to yeah and so what they're actually seeing is that FMT seems to be more um a more uh efficacy treatment option than what we're currently doing which is antibiotics um and because of the safety profile on FMT right now and as well as how you know efficient it seems to be with C. diff we're seeing a growth in outside of C. diff where it could be used and of course all of this is dependent on increased clinical research is needed um and just more clinical trials are needed to get a kind of better understanding but um for inflammatory bowel disease right now the studies are looking kind of long-term FMT treatments which is normally a loading doses similar to what we do in our protocols you have kind of a couple of treatments which are large doses and then short periods with like you know lower dose FMT over long periods um but for irritable bowel disease or IBD um it's about a 30 percent remission rate which is fairly good um and we're learning that in cases with something like IBD where it has inflamed periods and non-inflamed periods when treatment occurs and how how high inflammation it seems to impact the response um scurable bowel disease shows about a 50 percent remission rate which is quite good and that seems to be longer-term um there's not a lot of studies that've looked long-term so the ones that have seem to show that the results seem to kind of go on for longer periods um Parkinson's disease and multiple sclerosis are very early to the gait both actually have a Parkinson's disease has three or four clinical trials going on right now um and MS I think has two um the pre-clinical research is really positive and so um and the number of case studies there have been show you know both of these these diseases show you know gastrointestinal issues so we're seeing improvements there but these secondary improvements and kind of the core um processes within this disease also seem to improve um for autism spectrum disorder um which of course is our focus we see kids with ASD have more and more severe gastrointestinal issues than their pairs on top of that their gut seems to be more immature so it doesn't match what their age pairs look like and with with doing FMT we see improvements in these gastrointestinal uh symptoms uh one study showed a 77 percent improvement um which lasted over two years but on top of that which we see in a lot of disorders um is autistic related behaviors also improve um and so the study that I'm talking about is from Dr. James Adams group out of Arizona State um and they showed that initially they showed a 23 percent improvement in autistic related behaviors and two years after when they looked it was actually a 47 percent improvement so over time as the gut kind of more changes it integrates and you see um a whole shift to more normal gut microbiome we're seeing changes in these behaviors and we're seeing that in a lot of um neurological diseases um obesity and metabolic disorders is another area that's been kind of hotly looked at um this research is kind of all over the place um one of there's kind of two facets that have happened pretty clinically and what we've seen in in some studies is basically taking you know a lean healthy you know non-obese gut microbiome and putting it in someone um who is obese most of the changes there seem to be you know shift in the gut microbiome which is good and how it's you know metabolizing things but as well as for diabetes insulin sensitivity seems to change um but one of the areas that's been really interesting is uh atulgus fecal microbiota transplantation which is actually using your own gut microbiome and storing it and then using it later um and so what we see with um metabolic disorders is it's you know when somebody is at their leanest at their healthiest they store their gut microbiome and when that's they use that to restore their gut later on um we see you know improvements in insulin sensitivity um and it seems to hold off weight gain not that it solves all things but it does seem to shift um how quickly that happens um but of course that's really early days um and the whole concept of banking your your gut microbiome is is growing in popularity um and I think it is something that I think long term will be something that more and more people are doing because you know at your healthiest at your youngest when you've got your looks your best storing that because you know one time you take antibiotics and you get C. diff or you know you start to age and your gut deteriorates really quickly having that stored allows you to have this kind of health capsule ready and as we learn more about what the gut can do you know how important will that be to have um and I guess the last one I'll mention is is in terms of cancers what they're doing is some of the treatments related to you to cancer treatment are quite invasive um especially when you're looking at stem cell treatments and what has to be done to the body for the body to be able to to handle a stem cell treatment. The interesting thing they're doing is they're doing fecal microbiota transplants after this very after they do this treatment and that's actually helping with graft versus host um and it's also helping with some of those the secondary symptoms and so you know it's helping maintain health on top of these other um other treatments that are happening so I think that's another interesting area that's being looked at is like okay so maybe it's not the gut microbiome that's playing the role in cancer but we're doing all these other things and damaging the gut if we restore that can it kind of take some of these secondary symptoms away. Fascinating I have so many questions as you're talking first of all I don't know if you know but my history I had 25 year at 25 years old during medical school I had breast cancer had three-drug chemo and then six months later I got Crohn's disease and I had the genetics and there's no doubt in my mind that some of the chemo drugs created more permeability and had I known or been able to you know do something like this I probably would have staved off who knows right but it's interesting because it's very relevant to me personally because and and all my passion and work for the microbiome has been restoring the last 20 years what happened with the chemo and the Crohn's and I don't I no longer have Crohn's because of what I've done but I bet something like this could take it to the next level or had I known 20 years ago this would have been so amazing because that's my theory is the cyclophosphamide one of its mechanisms is creating intestinal permeability that probably created more impermeable gut while I also had a gene NOD2 for Crohn's and then crossover into immune system and triggered anyway the the rest is history but so fascinating so a couple of questions the donors are you homogenizing the donors together or does each patient get a different donor so we do um this is an example so you get two bottles of pills those will normally be two different donors okay and then we tell patients actually to mix between the donors during the day so it's not a mix within one pill but it's we do encourage them to use more than one donor and that's a because we're still learning about you know what's important in each donor but we know that the donor microbiome plays a huge role in engraftment and those outcomes and so by using multiple donors you kind of increase you know the likelihood that's yeah the likelihood the variability and and what's going into the gut to kind of make a new gut microbiome fascinating and are you testing for like keystones like akramansia and prusnitsky and rizberia so the kind of ones that really yeah so the number of questions these donors get asked so we look at both their health history and their family health history and anything that could possibly be impacted by the gut microbiome um and so that's you know everything from you know cancers obesity in your family any kind of neurological condition um if it is if it is a disorder it's most likely they will be negated um we don't let any of our all of our donors have never had antibiotics in their life um how do you find as I say I always joke to you to go teaching about FMT before you know we've had options like what your clinic does I would I say now for me I don't know where I'd find a good donor except for maybe pop a new guinea like yeah and it is hard to find and I mean in the published resources you're looking about three some of them go six months without antibiotics but how long does it take the gut to go back to 100% and what are the impacts of having to be restored so we kind of go the extreme and we know that without taking it you're getting the healthiest gut all of our donors are vaginally born because we know that that plays a role um and as well um their diets they report on their diets so they have to have a you know a wide variety um we tell everybody you know try to eat 50 different foods a week because what you eat what you eat feeds your guess yes um and the variety in which you eat is the variety in which your gut exists and so um as well as and then they they report on their physical activity which are all things we know impact it and the variety of questions we ask the length of time it takes to fill one of these out is really long but as well you know standard 50 to 80 percent of people don't meet the requirements of the initial screening um our screening is higher than that very few donors make it through and then on top of that their blood and stool is screened so even if you make it pass the initial health screening then on top of that your blood and stool is screened so it's you know it's all the aspects we can control we can control for and that's you know the donor can transfer things so everything that could be transferred we try to negate as much as possible that's amazing because I think so that's always been my thing with fmt and like this is amazing but the donor is what makes a difference and you guys are clearly doing your research and doing your work on that um fascinating stuff so where uh tell me about the clinic you work with and where if people do want to get a hold of you guys how would they do that and uh you said mainly autism there's definitely a few other indications but that's really where you focused yeah so yeah sorry our focus is is mostly kids with with autism assessment story as well as adults but we do treat people with a variety of other conditions anyone that reaches out with us you know we'll always work with them to see if it is a good fit um so because our process starts with a call that's all booked on our website there's no cost there's no you know you're not guaranteeing anything um it's mostly just because we want everyone to be informed and we want to be transparent about you know what we do know what it can do and what it can't do um and so you know you can go to our website which is uh www.novelbyam.com um and you can go there and then book a call with us look our website kind of ranges everything from the history of where fecal maker body that transplants happened which is about 1700 years ago um to you know our blog which walks you through like how is it done um you know why are you know why do why do some people use frozen stool one people some people use fresh so everything that we can think that has been a question we try to provide information on but as well then you can book a call and talk with someone on our team and ask all of the questions you have and we'll have questions for you to try to make you know the best pairing and and if we're not the right pairing try to you know guide you to to where the best next option is oh my gosh amazing that you're doing this I love it and I love hearing more and then one thing you mentioned that I think is realistic expectations is this doesn't like overnight change necessarily right it can be even months or years where you really see the maximum benefit and that makes perfect sense to me but what would you say is like when you really start to notice changes what's a kind of a time frame when patients might expect if they did this yeah so uh in terms of cdiff and even what we see gastrointestinal symptoms can approve quite quickly um we've had patients that have been treated for cdiff and they said within 24 to 48 hours they saw a huge improvement wow um and because it is it is you know the loading doses are quite high and it really is especially in terms of cdiff it's kind of battling back the bacteria that's negative and giving it you know allowing the host to build new bacteria um on average we see improvements gastrointestinal somewhere around five weeks we see huge gi improvements and then within eight weeks we start to see behavioral changes um and so it is a longer term course and what we're finding with fmt as you kind of indicated over time you can continue to see changes and so far you know two years seems to be the longest anyone has looked um but the improvements are continuous when we talk to parents they say the same thing yeah is that you know there's the first improvements and then those continuously kind of guide where things are going to go um and because of this you know diet changes that also has other impacts as well um and then just general quality of life improvements for both families and for the children themselves also have impacts so you know it's it's a holistic kind of change where the gut microbiome plays a big role and that causes changes but as well because of those other changes happen um so it's it's that holistic like you're treating the whole and you I'm guessing you give them that here's the ideal diet you should be eating to make it work right because that's yeah okay we've kind of provide support throughout and you know answer questions of like what is the best food yeah you know uh what kind of new changes what can you know these things have changed so what kind of foods do we do next or what kind of do you find that the fmt changes their cravings too like do they change their what they want to eat because that often I can see yeah we see augmentation in kind of their food versions yes um so with with kids what they see that's a big one um as well as you know we try to be realistic which is like in the first couple of weeks like here's here are ways to start integrating more foods and as more foods get integrated and the gut is being fed we see that they're you know we see how they take on new foods becomes a more positive experience so um you know we've been working with a lot of parents and we kind of try to we try to learn from them as well because um if you've ever met a child a parent or a family that has a child with autism they are so well informed they're more well informed than I am most days um and they're very willing to kind of discuss what works and what doesn't work and so in working with them we're kind of always kind of trying to tweak what the information we provide is as well because it's a huge life change it's a huge family change so it's you know what are the best ways to tackle that and and best feed this new gut microbiome and also support because life happens get sick so how do we you know also work with them when those kind of struggles happen love that and I'm assuming like maybe not a celiac kind of patient situation but some of the other food uh intolerances I'm assuming that could change as well right because obviously in your store do you see that where patients get less um reactive to certain foods um I wouldn't know if hang because it really is dependent like we have some people come with us that have no restrictive diets you know and then others that you know there's no gluten there's no dairy there's no corn there's no right so it really depends and it also is where they are in the journey I find people that um diet tends to be one of the first things we change yeah and when you think about having a dysfunctional gut that's not able to process or work the way it's supposed to foods that are hard on the gut to process are the first ones we take out um but we know that as the gut kind of changes their diets can change but you know it doesn't mean all their allergies are intolerances we'll go away and that will depend on why the food was removed as well got it amazing amazing information such a great resource I knew I'd enjoy this but it was so good um one last thing I'm sure people are wondering obviously this kind of thing right now is not FDA approved as is so this is part of what we need to do to advance research but what kind of cost would people expect for the full treatment for a patient yeah so for our um for our like ASU protocol which is you know 16 weeks plus one week um as well as meeting we have some some measurements that are done not done by parents them by a clinician as well as meeting with a physician's assistant so it's a quite extensive package which is specific for people with with the child or themselves with ASD so the cost is associated with what someone's coming with us for but um our ASD protocol is uh just for $14,000 um and so that includes everything and then support afterwards as well and again that makes sense this is incredibly intensive and and I'm assuming as a physician I could refer to you or have patients contact you or any docs that because we have a lot of docs who listen to so if they're listening to do functional medicine and they want so ASD is your primary thing right now yeah hopefully this will expand um I'm going to help you get the word out because I think it's a great resource um any last final takeaways if someone's like listening maybe they have a child who has autism and they try a lot of things any last little pearls for us before yeah I think looking at where the research is going and the support for how impactful gut change is um I think in disorders that we think that gut plays a huge role in and gut behavior seem to go together when we talk to parents they can say when gut symptoms are high behavior is high um or they'll call and and this isn't just specific to ASD because I have friends like this they call them like gut people like my gut determines everything in my life yeah well what if you could teach your gut to allow you to have more freedom or less severe behavioral swings or you know better moods that's what FMT is is allowing is allowing your gut the chance to learn how to be more normal or um more functional yeah and then allowing you to then you know augment things going forward because your gut is able to do and communicate the way it's opposed to and I you can't undersell the importance of your gut because if you just take the simple idea of you have a bad day you eat bad food you feel bad which causes you to have a bad day which causes you to eat bad food well that's all connected because you have a bad day stresses up um and your mood is down while you crave food that is not going to feed the gut the way it needs to which then kind of perpetuates this kind of momentum going forward so we know you know you are what you eat is becoming a more true statement than we ever thought um and I think understanding gut health and how that could play a role in in your everyday life I think is is invaluable couldn't agree more um Shana thank you so much for your time and your expertise super valuable I know a lot of people have gotten help and already had some comments um so thanks again for your time today no problem and if you want to learn more we have a youtube channel where you know every week I try to cover some topic that I find of interest um but that kind of brings in you know more about FMT or more about the gut um and we're always willing for people to give us topics they'd like to hear about as well um because this body of research as you said is growing every day and so we're trying to you know summarize it because I find it a lot I can't imagine somebody else trying to do it when it's totally yeah you need it exactly there's so much there so thanks again thanks for distilling it for us and then be sure and send me a link to your youtube channel I will include that wherever you're listening to this live as well okay thank you so much thank you so much to you