In this conversation, Taylor Soderborg MD PhD discusses her journey as a physician scientist and her focus on the microbiome's role in child health. The discussion emphasizes the importance of optimizing microbiomes, their impact on health, and practical advice for parents to support their children's microbiome. Soderborg introduces Tiny Health, a company dedicated to microbiome testing, and explains the testing process and personalized recommendations for families. Taylor shares insights from ongoing research, including the impact of microbiome restoration on clinical outcomes, and emphasizes the importance of making microbiome testing accessible to families.
Taylor is a licensed pediatrician with a PhD in microbiology. During her studies, she discovered the infant microbiome's role in the risk of developing obesity and liver disease, and has been obsessed with gut health ever since. After 15 years in academic medicine, she now builds bridges across all types of healthcare at Tiny Health. She is passionate about keeping people healthy and finding the root causes of health issues, while integrating different approaches to help set children up for lifelong wellness.
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com
-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20
-To test your child's microbiome and get recommendations, check out:
Tiny Health using code: DRJESSICA
Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.
The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
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Transcript
Episode Transcript
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Unknown (00:00):
Hi everybody. I'm Dr Jessica Hochman, pediatrician
(00:02):
and mom of three. On thispodcast, I like to talk about
various pediatric health topics,sharing my knowledge, not only
as a doctor, but also as aparent. Ultimately, my hope is
that when it comes to yourchildren's health, you feel more
confident, worry less and enjoyyour parenting experience as
much as possible. Hi everybody.
Welcome back to Ask Dr Jessica.
Today we're going to talk aboutthe microbiome, and I'm joined
(00:24):
by Dr Taylor soderborg. She's aphysician and a scientist, and
she's dedicated her entirecareer to understanding the
microbiome. In this episode,we'll dive into how the
microbiome connects to ouroverall health, and she'll share
practical tips for parents onsupporting their kids
microbiome. We also discussedour company, tiny health, which
offers personalized microbiometesting for families.
(00:45):
Personally, I'm really excitedabout what tiny health is doing.
Optimizing the microbiome couldbe a key part of high quality
medical care in the future. Andif you're interested, I've
included a discount code fortiny health in the show notes
below. And before we dive in, Ialso want to let you know that
I'll be taking two weeks off forthe holidays, so this will be
the last episode of the year. Ihope you have a wonderful
holiday season filled with fun,joy and relaxation and one last
(01:07):
thing, if you're enjoying thispodcast, please consider leaving
a five star review. It's a smallgesture that makes a big
difference to help the showgrow. Now on to today's
conversation with Dr Taylorsoderborg, it's so nice to meet
you. Thank you so much fortaking the time to come on the
podcast. Yeah, thanks so muchfor having me. I'm having me.
I'm really looking forward tothis conversation. So tell us
about yourself in addition toworking at Tiny health tell us
(01:28):
what kind of a physician you areand your medical journey to
getting here. Yes. So I startedmy journey through doing an MD
PhD, so becoming a physicianscientist, because I love
helping families and I loveworking with children. But I
also wanted to get to reallyroot cause and figure out why
(01:49):
health conditions arise, what wecan do to reduce the risk of
developing them. And so I reallywanted to understand why, you
know, how we can optimize healthand childhood, just to help
people have reduced lifelongconditions and have a better not
only lifespan, but also healthspan. So I did my MD PhD, and I
(02:10):
did my PhD in infant microbiome.
I was really interested in howall the microbes in our gut
influence our lifelong health.
And then I went into pediatrics,and I was training in
pediatrics, and I was working inthe hospital, and I got to work
with all these amazing families.
And, you know, as much as Iloved that, I knew I wanted to
really focus on the microbiome.
(02:31):
And I just knew that there wasso much power harnessed in our
gut health early in life, thatif we could understand that
better and optimize it, thatthat would be the way that we
could really make a huge impactin lifelong health. And so while
I was in my training as apediatrician, I learned about
this company that had fairlyrecently been created and
(02:55):
developed called Tiny health.
And tiny health is a companythat does microbiome testing,
and it's the only company thathas reference ranges for every
age stage phase of life. Andwhen I learned about this, I
just knew it was sort of like,you know, you have those
decision moments in your lifewhere, you know, if you wrote a
biography, where would it start?
(03:16):
And that would be sort of mymoment where my biography would
start, the moment that I decidedto transition from being
practicing, practicing physicianto helping develop and work at
this company that was bringingmicrobiome testing to the world,
notably to infants and children.
And so it was during my trainingphase in pediatrics that I
(03:39):
decided to make this transitionto tiny health to help bring
this testing and understandingthe results and interpreting
them and helping people to acton these findings to, you know,
bring that to parents and nowalso to other healthcare
providers. So this is amazing. Ilove that you have combined all
of your interests, you know,your research interests, your
(04:02):
pediatric interests, into afield that has a lot, in my
view, a lot of potential and alot of potential benefit for
children. I love that you arefocusing on prevention. I think
that is so wonderful because somuch of medicine now we spend
our money on trying to fixproblems that we could have
prevented in the first place. SoI, I'm all for that mission.
Yes, me, me too. And that'sreally how I became interested
(04:25):
in the microbiome, because Iknew if we could optimize this,
we could reduce the number ofkids who are struggling with
chronic conditions. And youknow, what is it? 40% of
children now have a chronicinflammatory condition that's
too that's too high, and then,you know, that's not even
including and thinking about therise in health conditions in
adults as well. And so it'sjust, you know, that number
(04:48):
keeps on growing. And sosomething is going on
generationally, that we are justcompounding health conditions on
health conditions. And where canwe intervene? And.
Was the biggest question that I,you know, sort of my early
career as like, Where can westop these generational cycles
of of illness and gets themicrobiome? So I have some
(05:11):
questions on that note. Sofirst, people use this word
microbiome a lot. Can you, insimple terms, explain to people
what is a microbiome? Yes, okay.
And I actually love thisquestion, because, okay, when
you hear the word microbiome,typically, what people are
talking about are the trillionsof microbes that live inside
your gut. Trillions, trillions.
(05:34):
Yes, it's like 38 trillion, Ithink is the the number we've
landed on. And there arebacteria. There are microbes
that live inside us. I know ifthat's like a new concept, that
might be a little jarring, butthey help us to, you know, set
up our immune system. Know,Like, who should we react to?
Who should we not react to? Andso that's typically what people
(05:56):
are talking about when they saymicrobiome. They're talking
about all the bacteria in yourgut. But I do like to highlight
there's actually microbiomes allover our body, all over the
world. So microbiomes are justreferring to collections of
bacteria or microbes that livein certain places. So we
actually have a microbiome onour skin. So sometimes kiddos
(06:19):
who are struggling with thingslike eczema that can be related
to not only imbalances in yourgut, but also on your skin.
There's soil microbiomes thatcan help understand if our food
is growing in nutritiousenvironments. So microbiomes are
all over our entire world. Butwhen people say microbiome the
(06:39):
biggest, most popular, mostresearch area is the gut
microbiome. Now, when childrenare born, when they come into
this world, can you explain toeverybody, do they have bacteria
in their gut when they are born?
Oh, my. So, you know, this is alittle bit of a controversial
question, so I won't go too muchinto the weeds. The general
consensus at this point is thattypically babies are fairly
sterile, or they don't reallyhave a microbiome when they're
(07:02):
inside, when they're in utero,and then in the process of being
born is when babies get exposedto those initial microbes. And
so this is why there's, youknow, a lot of research done on
vaginal delivery or C sectiondelivery, because that's going
to really influence what arethose first bacteria that baby
(07:22):
gets exposed to. It sets thestage for what that microbiome
is going to look like. So by andlarge, you get your microbiome
in the process of beingdelivered, and then the other
you know, other exposures youhave early in life, how you're
fed, what medications you may ormay not be exposed to other
(07:43):
family members. Those are allthings that continue to
determine what type of microbesare in your gut, in your gut
microbiome, but that very firstexposure is typically through
the way that you are born andthen subsequently, do you have
any advice for parents to keepthem exposed to a healthy
(08:04):
microbiome? Is it rolling aroundin dirt? Is it eating food off
the floor? What can parents doto help support a healthy
microbiome? Well, one thing I dolove telling parents is that if
you do want a pet, notably adog, that's a great way. So I've
certainly had a number of anumber of parents I've talked to
say, Wait, can you tell mypartner? Can you tell my husband
(08:25):
this real quick that we have toget a dog? Well, that's
decisions between you. Butscientifically, you know dogs,
pets are very helpful forreducing the risk of developing
like asthma food allergies,because of its influence on the
microbiome. I remember after wehad our first kid, my husband,
who's also a physician, we hadread that Living with Dogs does
(08:46):
help give a boost to your immunesystem. So I remember once we
were walking in a park and wesaw a dog, and he had our
daughter, who was barely oneyears old, just pet the dog, and
I said, Wait a second, ask theowner first, make sure it's a
dog that's okay being pet. Andthen I think also the big part
of it is you have to actuallylive with the dog for the
benefits to be a parent. Yeah,it is petting random dogs off
the street, exactly, exactly. Imean, we, you know, encourage
(09:08):
petting friendly dogs is alwaysgreat, and whatever exposure you
can get. So even things likegoing and visiting farms or
petting zoos, things like that,being in those environments,
spending time outside. Sothey're really, you know, just
even that exposure, as much asyou're able to, you know, when
developmentally appropriate, ofcourse, but having house plants
(09:29):
and having your kids help youwith repotting and dirt and
things like that can be verybeneficial. And the good thing
is, is, like, you know, in thefirst, especially, six months of
life. Babies don't have a wholelot of jobs. They have to do.
They they need to eat, which,Yep, great. And they need to be
adorable. And there's nointerventions needed for that.
(09:49):
They nail that automatically.
Then, you know, what are theyeating? Breast milk, ideally,
formula, if needed. So, butthey're not having this overly
complex diet. So the mic.
Biome doesn't need to be complexin that phase of life. And so in
that phase, it's really aboutlike, do we have the right
combination of bacteria that weneed to digest that great breast
(10:10):
milk, all the nutrients inthere? It's a very simple, non
diverse microbiome. And thenaround that four to six months,
you know, whenever ready tostart doing foods. You know, as
we developmentally change, like,we start moving around
differently, all of thosedifferent phases of life are
really well mirrored in themicrobiome. Like, the more you
(10:32):
move around, the more foods youeat, the more your microbiome
becomes complex to mirror that.
Ideally, there's not much thatit's needed to be done. It's all
about getting on trackinitially, because once you're
on track, all thosedevelopmental stages kind of
naturally help the microbiome todiversify and mature and develop
like it should. I always feellike kids are resilient and that
they can tolerate an antibiotichere and there. It's okay, but
(10:53):
it does. It does remind us that,you know, we want to use
medications when kids reallyneed it. We want to get them
outdoors. We want to have themhaving a normal child. So I more
wantto remind parents that I think
when they hear this news, oh mygoodness, my I had a C section.
My kids been on antibiotics,maybe they don't play outside
enough that there are thingsthat we can do, right? So
(11:16):
totally, totally Yes. And I lovethis magic message, like, life
happens, like, C sectionshappen, formula is needed. Like,
it's so amazing and great thatwe have these interventions that
allow us to get through thesethings safe and healthy. But
you're right. The question is,how do we how do we build that
resilience so that we cantolerate an antibiotic when
(11:37):
needed, that how do we restorefrom a C section? And so really,
it's all about knowing thestrategies to build that
resiliency that allows us tohandle all the things that life
throws at us. And so like, forexample, one of the things that
I love to share is a lot oftimes like C section was not in
(11:57):
the plan, and that's how babiesend up being born. Well,
laboring can help introducethose microbes to baby. So even
if baby is born by C section, ifyou labor it ahead of that baby
does you know, depending on sortsort of how far they descend,
they can get exposure to some ofthe microbes from the vaginal
community, which is a key partof that, like initial seeding
(12:19):
and development of themicrobiome. So laboring amazing
if you're mostly doing formulaand just able to do a little bit
of breast milk, oh, the contentsof breast milk is so powerful
that even a small amount of thatcan have huge, huge benefits. So
it really isn't this, like, allor none? Like, oh, I didn't give
(12:40):
birth vaginally. It's all over.
Absolutely not. And then part ofthe reason why tiny health
exists is that you can actuallylook at what's going on in the
microbiome and understand, aresupports needed? Are they not
needed? We don't want to oversupplement that actually can
have its own set ofconsequences, and so, you know,
(13:02):
how do we basically get kids ontrack to be able to just live
their lives without that highlevel of like concern and
scrutiny? I love that. So firstI want to say I love that you
mentioned that laboring isbeneficial. There are other
things that moms can do to helptheir kids microbiome. Because
part of me always feels uneasywhen we talk about how, how
having a vaginal birth isadvantageous for kids, because I
(13:24):
look at the statistics in thehospital over the weekend, and
oftentimes the C section ratesare near 50% over the weekend.
And so I don't want moms to feelguilty. I don't want parents to
feel bad, right? Because numberone is, you want to have a
healthy kid. So if having a Csection meant having a healthy
baby, that's obviously numberone, but then it's nice to know
that there are things that wecan do from that point forward.
(13:46):
So thank you for explaining thatabsolutely. And I think this is
really interesting what you'redoing, because I agree that, you
know, I'm not a fan of givingsupplements just for the sake of
taking a supplement, but ifsomeone's truly deficient in
something, or they're trulyneeding something, yeah, then I
am on board. Yeah, absolutely.
And so, you know, when I wastalking before about how the
early life microbiome, likeearly on, it's very simple, it's
(14:09):
not diverse. And so what wereally want to see in babies is
this dominance of this type ofbacteria called Bifidobacterium.
It's just like the most amazingat digesting the great things in
breast milk. It helps toestablish the immune system.
It's good for your gut lining.
(14:30):
And so if you don't have that,then you can't, even if you're
doing these great things, youcan't really boost it. Or if you
don't have enough of it, thoseunfriendly microbes can really
take over. And so, you know,it's that sort of like
understanding, do we have themicrobes that we you know, that
we ideally want to have inthere, that are there to help
support good microbiomedevelopment. And so if you're
(14:54):
able to test and look to see, dowe have that, or do we not have
that, and then use that.
Information to decide, should weuse a probiotic, or should we
not use a probiotic? Becauseanother question I get a lot is
like, Well, why don't we justhave everybody on this
Bifidobacterium probiotic? Ifit's like, so good for for
babies, and that's because, youknow, we need to honor the
(15:16):
developmental trajectory, like,how the microbiome changes,
like, you know, like I said, asyou start to eat foods, or you
start to move around, it's goingto gently become more diverse,
and you don't want to competewith that process. So it really
is like, do we need tosupplement? Kind of, for how
long do we need to supplement?
Did the supplementation work?
And yeah, because honestly,like, one of the one of the most
(15:36):
powerful recommendations I giveto parents is stop using the
probiotic you're using, we havethe data to show it has done its
job, and now we have, like, thestrongest recommendation I can
make is to not use it anymore,and I can't I can't know that
until we have that informationin front of us. So when should
parents think about looking intotiny health how would that
(15:59):
process work? When do yourecommend parents reach out to
you at what stage of theirchild's life, great question. So
one of one of the things Ideeply believe in the in this
world, and I want to see in mylifetime, is that this type of
testing is done for everynewborn. And so I think every
kiddo you know, probably betweenaround two weeks old, should
(16:20):
have this type of testing doneso we can identify imbalances
and help correct them before westart seeing issues and those
types of issues that you know,there's so much data showing the
relationship between themicrobiome and eczema, food
allergies, asthma, those aresome of the most strongly
researched conditions showing acausative role. The microbiome
(16:43):
can help to cause thoseconditions. But we're also
seeing more and more informationcome out about the microbiome
and neurological development,ADHD, autism, and then even
later on in life, there's linksbetween the microbiome and
Alzheimer's disease,osteoporosis. So really, it's
(17:04):
about identifying imbalancesbefore we even start to develop
those conditions. And so Ireally, really, really believe
that every child should havethis testing very early on in
life to make sure that we are ontrack or take quick action
again. It's a couple of weeksthat it takes for the microbiome
to change, if you know what, itneeds to take some very quick,
(17:26):
short action to help get it ontrack and build that resiliency
and help build the immune systemright from the beginning. So
that is the ideal. The ideal isthat this is checked in on and
optimized, if needed. Firstthing, however, another great
time to check in is when you dostart to see some of these
conditions popping up. That isthat, and that is most commonly
(17:50):
when people find tiny healthbecause, of course, you're going
to find things when you'redesperately looking for a
solution, when nothing else hasworked. And so you know, Eczema
is a really big one. Otherfamilies are we haven't slept
one night since our kid was bornbecause they're so uncomfortable
and fussy and they can't sleep,or mom has cut everything out of
(18:12):
her diet in order to continuebreastfeeding, because every
single food she eats istriggering. A lot of those
conditions are rooted in amicrobiome imbalance. The
microbiome is reallyinflammatory, and so it's
triggering inflammation all overthe body. Sometimes that looks
like eczema, looks like GIupset. It can look like food
(18:34):
sensitivity, and that is a hugething, that if you are
struggling with some of thoseconditions, looking at the
microbiome imbalances can be ahuge, huge, huge benefit,
because you're going to look atit at the root cause level, it's
not putting band aids on justtrying to dampen down the immune
system. It's truly getting towhat is causing this, these
(18:54):
disruptions. So that's anothergreat, great time to do testing,
is when you want to address someof these symptoms and walk
parents through the process. Doyou send in a poop sample? What
does the process look like tocheck a child's microbial
right here, so you get this cutelittle kit right to your house,
and it is no mess testing. I'mso glad you brought this up,
(19:19):
because sometimes people arelike, do I have to collect poop
in a bucket? Because I don'tknow if I want to do that. And
actually, it's just a quicklittle swab right off of the
diaper, right out of the toiletpaper, quick little swab. It
goes right back in here. Andthen this is very stable, and so
you don't have to worry about,you know, the bacteria changing
things over, growing thingsdying off. This preserves it,
(19:42):
and it includes a mailer, andyou put it in the mailer, and
you put it in your you know, mypost office takes it right off
my mailbox, or you can put it inany USPS, and it will get
processed from there. So it's avery, very no mess testing
situation, which is greatbecause we don't need to add any
any more challenges to change.
Diapers. And then what happens?
Parents get a report of theirchild's microbiome with various
(20:04):
reference ranges. And then doyou give them recommendations on
what probiotics to take if theyif they need a probiotic
Exactly, exactly, so they do thesample. And then we do have some
survey information that wecollect to help better
understand, you know, are youcoming because of a certain
condition, and that we can, youknow, provide some additional
recommendations based off of anysymptoms they're trying to
(20:25):
address, or health concerns thatthey have, and we also get some
information about how kiddoswere born, what medications
they've been exposed to, howthey're eating, or they have
they started solid foods. Andall of that information helps us
to better understand theresults. So you do the sample,
you take a survey, and then youonce you get the results, we
(20:46):
have an online portal where youcan view all of the results, and
they're all tailored to the ageof the person who went that
tested based on the birth datethat they provided for the for
the individual. So everything isalready age specific, and that
includes the results, but italso includes the action plan
recommendations. And so you canclick in we have tons of
(21:09):
information, you know, dependingon your level of nerdiness, you
can even click into theindividual papers that we're
referencing, like the publishedliterature that we're that we're
referencing. You can click onthose links. And so the action
plan is also provided foreverything that's flagged as
needing support or needingimproving. We provide
recommendations on how to dothat. And so that might be
(21:30):
probiotics, might be othersupplements like prebiotics. It
might also be diet. We providevery specific dietary
recommendations, so we canactually even look to see like,
what type of fiber your gutneeds more of. So maybe you need
more pectin fibers. So thatwould be things like apples with
their peels on, or pears. And sowe can help provide very
(21:53):
specific dietary recommendationsin addition to supplements. And
then we also have a lot oflifestyle recommendations. So
sort of like we talked about atthe beginning, like getting into
nature, time with animals, butwe we really have worked hard to
make that very tangible. So,like, we're not going to say,
eat more plants, because Okay,great. Thank you. We all know
(22:15):
that, but we're going to say,hey, aim for 30 different plants
a week. Here is a chart that youcan print out that has a rainbow
diagram on it to make it fun andactionable and trackable. What
amount of plants you're eating.
Oh, we're going to tell youexactly these types of foods are
the type of foods that would bebest for your gut. And so we do
(22:37):
really have very tangible actionitems to that are personalized
and also help really bring thisto life. And then also, with
tiny health testing, you don'tjust get the actions for right
then and there. You also getaccess to all of these guides,
recommendations. So you'regetting ready to introduce solid
foods. We have a whole guide onrecommend, on how to introduce
(22:59):
solid foods from a healthymicrobiome perspective. Oh, no,
antibiotics happened. That'slife. We have a whole guide on
how to restore the microbiomefollowing antibiotics. So you
don't only get actions for likethe then and there. You also get
actions for supportingmicrobiome health throughout
that whole phase of life. And solots of information about well
(23:22):
vetted products for eczema, foraddressing the flares on the
skin, probiotics that are notintended to shift the
microbiome, but can be veryhelpful for symptoms from a
microbiome perspective. Sonobody's going to leave without
something that they can do tohelp their microbiome, health or
symptoms. What I love about whatyou're working on is, I feel
(23:43):
like in the medical community,it's well established and well
decided upon that the microbiomeis really important. But I think
what's tricky is there's not alot of evidence to back up
specific probioticrecommendations or prebiotics.
So it's hard for me. As parentswill ask me, Hey, my child, I'd
like to give them a probiotic. Ihear that it's healthy. I hear
the microbiome is reallyimportant. What should I give
(24:04):
them? And I want to give themadvice that's evidence based or
that's specific for them. So Ifeel like tiny Health offers
that it fulfills that, that gapwhere you can actually see
what's potentially missing andoffer a concrete, actionable,
helpful recommendation. 100% allprobiotics are not created
equally. They are not allintended to have the same
(24:26):
impact. So knowing which onewhen for how long is so
important, and that's why wealso have this action plan, and
why I'm also working to helpteach more doctors, more
healthcare providers about thisas well and provide them with
those tools. Because, like yousaid, it's no mystery at this
(24:46):
point the importance of themicrobiome, a really big
question that a lot of parentsand healthcare providers have
is, well, what do I What do Ido? I don't know what I can
recommend that's going to besafe, effective.
Active. And so the great thingabout tiny health is that we
provide that data that's neverbeen available before, and then
(25:06):
we also do a lot of vetting ofall the products that we
recommend, so we know thatthey're high quality. And then
we also can look back at our owndata and ensure, over time, that
they are working in our youknow, kiddos who resample with
us, and so we're continuing toutilize our own ability to vet
resources, as well as our owngrowing set of data, to just
(25:29):
continue to provide the bestrecommendations to help optimize
health. That's so helpful,because I feel like this is a
burgeoning field. So we don'thave all the answers right now,
but I know it's so important towork on, so that we have good
information for the future,something I think a lot about.
And I don't know if you've heardabout this, but the Amish
(25:49):
population, I find reallyinteresting, because what I read
is that there is a very lowincidence of eczema in the Amish
population. But what they do dois they spend a lot of time
outside, hands in the soil.
They're around animals. And sopeople are trying to figure out,
what is it about this populationthat they have a low incidence
of very common childhood chronicdisease, and so one has to think
(26:12):
the microbiome is likely at playhere, but we're not exactly sure
how to replicate thatenvironment. I find this area of
medicine incredibly interestingbecause we see, as you're
mentioning, there's staggeringreports on how much chronic
disease in children haveincreased over the years. I
think kind of, one of the thingsyou're hitting on here is
there's so much amazing medicalinnovation, and we're learning
(26:34):
so much. And when it comes tothe microbiome, a lot of that
is, how do we just restore whatthings used to look like. It's
not that we need to come up withsomething entirely new. It's
that we need to figure out howto restore our microbiomes how
they used to be. And, you know,sounds like evidence by the
Amish population, like 90% ofkiddos are missing
Bifidobacterium infantis, whichby its name, clearly, it's a
(26:56):
very key Bifidobacterium forinfants, 90% of kids are missing
that we we've seen, you know,people have done studies showing
that the amount ofBifidobacterium over generations
has continued and continued todecline. And so really, it's
about, how do we ensure that wehave the right microbes that
we're supposed to have whenthey're increasingly
(27:18):
disappearing in our society, andthankfully, we have the tools to
look for that, and we do haveproducts like great, you know,
great probiotics, or greatinformation on prebiotics and
dietary actions that can helpboost these things. But really
it's about getting getting backto how our microbiomes should
and used to be. Do you have anyactual research that has shown
(27:39):
clinical improvement when kidshave replenished their
microbiome in the way that youguys have advised, yes, we do,
which I have to say is, youknow, tiny health has only been
around for a couple of years atthis point, and we already have
conducted and gotten results onclinical studies that We've
done, because this is a hugelyimportant part of tiny Health's
(28:01):
mission to bring this data thatwe're collecting to help support
the use of actions like this,testing like this,
recommendations like this. Andso hopefully, you know, we are
going to we have this data whichthen we can bring to other
healthcare institutions and say,look at how much this helps. And
so we that is why, you know,from the very beginning it was,
(28:24):
it's very important to us thatwe are contributing to this
field of research. So we have astudy coming out soon that I can
tease a little bit. It's calledthe infant restore study, and we
looked at the outcome of testingand providing this type of
information to parents whosekids were born by C section. And
(28:45):
then we did follow up testing,and we found that there was
significant improvement in themicrobiome community. And so the
microbiome overall did lookbetter. It looked less like the
kid was born by C section, moretowards a child who was born by
vaginal delivery. And also, eventhough this was a very short
(29:07):
study, just six months long, wefound that even in that short
amount of time, there was areduced amount of eczema in the
group that got their results andwere provided with the
recommendations compared tothose who did not see their
results and did not see any oftheir recommendations. We you
know, we are already collectingthat sort of immediate data and
seeing very, very promisingresults, even in this very short
(29:29):
time frame. That's reallyhelpful to know, because to be
honest, yes, it sounds reallynice that the microbiome looks
like you'd expect it to look ina with a healthy microbiome. But
I think for a lot of parents andmyself, we're interested in
clinical outcomes. We want tosee improvement in what they
came you know, what they came toyou for? So if your child's
(29:50):
suffering, if the child'ssuffering from eczema, asthma,
you know, and you do tiny healthand you take, you follow the
advice, what would feel reallysatisfying?
If you see clinical improvement.
So that's really great to knowthat you've seen some short term
improvement with eczema, andthat you have longer term
studies on the horizon, and Iget that you've only been around
for a couple of years, so that'shard to do, yeah, but it's nice
(30:12):
to know that it's on thehorizon. Yeah, yeah. And you
know, what was really cool aboutthat study was it was showing,
like before symptoms had evendeveloped, that we were able to
reduce them from even startingin the first place, and that
only backed up. What I see on abasically a daily basis is kids
who already have theseconditions getting significant,
significant improvement. We havea number of case studies on our
(30:36):
website as well, reallyhighlighting these individual
cases where we've just helped somany families that were really
just at their wit's end, nothingwas working. They were on
chronic steroids. So we have aton of case studies showing that
for families who are alreadyexperiencing these conditions
that this type of testing reallyhelps, and now we're developing
(30:58):
the data to back that up as welland show more of that
preventative role in Inaddition, I'm just so curious,
how are you doing this? Alllike, how are you how are you
marketing a product and thenalso having a robust research
arm? Tell me how big is yourteam? I'm just curious. We are
22 full time and about probably15 to 20 part time. That's
(31:25):
incredible. Congratulations.
Great leadership. Really greatleadership in, you know, just
not, not saying no. I mean, Ithink that part of we all
believe so deeply in thismission that we it's like that
we can't prioritize getting justthe research. We can't
prioritize just getting this toparents, or just getting this to
(31:49):
practice, to healthcareproviders, because we have to,
like, we have to get it toparents now they need this now.
We can't wait to educatepractitioners, because we're
seeing the data. We have to getthis into their hands to help us
reach more families, and then wecan't wait on the research,
because we have to work towardsgetting this insurance
reimbursable and part ofstandard of care, because we
(32:09):
need this to be available foreverybody. So it's we can't not
do all of it, because we believeso deeply, and we've seen the
power that this does have. So Ithink it's just that, you know
that mission that drives us allto just we have to get it done.
Can you comment on any potentialharms in taking too much you had
mentioned that not everybodyneeds to take the supplements
(32:31):
and for an extended period oftime. What would the harm be
that you can think of in takinga probiotic or a prebiotic for
an extended period of time?
Yeah. So this is a reallyimportant point. So the early
life microbiome is verymalleable, so it can change very
readily, and so you undergo likea maturation process in the
(32:52):
microbiome, from, you know, whenyou're born, until about age
three to five. About age threeto five, your microbiome becomes
a little bit more set, like alittle bit more of an adult
microbiome. And so in thosefirst couple years of life, the
microbiome changes a lot. Andso, you know, sort of a blessing
and a curse, like it's veryeasily changed in both negative
(33:12):
and positive directions. Now,what it should be doing is it
should be going from verysimple, not diverse to a very
nice, rich, diverse microbiome.
So how does it get from this notdiverse microbiome to this very
rich, diverse microbiome overthe course of a couple years? So
this is a very gentle processwhere you know your different
(33:35):
exposures, like crawling around,or that phase where you start
putting everything in yourmouth, introducing solid foods,
all of these phases gentlydiversify the microbiome, and
then over the first coupleyears, that diversification then
reaches adult form. And so youdon't want to do this too fast,
and you don't want to do thistoo slow. It's a very Goldilocks
(33:56):
situation. You want thatmaturation to happen on a nice,
gentle curve. And so when youare giving supplements early in
life, you may be delaying thatmaturation, or you may be
speeding it up. And so, forexample, if you're giving that
Bifidobacterium, that's so, soso good for babies to have a ton
(34:17):
of early in life, if you aregiving that but you're also
introducing solids. It's reallyhard for that like gentle
diversification that comes withsolid introduction to compete
with a high power, high qualityprobiotic, and that failure to
follow that maturation isassociated with increased risk
(34:39):
of conditions like eczema, foodallergies, asthma, and then, you
know, conversely, if youdiversify too early, that also
is associated with eczema, foodallergies, asthma, and so it
really is, like, you know, beingon that curve, which it's
amazing for the most part, thathave, like, once you get on that
curve, typically, it.
(35:00):
Follows that curve. It's justabout making sure that you're on
that right trajectory initially,and if there are disruptions
getting back on that trajectoryduring that very delicate,
sensitive time. And I'm justcurious, on a case by case
basis, have you gotten goodfeedback from customers?
Amazing.
This testing is truly lifechanging. And so I, you know,
(35:23):
just being able to get to theroot cause in help stop just
putting band aids on conditionshas been game changing for so
many families. What about whatabout adults? Yeah, do you
recommend this product foradults? And I'm listening to
you, and I'm thinking, I have somany friends that have that have
(35:44):
stomach aches or skinconditions. Can they? Can they
benefit from getting a tinyhealth Yes, absolutely, again,
because it gets to the rootcause imbalance. A lot of our
conventional approaches at thispoint are focused on just
dampening down the immunesystem, but not actually getting
to why it's so overactive in thefirst place. And that's like,
(36:08):
it's, it's no fault ofconventional medicine. That's
what's currently available, ismedications that will dampen the
immune system to reduce symptomsof chronic inflammation. And so,
you know, that's why we're soadamant about getting microbiome
testing, you know, awareness,into more conventional practice,
because what this testing can dois it can help to identify root
(36:29):
imbalances that are triggeringinflammation in the rest of the
body. And so, you know, ofcourse, health is multifaceted,
and there's a lot ofcontributing factors, but the
microbiome is one that in everysingle age we can look at, and
we can provide recommendationsto optimize. I do. I do want to
emphasize this is somethingthat's important to emphasize.
(36:50):
We do not diagnose or treat atTiny health so we are not going
to we can't diagnose a conditionand we can't treat it, but we do
provide recommendations onoptimizing your microbiome
wellness, which is often at theroot cause of a lot of symptoms.
And so this is, this is notreplacement for working with the
healthcare provider. And youknow, doing the things that you
(37:12):
need to do again, things likeantibiotics are necessary
sometimes. You know, theseimmune suppressing medications
can be very important for peoplewith autoimmune conditions and
inflammatory conditions. So thisis in no way meant to replace
that, but it is meant to provideinsights that are are not being
looked at by conventionalmedicine at this time. I think
it's nice to know about otheravenues, I think especially for
(37:35):
people that are frustrated withchronic health conditions. It's
just really helpful, I think, toknow that there are other things
that they can try that havepotential to ameliorate their
health conditions. Yeah,exactly. And all the
recommendations are going to beavailable over the counter or
are going to be food orlifestyle. So there are things
(37:55):
that you can do in conjunctionwith your other healthcare
recommendations. Also, we, youknow, share your results with
your provider. I would, I willtalk to anybody's doctor and
teach them about microbiometesting. But also, there's
really fascinating data comingout about the, you know,
centenarian microbiome, lookingat the microbiome and people who
(38:16):
live to be over 100there's really fascinating data
coming out where they can lookat the microbiome import predict
mortality. You we all want tolive as long as possible, but we
also want to be healthy while wedo that. And you know, a lot of
that comes back to themicrobiome, because
inflammation. Inflammation isjust like the driver of so much
(38:37):
disease, so many healthconditions, like very grateful
for our immune systems whenwe're sick, they help us battle
those infections, but our immunesystem is also at the root of so
much chronic health condition.
And something that we'rerealizing plays a huge role in
your health is this sub chronicinflammation, which, what does
(38:58):
that mean? That basically meansinflammation that's probably not
super noticeable on like, a dayto day basis. It would probably
not really show up in your labs,or it's not something you would
follow up on, but enough of thislow level inflammation
throughout your life, especiallyif it's starting in childhood.
More of that inflammation overtime can contribute to negative
(39:19):
health outcomes way down theroad. And so part of you know
the immune system health is themicrobiome. And so really,
anytime you want to check in onthat, is a great time to check
in on that to make sure thatyour microbiome isn't
contributing to inflammation inthe rest of your body. So this
leads me to my next question.
Everything honestly soundsgreat. I'm on board, but I think
the biggest roadblock for mewould be, is it cost
(39:42):
prohibitive? How much is thisservice to get your stool check,
yeah, and to get advice fromtiny health? Yeah? Great, great
question. And right now, thecost for parents to do this is
249 and that in.
Includes a test as well as a 30minute consultation with one of
(40:03):
our microbiome specialists whowalks you through the results.
Can help you to optimize youraction plan so prioritize. You
know, all the recommendations.
What should I do first? Which ofthese, you know, products that
you recommend? Can you walk methrough the differences between
those and so I it's, it's not aninsignificant cost, but it can
provide like, the value that youget from that is so huge. And
(40:25):
then if you do find that moresupport is recommended, or you
want to have continued support,you want to test other family
members through membership, youcan get, you get access to
member only pricing, which canactually bring additional kits
down to $169for members. We you don't have
to commit to membership rightaway. You can try it out, and
(40:48):
you can always upgrade to moreof that program level support,
which is a little bit moreintensive testing in a shorter
amount of time with morecoaching sessions. Or you can do
membership, or the whole familycan benefit from the member only
pricing, and so the value ofthat well, well exceeds the 249
I would say. And I saw, I didn'tlook at it closely, but someone
(41:11):
sent me an email with a code, soI'll make sure and put it in the
show notes below, yes, yeah. Andthat's also, I mean, through
amazing people like you, we alsooffer some some discounts as
well. We're working very, veryhard to make this as accessible
as possible so that people canbe invested in their lifelong
microbiome health and not seethis as a one time only. Out of
(41:31):
desperation, testing, we reallyaim to be a part of like
people's normal health check intheir annual testing. And so
we're really striving to be, youknow, to make microbiome health
a part of every family's annualtesting. It's really
interesting. I'm just sothrilled to know there's another
(41:52):
avenue that parents can thinkabout if they're struggling to
find answers and solutions fortheir child's health. Yes. So
this is great. I wish you thebest of luck. I can't wait to
see what else you discover. Whatelse your research brings you in
the years to come? Yeah, it'sit's just the beginning, and the
data so far is so incredible,from both just the individual
(42:12):
level and talking to families,talking to practitioners, who
say that this testing haschanged their entire practice,
their ability to help theirpatients. So from parents to
practitioners. I mean, we'vejust seen such an incredible
need for this and such anincredible benefit from it. So I
am so excited to see where itgoes. And I encourage everybody
(42:33):
to be a part of this from thebeginning. You could be in the
know before, before microbiometesting was cool. I mean, it's
cool now, but I have to say, thesmartest doctors I know, the
most Brainiac, I don't want touse the word nerdy, but the most
Brainiac, research orienteddoctors that I know are all into
the microbiome. They all tell methat the future is in the
(42:54):
microbiome. So thank you so muchfor sharing tiny health with
myself and with my audience, andI wish you the best of luck, and
I can't wait to touch base inthe future. Yeah, thanks so much
for having us today, andeverybody come be a part of the
the future with us. So thank youso much. So great to chat with
you today, talk soon. Thank youfor listening, and I hope you
(43:15):
enjoyed this week's episode ofAsk Dr Jessica. Also, if you
could take a moment and leave afive star review wherever it is.
You listen to podcasts, I wouldgreatly appreciate it. It really
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
You.
Hi everybody. I'm Dr Jessica Hochman, pediatrician
(00:02):
and mom of three. On thispodcast, I like to talk about
various pediatric health topics,sharing my knowledge, not only
as a doctor, but also as aparent. Ultimately, my hope is
that when it comes to yourchildren's health, you feel more
confident, worry less and enjoyyour parenting experience as
much as possible. Hi everybody.
Welcome back to Ask Dr Jessica.
Today we're going to talk aboutthe microbiome, and I'm joined
(00:24):
by Dr Taylor soderborg. She's aphysician and a scientist, and
she's dedicated her entirecareer to understanding the
microbiome. In this episode,we'll dive into how the
microbiome connects to ouroverall health, and she'll share
practical tips for parents onsupporting their kids
microbiome. We also discussedour company, tiny health, which
offers personalized microbiometesting for families.
(00:45):
Personally, I'm really excitedabout what tiny health is doing.
Optimizing the microbiome couldbe a key part of high quality
medical care in the future. Andif you're interested, I've
included a discount code fortiny health in the show notes
below. And before we dive in, Ialso want to let you know that
I'll be taking two weeks off forthe holidays, so this will be
the last episode of the year. Ihope you have a wonderful
holiday season filled with fun,joy and relaxation and one last
(01:07):
thing, if you're enjoying thispodcast, please consider leaving
a five star review. It's a smallgesture that makes a big
difference to help the showgrow. Now on to today's
conversation with Dr Taylorsoderborg, it's so nice to meet
you. Thank you so much fortaking the time to come on the
podcast. Yeah, thanks so muchfor having me. I'm having me.
I'm really looking forward tothis conversation. So tell us
about yourself in addition toworking at Tiny health tell us
(01:28):
what kind of a physician you areand your medical journey to
getting here. Yes. So I startedmy journey through doing an MD
PhD, so becoming a physicianscientist, because I love
helping families and I loveworking with children. But I
also wanted to get to reallyroot cause and figure out why
(01:49):
health conditions arise, what wecan do to reduce the risk of
developing them. And so I reallywanted to understand why, you
know, how we can optimize healthand childhood, just to help
people have reduced lifelongconditions and have a better not
only lifespan, but also healthspan. So I did my MD PhD, and I
(02:10):
did my PhD in infant microbiome.
I was really interested in howall the microbes in our gut
influence our lifelong health.
And then I went into pediatrics,and I was training in
pediatrics, and I was working inthe hospital, and I got to work
with all these amazing families.
And, you know, as much as Iloved that, I knew I wanted to
really focus on the microbiome.
(02:31):
And I just knew that there wasso much power harnessed in our
gut health early in life, thatif we could understand that
better and optimize it, thatthat would be the way that we
could really make a huge impactin lifelong health. And so while
I was in my training as apediatrician, I learned about
this company that had fairlyrecently been created and
(02:55):
developed called Tiny health.
And tiny health is a companythat does microbiome testing,
and it's the only company thathas reference ranges for every
age stage phase of life. Andwhen I learned about this, I
just knew it was sort of like,you know, you have those
decision moments in your lifewhere, you know, if you wrote a
biography, where would it start?
(03:16):
And that would be sort of mymoment where my biography would
start, the moment that I decidedto transition from being
practicing, practicing physicianto helping develop and work at
this company that was bringingmicrobiome testing to the world,
notably to infants and children.
And so it was during my trainingphase in pediatrics that I
(03:39):
decided to make this transitionto tiny health to help bring
this testing and understandingthe results and interpreting
them and helping people to acton these findings to, you know,
bring that to parents and nowalso to other healthcare
providers. So this is amazing. Ilove that you have combined all
of your interests, you know,your research interests, your
(04:02):
pediatric interests, into afield that has a lot, in my
view, a lot of potential and alot of potential benefit for
children. I love that you arefocusing on prevention. I think
that is so wonderful because somuch of medicine now we spend
our money on trying to fixproblems that we could have
prevented in the first place. SoI, I'm all for that mission.
Yes, me, me too. And that'sreally how I became interested
(04:25):
in the microbiome, because Iknew if we could optimize this,
we could reduce the number ofkids who are struggling with
chronic conditions. And youknow, what is it? 40% of
children now have a chronicinflammatory condition that's
too that's too high, and then,you know, that's not even
including and thinking about therise in health conditions in
adults as well. And so it'sjust, you know, that number
(04:48):
keeps on growing. And sosomething is going on
generationally, that we are justcompounding health conditions on
health conditions. And where canwe intervene? And.
Was the biggest question that I,you know, sort of my early
career as like, Where can westop these generational cycles
of of illness and gets themicrobiome? So I have some
(05:11):
questions on that note. Sofirst, people use this word
microbiome a lot. Can you, insimple terms, explain to people
what is a microbiome? Yes, okay.
And I actually love thisquestion, because, okay, when
you hear the word microbiome,typically, what people are
talking about are the trillionsof microbes that live inside
your gut. Trillions, trillions.
(05:34):
Yes, it's like 38 trillion, Ithink is the the number we've
landed on. And there arebacteria. There are microbes
that live inside us. I know ifthat's like a new concept, that
might be a little jarring, butthey help us to, you know, set
up our immune system. Know,Like, who should we react to?
Who should we not react to? Andso that's typically what people
(05:56):
are talking about when they saymicrobiome. They're talking
about all the bacteria in yourgut. But I do like to highlight
there's actually microbiomes allover our body, all over the
world. So microbiomes are justreferring to collections of
bacteria or microbes that livein certain places. So we
actually have a microbiome onour skin. So sometimes kiddos
(06:19):
who are struggling with thingslike eczema that can be related
to not only imbalances in yourgut, but also on your skin.
There's soil microbiomes thatcan help understand if our food
is growing in nutritiousenvironments. So microbiomes are
all over our entire world. Butwhen people say microbiome the
(06:39):
biggest, most popular, mostresearch area is the gut
microbiome. Now, when childrenare born, when they come into
this world, can you explain toeverybody, do they have bacteria
in their gut when they are born?
Oh, my. So, you know, this is alittle bit of a controversial
question, so I won't go too muchinto the weeds. The general
consensus at this point is thattypically babies are fairly
sterile, or they don't reallyhave a microbiome when they're
(07:02):
inside, when they're in utero,and then in the process of being
born is when babies get exposedto those initial microbes. And
so this is why there's, youknow, a lot of research done on
vaginal delivery or C sectiondelivery, because that's going
to really influence what arethose first bacteria that baby
(07:22):
gets exposed to. It sets thestage for what that microbiome
is going to look like. So by andlarge, you get your microbiome
in the process of beingdelivered, and then the other
you know, other exposures youhave early in life, how you're
fed, what medications you may ormay not be exposed to other
(07:43):
family members. Those are allthings that continue to
determine what type of microbesare in your gut, in your gut
microbiome, but that very firstexposure is typically through
the way that you are born andthen subsequently, do you have
any advice for parents to keepthem exposed to a healthy
(08:04):
microbiome? Is it rolling aroundin dirt? Is it eating food off
the floor? What can parents doto help support a healthy
microbiome? Well, one thing I dolove telling parents is that if
you do want a pet, notably adog, that's a great way. So I've
certainly had a number of anumber of parents I've talked to
say, Wait, can you tell mypartner? Can you tell my husband
(08:25):
this real quick that we have toget a dog? Well, that's
decisions between you. Butscientifically, you know dogs,
pets are very helpful forreducing the risk of developing
like asthma food allergies,because of its influence on the
microbiome. I remember after wehad our first kid, my husband,
who's also a physician, we hadread that Living with Dogs does
(08:46):
help give a boost to your immunesystem. So I remember once we
were walking in a park and wesaw a dog, and he had our
daughter, who was barely oneyears old, just pet the dog, and
I said, Wait a second, ask theowner first, make sure it's a
dog that's okay being pet. Andthen I think also the big part
of it is you have to actuallylive with the dog for the
benefits to be a parent. Yeah,it is petting random dogs off
the street, exactly, exactly. Imean, we, you know, encourage
(09:08):
petting friendly dogs is alwaysgreat, and whatever exposure you
can get. So even things likegoing and visiting farms or
petting zoos, things like that,being in those environments,
spending time outside. Sothey're really, you know, just
even that exposure, as much asyou're able to, you know, when
developmentally appropriate, ofcourse, but having house plants
(09:29):
and having your kids help youwith repotting and dirt and
things like that can be verybeneficial. And the good thing
is, is, like, you know, in thefirst, especially, six months of
life. Babies don't have a wholelot of jobs. They have to do.
They they need to eat, which,Yep, great. And they need to be
adorable. And there's nointerventions needed for that.
(09:49):
They nail that automatically.
Then, you know, what are theyeating? Breast milk, ideally,
formula, if needed. So, butthey're not having this overly
complex diet. So the mic.
Biome doesn't need to be complexin that phase of life. And so in
that phase, it's really aboutlike, do we have the right
combination of bacteria that weneed to digest that great breast
(10:10):
milk, all the nutrients inthere? It's a very simple, non
diverse microbiome. And thenaround that four to six months,
you know, whenever ready tostart doing foods. You know, as
we developmentally change, like,we start moving around
differently, all of thosedifferent phases of life are
really well mirrored in themicrobiome. Like, the more you
(10:32):
move around, the more foods youeat, the more your microbiome
becomes complex to mirror that.
Ideally, there's not much thatit's needed to be done. It's all
about getting on trackinitially, because once you're
on track, all thosedevelopmental stages kind of
naturally help the microbiome todiversify and mature and develop
like it should. I always feellike kids are resilient and that
they can tolerate an antibiotichere and there. It's okay, but
(10:53):
it does. It does remind us that,you know, we want to use
medications when kids reallyneed it. We want to get them
outdoors. We want to have themhaving a normal child. So I more
wantto remind parents that I think
when they hear this news, oh mygoodness, my I had a C section.
My kids been on antibiotics,maybe they don't play outside
enough that there are thingsthat we can do, right? So
(11:16):
totally, totally Yes. And I lovethis magic message, like, life
happens, like, C sectionshappen, formula is needed. Like,
it's so amazing and great thatwe have these interventions that
allow us to get through thesethings safe and healthy. But
you're right. The question is,how do we how do we build that
resilience so that we cantolerate an antibiotic when
(11:37):
needed, that how do we restorefrom a C section? And so really,
it's all about knowing thestrategies to build that
resiliency that allows us tohandle all the things that life
throws at us. And so like, forexample, one of the things that
I love to share is a lot oftimes like C section was not in
(11:57):
the plan, and that's how babiesend up being born. Well,
laboring can help introducethose microbes to baby. So even
if baby is born by C section, ifyou labor it ahead of that baby
does you know, depending on sortsort of how far they descend,
they can get exposure to some ofthe microbes from the vaginal
community, which is a key partof that, like initial seeding
(12:19):
and development of themicrobiome. So laboring amazing
if you're mostly doing formulaand just able to do a little bit
of breast milk, oh, the contentsof breast milk is so powerful
that even a small amount of thatcan have huge, huge benefits. So
it really isn't this, like, allor none? Like, oh, I didn't give
(12:40):
birth vaginally. It's all over.
Absolutely not. And then part ofthe reason why tiny health
exists is that you can actuallylook at what's going on in the
microbiome and understand, aresupports needed? Are they not
needed? We don't want to oversupplement that actually can
have its own set ofconsequences, and so, you know,
(13:02):
how do we basically get kids ontrack to be able to just live
their lives without that highlevel of like concern and
scrutiny? I love that. So firstI want to say I love that you
mentioned that laboring isbeneficial. There are other
things that moms can do to helptheir kids microbiome. Because
part of me always feels uneasywhen we talk about how, how
having a vaginal birth isadvantageous for kids, because I
(13:24):
look at the statistics in thehospital over the weekend, and
oftentimes the C section ratesare near 50% over the weekend.
And so I don't want moms to feelguilty. I don't want parents to
feel bad, right? Because numberone is, you want to have a
healthy kid. So if having a Csection meant having a healthy
baby, that's obviously numberone, but then it's nice to know
that there are things that wecan do from that point forward.
(13:46):
So thank you for explaining thatabsolutely. And I think this is
really interesting what you'redoing, because I agree that, you
know, I'm not a fan of givingsupplements just for the sake of
taking a supplement, but ifsomeone's truly deficient in
something, or they're trulyneeding something, yeah, then I
am on board. Yeah, absolutely.
And so, you know, when I wastalking before about how the
early life microbiome, likeearly on, it's very simple, it's
(14:09):
not diverse. And so what wereally want to see in babies is
this dominance of this type ofbacteria called Bifidobacterium.
It's just like the most amazingat digesting the great things in
breast milk. It helps toestablish the immune system.
It's good for your gut lining.
(14:30):
And so if you don't have that,then you can't, even if you're
doing these great things, youcan't really boost it. Or if you
don't have enough of it, thoseunfriendly microbes can really
take over. And so, you know,it's that sort of like
understanding, do we have themicrobes that we you know, that
we ideally want to have inthere, that are there to help
support good microbiomedevelopment. And so if you're
(14:54):
able to test and look to see, dowe have that, or do we not have
that, and then use that.
Information to decide, should weuse a probiotic, or should we
not use a probiotic? Becauseanother question I get a lot is
like, Well, why don't we justhave everybody on this
Bifidobacterium probiotic? Ifit's like, so good for for
babies, and that's because, youknow, we need to honor the
(15:16):
developmental trajectory, like,how the microbiome changes,
like, you know, like I said, asyou start to eat foods, or you
start to move around, it's goingto gently become more diverse,
and you don't want to competewith that process. So it really
is like, do we need tosupplement? Kind of, for how
long do we need to supplement?
Did the supplementation work?
And yeah, because honestly,like, one of the one of the most
(15:36):
powerful recommendations I giveto parents is stop using the
probiotic you're using, we havethe data to show it has done its
job, and now we have, like, thestrongest recommendation I can
make is to not use it anymore,and I can't I can't know that
until we have that informationin front of us. So when should
parents think about looking intotiny health how would that
(15:59):
process work? When do yourecommend parents reach out to
you at what stage of theirchild's life, great question. So
one of one of the things Ideeply believe in the in this
world, and I want to see in mylifetime, is that this type of
testing is done for everynewborn. And so I think every
kiddo you know, probably betweenaround two weeks old, should
(16:20):
have this type of testing doneso we can identify imbalances
and help correct them before westart seeing issues and those
types of issues that you know,there's so much data showing the
relationship between themicrobiome and eczema, food
allergies, asthma, those aresome of the most strongly
researched conditions showing acausative role. The microbiome
(16:43):
can help to cause thoseconditions. But we're also
seeing more and more informationcome out about the microbiome
and neurological development,ADHD, autism, and then even
later on in life, there's linksbetween the microbiome and
Alzheimer's disease,osteoporosis. So really, it's
(17:04):
about identifying imbalancesbefore we even start to develop
those conditions. And so Ireally, really, really believe
that every child should havethis testing very early on in
life to make sure that we are ontrack or take quick action
again. It's a couple of weeksthat it takes for the microbiome
to change, if you know what, itneeds to take some very quick,
(17:26):
short action to help get it ontrack and build that resiliency
and help build the immune systemright from the beginning. So
that is the ideal. The ideal isthat this is checked in on and
optimized, if needed. Firstthing, however, another great
time to check in is when you dostart to see some of these
conditions popping up. That isthat, and that is most commonly
(17:50):
when people find tiny healthbecause, of course, you're going
to find things when you'redesperately looking for a
solution, when nothing else hasworked. And so you know, Eczema
is a really big one. Otherfamilies are we haven't slept
one night since our kid was bornbecause they're so uncomfortable
and fussy and they can't sleep,or mom has cut everything out of
(18:12):
her diet in order to continuebreastfeeding, because every
single food she eats istriggering. A lot of those
conditions are rooted in amicrobiome imbalance. The
microbiome is reallyinflammatory, and so it's
triggering inflammation all overthe body. Sometimes that looks
like eczema, looks like GIupset. It can look like food
(18:34):
sensitivity, and that is a hugething, that if you are
struggling with some of thoseconditions, looking at the
microbiome imbalances can be ahuge, huge, huge benefit,
because you're going to look atit at the root cause level, it's
not putting band aids on justtrying to dampen down the immune
system. It's truly getting towhat is causing this, these
(18:54):
disruptions. So that's anothergreat, great time to do testing,
is when you want to address someof these symptoms and walk
parents through the process. Doyou send in a poop sample? What
does the process look like tocheck a child's microbial
right here, so you get this cutelittle kit right to your house,
and it is no mess testing. I'mso glad you brought this up,
(19:19):
because sometimes people arelike, do I have to collect poop
in a bucket? Because I don'tknow if I want to do that. And
actually, it's just a quicklittle swab right off of the
diaper, right out of the toiletpaper, quick little swab. It
goes right back in here. Andthen this is very stable, and so
you don't have to worry about,you know, the bacteria changing
things over, growing thingsdying off. This preserves it,
(19:42):
and it includes a mailer, andyou put it in the mailer, and
you put it in your you know, mypost office takes it right off
my mailbox, or you can put it inany USPS, and it will get
processed from there. So it's avery, very no mess testing
situation, which is greatbecause we don't need to add any
any more challenges to change.
Diapers. And then what happens?
Parents get a report of theirchild's microbiome with various
(20:04):
reference ranges. And then doyou give them recommendations on
what probiotics to take if theyif they need a probiotic
Exactly, exactly, so they do thesample. And then we do have some
survey information that wecollect to help better
understand, you know, are youcoming because of a certain
condition, and that we can, youknow, provide some additional
recommendations based off of anysymptoms they're trying to
(20:25):
address, or health concerns thatthey have, and we also get some
information about how kiddoswere born, what medications
they've been exposed to, howthey're eating, or they have
they started solid foods. Andall of that information helps us
to better understand theresults. So you do the sample,
you take a survey, and then youonce you get the results, we
(20:46):
have an online portal where youcan view all of the results, and
they're all tailored to the ageof the person who went that
tested based on the birth datethat they provided for the for
the individual. So everything isalready age specific, and that
includes the results, but italso includes the action plan
recommendations. And so you canclick in we have tons of
(21:09):
information, you know, dependingon your level of nerdiness, you
can even click into theindividual papers that we're
referencing, like the publishedliterature that we're that we're
referencing. You can click onthose links. And so the action
plan is also provided foreverything that's flagged as
needing support or needingimproving. We provide
recommendations on how to dothat. And so that might be
(21:30):
probiotics, might be othersupplements like prebiotics. It
might also be diet. We providevery specific dietary
recommendations, so we canactually even look to see like,
what type of fiber your gutneeds more of. So maybe you need
more pectin fibers. So thatwould be things like apples with
their peels on, or pears. And sowe can help provide very
(21:53):
specific dietary recommendationsin addition to supplements. And
then we also have a lot oflifestyle recommendations. So
sort of like we talked about atthe beginning, like getting into
nature, time with animals, butwe we really have worked hard to
make that very tangible. So,like, we're not going to say,
eat more plants, because Okay,great. Thank you. We all know
(22:15):
that, but we're going to say,hey, aim for 30 different plants
a week. Here is a chart that youcan print out that has a rainbow
diagram on it to make it fun andactionable and trackable. What
amount of plants you're eating.
Oh, we're going to tell youexactly these types of foods are
the type of foods that would bebest for your gut. And so we do
(22:37):
really have very tangible actionitems to that are personalized
and also help really bring thisto life. And then also, with
tiny health testing, you don'tjust get the actions for right
then and there. You also getaccess to all of these guides,
recommendations. So you'regetting ready to introduce solid
foods. We have a whole guide onrecommend, on how to introduce
(22:59):
solid foods from a healthymicrobiome perspective. Oh, no,
antibiotics happened. That'slife. We have a whole guide on
how to restore the microbiomefollowing antibiotics. So you
don't only get actions for likethe then and there. You also get
actions for supportingmicrobiome health throughout
that whole phase of life. And solots of information about well
(23:22):
vetted products for eczema, foraddressing the flares on the
skin, probiotics that are notintended to shift the
microbiome, but can be veryhelpful for symptoms from a
microbiome perspective. Sonobody's going to leave without
something that they can do tohelp their microbiome, health or
symptoms. What I love about whatyou're working on is, I feel
(23:43):
like in the medical community,it's well established and well
decided upon that the microbiomeis really important. But I think
what's tricky is there's not alot of evidence to back up
specific probioticrecommendations or prebiotics.
So it's hard for me. As parentswill ask me, Hey, my child, I'd
like to give them a probiotic. Ihear that it's healthy. I hear
the microbiome is reallyimportant. What should I give
(24:04):
them? And I want to give themadvice that's evidence based or
that's specific for them. So Ifeel like tiny Health offers
that it fulfills that, that gapwhere you can actually see
what's potentially missing andoffer a concrete, actionable,
helpful recommendation. 100% allprobiotics are not created
equally. They are not allintended to have the same
(24:26):
impact. So knowing which onewhen for how long is so
important, and that's why wealso have this action plan, and
why I'm also working to helpteach more doctors, more
healthcare providers about thisas well and provide them with
those tools. Because, like yousaid, it's no mystery at this
(24:46):
point the importance of themicrobiome, a really big
question that a lot of parentsand healthcare providers have
is, well, what do I What do Ido? I don't know what I can
recommend that's going to besafe, effective.
Active. And so the great thingabout tiny health is that we
provide that data that's neverbeen available before, and then
(25:06):
we also do a lot of vetting ofall the products that we
recommend, so we know thatthey're high quality. And then
we also can look back at our owndata and ensure, over time, that
they are working in our youknow, kiddos who resample with
us, and so we're continuing toutilize our own ability to vet
resources, as well as our owngrowing set of data, to just
(25:29):
continue to provide the bestrecommendations to help optimize
health. That's so helpful,because I feel like this is a
burgeoning field. So we don'thave all the answers right now,
but I know it's so important towork on, so that we have good
information for the future,something I think a lot about.
And I don't know if you've heardabout this, but the Amish
(25:49):
population, I find reallyinteresting, because what I read
is that there is a very lowincidence of eczema in the Amish
population. But what they do dois they spend a lot of time
outside, hands in the soil.
They're around animals. And sopeople are trying to figure out,
what is it about this populationthat they have a low incidence
of very common childhood chronicdisease, and so one has to think
(26:12):
the microbiome is likely at playhere, but we're not exactly sure
how to replicate thatenvironment. I find this area of
medicine incredibly interestingbecause we see, as you're
mentioning, there's staggeringreports on how much chronic
disease in children haveincreased over the years. I
think kind of, one of the thingsyou're hitting on here is
there's so much amazing medicalinnovation, and we're learning
(26:34):
so much. And when it comes tothe microbiome, a lot of that
is, how do we just restore whatthings used to look like. It's
not that we need to come up withsomething entirely new. It's
that we need to figure out howto restore our microbiomes how
they used to be. And, you know,sounds like evidence by the
Amish population, like 90% ofkiddos are missing
Bifidobacterium infantis, whichby its name, clearly, it's a
(26:56):
very key Bifidobacterium forinfants, 90% of kids are missing
that we we've seen, you know,people have done studies showing
that the amount ofBifidobacterium over generations
has continued and continued todecline. And so really, it's
about, how do we ensure that wehave the right microbes that
we're supposed to have whenthey're increasingly
(27:18):
disappearing in our society, andthankfully, we have the tools to
look for that, and we do haveproducts like great, you know,
great probiotics, or greatinformation on prebiotics and
dietary actions that can helpboost these things. But really
it's about getting getting backto how our microbiomes should
and used to be. Do you have anyactual research that has shown
(27:39):
clinical improvement when kidshave replenished their
microbiome in the way that youguys have advised, yes, we do,
which I have to say is, youknow, tiny health has only been
around for a couple of years atthis point, and we already have
conducted and gotten results onclinical studies that We've
done, because this is a hugelyimportant part of tiny Health's
(28:01):
mission to bring this data thatwe're collecting to help support
the use of actions like this,testing like this,
recommendations like this. Andso hopefully, you know, we are
going to we have this data whichthen we can bring to other
healthcare institutions and say,look at how much this helps. And
so we that is why, you know,from the very beginning it was,
(28:24):
it's very important to us thatwe are contributing to this
field of research. So we have astudy coming out soon that I can
tease a little bit. It's calledthe infant restore study, and we
looked at the outcome of testingand providing this type of
information to parents whosekids were born by C section. And
(28:45):
then we did follow up testing,and we found that there was
significant improvement in themicrobiome community. And so the
microbiome overall did lookbetter. It looked less like the
kid was born by C section, moretowards a child who was born by
vaginal delivery. And also, eventhough this was a very short
(29:07):
study, just six months long, wefound that even in that short
amount of time, there was areduced amount of eczema in the
group that got their results andwere provided with the
recommendations compared tothose who did not see their
results and did not see any oftheir recommendations. We you
know, we are already collectingthat sort of immediate data and
seeing very, very promisingresults, even in this very short
(29:29):
time frame. That's reallyhelpful to know, because to be
honest, yes, it sounds reallynice that the microbiome looks
like you'd expect it to look ina with a healthy microbiome. But
I think for a lot of parents andmyself, we're interested in
clinical outcomes. We want tosee improvement in what they
came you know, what they came toyou for? So if your child's
(29:50):
suffering, if the child'ssuffering from eczema, asthma,
you know, and you do tiny healthand you take, you follow the
advice, what would feel reallysatisfying?
If you see clinical improvement.
So that's really great to knowthat you've seen some short term
improvement with eczema, andthat you have longer term
studies on the horizon, and Iget that you've only been around
for a couple of years, so that'shard to do, yeah, but it's nice
(30:12):
to know that it's on thehorizon. Yeah, yeah. And you
know, what was really cool aboutthat study was it was showing,
like before symptoms had evendeveloped, that we were able to
reduce them from even startingin the first place, and that
only backed up. What I see on abasically a daily basis is kids
who already have theseconditions getting significant,
significant improvement. We havea number of case studies on our
(30:36):
website as well, reallyhighlighting these individual
cases where we've just helped somany families that were really
just at their wit's end, nothingwas working. They were on
chronic steroids. So we have aton of case studies showing that
for families who are alreadyexperiencing these conditions
that this type of testing reallyhelps, and now we're developing
(30:58):
the data to back that up as welland show more of that
preventative role in Inaddition, I'm just so curious,
how are you doing this? Alllike, how are you how are you
marketing a product and thenalso having a robust research
arm? Tell me how big is yourteam? I'm just curious. We are
22 full time and about probably15 to 20 part time. That's
(31:25):
incredible. Congratulations.
Great leadership. Really greatleadership in, you know, just
not, not saying no. I mean, Ithink that part of we all
believe so deeply in thismission that we it's like that
we can't prioritize getting justthe research. We can't
prioritize just getting this toparents, or just getting this to
(31:49):
practice, to healthcareproviders, because we have to,
like, we have to get it toparents now they need this now.
We can't wait to educatepractitioners, because we're
seeing the data. We have to getthis into their hands to help us
reach more families, and then wecan't wait on the research,
because we have to work towardsgetting this insurance
reimbursable and part ofstandard of care, because we
(32:09):
need this to be available foreverybody. So it's we can't not
do all of it, because we believeso deeply, and we've seen the
power that this does have. So Ithink it's just that, you know
that mission that drives us allto just we have to get it done.
Can you comment on any potentialharms in taking too much you had
mentioned that not everybodyneeds to take the supplements
(32:31):
and for an extended period oftime. What would the harm be
that you can think of in takinga probiotic or a prebiotic for
an extended period of time?
Yeah. So this is a reallyimportant point. So the early
life microbiome is verymalleable, so it can change very
readily, and so you undergo likea maturation process in the
(32:52):
microbiome, from, you know, whenyou're born, until about age
three to five. About age threeto five, your microbiome becomes
a little bit more set, like alittle bit more of an adult
microbiome. And so in thosefirst couple years of life, the
microbiome changes a lot. Andso, you know, sort of a blessing
and a curse, like it's veryeasily changed in both negative
(33:12):
and positive directions. Now,what it should be doing is it
should be going from verysimple, not diverse to a very
nice, rich, diverse microbiome.
So how does it get from this notdiverse microbiome to this very
rich, diverse microbiome overthe course of a couple years? So
this is a very gentle processwhere you know your different
(33:35):
exposures, like crawling around,or that phase where you start
putting everything in yourmouth, introducing solid foods,
all of these phases gentlydiversify the microbiome, and
then over the first coupleyears, that diversification then
reaches adult form. And so youdon't want to do this too fast,
and you don't want to do thistoo slow. It's a very Goldilocks
(33:56):
situation. You want thatmaturation to happen on a nice,
gentle curve. And so when youare giving supplements early in
life, you may be delaying thatmaturation, or you may be
speeding it up. And so, forexample, if you're giving that
Bifidobacterium, that's so, soso good for babies to have a ton
(34:17):
of early in life, if you aregiving that but you're also
introducing solids. It's reallyhard for that like gentle
diversification that comes withsolid introduction to compete
with a high power, high qualityprobiotic, and that failure to
follow that maturation isassociated with increased risk
(34:39):
of conditions like eczema, foodallergies, asthma, and then, you
know, conversely, if youdiversify too early, that also
is associated with eczema, foodallergies, asthma, and so it
really is, like, you know, beingon that curve, which it's
amazing for the most part, thathave, like, once you get on that
curve, typically, it.
(35:00):
Follows that curve. It's justabout making sure that you're on
that right trajectory initially,and if there are disruptions
getting back on that trajectoryduring that very delicate,
sensitive time. And I'm justcurious, on a case by case
basis, have you gotten goodfeedback from customers?
Amazing.
This testing is truly lifechanging. And so I, you know,
(35:23):
just being able to get to theroot cause in help stop just
putting band aids on conditionshas been game changing for so
many families. What about whatabout adults? Yeah, do you
recommend this product foradults? And I'm listening to
you, and I'm thinking, I have somany friends that have that have
(35:44):
stomach aches or skinconditions. Can they? Can they
benefit from getting a tinyhealth Yes, absolutely, again,
because it gets to the rootcause imbalance. A lot of our
conventional approaches at thispoint are focused on just
dampening down the immunesystem, but not actually getting
to why it's so overactive in thefirst place. And that's like,
(36:08):
it's, it's no fault ofconventional medicine. That's
what's currently available, ismedications that will dampen the
immune system to reduce symptomsof chronic inflammation. And so,
you know, that's why we're soadamant about getting microbiome
testing, you know, awareness,into more conventional practice,
because what this testing can dois it can help to identify root
(36:29):
imbalances that are triggeringinflammation in the rest of the
body. And so, you know, ofcourse, health is multifaceted,
and there's a lot ofcontributing factors, but the
microbiome is one that in everysingle age we can look at, and
we can provide recommendationsto optimize. I do. I do want to
emphasize this is somethingthat's important to emphasize.
(36:50):
We do not diagnose or treat atTiny health so we are not going
to we can't diagnose a conditionand we can't treat it, but we do
provide recommendations onoptimizing your microbiome
wellness, which is often at theroot cause of a lot of symptoms.
And so this is, this is notreplacement for working with the
healthcare provider. And youknow, doing the things that you
(37:12):
need to do again, things likeantibiotics are necessary
sometimes. You know, theseimmune suppressing medications
can be very important for peoplewith autoimmune conditions and
inflammatory conditions. So thisis in no way meant to replace
that, but it is meant to provideinsights that are are not being
looked at by conventionalmedicine at this time. I think
it's nice to know about otheravenues, I think especially for
(37:35):
people that are frustrated withchronic health conditions. It's
just really helpful, I think, toknow that there are other things
that they can try that havepotential to ameliorate their
health conditions. Yeah,exactly. And all the
recommendations are going to beavailable over the counter or
are going to be food orlifestyle. So there are things
(37:55):
that you can do in conjunctionwith your other healthcare
recommendations. Also, we, youknow, share your results with
your provider. I would, I willtalk to anybody's doctor and
teach them about microbiometesting. But also, there's
really fascinating data comingout about the, you know,
centenarian microbiome, lookingat the microbiome and people who
(38:16):
live to be over 100there's really fascinating data
coming out where they can lookat the microbiome import predict
mortality. You we all want tolive as long as possible, but we
also want to be healthy while wedo that. And you know, a lot of
that comes back to themicrobiome, because
inflammation. Inflammation isjust like the driver of so much
(38:37):
disease, so many healthconditions, like very grateful
for our immune systems whenwe're sick, they help us battle
those infections, but our immunesystem is also at the root of so
much chronic health condition.
And something that we'rerealizing plays a huge role in
your health is this sub chronicinflammation, which, what does
(38:58):
that mean? That basically meansinflammation that's probably not
super noticeable on like, a dayto day basis. It would probably
not really show up in your labs,or it's not something you would
follow up on, but enough of thislow level inflammation
throughout your life, especiallyif it's starting in childhood.
More of that inflammation overtime can contribute to negative
(39:19):
health outcomes way down theroad. And so part of you know
the immune system health is themicrobiome. And so really,
anytime you want to check in onthat, is a great time to check
in on that to make sure thatyour microbiome isn't
contributing to inflammation inthe rest of your body. So this
leads me to my next question.
Everything honestly soundsgreat. I'm on board, but I think
the biggest roadblock for mewould be, is it cost
(39:42):
prohibitive? How much is thisservice to get your stool check,
yeah, and to get advice fromtiny health? Yeah? Great, great
question. And right now, thecost for parents to do this is
249 and that in.
Includes a test as well as a 30minute consultation with one of
(40:03):
our microbiome specialists whowalks you through the results.
Can help you to optimize youraction plan so prioritize. You
know, all the recommendations.
What should I do first? Which ofthese, you know, products that
you recommend? Can you walk methrough the differences between
those and so I it's, it's not aninsignificant cost, but it can
provide like, the value that youget from that is so huge. And
(40:25):
then if you do find that moresupport is recommended, or you
want to have continued support,you want to test other family
members through membership, youcan get, you get access to
member only pricing, which canactually bring additional kits
down to $169for members. We you don't have
to commit to membership rightaway. You can try it out, and
(40:48):
you can always upgrade to moreof that program level support,
which is a little bit moreintensive testing in a shorter
amount of time with morecoaching sessions. Or you can do
membership, or the whole familycan benefit from the member only
pricing, and so the value ofthat well, well exceeds the 249
I would say. And I saw, I didn'tlook at it closely, but someone
(41:11):
sent me an email with a code, soI'll make sure and put it in the
show notes below, yes, yeah. Andthat's also, I mean, through
amazing people like you, we alsooffer some some discounts as
well. We're working very, veryhard to make this as accessible
as possible so that people canbe invested in their lifelong
microbiome health and not seethis as a one time only. Out of
(41:31):
desperation, testing, we reallyaim to be a part of like
people's normal health check intheir annual testing. And so
we're really striving to be, youknow, to make microbiome health
a part of every family's annualtesting. It's really
interesting. I'm just sothrilled to know there's another
(41:52):
avenue that parents can thinkabout if they're struggling to
find answers and solutions fortheir child's health. Yes. So
this is great. I wish you thebest of luck. I can't wait to
see what else you discover. Whatelse your research brings you in
the years to come? Yeah, it'sit's just the beginning, and the
data so far is so incredible,from both just the individual
(42:12):
level and talking to families,talking to practitioners, who
say that this testing haschanged their entire practice,
their ability to help theirpatients. So from parents to
practitioners. I mean, we'vejust seen such an incredible
need for this and such anincredible benefit from it. So I
am so excited to see where itgoes. And I encourage everybody
(42:33):
to be a part of this from thebeginning. You could be in the
know before, before microbiometesting was cool. I mean, it's
cool now, but I have to say, thesmartest doctors I know, the
most Brainiac, I don't want touse the word nerdy, but the most
Brainiac, research orienteddoctors that I know are all into
the microbiome. They all tell methat the future is in the
(42:54):
microbiome. So thank you so muchfor sharing tiny health with
myself and with my audience, andI wish you the best of luck, and
I can't wait to touch base inthe future. Yeah, thanks so much
for having us today, andeverybody come be a part of the
the future with us. So thank youso much. So great to chat with
you today, talk soon. Thank youfor listening, and I hope you
(43:15):
enjoyed this week's episode ofAsk Dr Jessica. Also, if you
could take a moment and leave afive star review wherever it is.
You listen to podcasts, I wouldgreatly appreciate it. It really
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
You.
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