The Gut Microbiome: Uncovering Secrets to Enhanced Health and Wellness

Last week, FMCA hosted a webinar exploring the complex world of the digestive system and its impact on our health, mood, and immunity. Dr. Sandi welcomed guests Leo Grady and Jaclyn Kawwas from Jona, a technology company working to reveal the relationship between the gut microbiome and our health using Artificial Intelligence (AI). Together, they discussed cutting-edge technologies that have the potential to revolutionize gut microbiome testing and feedback and provide personalized health strategies more sophisticated than anything we’ve seen before.

“The microbiome has been linked to nearly every system and health condition. It’s not just GI disorders like Crohn’s, colitis, and IBS but also autoimmune conditions. In fact, 70% to 80% of your immune cells are in the gut lining and heavily interacting with the microbiome.”

Leo Grady, Jona CEO

Throughout the conversation, Jacyln and Leo shared valuable insights on harnessing the power of the gut microbiome to enhance health and well-being. They covered topics like the health impacts of a poor microbiome, the influence of specific bacteria like Akkermansia on metabolic health, and offered ideas for coaches whose clients are interested in microbiome testing. They also explored AI’s potential use to achieve positive health outcomes and explained how Jona’s innovative gut microbiome testing can be a game-changer in bringing greater personalization to health improvement strategies.

Whether you’re a health and wellness practitioner who sees clients/patients or simply interested in the science of gut health and its impact on overall wellness, we invite you to check out the webinar recording below. This session offers actionable information on how gut health affects daily life and what you can do to leverage the latest research and tools to improve health outcomes. Health coaches will gain insights that will help you deepen your practice and expand your client offering in the increasingly high-profile area of the microbiome. Check it out and let us know what you think.

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About Jona

Transcript

Dr. Sandi: I first met Jaclyn at a conference. It was a very large conference in October called HLTH, and we connected right away, knowing that we have a similar mission and that is to…we trained health coaches, and their mission is to provide state-of-the-art testing assessment for the gut microbiome.

So, let me tell you a little bit about Jaclyn Kawwas. She has dedicated her career to advancing medical and health technology, striving to combat this growing challenge of chronic illnesses. She’s currently serving as the head of business development and GTM strategy at Jona. She’s committed to leveraging technology to make a positive impact on preventive health and patient care.

And Leo, Leo Grady. We did a podcast episode together on “Health Coach Talk.” He has 20 years of experience leading the development and commercialization of advanced machine learning, AI, computer vision, diagnostic, and digital health technologies that have made a very significant impact on healthcare practice. He is currently the founder and CEO of Jona and the CEO in Residence with Breyer Capital. So, I will turn it over to Leo and Jaclyn for this presentation.

Leo: Perfect. Thank you so much, Sandra. So, I’m going to get started now. And this is a discussion on the gut microbiome, how it connects to health and wellness, both from the science standpoint, a little bit on the business standpoint, and also on the technology side of things.

So, as Sandra mentioned, I started with a PhD in AI 20 years ago. I spent my career in healthcare, building AI at Siemens in radiology. Then, I was at a company in the Bay Area called HeartFlow, building a cardiovascular diagnostic test for coronary disease using AI and computational fluid dynamics, as well as a virtual stenting application that we built. And these were all FDA-approved, Medicare-reimbursed products. And then most recently, I’m a CEO of Paige.AI, which was a spinout of Memorial Sloan Kettering, building AI in pathology where we had the first FDA approval for an AI system in pathology for prostate cancer.

So, this is the agenda for us today. We’re going to start talking about why microbiome testing, talking about the microbiome science, using AI and how that can be used to decode the gut microbiome, and then also specifically on how to leverage Jona at the end.

So, why microbiome testing? You know, fundamentally it comes to root cause medicine. The gut dysbiosis is often root cause itself, but the gut microbiome is also connected to other root causes like nutrition, inflammation as well as parasites, mold, and other infectious organisms. What we’ve seen is that three different types of clients benefit from microbiome analysis. So, one group are people that are struggling with health issues, trying to find root causes, and they’re looking for answers. Then, there are also people who are well and really just want to do a checkup, a scan, make sure everything’s okay, and that they, you know, are really just looking to ensure that they stay well. And then there’s a group also of what we call health optimizers. These are people like biohackers, athletes, longevity, people really interested in taking their health to the next level.

Now, from a health professional standpoint, from a health coach standpoint, why microbiome testing? The number one answer is that your clients are asking for it. In addition, it is the root cause analysis of a whole range of different symptoms and conditions. It can help you expedite an elimination diet and really get to a solution much faster as well as providing a comprehensive overview of a person’s health now and being able to track that over time.

You know, in terms of why your customers are asking for it, consumers are paying attention to the gut microbiome and gut health more than ever before. You see a whole range of different publications talking about the microbiome, a lot of TikTok stars talking about gut health and the microbiome. You see a whole range of products that are adding probiotic strains to the products. And most recently, on Netflix, there is a special, “Hack Your Health,” that was really diving into the stories of a few different people and how the microbiome was really influencing their health and their health journeys.

And consumers themselves are paying attention. About half of people today in the U.S. are taking a probiotic daily. About a third of people are taking a probiotic weekly or monthly. And then only about 9% of people are never taking a probiotic in the U.S. And when you ask them why they are taking a probiotic, answers are general health benefits, digestive health benefits, immune health benefits, and they also want to know more about the different strains, the amount of live bacteria, but it’s really the health benefits both digestive, immune, and in general, it’s driving people to engage with probiotics.

So, your clients are asking for it, and microbiome testing can increase your care offering. Now, consumers are buying their own microbiome tests today, and unfortunately, though, what they’re finding is that they’re very confused by these tests. And so this is a montage of Reddit posts of people posting their microbiome test results and really saying, “I don’t understand this. This is confusing. Please help me. This really just seems, you know, unusable and unintelligible to me.” And it’s not so surprising because a lot of microbiome tests today are really just a long list of species, tells you how much you have, what a normal range might look like, and that these are PCR panels, so they’re not comprehensive. They just show you a fixed range of organisms. So, if you’re looking to see if you have a specific organism, you may or may not know unless that organism is part of the panel. And the information here is really limited. There’s no connection to all of the science on these tests that is being performed, and there’s no actionability really from these test results themselves except perhaps taking antibiotics or antifungals if one of the organisms or pathogens is too high.

So, let’s talk about the microbiome science and what we’re finding today. Now, I’m sure you’ve seen a lot on the microbiome. There’s been an incredible amount of enthusiasm, both in the scientific press as well as in the consumer literature, and for good reason because the microbiome has been linked to nearly every system and health condition. It’s not just GI disorders like Crohn’s, and colitis, and IBS but also autoimmune conditions. In fact, 70% to 80% of your immune cells are in the gut lining and heavily interacting with the microbiome. Metabolic disorders, obesity, diabetes, metabolic syndrome, a range of different cancers have been linked with the microbiome. In fact, one of the theories on early onset colon cancer and this increase that we’ve been seeing recently has to do with gut microbiome changes.

There’s the gut-brain axis. The microbiome has been associated with Parkinson’s, Alzheimer’s, depression, anxiety, autism, bipolar, and more. In fact, 90% of your serotonin and 50% of your dopamine is produced in your gut. Microbiome has been linked to skin health and beauty. Acne, psoriasis, eczema have all been linked to the gut microbiome as well as liver disease, cardiovascular disease, and performance, athletic performance and healthy aging. And some people have even described the gut microbiome as a new organ.

So, let’s dive into, just as an example, the metabolic side of things. From a metabolic health standpoint, there were studies that were looking at the linkage between antibiotic use and obesity. So, there’s a study in Korea. It was about 30,00 individuals. And what they did is they stratified these individuals into four groups. So, one group had zero antibiotics in their life. The other group had had a maximum amount of antibiotics in their life. And then there were two groups in between.

And what they found is that the odds ratio of a person being obese was much higher the more antibiotics they had, which of these four groups they were in. In other words, you’re much more likely to find somebody who is more obese than somebody who never had any antibiotics when you look at these groups of antibiotic users. And there’s almost a linear relationship between the amount of antibiotic somebody had used and their likelihood of being obese, regardless of how you measure obesity, whether it’s BMI or waist criteria or whatnot.

Now it’s not just obesity. Metabolic disease and glucose response has also been linked with the microbiome. There’s a study in Israel a few years ago which gave different people the same foods. And what they found is that you could take two different people, give them the same foods—in this case, bananas and cookies—and one person would have a glycemic response to bananas and the other person would have a glycemic response to cookies. And these researchers tried to figure out what factors in an individual predicted how they were going to respond to these different foods based on a glycemic response. And what they found is by far the most important predictor of glucose response was the individual’s gut microbiome.

In other words, a person’s gut microbiome was really determining, in many ways, how a person’s body reacted to the same foods, different people’s bodies reacted to the same foods. But if you try to look into the gut microbiome literature and try to understand the specific organisms that are involved, what you see is that it’s not just a single organism being linked with glycemic response or with obesity. This is a review article of a whole range of different obesity papers. And what you find is that, among these different studies, you see some researchers finding, you know, certain organisms are higher in obese folks. Other organisms are lower, and you see some concordance between different studies and yet some discordance as well. But almost nobody finds it’s a single organism that’s responsible for obesity or that’s linked with obesity. Same with diabetes. You know, what you find in these different studies is it’s a whole ecosystem shift that is found in a type 2 diabetic, in this case, versus a healthy individual. So, these associations between microbiome and different disease, different metabolic responses, they’re complex and they are not just a single organism being too high or too low.

So, you know, the second reason to care about the gut microbiome is that it’s associated with this vast number of diseases and symptoms. But if you can really understand it, it may help you identify root causes in your clients and help you really make changes that can help them most effectively. So, in terms of the changes, we know that the gut microbiome can be modified. There are a lot of studies on this showing that different dietary changes can change your microbiome. Lifestyle changes can change your microbiome, supplements, and also medications yet these changes are also not simple. They’re really ecosystem shifts.

So, this was a study surveying a whole range of different diets, and what you see is, for example, with a vegan diet, it’s a shift. Some organisms go down, some organisms go up. Gluten-free diet, other organisms go up and other organisms go down, and so on and so on. But it’s never just a single organism being affected by a dietary change. You have these whole ecosystem shifts. So, it’s complex.

Furthermore, the microbiome literature can be confusing. So, I’ll give you the example of Akkermansia, which you’ve probably heard of, given some of the research recently. And there were a number of studies that looked at Akkermansia and found that people who had really low Akkermansia, in the case of this study, were more likely to have Crohn’s disease. And in other words, people with Crohn’s disease had much lower levels of Akkermansia than healthy people. And there are a lot of other studies that found similar linkages between low Akkermansia and a variety of different diseases. And so many people concluded from these studies that Akkermansia is good because, you know, too little of it is associated with a range of diseases. And you’ve seen a proliferation of different products that can help you boost your Akkermansia.

However, if you keep reading the literature, then you also come across papers like this, which was a survey of Parkinson’s disease papers. And what they found is that, on average, people with Parkinson’s had elevated levels of Akkermansia. And so it’s not so straightforward to say that Akkermansia is good or Akkermansia is bad. It seems like too little is bad and too much can be bad too. But you don’t really know whether somebody should be getting a probiotic that contains Akkermansia unless you really know where they’re starting from.

But the microbiome literature can be even more confusing. So, take B. fragilis for example. There are a number of studies showing that small amounts…like, lower levels of B. fragilis were linked with Crohn’s disease. And then within the same disease, other papers were finding that high levels of B. fragilis were linked with Crohn’s disease. So, you have contradictions within the same disease of whether B. fragilis is helpful or harmful. So, the microbiome literature can be very confusing in many ways.

Now, if you think that there are a lot of microbiome studies out there, you’re right. This is the number of microbiome studies published in PubMed over the last 20 years. And what you see is there’s been just an explosion over the last five or so years. Today, there are more than 2,000 papers published every month on the microbiome in PubMed. So, this really goes beyond the capacity for any clinician or provider to keep up with all the scientific literature. And even if you did, as we were just seeing, it’s very complex and, in some cases, contradictory. So, although it’s complex to interpret, the gut microbiome is modifiable with diet, lifestyle, and supplement changes, but it is complex and exploding at a rate that’s very difficult to keep up with.

So, that’s why we believe that artificial intelligence may provide a new path forward. As you’ve probably experienced by playing around with ChatGPT or some of these other services in the last year or so, you found that AI can read and synthesize massive amounts of information. So, you look at something like this and say, “Well, maybe AI could help us interpret a microbiome test.” And so a lot of people have looked at this and said, “Well, maybe I can just feed a microbiome test into ChatGPT, and it’ll read all this literature, and give me the answers, and tell me what to know about it.” Unfortunately, that doesn’t really work. So, if you were to feed a microbiome test result into ChatGPT, the results you’d get would not be very good for a number of reasons.

So, first of all, ChatGPT doesn’t have any idea what normal ranges are of different organisms for a given population. ChatGPT doesn’t know how to apply those results from a microbiome test or resolve contradictions in the literature. ChatGPT is famous for hallucinating. All of these large language models, these generative AI systems can hallucinate and really make things up and make up false information. And ChatGPT isn’t going to know how to apply an intervention to a person’s microbiome. So, if somebody goes vegan, ChatGPT doesn’t know exactly how that’s going to affect this person’s microbiome.

So, can AI really help us interpret microbiome tests? And the answer is yes. But in order to do that, you really need a dedicated AI system that is built for microbiome test interpretation. And that’s what we did at Jona. So, we built this AI system and it only reads relevant studies, meaning it only reads peer-reviewed studies, credible journals, studies on human subjects obtained from stool samples that were in vivo. All of the studies that it looks at were based on sequencing data, not culturing data, and it was all on subjects that were age 5 and older, so it’s not babies and infants.

Within all of these studies that Jona AI reads, then all the studies are given a quality score based on the size of the study and the quality of the journal it was published in. And that way we can resolve contradictions by effectively adding up the evidence on all sides, you know, taking that B. fragilis situation. If the study is showing that high levels of B. fragilis were higher quality than… Sorry. If the study is showing that high levels of B. fragilis linked with Crohn’s were of higher quality and, you know, greater number than the study showing that low levels of B. fragilis linking with Crohn’s, then those studies that are higher quality are going to win out by basically averaging across all these studies but weighted by the quality of these studies.

Within Jona, we have expert review of each paper that’s read by the AI system that make sure the AI interpreted the results from that study correctly. And then we can also apply virtual interventions to assess the effects of each action. So, let me show you what that looks like. So, the AI will assess linked conditions and symptoms and the effects of intervention. So, given a microbiome test result, then we can compare the client’s microbiome to every study that’s ever been published in the literature. So, for example, all of the studies on Crohn’s disease, or colitis, or IBS, or celiac, or food allergies, and really see whether on average, weighted for quality, all of these studies point to a person having a signature for one of these diseases or conditions.

Then, the AI looks at the interventional literature. And we know that going vegan causes this ecosystem shift. Going keto causes a different ecosystem shift. And we make a virtual microbiome, a virtual vegan version of your client or a virtual keto version of your client. And you can think of it as a microbiome digital twin and really look at all of the effects of different dietary choices, different lifestyle choices, different supplement choices, different medications based on every study that’s been published on the effects of interventions on an individual’s microbiome.

And then for each of those virtual versions of your client, the vegan version, the keto version, the whatever, we can see, does that vegan version move away from the signature of Crohn’s disease or does the move exacerbate the signature of Crohn’s disease, or colitis, or IBS, or whatnot? And then based on asking your client or you what the health goals are of this individual help select those interventions that are going to help you really move your microbiome in the right direction to achieve those health goals. And so that’s really what comes out at the end. And you can think of Jona AI as next-generation gut testing and personalized recommendations.

So, I’m going to show you a case study, and this case study is actually my own son. So, his mom has Crohn’s disease and he’s 14. He’s had GI issues his whole life really since he was a baby. And recently he had really severe abdominal pain. There are some days he wasn’t able to go to school, and he was really, you know, in bad shape and we cleared out CVS and nothing was really working for him and, of course, you know, because of his mom having Crohn’s disease, something that we worried about.

So, we did Jona on him. We did a microbiome test. We ran this Jona AI analysis. And here’s what we found. We found that his microbiome had the signature for abdominal pain strongly against multiple studies in literature. His microbiome also had the signature for anxiety. It had a weak signature for fatigue, for IBS, and also for Crohn’s disease, like his mom. He had some of a pathogen, C. diff but not a lot, just a little bit. And he lacked the organisms to effectively process lactose as well as galactooligosaccharides, which is in here.

So, here’s what we did. We increased… And then the AI, by applying all these virtual interventions for him, what it found is that we could shift his microbiome away from the signature for abdominal pain and anxiety by increasing healthy fats and polyphenols, by decreasing lactose, gluten, galactooligosaccharides. And then we got him supplements that had some of the specific organisms that he was lacking. I also got him polyphenol supplements because I know him and he’s not likely to want to eat a lot of those foods. And this is what his action plan looked like for abdominal pain at least on the front page. Okay. So, with an AI system like Jona, you can save time while providing cutting-edge technology to comprehensive care for your clients.

Okay, I’m going to turn this over to Jaclyn now to talk you through some of the practicalities.

Jaclyn: Thanks, Leo. So, there are effectively about four or five steps to actually operationalize this in your practice. The first thing we ask is you make an account on the web app so that way, you can order tests for your clients. So, in general, you would email a support email with information regarding your practice, your name, your email, your preferences. And that way, you have your own portal, and so that way, you can easily order it for your clients, or if you wanted to send, like, your own customized link to your clients on their behalf and they can order themselves, those are, kind of, the two options.

Once that’s actually ordered, then the client will receive their microbiome test kit, which is nice is that it is delivered directly to their door. So, once it’s ordered and we ship it next day, it arrives to the address that’s provided in the client’s address. And this kit itself…so, it’s a stool sample. It has an instruction booklet inside, and there’s materials underneath it. You can see a picture of what it looks like here. Essentially, it’s, kind of, like a COVID test in a way where it has a test tube filled with liquid, and that is shipped back within a return prepaid mailer, and you send it back to the lab.

Once it gets to the lab, we do shotgun sequencing. So, again, if those are familiar with shotgun sequencing, it’s a more comprehensive view of the entire sample. So, instead of going in with a certain set list of organisms that historically people looked for in the qPCR, you go in unbiased and you can pick up whatever is there. So, usually, the reports that I see are several hundreds of organisms between bacteria, viruses, different pathogens that come out, and that’s what we call your microbiome profile. And we partner with a lab that is specialized in microbiome sequencing.

Once we get your microbiome profile, we use that to run it through our AI engine to interpret what it actually means, the connection to different conditions and symptoms, along with the digital twin that Leo talked about with dietary and lifestyle interventions. And then about three weeks later, once we get the results into our lab, it takes about three weeks or so for you to receive an email notifying that your report is ready. So, as a health coach or as a provider, you’re able to, kind of, choose your preferences. So, if you decide that you want to see the report first, you can do that. If you want your client to receive it first, you can, kind of, choose that. So, we enable different preferences based on how you run your practice.

So, quickly, in the first step, I just want to, kind of, highlight. There’s an account setup process where you provide us information, and I will go over that in the next slide. And we can set it up on the backend to make sure that you have all the information. You add a new client and so you enter…if you have the kits on hand in your in-person clinic or wherever you’re operating, you can just notify what that barcode is of the kit because each kit has a six-digit barcode. If you decide to order a new kit for your client, you can prompt them with an email that you ordered it. And if you want them to order it, you can also send an email based on our system that gives them the information and they can order it on the website on your behalf and make sure that it’s still affiliated with your account.

Then, you’ll be able to view and manage all the different clients on the portal and the client’s page. And then you can see, like, the progress and the status of where they’re at and then as well look at the reports for each individual client when they’re ready.

So, I have a little bit of information here. Again, you can email support at Jona if you want to set up an account, and this is the information here. I believe we’ll probably follow up in an email. So, you don’t have to screenshot this if you don’t want, but we will give you some more information after the fact as well as, you know, as part of our partnership with FMCA, any health coach that’s affiliated will get special pricing and wholesale pricing on the Jona test for their clients in the future. So, something just to note with that.

And I just want to thank Sandi and Scott in general. Obviously, Sandi, we met back in the fall. It’s been incredible to learn about what you guys are doing and your mission of educating health coaches and having that with a holistic root cause functional medicine lens. And so for those that are on the call, there’s a special promo and we can send this out after, but we are giving $90 off for your first test using that promo code. So, I just wanted to thank you again for having us on this webinar, and we really appreciate working with you and in the future. And then we’ll pause there for any questions.

Dr. Sandi: Well, thank you, Leo, thank you, Jaclyn, for that wonderful presentation. I know I learned a lot. And what I particularly like is that there are a number of options. So, we may have people on this call who do hold a license to practice. And for them, they would have reports sent to them. And then for others, if you are concerned as a health coach, you might choose the option for everything to go to the client and for the client to order. And you can be the one, when they receive that report, to help them. You’re not diagnosing anything, but you are helping them make sense of it. And you’re also the bridge of communication to their medical doctor, or perhaps they need a consultation with a nutritionist. So, that would vary, again, based on your experience and your background as a health coach as well as the complexity of the health conditions that your clients may or may not be dealing with.

Jaclyn: Thank you, Sandi. Yeah, I just want to emphasize, too, there are multiple options and we know there’s different types of health coaches and providers. So, we wanted to make that flexible. Some people prefer to review the report first. Some people don’t. So, I wanted to serve that. And I’ll just clarify, it’s not a diagnosis. Again, we’re a reflection of the literature, so we’re not saying that this client has, you know, X, Y, and Z conditions. I just wanted to definitely preface that as well.

Leo: We also mentioned that we will be at the IFM meeting next week, AIC. And so we’ll have a booth. And if you’re going to be there, you know, please go ahead and stop by and say hi.

Jaclyn: Yeah, Booth #814, I believe. So, come check it out.

Dr. Sandi: And we’ll have a booth as well because IFM is our collaboration partner. Their senior faculty teach for us. We use their content. And this has been a relationship that really we value so much. And the AIC, their Annual International Conference, is a great place to connect and create relationships. We have a lot of people coming to our booth in years past saying, “Help me find a coach. I only hire health coaches from FMCA. I need a coach. Can you help me?” So, it’ll be a great way to connect, and I’ll be able to connect with you in person, Leo and Jaclyn. So, all right. Well, let’s get to the questions.

Jaclyn: You know, the first one I think as good to start off with, Leo, is someone asked, out of curiosity, where did the name Jona come from? So, I know, Leo, you thought a lot in depth about this in choosing the name. Do you want to share where that name come from?

Leo: Yeah, yeah, so I started the company. And Jona is named after Jonah and The Whale, you know, the story from the Bible of Jonah going in the belly of the whale and emerging enlightened. And I thought it was a great metaphor for the company. I’m not particularly religious myself, but I thought it was a great metaphor for the company and what we’re trying to do on two levels.

On one level, like, literally going in the belly and trying to understand and become enlightened but also, you know, the story of Jonah is a story of transformation. It’s a story of rebirth. It’s a story of, you know, going in and finding yourself and really coming out a new person. And that story, that sort of concept of going inside the belly of the beast and facing your fears and coming out better on the other side really appears in a whole range of different folk traditions around the world. Gilgamesh goes in the belly of a beast. Hiawatha gets swallowed by a sturgeon. Cú Chulainn, the Irish hero, swallowed by a beast. Even Pinocchio gets swallowed by a whale. And in the Judeo-Christian Islamic tradition, you know, that figure is Jonah.

But I thought this idea of transformation of people that have decided to face their health issues, that have decided to face their fears, that are trying to, you know, achieve that, sort of, rebirth, that that’s really where we were trying to come in and help them by sorting through all of this complex literature and really understand how they can, you know, get to root causes and take action. Anyway, that’s probably a longer answer than what you’re looking for, but that’s where the name comes from.

Jaclyn: Yeah. So, we go into the belly, and you come out with wisdom and enlightenment. So, that’s kind of the…

Leo: Exactly. Yeah, that’s right. You’re the hero in this.

Jaclyn: There’s a lot of questions. This might be an international audience. There’s a lot of questions asking if it’s available outside of the U.S., and I see some name drops of a variety of different countries. So, we’re available in the U.S. in all states except for consumers in New York, New Jersey, and Rhode Island, and then we’re also available in Canada through our distribution partner. So, if you’re in Canada, and you’re interested in offering it for clients, reach out to us and we can set that up. So, unfortunately, not yet. We’re not in New Zealand, South Africa, and some of the other countries that people have been calling out but maybe in the future.

Okay. So, this is a… Leo will take this question. How is this different than a GI-MAP or GI Effects or some of these other tests that some of you all might have been used to using?

Leo: So, those are perfectly fine tests. They’re qPCR tests. And what qPCR does is it has a fixed panel of organisms that it looks for. So, if it’s looking for 20 different organisms and you have different organisms that are outside that panel, it’s not going to identify any of those organisms. It’s only going to tell you what’s in the panel.

And those tests don’t connect you to all of the signs. They don’t say, “This person has the signature of IBS.” They don’t say, “This person has the signature of Crohn’s disease, or cancer, or just bloating and brain fog and diarrhea.” Those tests don’t tell you what changes to diet, lifestyle, supplements, or drugs are going to be able to change your microbiome in the most effective way. And so there’s nothing fundamentally wrong with those tests, but they’re incomplete in the sense of not capturing the full microbiome and not being able to tell you what to do about it, or, you know, to connect it to all of this exploding science that’s out there.

Jaclyn: Great. There’s a question, how often should we retest? And I think it depends. I think there’s, kind of, three groups of people that come to us that Leo mentioned, those that are having issues and symptoms and they’re trying to find relief. And for those, if you’re actively trying to solve a problem and you’re trying to look at the recommendations, change your lifestyle, change your diet, we recommend every testing every three to six months to see how it progressed and if you’re feeling better. If you’re someone that is generally healthy and is curious and focusing on more preventative health, I think an annual gut check, we say, once a year would be good to, kind of, see where you’re at. And then there’s other…the third group is more like the health optimizers, those that are pretty healthy, and they want to take the health to the next level. And that’s kind of dependent on their own but I think once a year would be appropriate unless, again, they’re trying to actively change their diet to get to that next level.

So, it, kind of, depends on what the goal is of your client, but that’s just the general rule of thumb that we offer. And the reason for that is to actually have enough time to implement some of those changes and see how that impacts you. If you’re doing something where you’re traveling abroad, you know, get food poisoning or taking antibiotics, something drastic shifts in your lifestyle, then we recommend retesting as a baseline, but hopefully that doesn’t happen. So, in general, that’s, kind of, the standard that we like to say.

Leo: So, I see another question here saying, from a diet perspective, isn’t variety in fiber the golden standard? Increasing whole food, plant-based fiber intake to reduce inflammation, increase fiber diversity would probabilistically improve one’s microbiome. And that’s absolutely true that that’s good advice.

You know, you could say the same thing about cardiac disease, right? Don’t eat a lot of red meat and don’t eat more plant-based fibers and get more exercise. But that doesn’t mean you shouldn’t test your lipid levels. It doesn’t mean you shouldn’t do blood work. You still need to monitor what’s going on and what’s actually happening with somebody. And especially if they’re having issues and you suspect that the gut microbiome may be at the root cause, then the only way you’re going to figure that out is to really see what’s going on in the person’s microbiome. And depending on what you find there, different people may respond better to different paths. And also people may not have the right organisms to be able to process certain food groups. And so you’re not really going to be able to know that unless you go in and have a look at it.

I see another question. Sorry, Jaclyn. I see another question on metabolites. We are not looking at metabolites in this test. So, we are looking purely at the microbiome itself. You can infer metabolites to a degree based on knowing that, for example, some organisms produce short-chain fatty acids. If you don’t have those, you can be pretty confident that you’re not producing short-chain fatty acids. But we’re not measuring the metabolites themselves. That would have to be done through a metabolomic test.

Jaclyn: Okay, there’s a lot of questions, so I’m trying to keep up. There’s a question I saw earlier. It says, “Won’t functional medicine doctors be doing these labs for the patients that want to feel like I’m trying to do their job?” I think there’s a very clear difference between, and Sandi, feel free to jump in on this, but between health coaches and functional medicine doctors, I mean, from my point of view, you know, doctors can prescribe a lot of different tests, a lot of different medications. They might be looking at not just the microbiome but potentially the blood results or other aspects in regards to other testing that they’re hormone testing. And health coaches, you know, really specialize in helping them take those changes and actually implement them into their lifestyle.

Both groups have been using Jona and are super interested in working with it. It depends on, kind of, where they fall and what they specialize in. I think there’s plenty of people, quite frankly, that need help and need support. And so I think there’s plenty of room for both functional medicine doctors and health coaches to provide value in their own specialty and be able to help people interpret the Jona test, put other elements into their lifestyle to make it impactful for them. But definitely Sandi, feel free to jump in there.

Dr. Sandi: So, that’s a great answer. And I want to be clear that, if you have a client and you educate them about an assessment like Jona, and that they go and they take that test and they discuss the results with you, and from that, you have an incredibly impactful conversation where they are now willing and able to embark on some behavior change that has to do with changing their diet. But as Leo mentioned in the presentation, it could also be lifestyle. Maybe they’re going to commit to better sleep, to dealing with stress better, exercising, all that’s going to impact the microbiome.

And so you can use this as a way to mark progress in their lifestyle change journey, and I think that’s a great way that coaches can use it. And they can also be the ones who can help pull many people out there who do not have functional medicine doctors. They can’t afford it. And you are not acting out of scope when you are helping them access these resources. So, they are getting the resources. The information is coming to them, and you are helping them make the decision of, “Hey, let’s do an experiment and see how some changes might impact your microbiome.”

Jaclyn: Great.

Leo: Absolutely. I see one question on H. pylori asking if H. pylori is detected and questioning whether or not we’re measuring quantity as well. So, H. pylori is absolutely detected. When you do shotgun sequencing, you identify all bacteria, all fungus, all viruses, protists, archaea, really everything in the gut down to the strain level. So, H. pylori is absolutely detected. And we do detect the quantity as well. So, I think maybe I misspoke, but the quantities are detected for each of these organisms as well.

There’s a question here on the efficacy data on the efficacy of microbiome testing and, you know, asking, do we know whether we’ve been able to decrease certain markers or weight loss or whatnot? And I want to be really clear about what we’re offering. What we’re offering is a connection to the literature, right? So, we’re not replicating all of these studies. We’re not doing them ourselves. We’re not, you know, going through the literature and getting our own patients and saying that the results of the study are correct. What we’re doing is connecting you to that literature and operationalizing it so that you can use it to interpret a microbiome test result. And it’s both on the analysis side and also on the change side.

So, we are monitoring people who are getting these tests. We are working with providers and clinicians on collecting all of this data, but we are not…you know, we didn’t… As Jaclyn said, this isn’t a diagnostic. This is not a prognostic test. This is telling you what the literature said. In theory, if you were to read 2,000 papers a month, you should come to all the same conclusions that we’re providing you with Jona.

Jaclyn: Might be a little challenging, Leo, but yeah, definitely. There’s a question on, is it correct in saying that general results will have a treatment action plan in relation to dietary changes and supplement? So, there is an action plan and we, kind of, let you choose your own adventure. So, we let you pick… For right now, there’s a lens of, like, symptoms. So, if you’re trying to reduce bloating, for example, I would say bloating and gas are probably the top two things that people come in and complain about. You can choose your own symptom and based on that, you’ll get an action plan of, “These are the foods or diet that you should adopt. These are some that you should avoid if there is a supplement.” Again, we don’t call out brands. Like, we don’t make probiotics. We don’t make these products. We’re kind of agnostic to that whole thing. We’re letting you guys choose like what you would like to use.

But if there’s a certain strain that might help or a certain vitamin, like a vitamin A or B12 or whatever it may be, we’ll call that out as well. There’s some lifestyle changes like certain exercises, intermittent fasting, there’s a lot of literature on that. So, we do have that in the action plan. But yeah, I also just want to preface because no one’s actually really asked that, which I’m surprised about. But our whole thing is that we’re trying to bring transparency and truth and evidence behind the microbiome. And so we’re not making or promoting brands right now, because we want to give you all the information. Then, you could decide as the health coaches and the professionals how to best treat your clients.

Leo: I see a question here on comparing the results to something like GI-MAP. Yeah, I mean, we’ve taken the same sample and sent it for GI-MAP and run it through the shotgun metagenomic sequencing. And what you see is largely very similar numbers of organisms that are being measured in both, except the only thing is that Jona also finds all the other organisms that are not part of the GI-MAP panel and does the connection to the literature and the actions for how you can change them. But in terms of the organisms that are part of the same panel, we see very similar results in terms of, you know, quantities and detection of different pathogens, which is to be expected. Shotgun metagenomic sequencing is going to find levels of every organism, including the ones in these panels. It’s a slightly different technique. It’s, you know, using PCR versus sequencing, but they are comparable techniques in terms of finding the same organisms.

Jaclyn: There’s a question, are conventional doctors using this testing? Yeah, we have a wide variety of people using this. You know, our board of advisors, our scientific advisors, a lot of them are GI doctors, kind of, more conventional doctors. There’s a lot of MDs in general that are using between concierge medicine, anyone in that, kind of, cash pay world, longevity medicine, they’re all medical MDs or DOs. And with our advisory board, you know, we all come from that. conventionally strict clinical lens.

We do also have people that come from functional medicine and holistic as well. So, we, kind of, dabble both worlds, and there’s a growing interest in general of a lot of conventional doctors understand the importance of the microbiome because a lot of their patients are asking for it as well. I just went to a big conference that was focused on GI doctors, and the interest in general about the microbiome is extremely growing. And we have people reaching out to us all the time that want to adopt it into the clinic.

Leo: And, Jaclyn, also our chief medical officer is a GI doctor who was in private practice for many years really in conventional/allopathic medicine. And, you know, this is a product that is a wellness product. It’s not reimbursed by insurance. It’s not a diagnostic. Ultimately, our goal as a company is to really build those true diagnostics and therapeutics that will go through FDA and really bring the microbiome medicine into conventional medicine. This product is really allowing you to take advantage of all the literature and all the science that’s there today as a starting point.

Jaclyn: I see a couple questions about cost and promo code. So, the retail cost of the test is 485 USD. And in terms of the promo code, we can send it out after, but it’s FMCA90. I can maybe write it in the chat, but it’s a way to… It’s $90 off. And as a partner of FMCA and being an affiliated health coach, we also offer wholesale pricing. So, not just for your first test, which is what the promo code is for, but in general, long term, if you want to offer this to your clients, we are in collaboration to be able to do that as well.

Leo: So, there’s a question on H. pylori. Is medical treatment recommended? Can you take the report to your doctor? Obviously, you know, the results are yours. You can take it to your doctor if you choose to. And certainly, we’re providing you this information. If you see something on there that’s concerning, like H. pylori, we always recommend talking to your doctor or your health professional. I see there’s a scientific question on the intersection between DNA analysis and gene expression. This is something that’s really interesting.

What are the advantages of shotgun as compared to PCRs? I can actually see the genes of all these different organisms, and that allows you to measure things like antimicrobial resistance and allows you to see what metabolic pathways are being upregulated or downregulated by the microbiome as a whole. And there’s some additional research that’s coming out that’s showing, that not just, you know, abundance or lack of abundance of species is linked with a disease but actually just sort of a DNA sequence, regardless of the species that it’s in.

And so the sequencing that we’re doing, the shotgun metagenomics is not looking at expression per se, but by measuring the entire genome of all these different organisms that are found in your gut, it allows us to do a lot of additional advanced analysis in the future.

Jaclyn: Mm-hmm. There’s a question on, is there a list of all the conditions and symptoms it looks for? We have a sample report. You can download it online. And off the top of mind, we focus on GI, metabolic, autoimmune, and mental health, I mean, both symptoms and conditions. So, you know, fatigue, brain fog, gas, bloating, constipation, joint pain, anxiety, depression. I mean, that’s like some examples of symptoms, conditions, celiac, IBS, obesity, pre-diabetes, high blood pressure, just spitting off the bat. There’s a whole variety of ones, but it’s connected to everything as Leo mentioned, so we, kind of, cover a wide variety of conditions and symptoms.

Leo: Yeah. I mean, whatever has been published in the literature is what the AI is reading and really providing that translation. So, long as those papers are peer-reviewed and human subjects and so on and so on.

Jaclyn: I mean, we tell you the level of evidence too on the report. So, if it’s like, you know, established research, meaning a lot of papers are saying this strong profile connection, we’ll say that. If it’s, like, limited research, you know, some papers say this or maybe there’s not that much of a signature, we’ll call that out too. And we have the papers there for each one. So, you can, kind of, go… If you want to read it, you can go read the abstract or go deeper and see what that paper is saying. There’s a question on this category too. If you guys test for leaky gut, leaky gut is one of the conditions that we also also use or look for.

Leo: There’s a question on whether or not we’re measuring steatocrit, elastase, beta-glucuronidase, or secretory IgA. I imagine calprotectin would be on that list too. Jaclyn, do you want to answer that?

Jaclyn: Yeah, at the moment, we don’t. You know, we’re focusing a lot on providing a lot of value for the microbiome. And I think historically, a lot of people have used these markers to, kind of, make those conclusions and make those things like calprotectin, you know, linked to inflammation and making those leaps and jumps. We’re, kind of, doing it for you quite frankly. We’re already telling you what the bacteria means and its connection to different conditions and symptoms. So, we are going to do that legwork for you, so you don’t have to make those connections. And historically, it hasn’t been done before.

We are considering adding a few biomarkers to our panel, and that might be in the next couple quarters at some point this year. But we found that quite frankly, the microbiome itself is so heavily linked to all these conditions and symptoms, and you can get a lot of value from that itself. But if there’s a certain set list that you’re super interested in, we’re always taking feedback and trying to improve. So, whether you’re at the conference next week or you want to email us, I’m happy to talk and, kind of, go through some of the things that we test for.

Leo: I also see another question on whether we pick up parasites, viruses, and the answer is yes. It’s DNA testing. So, really anything in your gut that has DNA, which includes viruses and parasites, get picked up by the shotgun metagenomics.

Jaclyn: I see someone that’s not a health coach and is on the webinar is curious how to get tested. So, it’d be good opportunity to link with one of the amazing health coaches probably on this webinar, registrants, and maybe we can kind of follow up on how it’s going and if there’s certain health coaches that are affiliated and have their own link, you can kind of work with them to get follow-ups and talk about the report. So, it seems like we have a mixed audience but…

Leo: I see one more question. When you have a client that has low blood sugar, can you input that under a family history? And does it change recommendations based on, you know, leveraging the literature? And the answer is that what Jona is doing is interpreting the microbiome results and applying those results to interpret somebody’s test results. And the action plan is based on their microbiome.

You as the health practitioner may be looking at other information, including blood panels, lipid panels, hormone tests and whatnot. And you may be seeing aspects of their health and of their body that have nothing to do with their microbiome or that are not reflected in their microbiome. And as a result, we’re not taking into account all that other information today. And so we’re able to tell you what the microbiome says and what you can do to change the microbiome. But as you work with your clients and you look at hormone tests or blood panels or whatever, you’re going to have to integrate all of that information together into what’s going to make sense for that individual. You know, in the future, we may be able to build something similar to Jona for blood tests or lipid tests or something like that. But today it’s really just focused on the microbiome and applying that knowledge to helping you inform you and help you care for your patients.

Jaclyn: There’s a question on the process to take the test. You alluded to that in a few different slides, but in general, if you’re a health coach and you want to get started and have an account, you can email support at jona.health, with your name, information, role, the address you want associated with your account. We’ll send out some follow-up information so you have that, but that’s just the general flow.

Leo: Or, email either of us. The question was more about the sampling process itself. It’s really a pretty straightforward stool sample. So, you know, you get a kit. It’s got, you know, instructions. It’s got a stool catcher. You know, you put the sample on a test tube. It’s got a prepaid envelope, you mail it back. So, from a very practical standpoint, that’s how you send your sample.

Jaclyn: Yeah, it’s not that dramatic. Honestly, we’ve gotten great feedback. We haven’t had anyone complain about that process. And the kit looks pretty cool, so I think that experience is pretty, pretty dialed in. Just to clarify, again, only available in the U.S. because people are asking about the U.K. and Canada through a distribution partner. I know we’re probably running at the last few minutes. Maybe we’ll hand it back to you, Scott or Sandra, if you wanted to end here.

Dr. Sandi: Well, first of all, I want to thank you both. This has been a phenomenal presentation. I know we’ve gotten a lot of comments in the Q&A that this has been very helpful. And from my perspective, this is a match made in heaven. Because when you are encouraging a client to get tested, you’re educating them about it. And all parts of this, you can be that educator. You can help them if they see a report and they’re freaking out or even the procedure, “Oh, I don’t know how to do this stool…” So, you can help them there.

But most importantly, you are not interpreting these results. You’re not ordering the test and telling them they need to get this and you are not interpreting it. You are acting as a health coach where you’re providing this education, informing them this test is available. And then the results are data-driven and they’re right there on the report. And all you’re doing is having that conversation about how that individual then wants to use the results. They may want to or may need an opinion with their medical doctor or a nutritionist, or they may want to embark on a modern experiment. I’m going to give up these particular foods. I’m going to add these foods. We’ll retest. I’m committed to doing that. And so it is a great jumping-off point for what coaches do, which is helping people with lifestyle change.

So, I want to thank both of you. And for anybody who is listening, if this is interesting to you and you’re saying, “I want to be a health coach,” we are enrolling for the September class and we right now have a very special offer on the best tuition available and that is running through June 10th. So, we hope to see you as a health coach so that you can have clients and partner with organizations like Jona to provide good options and help people create better, healthier lives, and healthier gut microbiome. So, thank you, Leo, and thank you, Jaclyn. Thank you to everybody who was registered, who came to the webinar, and just a reminder that you will get the recording as well.

Jaclyn: Thank you. Thanks, everyone.

Leo: Thank you so much, Sandra, Scott, and everyone who made the time for us today.

Jaclyn: Thank you.

Dr. Sandi: Thank you. Bye, everybody.

Leo: Bye, everyone.