Infant Gut Microbiome 101: Insights for Parents and Health Coaches

On Tuesday, February 4th, 2025, FMCA hosted an insightful webinar featuring Dr. Sandra Scheinbaum, Cheryl Sew Hoy of Tiny Health, and Scott Hawksworth of FMCA. They explored the critical role of the gut microbiome in a baby’s first 1,000 days and its lasting impact on lifelong health.

This must-watch session covered:

• The First 1,000 Days – How early gut health influences immunity, digestion, and overall well-being.
• Microbiome Insights – What specific bacteria in a baby’s microbiome mean for their health and development.
• Actionable Strategies – How parents and health coaches can use microbiome data to support healthy gut development.
• The Role of Health Coaches – How coaches can guide parents in translating microbiome testing results into meaningful lifestyle changes.
• Real-World Impact – Scott Hawksworth shared how Tiny Health’s testing transformed his approach to parenting.

The discussion also included a LIVE Q&A with Cheryl Sew Hoy, where attendees asked pressing questions about gut health, testing, and actionable next steps for parents and practitioners.

Whether you’re a parent, health coach, or practitioner, this replay provides practical, science-backed strategies to nurture a healthy start for babies.

“We always think that the gut is the leading indicator before symptoms actually do exist. It’s a precursor, right? When you do have symptoms like, ‘Oh,’ it’s already kind of pervasive in a way.”

Cheryl Sew Hoy

About the Speakers

• Dr. Sandra Scheinbaum is the founder and CEO of FMCA, a leader in functional medicine and health coaching.
• Cheryl Sew Hoy is the CEO and Founder of Tiny Health, a pioneer in gut microbiome testing for infants, children, and parents.
• Scott Hawksworth is a father of twins who has firsthand experience using Tiny Health’s testing to optimize his babies’ gut health.

About Tiny Health

Tiny Health specializes in gut microbiome testing for babies, children, and parents, using shotgun metagenomics to identify key bacterial strains essential for immunity and digestion. Their science-backed insights empower families and practitioners to take proactive steps toward better health from the very start.

Interested in testing your family’s gut microbiomes? Use discount code FMCA for $20 off when you purchase a test kit. 

Don’t miss this opportunity to deepen your understanding of infant gut health and how health coaches can support parents in fostering lifelong wellness. 

Watch the Replay

Infant Gut Microbiome: Insights for Parents and Health Coaches

More Resources On DTC Lab Testing, Gut Health, The Microbiome, and Family Health

Lifelong learners are a pillar of the FMCA community! If you’d like to explore this and similar topics further, here some additional resources you may want to browse.

• Food is Medicine: Why What You Eat Really Matters [Article]
• The Gut Microbiome: Uncovering Secrets to Enhanced Health and Wellness [Webinar Replay]
• Why The Recipe For Healthy Eating Requires Relationships, With Shawn Stevenson [Podcast]
• Why DTC Lab Testing Needs Health Coaches [Article]
• DTC Lab Testing and Health Coaching: From Insights to Impact [Webinar Replay]
• Food Plans 101: The Healing Power of Nutrition [Article]
• Nurturing Gut Health in Mothers and Babies, With Cheryl Sew Hoy [Podcast]

Transcript

Dr. Sandi: Well, I want to formally welcome you to this webinar. I am Sandra Scheinbaum. I’m the founder and CEO of FMCA. And I’m so glad that you are here. And I’d love to know where you’re from. Feel free to use the chat to let us know.

And I want to introduce Scott first. Scott is our director of marketing and sales, but he is here today as a dad. And so we are going to be talking about his results from him, from his family, from his twins. I am also… I am a grandma of twin toddlers, so I am very, very interested in this webinar as well.

And we have as our very special guest from Tiny Health, Cheryl Sew Hoy. And I got to interview Cheryl a few months back when we did a podcast, and I just love the work that they are doing. And you’re going to hear all about it, and you are going to see an actual interpretation of results. We did the microbiome testing on Scott’s twin babies. So, I’m going to turn it over to Cheryl and Scott to take it away and start the webinar.

Scott: Once again, hi, I’m Scott, and I’m a father of three, actually. So, I have a five-year-old daughter, and then, well, almost a year ago, my wife, we had twins. And they were brought into the world via C-section. Noah, he was… What was he? Was it transverse? He just didn’t feel like moving. He was posted up. And so when we went to the hospital, we had kind of hoped that maybe he would move around, and he just didn’t. And they were like, “Okay, we’re going to need to go right into a C-section,” which was different than our first, you know, where my wife gave birth vaginally to our first.

So, that whole experience was wild. And it was just so different. Noah had some complications, so he had to actually spend a day in the NICU. And so different things like skin-to-skin, we didn’t go right to that as early as we did with my first, Charlotte. And we didn’t get either of them, I think, on the breast as soon as we did with Charlotte and different kinds of things like that. So, it was just a different experience.

And also I would add, with twins, my wife breastfed pretty much exclusively our first. But with twins, that is just really, really hard. And while she did breastfeed, we almost immediately had to start supplementing with formula. I know many parents, there’s all sorts of questions around breastfed versus not and formula questions.

And so I think these were some of the things that started coming up for me when I came across Tiny Health and saw that great interview between Sandi and Cheryl. And I got to thinking… I’d love to know more about, you know, my children’s health, and their gut, and what’s going on there, especially at the time that we did this test, you know, we’re starting to introduce solids. And we’re still doing that. We’re kind of ramping it up. And I think with all of that, you know, what do we say here at FMCA—food is medicine? And as parents and we have two working parents, okay, how do we make sure we’re getting all the right foods, and eat the rainbow, and everything? Really just a whole process there with a lot of questions.

And in terms of collecting it, it was pretty straightforward. The twins were nice and obliged by providing some dirty diapers. And I think the big thing… Yeah, there you go, that was the swab. And I think the big thing I was really stressed about was getting the right amount—not too much, but not too little. And so, kind of, like getting the swab there. But it was really quite simple. A lovely kit. As a marketer, Cheryl, I just have to compliment how the kit came. I just nerd out about things like that. And it was really easy to, kind of, take the sample, put it back in exactly. And then I went on the Tiny Health website, was able to put in the numbers for the sample, and send it off, and we got the results.

Cheryl: Yeah, yeah. And I have the instructions here. You can’t do too much, not too little, just right. But it should be pretty easy to just, like, kind of touch the stool from the diaper or for an older kid or an adult, you can sample directly from a soiled toilet paper, which makes it easy. Traditionally, if you’ve taken a PCR stool test, you poo into this French fry thing, and then you have to collect this much, which, for an infant, sometimes you really don’t get that much stool. In fact, some labs make you collect two vials, which is quite a lot.

We have an adult pro version that has these additional stool markers. We actually do sell these, too, for advanced testing. You have to have certain practitioner licenses for that. But, yeah, it goes back to saying that we do support stool testing for all ages, not just babies. But the reason why we’re here to talk about your twins and your babies is because it’s such an innovative test that, you know, no one else has on the market for under three. Most PCR stool tests are for 3 and above. And what we consider an adult range, because the gut of the child matures into adult-like by the time they’re 3, well, 3 to 5, there’s a transitional stage, that Tiny Health is actually leading the charge in defining that 3 to 5 transitional stage before it’s fully adult-like. But that’s kind of why most tests in the market you see are for 3 and above.

So, going back very briefly to my story, which is very similar to your wife’s story, except that my first child, Charlie, she was the C-section born baby. She was breeched. So, not transverse but breeched. And I labored. I chose to go through labor instead of scheduling a C-section because I knew that there were benefits to labor. And going back to the science of it, the fetus is actually sterile in the womb. There was some contention around, “Oh, is there is a microbiome in the mom’s womb for the baby, the fetus?” Pretty much, we’ve shown or there’s papers published that there is no microbiome. And the major event that seeds the infant’s microbiome is the water releasing. When the water breaks, that’s when the baby, in the birth canal, you know, on the way out, they’re, kind of, swallowing that fluid, the vaginal fluid. So, they first get seeded with the mom’s vaginal microbiome. So, the vaginal microbiome of the mom is actually quite crucial in this equation to be healthy and in an acidic state. So, you want it to be Lactobacillus-dominant. And we have a stool test for mom for prenatal to check on the vaginal microbiome to make sure that’s healthy. And then some fecal fluid during the laboring process also gets swallowed by the baby. The anus is so close to the vagina for a good reason for birth. And nature has its way of seeding the baby with those things.

So, that’s kind of what’s expected of a normal vaginal birth, and that’s where babies get most of mom’s microbes—a combination of vaginal microbes, which disappears very quickly. And by day 7, by one week, you don’t really see the vaginal microbes seeding baby’s gut anymore. Sometimes you do, but most of it is then taken over by the mom’s gut microbes through that initial birthing-labor colonization, and then breast milk. If the mom is breastfeeding, she’s actually continuing to transfer these gut microbes from her own gut through the breast milk to the infant, which is fascinating science.

So, this whole progression could be disrupted by a C-section or other interventions like vacuum, forceps, and things like that. So, in my case, from reading the impact of C-section is the reason why it impacts the infant gut is because, one, they’re not birthing through the vaginal canal, so they’re missing the vaginal microbes and also potentially the gut microbes, right? So, what makes up the infant gut in the early days of a C-section baby are mostly hospital bugs, antibiotic-resistant maybe from the skin or environment of the hospital. More skin of the doctor or mom/dad in the hospital environment. And so that is one factor.

The other factor is that baby is probably exposed to mom’s antibiotics from the operations because, obviously, you’re kind of, you know, with the operations, mom’s given antibiotics and that directly gets absorbed into baby’s system too. So, they do have, you know, at birth, if you measure the one-week or one-month-old gut from a vaginally born versus a C-section born gut, there’s various papers showing it’s quite different.

And so I was reading those things, and I’m like, “Okay, what does that mean for the infant’s health?” And, you know, my whole journey, which is kind of my webinar with Sandra earlier on, was describing how the early colonization impacts baby’s lifelong immune training. So, you know, we kind of now know that 70%, 80% of our immune system lives in our gut, and we get it from our mom through the initial process. What seeds baby in these early days, in the first few months, first few years of life, is quite crucial because these bugs, and more specifically, the balance between specific beneficial microbes like bifidobacteria and Akkermansia versus maybe more destructive microbes like E. coli and whatnot, Klebsiella. The balance between the two really trains the baby’s immune system.

So, what happens if there isn’t the right balance in the early months of life are chronic conditions, specifically atopic march conditions. So, atopic march is an allergic progression of allergic diseases that typically starts with eczema between three to six months, most commonly at six months when you start solid. Solid introduction triggers a response to dietary allergens. And then if the kid has eczema, they are also more likely then to have food allergies between six to two years of age, six months to two years of age. And then that could progress into asthma, respiratory allergen or a reaction to respiratory allergens between three to six years of age. So, it’s kind of this progression.

And then hay fever is also kind of part of that journey. Some kids have hay fever before asthma. Some kids have it after or into adulthood. So, it’s kind of an indication these progression of allergic diseases is an indication that their immune system wasn’t trained correctly by the right balance of microbes in early life.

So, when I read those papers, I’m like, “Oh, no, you know, what is her risk?” There’s something called a C-section signature. So, how many antibiotic resistant bugs versus vaginally… or bugs found in vaginally born babies, the ratio between the two. So, there’s a paper published by Stockholm. This is a scientist that shows by one year of age, most C-section-born babies, the C-section index has gone down, and they look more like vaginally born babies through breastfeeding and things like that can course-correct. You can course-correct an infant’s gut.

But there’s a small percentage of C-section-born infants whose C-section signature remains high at one year of age, and their risk for asthma is three to four x. So, when I read that paper, I was like, “How would I know what my daughter’s C-section index is at one year? At six months, am I kind of maturing her gut towards lowering her risk for atopic conditions and asthma, or am I not?” because she did get eczema at six months when we started solids—quite, you know, bad eczema—and then not food allergies but food sensitivities. She had some sesame sensitivity but also gluten and dairy intolerance and things like that.

So, I knew that my immune system wasn’t quite in the right shape, and so I was really trying to de-risk her. And there was no test in the market for infants specifically or kids that I wanted to also use this technology called shotgun metagenomic sequencing, which is a new technology—next-gen sequencing tool—that is being used by all the latest publications in microbiome, you know, academic research. So, they’re not using PCR or culturing anymore because that shows you a very limited panel of what’s going on in the gut. I wanted to use shotgun because it can measure strains because the different strains… We talk about species. Strain goes to the next level resolution. So, we now know that different strains perform different functions, so I wanted to look at that. I wanted to look at the function of the microbial environment in the gut, not just the microbes that are there but what they’re actually doing.

So, using shotgun, you’re able to see these two things. So, there was no test in the market for that, and I was like, “This is so foundational for my child’s lifelong health. How do we not look into it when the window to course-correct is in that first few years of life but more importantly, the first few months or the first year of life based on that C-section index, kind of lowering that risk in that first year? And there were, more importantly, a lot of interventions that one can do to course-correct. And the infant gut is very malleable. So, if something was really off in the infant’s gut, a lot of parents freak out when they see zero beneficial bacteria in their infant’s gut in that first year and all unfriendly. It’s not a good picture to see, right? But we always try to reassure them that it’s very easy to change. It is very malleable, and it’s very driven by diet, which is milk, breast milk or formula. And more specifically, the HMOs, or human milk oligosaccharides, that makes up a third of the breast milk composition. So, HMOs are like prebiotic fibers for the beneficial bacteria. So, if you want beneficial bacteria to colonize and stick around and push out unfriendly bacteria, then you kind of need food for the probiotic, right? So, probiotics are not enough. You need a prebiotic, which then comes from mom’s breast milk.

Then there’s that question of like, with formula feeding, there’s no HMOs in most formula. And even formulas who market HMOs don’t disclose how much there is in formula. It’s usually just a marketing thing. It’s very minimal. So, you might need to add an HMO supplement if you are formula feeding to make sure that, when you do have the right probiotics in your infant’s gut, it’s colonizing. But there’s so much nuance towards it because you only need it. If you don’t have it, your child doesn’t have it, and you don’t want to oversupplement, too.

So, at Tiny Health, our approach is that we don’t believe everyone needs a probiotic or every child needs a probiotic. It really depends if they’re missing those strains because we know that the native strains from mom is actually superior because nature has its way of designing maybe what should be there. Most of the time, not all the time, it really does depend on the mom’s gut health as well. So, we also usually highly recommend that the mom checks in her gut health during pregnancy, even before trying to conceive, even postpartum if she’s breastfeeding, because we want to know the state of the mom’s gut as she’s passing on her gut microbes to her babies, right?

So, if mom is actually deficient of certain strains of bifidobacteria, which is the important thing to colonize the baby’s gut, then even through a vaginal birth… Not even a C-section. Even through a vaginal birth and breastmilk, infant may not be receiving any bifidobacteria, right? So, sometimes we see parents also being shocked, “I did everything right—vaginal birth, breastmilk, blah, blah, blah. Why is my infant deficient completely of bifidobacteria?” Well, then, when we have mom’s sample, mom completely had no bifidobacteria in her gut. And sometimes it’s hard for us to explain why, but that was my case.

My second child was a home birth, vaginally born, VBAC. And I thought, “Okay, great. This time, I had it all right.” I breastfed for two and a half years. But guess what, I had no bifidobacteria. And I was like, “But I eat so healthy now.” And everyone tells us, oh, I eat so healthy, and I’m living the non-toxic, clean life, yada, yada, yada. But then, what I learned going through my own journey was that I was given antibiotics in early life for certain things. At the time, my parents didn’t restore it, because if you don’t actively restore some of these bugs like bifidobacteria, Akkermansia are very sensitive to antibiotics.

So, if you do a round of antibiotics and it’s depleted, and if you’re not consciously restoring it, it may just be gone forever. So, to keep in mind for adults, Scott, maybe you want to check if you have bifs, if you had any prior antibiotics in your early life. And then, my diet in my 20s was horrible too. So, again, there are so many factors that could deplete that beneficial bacteria. If you don’t restore it, you may not even have it as your baseline, right? So, yeah, something to keep in mind. But, yeah, I’ll kind of pause here. I just wanted to give everyone the context a little bit of my own story and how I came about this. And also how the infant gut is so important for lifelong immune training, where it comes from, and how you can actually course correct.

Scott: That’s fantastic, Cheryl. And I just want to add, just from a health coaching context, just as a parent, as you’re saying that, I’m like, “Oh, my gosh, this is so powerful.” And then I start feeling that anxiety like, “Oh, gosh, can I get there in time? How can we course correct if we need to?” These are the kinds of things that health coaches can really support parents in if lifestyle changes need to be made. How do you go about that? How do you stick to it? So, really, really fascinating.

And then one question came up as you were talking, Cheryl. So, for my son Noah specifically, he spent some time in the NICU because what happened is my wife’s placenta or, I guess, while she was in labor, what have you, and he ingested a lot of her blood. And that’s why he… Basically, they had to go take him to the NICU to, sort of, monitor and make sure it all passed through. And so as you’re talking through that, I’m like, gosh, how might that impact a microbiome if he specifically had that happen? Fortunately, Eliza did not. But yeah.

Cheryl: Yeah, fascinating. So, maybe we can dive into your twins’ sample, and I can walk through how I would evaluate it as a health coach. We actually do, on Tiny Health, have a team of what we call microbiome specialists, that each test that a consumer purchases comes with. So, consumer pricing is $249. It comes with a coaching call. Two of our specialists are actually FMCA-trained health coaches, and they’re one of our better coaches. So, that and then there’s a practitioner rate, too. If you’re a practitioner practicing, it comes without the consult call. So, let me just share my screen if you’re ready for me to compare your twins’ sample.

Scott: I’m ready. I’m so excited. I didn’t want to spoil anything, so I, kind of, only glanced at them.

Cheryl: Okay, all right. I was gonna ask, you know, if you understood your results or how you walk through it. Can you see the comparison between the two?

Scott: I can.

Cheryl: Okay, sorry. I couldn’t hide your email. I was exposing your email a little bit.

Scott: It’s okay. That’s my work email.

Cheryl: Okay, great. All right. So, they were sampled—I just noticed, actually—a few days apart. And actually, the C-section index actually was a different range because we actually have a new range for nine-month-olds. And I think Noah was at the nine-month-old and then Eliza was at the six-to-nine-month. This is one of the special things about our test is that actually the reference range changes slightly as the baby ages, because this is the work we did over two years of R&D, mapping out the very quick changes because the baby’s gut, remember I said, is malleable in the first few years of life, especially the first year, first six months of life. The earlier, the more rapid changes. So, I’ll walk through that C-section index, but it’s very minor.

So, yeah, at a high level, I didn’t go through their survey. We do ask a survey, so I kind of knew about the C-section and the NICU and all that. I did not know that Noah had spent time in the NICU and Eliza didn’t. Is that right? Is that what you said?

Scott: That’s correct. So, Noah had been in NICU but not Eliza.

Cheryl: Right. So, it’s interesting. His score is just very slightly higher than Eliza. But it’s interesting. In your health rating, you rated Noah 9 and Eliza 8. I don’t know if you remember.

Scott: I did do that. I think maybe because I was going on Eliza seeming to struggle more like getting more illnesses and getting over a cough and things like that. Noah seems to be… He’s been larger than Eliza the whole time. He’s been a tank in terms of how he eats. And so, I guess, I don’t know, maybe there’s parent bias there but maybe I felt like he’s hardier.

Cheryl: No, no. But when I looked at his results, if you didn’t tell me all this, he actually has a lower maturation, which is what we want to see a little bit in the early days. So, this is something we just launched. We can now predict with fairly good accuracy what your child’s microbiome age is. So, here, I know it’s eight plus, but we predicted Noah and Eliza’s gut pretty accurately. In fact, Eliza has slightly higher maturation than Noah, which is not a problem. It’s still within range. This is largely driven by things like C-section can accelerate maturation a little bit. Formula feeding certainly can. So, if they were exclusively formula fed without any breast milk, this would shoot up pretty high. And even early introduction of solids before 4 months and such, you’ll see their infant gut prematurely accelerating the maturation and that could be connected with obesity and metabolic health issues later in life.

So, here we see them pretty close to each other’s. The more breastmilk, I would say, and the lower diversity, which is what we want in the early life, the lower the maturation, which we see very slightly lower maturation in Noah’s gut. But, sort of, like, maybe just click in quickly for you to see… So, nothing here to do because they’re fine but it sounds like they were both breastfed for about six months, right? Some supplementation. And to note here, even if the mom was supplementing with formula but primarily breastfed, we see that maturation suppressed by the breastmilk, which is a good thing, again. And then when they do start solids, we actually do want to see this maturation taking off.

So, sometimes if the child is starting solids a little bit slower, we need to speed up allergen introduction and maturation because you want it to be very low in the first six months because the primary diet of the infant is just milk, breastmilk or formula. So, higher with formula, lower with breastmilk, which is what we want. And then post-weaning, we see that taking off and high maturation… But you kind of want… Again, this is scientifically referenced from what is kind of the trajectory that we want to see that’s healthy. So, I’ll just back out because I thought that was pretty interesting.

So, the way I like to walk through the results is this is the dashboard of what everyone would get if you are a baby or a child or an adult. We have a high level score to tell you what you’re doing. So, obviously, Noah could be better in the green, but I would say there’s some work to be done but it’s not terrible. I mean, given his circumstances, right? It’s pretty good, you know? So, then, here, you can click into reading the high priority, but I would just walk you through. This is a good place to start to see what’s the top things to focus on. And it’s very interesting that your kids have pretty similar top thing to focus on, which is fragilis, which is kind of associated with constipation. so, I’m not sure if any of your kids have that sign yet. Any…?

Scott: A little bit. It hasn’t been too bad. My first definitely had some constipation issues, but we haven’t noticed anything crazy with them just yet.

Cheryl: So, something to keep an eye on. We always think that the gut is the leading indicator before symptoms actually do exist. It’s a precursor, right? When you do have symptoms like, “Oh,” it’s already kind of pervasive in a way. So, it’s just something to watch. Again, I wouldn’t worry or freak out about it, but there are things that you can do to lower this, which there’s a long list here of what you can do, specific probiotics you could take. This B. longum BB536 has been clinically shown, with actual published papers, to lower fragilis in the gut. So, I’ll back out later.

And then there’s dietary actions and lifestyle changes that one can do. I know it’s a long list, but someone can just pick… Some of it is just a guide and how to introduce allergens and first foods, what you were concerned about earlier. Just some resources for you here. That’s, you know, an allergen, powders if you want to speed it up a little bit more. Just a lot of helpful resources. But sometimes, there’s very specific supplements that we would recommend to target specific microbes that are a little bit high in abundance compared to what we normally see in a healthy developing infant gut, for example. So, that’s one example.

I don’t want to go too deep into that for now, but let me just back out again. That’s where you go to start, I would say. But how we organize this dashboard is by, kind of, pointing out the top three things that are in that red range. And then the yellow is kind of then the next optional steps. I would target the red stuff to tackle first and then the yellow stuff. Otherwise, some people might have a lot and it feels overwhelming on what to do first, right? So, I would target the ones that need support first. We do have an action plan here so you can quickly click on the left nav to just see all the things that are recommended for the reds. And then once you get through that, you could work on the next things in the yellow and then maybe some additional resources down here.

Scott: And to be clear, sorry, this would be Noah. So, it’s like, okay, I want to consider a probiotic for Noah.

Cheryl: Yeah, yeah, your twins are twins. They have very similar guts. And I’ll walk you… I analyzed them already. Literally, it could be from the same person.

Scott: That’s really cool.

Cheryl: But they diverge once they grow up if they’re going to different schools, eating different diets, or, you know… I’m sure that will be a long time away before they start diverging paths. Their guts will mirror their lifestyle, right? Their diet and their living environment. They get the same amount of kisses from Mom and Dad, so probably… However, we’ve seen with twin samples where one was vaginally born first and the second one was C-section born, then we see differences in their gut at birth, which is fascinating. So, I think the two of them were C-section born.

Scott: Yeah, both were C-section. Yes.

Cheryl: And so then I want to see then, backing up, can we see some NICU impact in Noah but not Eliza, right? So, we’ll back up to that. But, you know, high level, we break it down by… And this is how it would be useful if you have a patient you’re walking through a health coaching session, you want to see what the problem areas are in a summary. We see that there’s not really any beneficial microbes in question here. Sometimes, if it’s all…kind of a lot of reds, then, oh, they don’t have enough beneficial bacteria. That’s maybe something to work on. Here, we see a couple of microbes that are red, so we want to double-click into that later to see which ones could be causing problem.

Under three, we don’t really have gut inflammation. It’s something to keep track of, but it really isn’t relevant until three years and above. This is our leaky gut intake here. Leaky gut is everywhere, but basically your gut lining and, you know, do you have, you know, good gut barrier integrity? The reason why for infants this isn’t relevant is because infants are born without a gut barrier, actually, because you want the kind of microbial training, right? So, the gut lining is actually permeable in the first few months of life. So, like, again, a lot of science there I won’t go into.

And then the short chain fatty acids that you want to see in early life are mostly acetate high in the first six months of life and butyrate low. And then when they start solid, it’s kind of like at nine months, you do want to see butyrate high and acetate still relatively high because there’s probably still some milk involved. So, we see that they’re both kind of very similar here, and acetate needs a little bit more help. But their butyrate function is pretty good, which indicates that they’re eating, you know, diverse enough solids. Short chain fatty acids is very important in infancy and it changes into adulthood.

Digestion absorption markers, we focus on HMOs here. And this actually is what I mentioned earlier, driven by breast milk and breastfeeding. And they look like they all have very healthy amounts, which then encourages the bifidobacteria to stick around.

Scott: That’s going to make my wife feel very good. She’s going to be very happy with that. That’s great.

Cheryl: Yeah, yeah. So, normal breast milk will have 200, 300 types of HMOs. We have this grouping here. But if the infant was exclusively formula feeding, we see this very low usually, so it’s a sign they need to add an HMO supplement, for example.

Scott: And by the way, to your point, as you were talking about the formula, I know on our formula can, it says, you know, HMOs, but it’s just an interesting factor that, you know, it might be more marketing than that and really we’re getting a lot of it as the breast milk.

Cheryl: Look out for the volume. And then there are infant-approved HMO supplements, like we love one from Begin Health. They have an infant-approved one. And then for kids a year above, if they are having some constipation issues—and because we saw the fragilis high in your twins—at one year, I would switch to the Begin Health with inulin, because then that could help with the constipation bit. But again, only if they need it. I wouldn’t supplement if they don’t need it.

Scott: There’s been a few nights where I remember Eliza, she was working on something, and it was tough. I had to be up with her. So, I’ll keep an eye on it.

Cheryl: It’s good to have them on hand. Yeah, especially if moms wean them from breast milk. If breast milk is there in any bits of amount, one serving of breast milk is equivalent to one… I think not even maybe one serving of HMO. So, if you’re breastfeeding, I would say you don’t really need HMO supplements at all.

So, coming back here, this is like where you can really see this is the power of shotgun sequencing versus a PCR test, which gives you a very small panel what’s in a person’s gut. This one you can actually see that, you know, overall Noah’s gut has 3% unfriendly, Eliza has 2%. So, he does have slightly more unfriendly bacteria. And 66% by and large pretty… Oh, it’s up here summarized for you. And then variable is just something that is very common in the person’s gut, but you don’t want it to be in the top species. Because if you have an overabundance of some of these, then it’s kind of linked to… I know it sounds really terrible here, but most commonly in kids, it’s constipation here.

And everything that we list in the test is linked to a PubMed article, so it’s very evidence-based. And that’s why practitioners and coaches and families love using our tests. It’s all based off of, you know, evidence. And there’s so much evidence that B. infantis is really the most important strain of bifidobacteria for an infant in the first year of life. So, it’s really great to see that Noah and Eliza both have this as their top species. And Eliza does have B. longum too, which we saw that your wife was taking a line probiotic [inaudible 00:37:11.021]. And that is primarily… They have B. longum in it. So, I wonder if some of this came from her probiotic. It is the second most abundant species in Eliza and third in Noah, but the B. infantis must have come from her.

So, if we have your wife’s gut, we actually do a seeding comparison for how many microbes mom and baby share in the first six months. So, we can attribute it to, you know, if not a vaginal birth, then breast milk, you know, could come through the breast milk, or sometimes if mom is completely deficient of these microbes but somehow baby had it, that can actually contribute to it. So, it can seed baby from that or older siblings. Your Charlotte, if she had B. infantis, and let’s just say your wife and you didn’t have it, somehow Charlotte had it, she can pass it on to her siblings if she’s kissing and sharing food and just being in the same household environment.

Scott: She’s doing all that. So, yeah.

Cheryl: So, I would be curious if you had Charlotte’s sample, any one of your samples, if we see the same strain of B. infantis there where the twins got it from, because they certainly didn’t get it from a C section. So, they either got it from the breast milk or from from you guys, right?

So, anyway, it’s pretty—you can kind of scroll down to see—interesting that, you know, sometimes you just want to see all the full list of what’s unfriendly. And a lot of it when I was digging into last night, some of it is connected to like, you know, resistant to antibiotics, or found in preterm babies, which I think your kids are…

Scott: Both of them are, yeah.

Cheryl: And some of them are connected with C section birth specifically. So, you do see some signs of, you know, kind of microbes that are connected to that, but not too concerning because they’re by and large pushed out, which is what we want to see.

Scott: Cheryl, I had a quick question. So, we have three cats at home, and we don’t live in a huge house. So, I mean, the cats are milling about and with the kids. I’m curious, are there any indicators for that? I know lots of parents have pets and different things. And sometimes it says, “Oh, it’s great to have pets, because, oh, those kids have more hearty immune systems, yada, yada.” I’m just kind of curious if any of that’s showing up here.

Cheryl: Yeah, it’s hard to say, but I think it will show up more when they are maybe like Charlotte’s age in diversity. Because in the early ages, you actually want low diversity, as I mentioned, for an infant’s gut. So, for example, coming back to the microbiome breakdown… Oh, sorry, we just launched a new indicator. Okay, so at 9 months, Noah has 149 bugs that we detected, and Eliza is pretty close to it. So, you kind of want lower… In the vaginal birth, say in the week, you might only see 10 bugs, and that’s actually very healthy, so you want low diversity. And as I mentioned, post-solid introduction, post-six months, and post-weaning, too, you want to see that taking off to… If you did a stool test, Scott, or you and I would have about 300, 400, maybe 500, and the more, the better.

So, obviously, this is a very immature gut where they’re only like at 140, right? And just now, the microbiome breakdown, you see all the 149 species. So, the cat and a dog is partially helping with species richness because they’re going out and bringing the dirt—good, healthy dirt—inside. Remember, we used to live on farms and go out in nature a lot back in the day. Now, we spend 92% of our time indoors, which is not a great thing. So, in a way, the papers that show why pets, specifically dogs and cats, because they do go out and come back in is because they actually help us diversify. They bring nature to us, or you walk them. You go out with them, right? And so, ideally you are spending that time outside, and you’re getting that diversity. And having your kids actually play outside will increase this as they grow up. But hopefully, that answers your question.

Scott: That does, that does. And I just wanted to point out, it looks like we’ve got some other questions coming in. So, I’m curious if you have anything else to share…

Cheryl: Yeah.

Scott: …and [crosstalk 00:41:46.044] the audience here.

Cheryl: So, the main thing that’s really, really important in your gut is bifidobacteria. We want to see 50% to 90% in the first year. So, again, kind of like, you know, B. infantis is the most important. We see a huge diversity in your child’s gut. So, usually, when we see this much diversity, it’s coming from mom. These kinds of weird species I’ve never seen before I think are probably from her, which is great. But, you know, sometimes the infant’s gut might have mostly adolescentis. So, these are actually adult bifidobacteria, so they don’t actually belong in an infant gut and they don’t do much for increasing acetate production or degrading HMOs in mom’s breast milk. So, the type does matter. We actually want to see these… These top four are the ideal ones we want to see in an infant dominating their gut. The ones on the bottom, not so much. But as they get more solids, it is healthy to see a diversity of it. So, I want to quickly point out how important that is.

And then the other thing we want to look towards is Akkermansia. By one year of age, Noah and Eliza should have some. This is important for allergy prevention and also metabolic health, gut lining. So, most infants don’t have it, but this is where I would also want to check in the mom and dad to see if they have it. Because if they have it, they can pass it on to their kids. So, another keystone taxa.

And then, I quickly want to go through the unfriendly microbes. Double-click here. That is sort of like, you know, we do see a few more unfriendly bacteria in Eliza’s gut. But the thing I wanted to point out is we have a strain function here for Staph. I saw that they actually have this toxin type A which… I click into E. coli, I didn’t see any toxic strains. So, this one is, in a way, common. Not as rare but non as common either, and it is kind of one of those that are skin indicated. So, watch for eczema or any skin issues, rashes here. If they don’t have it, maybe this is just not impactful, because they could have this toxin but it’s also epigenetics, right, what else you do in your lifestyle. So, it seems like this is not really impacting them. They don’t have eczema, right? They don’t have any…

Scott: No, not that I’ve seen.

Cheryl: Yeah, so this is interesting. So, again, something interesting can look into it here, but typically we find it more in people who have skin issues.

Scott: I have eczema if that is relevant.

Cheryl: So, yeah, I don’t know if maybe this came from you or whatnot. You want to check in and see how you can then, kind of, do some of these actions to help lower that risk. So, very useful information for diving. Again, we particularly approach symptoms from everything, symptoms and conditions. So, the gut test is just one mechanism to deep dive into what could be contributing.

And sometimes in the early days, you do want to be proactive about course correcting before symptoms happen. But if the gut by and large looks good, and you have some of these small little bugs that are a little bit higher but they’re not so irritated and not so bothered by it, then I wouldn’t freak out in a way emotionally. I wouldn’t be too concerned, but I would start working on, okay, what can I do to to support that high Klebsiella, which is again, connected with eczema actually? And so sort of like, do I need maybe just a very short course of bifidobacteria to push some of the unfriendly out?

We wouldn’t do five months supplementation, I would do just very short courses. And this is what a health coach would, kind of, walk us apparently through is that because… And the reason why you shouldn’t take a probiotic ongoing is because, remember, I said you want diversity to happen at certain point. If you’re taking the probiotic and prebiotic or breastfeeding, then this B. infantis could be overpowering and suppressing diversity when it actually should be blooming, right? So, that’s, kind of, why you really want to be very targeted, especially in the first year of life, with probiotics and prebiotics, and take it only if you need it.

Scott: Logical changes rather than just full scale.

Cheryl: Yes, and check in. And if it’s, kind of, made its purpose, just push out the Klebsiella and some of these high bugs, then I would stop, frankly, you know?

So, yeah, most kids have C. diff, nothing to be concerned about. People freak out about that a lot too, but it’s not too alarming. And we would expect this in a C-section baby. But I think mom has done a great job I think with her breast milk and her gut health must be in not a bad shape, that we see, kind of, the child’s gut being already course corrected. And I also know this because they don’t have a very high antibiotic resistant index. We did see some bugs, but it’s, kind of, not too too bad. And there’s a C-section index here, which is, kind of, what I mentioned from the paper, that I definitely wanted to check in with C-section babies or any babies. Basically, not too bad. This is where the nine-month old with Noah, kind of, kicked in, and this was the three to six month range, I think, so slightly different ranges here. But looks like, yeah, the breastfeeding has healed their guts really well. So, no concerns here from the NICU or the C-section. I hope this gives you a piece of mine.

Scott: It does. I was like, “59? Is that a is that a D or…?”

Cheryl: Yeah, it’s to give you tools to work on, right? You can have this plan on hand and buy some of these supplements. If you do see signs of constipation or x, y, z, you can give it to them. But otherwise, because their results are pretty decent, I wouldn’t worry too much. And I would work on the diversification with the foods and allergens. And some of these things, I see you use hand sanitizers still and harsh chemicals. I would start replacing those if you can, like find ways to offer fermented foods, things like that. So, there’s just a lot of resources that may seem like, “Oh, of course,” but it’s something that you can bookmark here to to then like, “Okay, let’s just be more conscious about biomarker fear and incorporating that into our kids’ lives.” So, yeah.

Scott: Thank you, Cheryl. This is so, so informative. And now I’m like, okay, now this is where I need a health coach here to really go about getting those foods incorporated. I know we’ve got a lot of questions. Sandi, I don’t know if you want to come on back and see if we can get to some of these because there’s some great, great questions here, Sandi.

Dr. Sandi: Yes, well, this has been so informative. And we do have some great questions. Before we begin, I just want to remind everyone that this is not for specific, tailored medical or nutritional advice. So, even though some questions were you wanted to know for your own child, that we can’t give specific advice but can provide general education around these issues. So, Cheryl, I don’t know if you can see the questions. Perhaps it’s best if you went through those.

And that is the first one, that he was fully breastfed. She had to stop on supplement for her son, then breastfed again, then he went back to fully formulated, and that his GI tract’s all over the board. What can I do to correct that now that he’s over a year old and no longer taking formula?

Cheryl: Yeah, and to echo what Sandra said, this is not a diagnostic test by any means. It’s a wellness, educational test. We do have disclaimers here. Obviously any recommendation, including supplements and dietary advice, please run it through your pediatrician or your functional practitioner. We advise you to definitely work with someone.

Our microbiome specialists are here to guide you on the microbiome piece of it, but it’s multifactorial, right? And if you become a practitioner in our network, we offer free training on how to specifically interpret the report. As I walk through all the nuances, we actually offer free training specifically to use this test in your practice.

So, for cases like that, I know I mentioned the earlier, the better, the easier to course correction. But really there’s no such thing as too late, even if you started at 18 months or even if your child is 5 years old, 8 years old and has a teenager having acne problems, chances are something is off in their gut that you can course correct and rebalance. So, even me, I had one day of diarrhea when I went traveling and I saw 17% E. coli in my gut from zero. I had none and I’m now on a healing journey to get that 17% E. coli down to zero in my gut, which I did.

So, at any age, you can see what’s triggering the symptoms in their guts and, kind of, work… This is why I would test, not guess, and, kind of, have a very specific, personalized guide on what to do next, right, and what to troubleshoot first. So, I would highly recommend to check in, given his history. Yeah, and then hopefully, it will lead you to a path where you know what to do next. But again, keeping in mind, this is one part of the puzzle. The gut is a big puzzle piece for sure, but it’s one piece to genetics, lifestyle factors, so many things. So, hopefully, that answers your question.

Dr. Sandi: Thank you. April wants to know about H. pylori. This is her 23-year-old, C-section daughter, but anything that… Is that even measured?

Cheryl: Yeah.

Dr. Sandi: Yes. Okay.

Cheryl: We have this. We really don’t see this in kids, probably adults. But it’s important to know that… I know it has a bad name, but it’s actually pretty healthy in the gut if found. So, you don’t want to actually eradicate it completely if you find some bits of it. But it also lives in the stomach. So, remember, stool testing represents the large intestines. So, if you do find… We rarely find H. pylori in the large intestines, and some other PCR tests have been known to over-index on H. pylori. So, for adults and grownups, like a 23-year-old, I would actually do something called the baking soda test. You, kind of, take it in the morning and see if you burp or not to really measure the acidity in your stomach. I’m not an expert in it, but I would encourage you to look into it to double-check if H. pylori is actually a factor. It’s usually linked to stomach acid or a lack of stomach acid. It’s a huge topic. So, bottom line is we do test for it, and I just want to remind people that it’s not bad to see some of it, only if it’s causing trouble in large amounts.

Dr. Sandi: Okay, another question: a six-month-old, not on solids. So, how can you get poop from the diaper to get a good sample, the scraping count? And then how accurate is the test for infants?

Cheryl: If it’s not pooping… I mean, they should be pooping. I mean, like…

Scott: They could be breast milk poops, right?

Cheryl: Yeah, I mean, if it’s, kind of, watery, you can still, kind of, get a little bit of sample. And scraping from that… As long as you just try not to touch the swab to the diaper too much, because you’re wanting to get the microbial DNA from the stool. So, infants that are not on solids, you should be able to get some solids out of there. Hopefully, it’s not entirely watery but yeah.

Scott: Yeah, I was able to just… Obviously, they were doing a little solids, but they’re still mostly breastfed, so I was able to get that.

Dr. Sandi: Okay. And I’m assuming, in terms of the accuracy, that you’re confident, or you wouldn’t be selling this.

Scott: You wouldn’t be here.

Cheryl: I mean, I created this for my own kids, right? So, we started off with 3,000 published papers on infants, mapping that out over time. And then now… I mean, 3,000 samples. Now we have over 55,000 samples. Most of them are infants or kids over the two and a half years we’ve been around. So, we’ve surpassed even the publicly published data, and we have even more accuracy on what’s normal and what’s not normal in an infant gut.

Scott: So, I’ve got a question that came in from Jessica that I’m so curious about because this impacts me. You mentioned a reduction in the use of hand sanitizers. Do you mind elaborating on this point? I’m kind of wondering, where do I wash or not wash my eight-month-old’s hands? And I got to say, with a five-year-old, I’m like, “Just get the hand sanitizer. Oh, my gosh.” So, I’m curious.

Cheryl: It’s banned in my house. I’m sorry.

Scott: I know.

Cheryl: I mean, hand sanitizers are… Literally, it kills everything, right? To me, that’s the antibiotic you’re carrying in your little purse. And the thing with a five-year-old or even a toddler is that they put the hand sanitizer, and then they grab the snacks and eat it. So, do you want your infant, your kids, actually ingesting hand sanitizer? It gets into your gut, and guess what? It’s going to wipe good germs… Bad germs maybe but also good germs, right? So, you don’t want that. Same thing with your household cleaners. If you have infants crawling on the floor and you’re using Clorox, some antibacterial soap is also banned in my household. Anything antibacterial. Some formulations, some soaps have triclosan, which is banned in Europe. It can last in your toothpaste, toothbrush, and floor for months, even after you’re using it. And that triclosan, for example, an antibacterial, has been shown to wipe out species in the gut. So, be very judicious about antibacterial soap and harsh cleaners. We use Branch Basics. It’s very clean. You just have to assume that any kind of sanitization or chemicals your kids are ingesting could impact their gut and lower diversity in the soil. You don’t want that.

So, hand wash with soap. I use Dr. Bronner’s or Branch Basics. That’s kind of clean and no additional chemicals. I would say there are papers showing, too, if you are the kind of parent who always cleans the pacifiers, you pick it up and clean it, parents who don’t clean the pacifiers have less incidences of allergies. So, the hygiene hypothesis, right? Same thing with pets coming in, bringing dirt and nature in. You actually want that healthy dirt. In an over-sanitized environment, you actually see more allergies in the household. You don’t want that.

Dr. Sandi: And this is right in the health coach’s wheelhouse.

Scott: I rinse it off with water.

Dr. Sandi: Yeah, water is good. This is the health coach’s wheelhouse, to support people on making these changes. So, we’ll take one more question. Actually, there were two. One is, is this test for three-year-olds, almost four?

Cheryl: Oh, we have for all ages. It’s actually the same exact swab. So, if you get a swab at this age, when you activate the kit ID on our site and fill out the survey, you fill out your birth date, that’s when we personalize your test to the age. So, a four-year-old will have an adult-like microbiome. So, it’s kind of heading to an adult microbiome at that point or range. But the copy of how we talk to you about your action plan will be geared toward a child. Supplements we recommend are age-appropriate. So, it’s important to get that birth date right to activate it.

Dr. Sandi: All right. And let’s say, do you guys test adults as well?

Cheryl: Yes. So, same thing with adults. I would say even more important. I always, kind of, mention you shouldn’t just think about fixing your child’s gut or if there’s imbalances because, ultimately, they’re going to eat what you’re eating. They’re going to live in the same environment—air, floor, and chemicals—that you’re living in. So, their guts at three or five will mirror your gut as an adult. So, even though you might, kind of, set them up well for the immune training in early life to prevent chronic conditions later, their gut’s going to look like yours. So, I would highly recommend that parents check in, too. And even if someone does not have kids, we have a huge adult population testing just to improve their gut health in general. And there’s more and more signs. And the beauty about what we do here, because we start from a strong science in the infant gut, the stronger science, they’re supporting course correction, we are mapping out what are features of a healthy microbiome from infancy to toddlerhood to adulthood. So, we actually have we think the best stool test for adults too, because we know that trajectory of maturation and what a healthy adult…

Dr. Sandi: Well, this has been fascinating. I know I learned a lot. I want to thank you, Cheryl and Scott, and thank the babies. Thank you, Noah. Thank you, Eliza, for participating. And thank you for everybody who attended. We tried to get to most of your questions. I’m sorry if we were unable to answer all of them, but we will be having more of these types of webinars, and I hope you will join us. So, this has been absolutely a great presentation. Thank you.

Scott: Thanks, everybody.

Cheryl: Thank you, Scott and Sandi.