Understanding and Balancing Bacteria and Fungi For Children’s Gut Health

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show. I am Dr. Nicole and on today’s episode, we’re going to talk about gut health and the balance of microorganisms in the gut, but we’re going to focus on something a little bit unusual when we talk about the gut microbiome and that is fungus. When we talk about the gut microbiome typically on this show, we’ve tended to focus on more of the bacteria aspect of that, but the microbiome is actually a community of all different types of microorganisms, not just bacteria, and if we want to support our children’s brain and body health, we need to keep all of those gut microorganisms balanced. So to help us understand the important role that fungi play in gut health, I’ve invited Dr. Mahmoud Ghannoum on the show today. Let me tell you a little bit about him. 

He is one of the world’s leading microbiome researchers and the scientist who named the mycobiome, our body’s fungal community. He lectures at many institutions globally, including the National Institutes of Health, on the microbiome and his breakthrough research on probiotics. He’s published over 400 papers on his research and has been cited over 20,000 times by other scientists. For over 25 years, he’s been funded by the NIH, who’ve provided Dr. Ghannoum with over $50 million in grant funding. Super impressive researcher. He also has a new book called ‘Total Gut Balance’ that provides information and strategies for balancing both bacteria and fungi for optimal health. It’s such a pleasure to have you with us today, Dr. Ghannoum, welcome to the show!

Dr. Mahmoud Ghannoum:

Thank you very much and I really appreciate your kind introduction and for inviting me as well. 

Dr. Nicole Beurkens: 

Well, I’m so excited to have you because we talk on this show quite a bit about the importance of gut health to support brain health for children and adults, but you know, as I said in the intro, we tend to focus more on the bacterial aspects and that’s why I’m so excited to have you because you’ve done so much research, not just on the gut microbiome in general, but particularly on the fungal communities there. So let’s start by defining this. We’ve heard about the microbiome, but talk to us about what is the mycobiome?

Dr. Mahmoud Ghannoum:

It will be my pleasure. You know, as you mentioned, our gut — in fact, also on our skin, different parts of our body, we not only have bacteria, but we also have fungi, we also have viruses as well as parasites in our gut, for example. So we started really a very long time ago — I stopped for a minute because I was thinking how long, it’s over 40 years ago when I figured that there is a relation between bacteria and fungus in our body. And how I knew that — my mentor, when I was doing my doctorate in England, he gave me a paper and said, “This is what you’re going to be working on.” And lo and behold, I’ve been spending all my life doing that! And that paper, what it shows, it shows that when you take an antibiotic, what happens is you kill the bacteria, which is the good and the bad one, and at the same time, this gives the opportunity for the fungus to overgrow. That’s why, for example, kids, since your audience are mostly kids, when they have antibiotics, guess what happens? They have thrush in their mouth, for example, especially little babies. So that’s when I said we really need to start looking at both bacteria and fungus. So fast forward, 2010, I wrote an article because as you mentioned, you go to these meetings about the microbiome and all that they talk about is bacteria. I wrote an article, I said, “No, no, we really need to look at this” and I told them the story which I just mentioned. 

The good news is that now people are starting to see that not only our research but those of others is starting to show that, really, bacteria and fungus work together towards our good or our bad. And that’s really delightful because I think by addressing both bacteria and fungus, we are going to try to help people with respect to their gut health and overall health as well. 

Dr. Nicole Beurkens: 

Yeah, it’s so true that the focus tends to be on the bacteria, and I think when we do talk about fungus, particularly in the gut, it’s mostly in a negative way, right? People usually are familiar with things like candida overgrowth, fungal overgrowth, so it’s usually talked about as, “Oh, that’s a bad thing.” But what you are saying is that, actually, the fungi do important things in the body, we need to have those in balance. So I’d like you to talk about that. What are some of the ways that the mycobiome impacts us for good and for bad?

Dr. Mahmoud Ghannoum:

That’s a very, very good question and you are absolutely right. We always are frightened with candida and everybody really says that all types of diseases are caused by it. When people know that they have some candida in their gut or in their mouth, they get worried. I’m here to tell you that 50% of the people can have candida in their gut. However, these are colonizers, which means they colonize, they live in our body, helping us and helping themselves. It’s a good environment for them. And I’ll give you one example of how candida when it is at low levels or low abundance as we say, can help us. It can break down some complex molecules and nutrients we eat like complex carbohydrates, which gives food to the beneficial bacteria, which again break it down where candida use the broken down product — and all of this helps us from the nutritional point of view and also helps us because we are encouraging the growth of good bacteria which keeps the overgrowth of candida under control. So that’s one thing. 

Also, it is not only candida in our body. There are some good yeasts, as you mentioned, such as  Saccharomyces. We all know about Saccharomyces, like Baker’s Yeast, for example. This is very good. Studies have shown that having this good yeast in our body, Saccharomyces, particularly when a species called Boulardii, Saccharomyces Boulardii, can keep candida under control. So you are absolutely right. It’s both helpful and harmful, especially when it overgrows. 

Dr. Nicole Beurkens: 

Yeah, and I know that the Saccharomyces, in particular, there are a lot of formulations now, probiotic formulations and things that incorporate those, but I think that’s tricky, right? Because you can have too much of that too. It’s really the balance of that, right? I get concerned because sometimes people say, “Oh, I read something about this so I went out and got this, now I’m supplementing with all these different things”, which may or may not be helpful, right?

Dr. Mahmoud Ghannoum:

Absolutely. My motto, in general, is that moderation is the way to go. Sometimes, people think the more you take, the better. It’s not that. As long as you have a balanced gut, you can supplement it and help it by, not only having probiotics but by eating better. Then as long as the balance is maintained, you are going to be fine. The problem we start to have if we have an overgrowth of the pathogenic organisms or organisms that can cause disease, then we need to take more drastic measures, as you will, to try to keep it under control — which is really, even though I used the word ‘drastic’ because of the fact that people are worried about overgrowth, there are ways which we can follow, dietary as well as some supplements which are going to help us and even get us rebalanced and also maintain this balance in our gut, and therefore, we are going to feel much better. 

Dr. Nicole Beurkens: 

You mentioned a few minutes ago about — you gave the example of antibiotics and how this kind of first came on your radar, reading a paper about antibiotics and that they kill not only the bad, but also the good bacteria, but they also change the balance in the microbiome to allow things like thrush to happen and those types of things. So I’d like to have you talk a little bit about antibiotics and other things. What are the things that we do or that we take that disrupt the balance of the fungal community in our gut in a bad way? How are we damaging that important fungal community?

Dr. Mahmoud Ghannoum:

There is a big list of over-the-counter medications, like for example, non-steroidal analgesics or painkillers. Then you have a lot of these people, when they have GERD, for example, they take an antacid product. These all have been shown to really disturb the balance. They affect the balance of good bacteria and good fungus together. And then by affecting one, we will have a problem. The other way also is — what some of these products, what they do is affect the beneficial bacteria and allow other bacteria to grow, which are what we call pro-inflammatory, which means they increase our inflammation, okay? So these are some of the factors that could affect it. Also, the way we live, lifestyle is very, very, important. We should exercise. Exercise has been shown to be very good for balancing our gut, you need to sleep well, and by the way — stress is a huge player, as you know, and we are all stressed, we’re all working hard — especially for the ladies, they work during the day, then you go home and take care of the kids. It’s a very stressful life. So because of this, it’s very important for us to try to lower our stress level, and I recommend that people do some yoga, I’ll give you a laugh — I never did yoga before, but now I go and I am the only male there and I say, “Oh my God, men should go there!” It really relieves you. So that’s very good. Sometimes during the day, because we are all running around like headless chickens as you may say. Take 15 minutes and just meditate, just don’t think about anything, and that, I think, goes a long way to help us with balancing our gut. 

Dr. Nicole Beurkens: 

I think that’s true for kids too. I see a lot of complicated cases at my clinic and some children and teenagers who have had a really unbalanced gut for a long time have constant problems with candida overgrowth, these kinds of things. And parents who are doing all of these intensive treatments for that but it creates so much stress. The kids are so stressed out all the time that I really feel that that’s a factor in why they don’t truly get better. I mean certainly, diet changes and medications and supplements and all those things can help but I think it’s important if parents are saying, “I’m doing all of those things and we’re not really getting good progress”, I think looking at the stress level for the child is a really important factor. 

Dr. Mahmoud Ghannoum:

Oh, no doubt about it. Unfortunately in our days now — I remember when I was a young boy, I’d go and play outside, and my mom, the only condition — she used to tell me, “You have to be back at home before the sun sets.” So now, we can not do this. We have our kids, which is understandable of course, different times, different things happening, we need to watch them all the time, we need to do this, but I really think it’s very important to allow our kids to play and relax. We tend now, as you mentioned, a lot of families overbook their kids. They do one activity after the other. In fact, let them just sometimes go play in the yard. This is another thing which is really going to help them, because they get exposed to germs outside in the soil, which is fine, because that will train their body to fight germs. So they need to do that. Let them play with the dogs, let us help them go hiking. All of this is really important. It helps them both ways, first of all, they are going to be more relaxed, they are going to try to improve their microbiome, which is good for them, and also it’s lovely to be outside. We have a great country, we have lovely national parks and they are close to us. If the kids are engaged in these activities rather than one thing after the other and sitting in front of the television and playing with their Xbox, this will be very helpful, absolutely what you said. 

Dr. Nicole Beurkens: 

You’re speaking my language, that’s exactly the kind of thing that I talk with parents about. So let’s talk a bit about how somebody might know if they have a balanced or unbalanced gut, particularly when it comes to fungi — how might somebody know if they have an imbalance there.

Dr. Mahmoud Ghannoum:

There are a couple of things. Number one is you really need to listen to your body. If you have pain, if you have, sometimes, fatigue, if you have a little bit of diarrhea — all of that tells you there is something wrong in our balance of the gut. But there are now other ways, where you can actually — the kids can do gut testing. We have the technology that has advanced so much, this next generation sequencing where you can send the poop or stool sample and it can be analyzed to see if it’s balanced or balanced. You can have a way of starting to eat better and doing other activities, as we mentioned — lifestyle, to improve your gut balance again. So two things: One, you listen to your body and two, there are more practical — but I think not everybody can go and do those tests, even though they are at home. Listen to your body, it will help you a lot. And in fact, in the book which you mentioned, Total Gut Balance, I made a checklist where if you check more than three things in it, then you may have dysbiosis, so that could be a guide for people as well. 

Dr. Nicole Beurkens: 

Yeah, that’s very helpful because I think some of the things that I see in children who have yeast overgrowth, dysbiosis in their gut — they may have the GI symptoms like you mentioned, diarrhea, some pain, things like that, but I see a lot of brain-based symptoms in those kids with the fungal overgrowth, in particular, like some children, I see a lot of hyperactivity, a lot of just really disorganized, not thinking clearly, kind of overly silly behavior, just a lot of problems managing themselves and I think a lot of times, people don’t recognize that those kinds of symptoms in the brain are related to this dysbiosis or this imbalance that’s going on in the gut. 

Dr. Mahmoud Ghannoum:

Absolutely. I mean first — I will talk about the gut-brain access in a minute, but before that, the same sort of thing we are looking at kids with autism and we just completed a study, which I’m hoping to publish very soon where we show that there is imbalance in the gut — both bacterial and fungal imbalance and that’s is compared to controls. But let’s go back. Why I mentioned autism is because it’s to do with the gut-brain access as well. So, earlier, we always thought our brain will direct everything in our body. And now we are starting to figure out, there is a bi-directional communication. Our gut and brain talk to each other. It’s not always the brain talking to our gut. It’s also our gut talking to our brain. The brain’s job is to try to keep a balance in our gut. If you don’t have this balance, then you will start to have gut-related issues, dysbiosis or imbalance. Now, the other way, if we have — we are doing something which affects our gut microbiome, these organisms start to secrete some molecules or small compounds that could trigger, for example, serotonin in our brain. This serotonin, as you know, it’s related to the mood. So it affects our mood, and that’s why we really find now with a number of degenerative diseases that this gut-brain access plays a very important role in that. That is why, at least, we want to try to control the gut by balancing our microbiome and that’s going to improve our mood, definitely. 

Dr. Nicole Beurkens: 

Yeah, and with the mood in kids, especially comes the behavior too, because a lot of parents have such challenges with different kinds of behavior with their children, but the gut is so related to that. Kids who are just irritable or angry all the time and lashing out, or like I said, hyperactive, all of those things are directed so much by what’s going on in the gut and I find, in particular, with the fungal overgrowth, the candida overgrowth issues that it can be hard because you do testing and you discover that there is overgrowth there and a lot of times, people think — well, we just treat that, we use an antifungal medication or we’ll change the diet or whatever, and then okay, whatever — we don’t have to worry about that anymore. But that’s not really how it works, is it? 

Dr. Mahmoud Ghannoum:

No, no, it’s not — definitely not. One of the things, which is ADHD, attention deficit, it definitely has been shown that it is due to imbalance in the gut. So you are absolutely right. It is not always medication, that’s the good news. For a long time, we only tried to treat a disease. Now, we are starting to figure out — You know what? Maybe it’s better to prevent it. And in this way, we know if candida overgrows, it is going to cause issues. So what we want to do is to make dietary approaches as well as lifestyle. Both of them are very important to try to keep that under control. The good news also is that we already know what sort of food or vitamins, for example, are going to help you to keep candida under control, while at the same time, we encourage the beneficial organism, such as good bacteria like lactobacillus or bifidobacterium, for example. Or for that matter, the good fungus, if we talked about Saccharomyces.

Dr. Nicole Beurkens: 

Well, let’s get into that, because I know that in the book, you provide some really specific strategies and information for people about how they can improve the gut-health, how they can keep the fungal community balanced, bacterial community balanced, so you just mentioned that the good news is that we know certain kinds of food and certain kinds of nutrients that are helpful. What are some of the things that people should be incorporating in their diet in order to have good gut balance and maybe also, let’s talk about things that make that worse, that create dysbiosis.

Dr. Mahmoud Ghannoum:

Good, that’s a really good question. So after my research over the last nearly two decades looking at the gut imbalance as well as how to adjust it, that’s when I started thinking — because people started reaching out to me saying, “What can we do about it?” We did a big literature search, my team studied the literature that’s published from our group as well as others and we put this diet. This diet is a new way for us to let our microbiome play good for our wellness by specifically targeting the fungus, the mycobiome as you said, the microbial community. At the same time, to try to encourage the growth of beneficial bacteria as well as yeast, so how can we limit? 

Number one, we need to limit fungus. To do that, there are — it’s well known that sugar is a great offender. Fungus loves, especially candida, loves sugars. So having a low-carb diet is good. It doesn’t mean no carbs, it’s low-carb. That’s one thing. Also, studies have shown that lean proteins from, let’s say, plants or even animals, from fish, from chicken, are also good for you. So if you have those, you have good monounsaturated and fully unsaturated fats. They will all help limit candida. One last thing, studies have shown that if you have some vitamin deficiency such as in A, C and B vitamins, candida loves it. So that’s why if you have vitamin deficiency start to eat some food, some vegetables, now we are talking about Thanksgiving coming and pumpkin season — it’s a great source of some of these vitamins as well as it’s a great source for fiber, which will support the beneficial bacteria as well. 

So the first thing is, let’s limit it by cutting down the sugar, trying to, as I said, have a variety of vitamins and lean protein. Now we need to encourage good bacteria. How can we do that? One of the greatest ways is to food, plants, vegetables that have a lot of fibers as well as resistant starch. Resistant starch, I know it’s a new term, people are not familiar with it. You can find in bananas, unripened bananas, oatmeal, in a lot of different types of beans, which could act as a good fiber source as well as a good fatty acid source. All of this will encourage the good ones.

One last thing, remember, we said bacteria and fungus come together to cause trouble. They make what we call biofilm, or we call it digestive plaque. It’s like the plaque in our teeth. Every morning, we brush our teeth to get of the plaque, otherwise, we are going to have periodontitis or infections in our gums. The same happens in the gut. Because of this, we need to break this digestive plaque-like we break the plaque in our teeth. Doing that, there is also good food to use. Garlic, for example, is very good. Apple cider vinegar is great. You have some good fatty acids. Coconut oil also helps. We encourage the good ones and get rid of this digestive plaque. By doing this, you are going to have a good balance of both bacteria and fungi, and that’s going to help you with your GI or gastrointestinal symptoms. You are going to have less diarrhea, less constipation. We also studied one thing which was good to see, that’s that people can also control their weight, they’d lose 10 pounds doing that. So all in all, once you improve your total gut balance, you are going to have a hopefully better GI or gut health as well as overall health. 

Dr. Nicole Beurkens: 

It’s so interesting. I like that you talked about the biofilms or the digestive plaque. That’s something that many people don’t talk about and it is helpful to think about it in the same way as on our teeth, because we are aware of the plaque on our teeth, but that same idea of needing to get rid of that in our digestive system on a daily basis as well, and so knowing what kinds of foods can help do that is so important. The thing is that all the foods which you mentioned are all things that we can work into, not only our diet as adults, but that we can give to our kids too. Sometimes we have to get a little creative about working that in, but to move kids towards more of a whole foods diet that incorporates these vegetables, the resistant starches, those kinds of things — that’s really how we start to get ahead of these problems, as opposed to staying in a cycle of just giving an antifungal medication and then the candida comes back — there are more things that we need to be doing. 

Dr. Mahmoud Ghannoum:

I really agree with you. Look, if somebody has a real fungal infection, then you need to treat it with an antifungal, there is no doubt about it. You know candida can cause serious infections like systemic infection apart from thrush or vaginal candidiasis or that sort of thing — that, we need to treat with antifungal. But this is not the way. We want to really get it before it starts causing trouble and you are absolutely right. If we can control the type of food we eat, the type of things we do, overall, it’s going to really improve. With respect to the biofilm, it’s very interesting. You are absolutely right, people don’t think about it. The interesting stuff, I was funded by the National Institute of Health many years ago to study biofilm but on catheters. You know, when somebody goes to hospitals, they put a catheter to give them medication, or if it is a baby, they want to give him new food because sometimes they can’t eat. So what happens is candida comes to stick to the catheter and it makes biofilm. So when I started to figure out the gut, we had so much information about the biofilm from really serious infections, hospital-acquired infections that really helped us to see what we can do to manage it. So that’s why, as you mentioned, we proposed to do it through diet, good lifestyle before it happens and causes problems. 

Dr. Nicole Beurkens: 

Your career has just been so fascinating. I feel like I can talk to you for hours about all the research that you’ve done and I love that you’ve taken the research on some really specific, severe problems and then you’ve looked at it and generalized it and said, well here is how we can apply this to help all of us be healthier and I think that’s really an amazing thing and obviously, we have so much that we owe you and your research in terms of just understanding all of this. It’s really incredible. So I want you, while we wrap up here, to tell people a little bit about the book and where they can get the book, because I really want to encourage listeners to get it. 

Dr. Mahmoud Ghannoum:

Thank you very much. So this book, as I’ve mentioned, is going to be published by Norton Publishers country-wide. It’s one of their affiliates, it’s going to be published there, it’s called Total Gut Balance. It’s already on Amazon, it’s going to be published on December 24th of this year, but also, I’d like people to visit my website, www.drmicrobiome.com. You’ll find a lot of information and tips that are in the book. Also, if they can visit totalgutbook.com, they will also find it there and we are really trying to provide a lot of instructions on how to use the diet, and what excites me about this is that it’s going to hopefully make a difference in the kids’ lives. 

Dr. Nicole Beurkens: 

Absolutely, it’s such a practical book and I really want to encourage all of you listening to check out not only the book, but as he mentioned, the website — so many great resources and pieces of information there. We will have all those links with the show notes so everybody can check all that out. Dr. Ghannoum, it’s been wonderful to have you with us today — thank you so much for taking the time to do this interview. 

Dr. Mahmoud Ghannoum:

It really was a pleasure and thank you very much for having me, have a great day. 

Dr. Nicole Beurkens: 

And thanks to all of you for listening to this episode, we will see you next time for our next episode of The Better Behavior Show!