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Putting Patients On A Gut Health Program Using Gutbio: A Candid Interview With Step-By-Step Considerations

Onegevity Science Team

Watch and listen to Sonja Horner interview Dr. Bob Rountree on how he uses Gutbio with his patients as part of a gut health program. He talks about what he asks a patient on their first visit and what qualifies a patient to be a Gutbio test candidate. He discusses what supplements to start a patient on while you wait for results, what additional blood tests to consider, and mentions tools you can easily implement into your practice to improve your patient's gut health and resolve their symptoms.

Sonja Horner:                    00:02                    Hi, my name is Sonja Horner and I am the chief commercialization officer for Onegevity. I have the distinct pleasure of introducing and interviewing today, Dr. Bob Rountree. He needs no introduction, but I will do him the courtesy of an introduction in any way. He is an IFM faculty member of practicing a physician for over 38 years, a dear friend to many in the industry and also Linus Pauling award winner. Dr. Roundtree, thank you so much for joining us today. We wanted to spend a little bit of time with you and talk a bit about the Onegevity Gutbio tests and what your thoughts are about what's being offered by Onegevity and how you use it in your practice.

Dr. Rountree:                    00:48                    You bet. I'd be happy to talk about it. I can give you some context, which is that I've been doing gut microbiome testing for many, many years now using various other labs. And I've used most of the commercial labs that are in business today. I have some experience with what's out there and what's available. And I do want to kind of make a point very early on that this new Onegevity test is really revolutionary, because of its accuracy. The tests, what can I say, the early versions of these tests have been somewhat crude. And so, you know, in essence they're using something called the 16s sequencing. They're looking at the 16s ribosomal gene, which was pretty good in its day. It was a very good start. But we've since learned that there are a lot of limitations and the problem is, and this is going to shake some people up, but that you can do repeat testing on the same sample and get different results when you're doing 16s sequencing.

Sonja Horner:                    02:02                    And when you're referencing the 16s sequencing, are you referencing, and you don't need to bring up any names, but, the players in the market that are currently marketing directly to consumers?

Dr. Rountree:                    02:13                    With the exception of one lab that does RNA transcriptomic testing, the rest of them are doing 16s. Now some of the newer published studies that are coming out of universities are using the same technology that's in the Onegevity test, which is the metagenomics testing. Metagenomics testing basically looks at all DNA in the sample and that's going to include human DNA.

Sonja Horner:                    02:41                    Okay.

Dr. Rountree:                    02:42                    Right? I can't even stress how sophisticated this testing is. It's just a whole different level. The other thing with typical 16s sequencing or some labs use PCR testing, is that you only find what you're looking for. So, you do a probe to see if there's a certain microorganism. Okay. Right? If you're not looking for that microorganism, you won't be able to find it. Whereas the metagenomic sequencing that's done in the longevity tests is agnostic. It just says what we just want to know everything that's there. And so, the report that you get, it provides what's called a community breakdown that's pages and pages of bacteria, fungi, parasites. It's really, really, really comprehensive.

Sonja Horner:                    03:44                    Do you also feel that it's consolidated in some ways so patients when they receive the results and they're reviewing them with their physician that they are able to interpret the information?

Dr. Rountree:                    04:00                    Yeah. There's both the simple version and the complex version. So, the simple version breaks it down and says, first of all, do we find any pathogens? Right? Which I think is useful. So, this is not a diagnostic test for Clostridium difficile, for example. Right. But if there's clostridium difficile in the sample, it will find it because it's that accurate. Why isn't that diagnostic? Because certain people will have Clostridium difficile in their gut and it's not causing any symptoms. So what I'm saying is you do the pathogen analysis and then if it's there and you have any reason to be concerned that that's causing problems, then you would do a follow-up test, which is to look at the C-diff toxin. Right. So, this is your initial screen. 

Sonja Horner:                    04:56                    So do you find that the test is, it's obviously communicated it in a form that works with a patient, but it provides comprehensive information that a physician needs in order to or a provider needs in order to design recommendations for the patient.?

Dr. Rountree:                    05:12                    Right. A patient can understand it. The analogy that I've used when I've talked to practitioners about this test is like you can get a Tesla and drive it off the lot without knowing anything about electronics, right? You push this button, you know, you put it in drive and you go, and this test actually has that level of reporting, where it will say, number one, we did or did not find any organisms that could cause serious problems, pathogenic organisms. Then it says, this is how you compare to other individuals. Are you more or less diverse than the general population? Everybody can understand that, right? 20% of the population is more diverse than you. 80% is less diverse than you, so that's understandable. Then we have a list of organisms that can cause inflammation.

Sonja Horner:                    06:11                    That's very useful. So, if a person was at risk of inflammatory bowel disease or cancer, they may have higher levels of the bacteria that can cause inflammation. So again, very straight forward. Then a list of organisms that could cause constipation and a list of organisms that can cause diarrhea. So that's the user interface as it were if what this test looks like. Right. How do you compare to other people? Do you have any bad bugs, you know, anything that needs follow-up testing, all that's there. But then I mentioned this community breakdown, that's a downloadable part of the report. So that's the person that says, well I want to know how this Tesla runs.

Sonja Horner:                    06:56                    Right.

Dr. Rountree:                    06:56                    You know, let's lift up the hood and let's take a peek at the electronics and I want an explanation of those electronics. Some people don't want that or don't need that. They just want to know what are the general findings and what do you recommend. But other people I know, and I've certainly talked to doctors that have been doing testing like I have been for years, they're ready for that extra data and they know what to look for. An example I can give you is that we know there are certain organisms that are more likely to ferment food and cause gas and bloating-- and that gas and bloating can be a major part of symptoms of Irritable Bowel Syndrome, right? So, if you know what those organisms are, then you can do a quick search in this downloadable report and you can immediately find out whether those organisms are there and if they're there in what level of abundance those were there. Or if a person says to me, like a patient I had the other day, well, will this test tell me if I've got yeast? You know, do I have Candida Albicans or other organisms? Absolutely. If they've got fungi, this will show up because this is looking for the DNA of the yeast. So, it's all in there. But that part of the report is really designed for the physicians that want to take, or the healthcare practitioners, that want to take it to the next level.

Sonja Horner:                    08:22                    So you just mentioned one of your patients. I think it would be really helpful for us here how you would walk through a first visit with a patient that you think would be a good candidate for this type of test.

Dr. Rountree:                    08:34                    Okay. Well, you know, a typical patient that's going to benefit from this as somebody who's had chronic GI problems, say they've had gas and bloating for years, uh, or they have chronic constipation or constipation alternating with diarrhea, you know, classic Irritable Bowel Syndrome patient. Or maybe it's somebody that you're a little worried that they can have colitis, Inflammatory Bowel Disease, right? But they're not having full-blown symptoms there. Maybe they're having some pain, they're having some diarrhea and you're not sure if they've had bleeding or not. Well, I mean, the first thing you're going to do is your due diligence as a physician right. There are standard blood tests that I would do an anybody, that, especially if they've had new onset of symptoms or somebody that I'm worried about, inflammatory bowel disease, I'm going to do a complete blood count, make sure they're not anemic, you know, so that I'm not worried about hidden bleeding.

Dr. Rountree:                    09:34                    I might do an iron level to make sure they're not iron deficient. Men shouldn't be iron deficient. So, if you find that in a male patient that's going to make you suspicious of blood loss, I do a complete blood count. I would do a C-reactive protein to look for inflammation, you know, so I would do these basic tests on most everybody. And again, if there's any concern, if there's weight loss, for example, the concern that this could be some chronic disease then I'm going to do a fecal occult blood test. And you know, there's a number of really good ones. The fecal immunochemical test is a really good one, so again, I want to make sure that have ruled out disease. So, I'm not, you know, telling somebody you have bacterial overgrowth and there's something more serious going on.

Dr. Rountree:                    10:24                    So it’s sort of by doing. I'm a doctor, that's what I do. So, you rule out disease. But mainstream doctors, a lot of times they feel like they've done their job when they've ruled out disease; you don't have a disease, you have irritable bowel syndrome, just learned to live with it. Here's your label, we've got the label and we're done. You know, what I'm going to do with a patient like that is to collect data about their diet. It's surprising to me how often people don't really understand the relationship between their food and their symptoms. Right. You know, they kind of have a feeling something gives me gas, or something gives me diarrhea, you know, or there's something about how I'm eating that makes me constipated, but they haven't really thought it through.

Sonja Horner:                    11:16                    So what's that information?

Dr. Rountree:                    11:22                    Well, the simplest thing to do is a basic diet dairy. Just a piece of paper, that says, this is what I hate, and these are my symptoms. And the Institute for Functional Medicine has a really, really good handout for that. So that's for somebody who doesn't want to take any extra steps. I just want to do something basic or are they could use an iPhone APP. Like there's one called "my symptoms" that you and I have talked about in the past. It's really elegant. That gets down to the nitty-gritty. It's very, very granular. So, for a person that wants to go beyond a basic food diary, then that's the ideal direction to go with. Now occasionally I'll have somebody that comes in that's just got a classic case of what appears to be small intestinal bacterial or microbial overgrowth. You know, with gas and bloating that occurs, say within one to two hours after they eat.

Dr. Rountree:                    12:23                    And that person, I might get a little more specific with diet and say, I want you to be on a low FODMAP diet, fermentable carbohydrates that can cause gas. So, I might even go to that level with them on the first visit if they have classic symptoms.

Sonja Horner:                    12:40                    Okay.

Dr. Rountree:                    12:40                    And there is an APP that Monash University has that I think is really great. It costs about eight bucks and I've gotten rants and raves from patients about that. Then I'm going to probably start some simple supplements. I'm going to use probiotics probably from the get-go. And there are some really elegant algorithms out there for deciding which probiotic. The on the Thorne website for example- there's a nice algorithm that you can walkthrough. Do you have these symptoms, those symptoms? And it will help you determine which probiotic to use out of the Thorne range of products.

Dr. Rountree:                    13:21                    So I almost always put people on a probiotic. I may put them on a digestive enzyme. If it sounds like they're not digesting their food, I may put them on a fiber supplement, or I might even put them on an anti-inflammatory like EnteroMend. So, I'm going to do some really basic interventions. But again, if somebody said chronic symptoms at some point I want to know about their microbiome. And either the first or maybe the second visit, that's when I'd recommend something like the Onegevity Gutbio tests. Okay. And it's going to take a month or so to get the results back. So I like to get started on the diet, get started on some basic supplements, and then when they come back for their follow up visit, we can have these results in hand and we can say, look, this is what we found.

Sonja Horner:                    14:16                    And do you find too, Bob that when patients see what the test tells them and then you make a recommendation, do you think that that education with the recommendation builds acceptance of your recommendations?

Dr. Rountree:                    14:34                    Well, it's one thing if you tell somebody, I think the gut microbiome is involved in your symptoms. And they go, yeah, yeah, yeah. But that's a very nebulous concept.

Sonja Horner:                    14:43                    Right.

Dr. Rountree:                    14:44                    But if you can say I think that you are fermenting your food excessively, and there are certain microbiome microorganisms they can do that-- here's one: Ruminococcus gnavus. You know, they could do that and hey look, this is an actual patient. I could pull out his microbiome results and go, look, you've got an abundance, an overabundance of that particular bacteria and we need to do something about it. We need to starve it out. Maybe a low FODMAP diet or use something like Berberine, which is a kind of a broad-spectrum antimicrobial to lower the levels of that particular organism. So, there's no question that this helps with compliance. That's really the big issue here. You could do all the same interventions without the information, but you know, it's analogous to measuring cholesterol in someone who is concerned about their risk of heart disease.

Sonja Horner:                    15:47                    Right.

Dr. Rountree:                    15:48                    You can say, "Oh, I think you should eat thus and so a diet, we don't need to check your cholesterol”. But if you do a lipid panel and their LDL is off the chart, you can say here is something that's going to give us feedback about our intervention.

Sonja Horner:                    16:07                    And the fortunate thing is that as the patient is working with you and following the recommendations are symptoms are hopefully regressing at this point. So, it feels like over this two-month period of time between when the initial test is collected, within four to six weeks the task results are delivered, you've got a patient within a two-month period of time who has now made lifestyle modifications. They've tracked the dietary modifications that they've made. So, they're starting to understand their triggers a little bit more after that two-month period of time. And you are kind of inching your way into the third month. What do you see happening with the physician or the provider, and that relationship with the patient. And do you find that it's necessary to have another Gutbio test drawn at that point? What would your recommendation be?

Dr. Rountree:                    17:01                    Well, certainly an ideal scenario is to be able to show the patient that something changed.

Sonja Horner:                    17:06                    Right.

Dr. Rountree:                    17:08                    Or that it didn't change. Let's say the test came back and it showed that they have high levels of inflammatory organisms, and so you put them on Meriva -- curcumin phytosome. And, there may be other things like I've mentioned the EnteroMend product, which is Meriva and Boswellia, aloe, partially hydrolyzed Guar Gum, glutamine. So, they're things that we can do that are really specific for these inflammatory organisms. But you'd like to see that you're making a dent.

Sonja Horner:                    17:43                    Absolutely.

Dr. Rountree:                    17:44                    And the reason for why didn't you just assume that? Because a lot of times these microorganisms get sucked in. Sometimes the person has had that microbiome for years, maybe their whole life, you know, and I love it when you do some simple interventions, you put them on probiotics and digestive enzymes and it dramatically improves. But sometimes it doesn't. So, you need to know, well, are there some hardcore organisms that we're not getting it? Do we need to double up on our therapy? Do we need to be more aggressive? So, the follow-up tests can actually be very useful to tell what direction you're going in.

Sonja Horner:                    18:26                    And it really kind of solidifies the patient is improving, the physician or the provider's also seeing those results improve. So, as they kind of exit the program, so to speak, they've got life skills that they can use and it's been confirmed for them that they are in fact at fewer symptoms and that their microbiome has improved.

Dr. Rountree:                    18:48                    Yeah, absolutely.

Dr. Rountree:                    18:49                    Heaven forbid in the future, years from now, should they need to revisit this information with you, at least we have it. Right. So, we know with that second task kind of how much they improved and it can always serve as a good reminder of the work that they followed during this three month period of time. Is there anything else you wanted to share with folks?

Dr. Rountree:                    19:14                    Umm, just again, I've mentioned this before, but I do think this is a revolutionary advance in gut microbiome testing. It is designed to be readily accessible and at the same time, incredibly comprehensive. And what I think is exciting about it is that, now that we've got this level of detail available to practitioners, there's going to be a lot of learning involved in terms of what are the ideal interventions for these particular microbial signatures.

Sonja Horner:                    19:49                    So there's definitely more to come.

Dr. Rountree:                    19:51                    There's more to come, a lot more to come.

Sonja Horner:                    19:53                    Well, thank you for sharing your expertise.

Dr. Rountree:                    19:55                    My pleasure.