Radiolab Presents: Viscera - The Elixir of Life

What this episode is about

"Viscera - The Elixir of Life" delves into captivating stories about the human body, featuring ER doctor Avir Mitra as the main storyteller. The event combines engaging narratives with live musical scoring, offering a unique and immersive experience that explores the intricacies of our physical existence.

Key takeaways

• In a world obsessed with diets, breast milk remains the original superfood—nature's secret recipe since mammalian times.
• Human milk oligosaccharides: the unsung hero of breast milk, dwarfing proteins in importance but rarely discussed.
• Breast milk: 87% water and a cocktail of nutrients, yet we often bypass its complexity for trendy diets.
• Lulu Miller shares the stage with an animated breast—proof that even science can embrace the absurd and beautiful.
• Audience interaction reveals knowledge gaps; if only we treated the contents of breast milk like dietary gold!

Who speaks in this episode?

• Lulu Miller (Host) · 32 min speaking
• Avir Mitra (Guest) · 40 min speaking
• Iván Barenboim (Guest) · 4 min speaking
• Bruce German (Guest) · 4 min speaking
• Brian Scadalini (Guest) · 4 min speaking

What is discussed, and when

1. 0:00 – 10:00: Avier Mitra, HMOs, Iván Barenboim
2. 10:00 – 20:00: Bruce German, Bifidobacterium infantis, UC-Davis, Gates Foundation
3. 20:00 – 30:00: Shara Sheldon, Bruce German
4. 30:00 – 40:00: Shara Sheldon
5. 40:00 – 50:00: Brian Scadalini, Bifidobacterium infantis
6. 50:00 – 1:00:00: Bruce German, Bifidobacterium infantis, UC-Davis
7. 1:00:00 – 1:10:00: Bruce German, Bifidobacterium infantis
8. 1:10:00 – 1:19:06: Bruce German, Brian Scadalini, Avier Mitra, Bifidobacterium infantis

Notable quotes from "Radiolab Presents: Viscera - The Elixir of Life"

• Bring us the music. And then we just, close it down and I don't know, we'll see how it goes. It's gonna be a peek behind the curtains. LULU: And so to really kick us off, we…

  about Avier Mitra · at 2:22

• AVIR: Amino—amino acids. Yeah, you guys are right. everything you're saying is right. But there is something that we've missed. And to be fair, I went to med school for way too…

  about HMOs · at 5:45

• Thought about them. They're sort of written in the sidelines of textbooks and, I don't know, they're not in formula so, it's really just like a nobody. And no one ever really…

  about Bruce German · at 10:52

• AVIR: Zoom in a little more. A little more. LULU: And so this is the bacteria that likes to eat the weird alien sugar in the breast milk? AVIR: Exactly. And so it turns out…

  about Bifidobacterium infantis · at 16:10

• AVIR: So Bruce is working at UC-Davis. He's around getting his friends and neighbors and strangers on the street to give him their dirty diapers. Let's culture it. Let's see if we can find some Bifid in there.

  about UC-Davis · at 17:46

• [ARCHIVE CLIP, Shara Sheldon: I was Good job, brain, for remembering the random lecture with Bruce German.] [ARCHIVE CLIP, Avir: There are so many random lectures I had in med…

  about Shara Sheldon · at 26:55

• AVIR: Okay, so he does that, and lo and behold, he finds that the incidents of NEC goes from 11 percent down to 2 percent. LULU: Whoa!

  about Brian Scadalini · at 43:59

• Radiolab team lurking in the background. Stand up: Harry Fortuna, Sarah Sandbach, Soren Wheeler, Pat Walters, Anisa Vietze, Jeremy Bloom, and George Wellington. Speaking of…

  about Ellen Horne · at 1:16:23

Who and what is mentioned in this episode?

People

• Avier Mitra — Person · Main speaker / storyteller (featured ER doctor) · 5 mentions · first at 0:37
  Leads the live 'Viscera' installment, explaining HMOs and B. infantis research and interviewing guests.
• Bruce German — Person · Featured expert guest (scientist) on stage · 24 mentions · first at 11:02
  Presented as the scientist who asked why HMOs exist and helped drive research on B. infantis; answers audience questions and discusses mechanisms and history.
• Brian Scadalini — Person · Featured expert guest (neonatologist) on stage · 12 mentions · first at 41:38
  Describes NICU use of B. infantis to prevent NEC at OHSU, the FDA cease-and-desist, and the risk/benefit and clinical-trial pathway.
• Shara Sheldon — Person · Referenced scientist / interview subject (archive clip) · 10 mentions · first at 23:39
  Her story provides a vivid case example: using B. infantis in foals to prevent C. diff and later giving it to her infant (Connor), prompting stool/microbiome follow-up.
• Iván Barenboim — Person · Guest musician (live performance) · 2 mentions · first at 1:46
  Performs live music (“play some wind”) as part of the live-scored Radiolab episode.
  And he has brought with him his friend, musician Iván Barenboim. How'd I do? What's better?
• Ellen Horne — Person · Referenced attendee / production support (Radiolab OG executive producer) · 2 mentions · first at 10:30
  Helps on stage (wardrobe mishap) and is credited as an original executive producer of Radiolab.

Companies & orgs

• UC-Davis — Company · Affiliation · 2 mentions · first at 17:46
  Bruce German's affiliation where the research on Bifidobacterium infantis and HMOs was conducted.
• Gates Foundation — Company · Referenced expert · 1 mention · first at 18:19
  Provided stool samples from around the world for the research on Bifidobacterium infantis.
  AVIR: So it turns out that the Gates Foundation, for some reason, has collected stool samples from all over the planet. I'm not sure why, but don't tell Elon Musk about this, please.

Concepts & topics

• Bifidobacterium infantis — Concept · Core topic · 9 mentions · first at 16:25
  Central to the episode's discussion on gut health and its symbiotic relationship with human milk oligosaccharides (HMOs).
• HMOs — Concept · Key argument · 1 mention · first at 5:56
  Human milk oligosaccharides are the third-largest compound in breast milk, feeding Bifidobacterium infantis.

Full transcript with timestamps

0:14 LULU MILLER: Hello! So many beautiful faces! They didn't warn us that our listenersꟷ we know a lot about the demographics, but I didn't know about the beauty thing. Okay, thank you all for coming out. Thank you Caveat for having us. Welcome to our second installment of Visceraꟷgripping, even visceral tales of the human body, with ER doctor Avir Mitra. Yeah! LULU: I am Lulu Miller, one of the co-hosts of Radiolab. LULU: And before I bring out our star storyteller, I just want to talk a little bit about what's going on. First of all, I'm achieving a lifelong dream of sharing the stage with an animated breast.

1:11 LULU: Dripping breast milk. So let me just take that in. Okay, second of all, weꟷif you've listened to Radioꟷ if you've listened to Radiolab, you know that we like the music and the sound design. And our director of sound design is this tall man with the upright bass, Dylan Keefe. LULU: If you'veꟷif you've had a pretty moment listening to something and you're, like, contemplating and you're enjoying the space inside your head with musical undertones, that'sꟷlike, that is because of him. And he has brought with him his friend, musician Iván Barenboim. How'd I do? What's better?

1:55 IVÁN BARENBOIM: Barenboim? LULU: Iván Barenboim. LULU: To play some wind. LULU: And while we are usually a highly-edited, like, borderline pathologically tweaky situation, we're trying to make a Radiolab episode live for you tonight. Harry said go up more to the front because you don't usually—okay. And so they will be live scoring. You'll see some hand signals like, "Bring us the music." And then we just, like, close it down and I don't know, we'll see how it goes. It's gonna be a peek behind the curtains. LULU: And so to really kick us off, we have quite an adventure ahead. If you listen to Radiolab, you have likely heard the voice of doctor ER doctor Avir Mitra. He is such a voracious storyteller. In addition to saving lives in emergency rooms in the city, just down the street, he can't stop thinking about why our medicine got here—the strange stories, the strange people that brought it to us, how our body functions. You've maybe heard

2:58 him tell stories about vultures predicting strange human health crises. Maybe you've heard him tell a story about a lifesaving compound illicitly smuggled over borders in a very old yogurt container. And tonight, he assures me, we are going to travel around the globe, back into the past to encounter one of humanity's oldest friends—a friend that we lost. But tonight, for those of you who dare, with your consent, we will be reunited with via ingesting it through our mouths. If you want. LULU: Okay. But we're gonna get there. Don't do it—you don't do it yet until we cue you. Without further ado, Avir Mitra. Can we get some bring-on music?

3:44 AVIR MITRA: Thank you! Thank you, thank you! Wow! Thank you so much. Wow, a lot of people on a Tuesday. I love this. LULU: AVIR: So glad you guys are here. So, you know, the theme of the show is viscera. It's like things inside of your body that you didn't really think about or know about. We look at them in different ways. Last time we talked about the heart. Today we're talking about something that's never really been in my body, but it's probably been in some of your bodies. But right now it's definitely in your body. We're talking about the magical substance that is breast milk.

4:24 AVIR: Just pumped, like, before we got here. LULU: Yes. Okay, so I have—this is in my body at the moment. I have an eight month old. I am breastfeeding. I also use formula; this is not a—this is not—we're not here to say one or the other is better. But instead, there are strange things inside this substance that is as old as mammalian times. AVIR: Yeah. LULU: And I guess you're gonna tell us what. AVIR: Well I mean, I think that's the thing. What inspires me is to think about—we think about all these different types of diets, should we be eating keto? Should we be vegan? We don't really know. But we only have one clue left by nature about what homo sapiens should eat, and it's breast milk. We know that this was designed for at least babies. So do we really know, like, what's in here? Have we really thought about everything that's in here? AVIR: I guess I'm gonna throw it to the crowd.

5:16 Like, if we just had to name the components of breast milk—and I'm gonna take one off the table. We know that it's 87 percent water. Okay, fine. That's easy. But the solid part. Like, name some things. What's in breast milk? AUDIENCE MEMBER: Vodka. AVIR: Vodka? LULU: Depending on the mother's night. AVIR: Yeah. Yeah, right. AUDIENCE MEMBER: Fat. AVIR: Fat. AUDIENCE MEMBER: Sugar. AVIR: Sugar. Proteins, hormones. Calcium. LULU: Calcium. AVIR: Antibiotics? LULU: We heard amino acids. AVIR: Amino—amino acids. Yeah, you guys are right. I mean, everything you're saying is right. But there is something that we've missed. And to be fair, I went to med school for way too long, and I didn't know about this either. It's called human milk oligosaccharides.

6:03 LULU: HMOs. Not my—not my medical plan. AVIR: No, not your medical plan. LULU: Abbreviation for weird—okay. And okay, so oligosaccharide. I'm feeling "saccharine," I'm feeling sugar? AVIR: Exactly, yeah. LULU: Okay. AVIR: These are sugars. And what's crazy is probably most of us have never heard of this term, but it's actually the third-largest compound in breast milk, way above protein. LULU: Oh! AVIR: So, you know, you have lactose, that's the sugar that someone mentioned. You have lipids, that's fat. And then you have these HMOs, which none of us—I don't know. I don't think any of us really talk about it. And then you have proteins. LULU: That's bizarre!

6:36 AVIR: It's just kinda weird that we don't talk about it. LULU: Yeah. AVIR: And I think it's even weirder because, you know, just to tell you why I think this is weird, how can I put it? Everything you've ever eaten, right? Like, every sugar, every sweet thing, every carbohydrate, every starch is essentially made up of, like, three basic building block sugars. I'm gonna name them for you here. [ARCHIVE CLIP: Glucose!] AVIR: All right, you got glucose. LULU: Are these the technical drawings? AVIR: Yeah, these are chemical structures.

7:05 LULU: Okay. Okay. [ARCHIVE CLIP: Galactose!] AVIR: Okay. So, you know, just for example, table sugar. That's the glucose mixed with a fructose, or honey, that's like chains of fructose. You know, potato chips. Like, just a bunch of glucoses together. You get the idea. Everything you've ever had is one of these things. LULU: Avir, why—why do they look like this? You made the slide show. AVIR: I was literally laying in bed and just started thinking about these guys as Nintendo Wii characters. I don't know why. LULU: Just like boring Nintendo Wii—or okay. AVIR: I don't know, it just—yeah.

7:34 LULU: Okay. AVIR: It felt right. LULU: Okay, into Avir's mind. Okay. AVIR: Yeah. LULU: So that—okay, so these are, like, the sugars we see in the world? AVIR: Yeah, these are—this is every carbohydrate you've ever had is one of these. LULU: Okay. AVIR: And then you have these HMOs. And they are strange. [ARCHIVE CLIP: Fructose!] LULU: [ARCHIVE CLIP: Nada!] AVIR: Okay. LULU: Wait, these are the real names? AVIR: Those are the names. I'm not making those names up. I mean, they're weird. They're alien sugars. Like, it's literally as if, like, you've, you know, had an alternate reality where, you know, you still have Caveat but it's spelled differently; it's a totally different Caveat.

8:10 LULU: Okay. AVIR: Or you have everything, just a different version of it. There's these three different sugars, and what's crazy about it is they sort of combine into these weird shapes and change. LULU: Does it feel like we should get some, like, mysterious alien sugar music? AVIR: Yeah, we should. LULU: Okay. AVIR: We should get some music. AVIR: Yeah, exactly. So these sugars, right? LULU: Yeah. AVIR: They're very strange. You've never seen them, you can't get them at the local grocery store. You've never tasted them. They combine into these weird branches and chains with ferns and weird shapes. And those combine together into even weirder shapes.

8:49 LULU: Whoa! AVIR: Beads, forests. LULU: And are these—are these other places in nature? Like, are they out in... AVIR: No. LULU:... honeysuckles, or... AVIR: No. LULU: Just... AVIR: Just in milk. LULU: Would they be in dolphin or cat, other mammal breast milk? AVIR: Yeah, they would be. LULU: Okay. AVIR: They're in—every type of mammal makes these, but humans make the most. LULU: Okay. AVIR: But here's what's weird: humans can't digest this stuff at all. Like, literally no human being can do anything with these sugars. They go in you and they go right out of you.

9:21 LULU: Wait, so this huge amount of breast milk which, like, that takes frickin' time to pump. AVIR: Right. LULU: A huge portion of it just if a baby eats it, not—not using it, not turning it into, like, energy, just... AVIR: Yeah, exactly. And I know when some of you guys walked in, you may have picked up some drinks. LULU: Yeah? AVIR: Those are HMOs. So can we get some up here? LULU: Oh! Okay. AVIR: I want to try to—I've never tried this before. I've been saving it. LULU: Okay. AVIR: Oh, it's back here? LULU: Oh yeah, where are—oh, it's already pre-dissolved? Is this okay, so... AVIR: Is this it?

9:52 LULU: Okay, so we're getting to taste this sugar that you... AVIR: So if you want to try them... LULU: So if anyone else wants to try it, so it's sugar that's found in breast milk, and we don't know what it—you haven't tasted it yet, right? Cheers! Tin tin! Okay. Barely—it's like —oh! It almost tastes like really fresh water. How, like, really fresh water tastes a little sweet? AVIR: I guess so, yeah. LULU: I don't know. What do you think? AVIR: I think I'm imagining something. I'm not sure. Do you guys taste anything? LULU: Also, can I get audience help? Because I didn't mean for my dress to unclasp.

10:26 LULU: This isn't like a live breast pump situ—it's not where this is going. LULU: Okay, can you just come over? Okay. Anyway, so... AVIR: Ellen Horne! LULU: Ellen Horne! OG Executive Producer of Radiolab! LULU: Still here to make things run smoothly. AVIR: LULU: Okay, continue. AVIR: So—so here's the thing about these HMOs— I'm gonna call them 'alien sugars'—that you guys just tried. They've sort of been written out of history, right? Like, none of us ever thought about them. They're sort of written in the sidelines of textbooks and, I don't know, they're not in formula so, you know, it's really just like a nobody. And no one ever really thought to ask, like, what's going on, really, until a scientist by the name of Bruce German came along and basically just asked this simple question. LULU: What's that question?

11:12 AVIR: The question is why? LULU: Can we get some 'why' music? AVIR: We need some 'why' music. LULU: Okay. AVIR: So, like, why would a mother who's got very precious, limited calories, why would that mother literally dissolve her own body, taking all these precious nutrients and calories to make milk that needs to feed this baby, why would the mom make these sugars that no baby can use? Why? LULU: Could—should I guess like, could it be waste? Could it be waste? Could it be some byproduct of some metabolic function? AVIR: Well, Bruce is considering that, you know?

11:52 LULU: Okay. AVIR: He's asking this question, and certainly it could be a waste product. LULU: Okay. AVIR: But Bruce has this hunch that, like, nature, human nature, evolution is just, like, too perfect, you know? LULU: Yeah. AVIR: Too perfect to create all this waste. Like, Lulu, you are too perfect to be creating a waste product in your breast milk. Your breast milk is way too good to be creating all this waste. LULU: Okay. All right. So he thinks there's a reason. He thinks it's not waste. He thinks there's a reason. AVIR: He thinks there has to be a reason. LULU: But again, humans can't do anything with it. AVIR: Humans can't do anything with it.

12:21 LULU: Okay. AVIR: So... AUDIENCE MEMBER: That we know of. AVIR: That we know of. LULU: That we know of. AVIR: So this is around 2005. LULU: Our fact-checkers are in the audience tonight. AVIR: We'll put you on the salary. Oh, Robert Krulwich in the audience, guys. LULU: Robert Krulwich! AVIR: The legend, the godfather. LULU: AVIR: All right. LULU: He looks so tan. AVIR: Okay. LULU: Okay. AVIR: So yeah. So this is around 2005, Bruce is having these thoughts, and this is the era, sort of, of the microbiome, where we're all thinking about the microbiome.

12:58 And it's this idea that, like, you know, we've been spending the last hundred years trying to become clean and sterile, but actually, we're completely surrounded and completely covered in bacteria at all times. LULU: Hmm. AVIR: You know, this is that idea that persisting—that, like, wow, it really turned the idea of cleanliness on its head. We're basically human suits covered in bacteria, filled with bacteria. LULU: AVIR: You know? And so he has this hunch that's basically like, okay, well, if we can't use it maybe there's a bacteria that can.

13:31 LULU: Huh! Okay, so maybe like a bacteria... AVIR: Yeah. LULU: In where? AVIR: That lives inside of a baby. You know, maybe there's a bacteria that lives in the baby. LULU: All right. That would make sense. Like a puzzle piece. AVIR: Right. LULU: Food for our baby bacteria. AVIR: Right. LULU: Okay. AVIR: But, you know, here's the problem. LULU: Yeah? AVIR: There's 36 trillion bacteria in the gut, okay? Just to put that in context, if you took every human on Earth and then took 5,000 of those Earths. LULU: Yeah. AVIR: That would be how many babies—that would be how many bacteria live inside of each one of you. I mean, it's a lot. LULU: That he would have to audition to find out if it's eating it? AVIR: Exactly.

14:07 LULU: Okay. AVIR: It's just there's thousands of species. LULU: Computationally difficult. AVIR: Right. LULU: Okay. AVIR: So that's the problem. But so they decide— I just took this from a textbook. I mean, this is just like one page of a textbook of the different bacteria that we know exist in the gut. LULU: Whoa! AVIR: And you don't have to read the names. It's a lot of names. LULU: Can we read some of the names? AVIR: Yeah. LULU: Edgarthellolenta ubacteriumvensolium. AVIR: Yeah, that's a good one. LULU: Okay, so you're saying times, like, five trillion million...

14:34 AVIR: Exactly. LULU: Okay. AVIR: So they design an experiment basically taking an agar plate where bacteria like to grow. LULU: Okay. AVIR: So they decide, "Okay, we'll take the agar plate, we'll get some breast milk, take all the normal stuff out of breast milk, just keep the alien sugars." LULU: Okay. AVIR: "Sprinkle the alien sugars on a plate, and throw a bacteria in there and see if it grows." LULU: It's like, if you eat it, you'll proliferate. If you don't, you're gonna die. AVIR: Exactly. LULU: Okay. AVIR: Yeah, you got it. LULU: All right.

15:02 AVIR: So that's the idea. So they throw some bacteria—you know, take a common bacteria that lives in the gut, throw it on there, throw some HMOs. It dies, doesn't work, no luck. LULU: Okay. AVIR: Try another one, no luck. Try a third one, no luck. LULU: Luckily, they only have 37 trillion... AVIR: Yeah. It's a long ways to go. LULU: Okay, how long is this taking? AVIR: Well, so a year goes by. LULU: Yep. AVIR: Bruce and his team are, like, begging, borrowing, stealing, to get, like, any bacteria or any, you know, breast milk that they can. You know, begging on the street. Like, "Can I get some?" LULU: AVIR: You know, it's not working. A year goes by. Two years go by.

15:36 LULU: Okay. AVIR: And finally on the third year... LULU: Yeah? AVIR: Boom. LULU: [gasps] AVIR: They find something. LULU: Okay, can we... AVIR: Can we get a little dun-dun-dun? [suspenseful music] AVIR: That was perfect! LULU: Ooh! AVIR: Wow. Why do we prep for these podcasts? We could just do this. LULU: I know. Let's just always do that. Okay. AVIR: Okay, so yeah, they find something that's growing. You could see all this white stuff is bacteria that's growing. Let's get a little ominous music. I want to zoom in because you put it under a microscope and it looks very strange. LULU: Ooh!

16:07 AVIR: Zoom in a little more. LULU: It's beautiful! AVIR: Zoom in a little more. A little more. LULU: And so this is the bacteria that likes to eat the weird alien sugar in the breast milk? AVIR: Exactly. And so it turns out this bacteria is called Bifidobacterium infantis. LULU: Bifidobacterium. That's so cute. Okay, word nerd, "bifid" like, bifurcate? So we get that Y shape? AVIR: Yeah, exactly. It's got a Y shape. And this is a bacteria that was known. It was actually discovered by some guy in 1899. He sort of saw it, wrote it on a list and forgot about it. So it's just been sitting around in the back of someone's textbook for a long time. LULU: Okay.

16:48 AVIR: Yeah. LULU: So does that mean this is in my baby's belly? AVIR: Well, that's the next question. Exactly right. So you have found, out of the thousands of bacteria, you found one that can eat these sugars. That's crazy enough. LULU: Yeah. AVIR: Because, like, you know, we don'tꟷwe can't eat them, but it has all the genes and all the enzymes to eat these sugars that we make that we can't eat. It's just weird, right? LULU: Yeah. AVIR: So you would think okay, thisꟷthis should be in some babies' guts. LULU: Yeah.

17:17 AVIR: And so the way to look for that is, you know, when you have bacteria in your gut, you're gonna poop out some of that bacteria. So you really gotta get into poop. You know, that's where this story is going. And so basically from there, Bruce and his team need to start collecting dirty diapers, you know? Which I don't know if that's an upgrade from begging for milk, but that's where they're at. AVIR: Someone's gonna be offended, I think, but this isꟷChatGPT made this. I didn't do this. AVIR: So Bruce is working at UC-Davis. He's around getting his friends and neighbors and strangers on the street to give him their dirty diapers. "Let's culture it. Let's see if we can find some Bifid in there."

17:57 LULU: Yeah. AVIR: But no, he can't find any Bifid in any of theseꟷin any of these diapers. LULU: They're just notꟷso that theory's gone? AVIR: Well, it might just be where they're located, you know? So they realize they need to sort of expand the search. And that's where this idea starts, what I call the amazing global baby diaper hunt. LULU: Okay. AVIR: So it turns out that the Gates Foundation, for some reason, has collected stool samples from all over the planet. I'm not sure why, but don't tell Elon Musk about this, please.

18:33 LULU: Basic science! You never know! AVIR: So they have just baby poop, likeꟷlike, just lining their walls, I guess. I don't know. LULU: Libraries of poop. AVIR: Just libraries of poop from all over the world. LULU: Okay. Yeah. AVIR: So Bruce calls them, you know, sets up a meeting and says, "Guys, can I get some of this? Let me get some of this poop!" So yeah, they set up a deal where he's gonnaꟷthey're gonna send him poop from all over the world. And they're gonna look all over the place. So they look. They start looking at poop in Denmark.

18:58 LULU: Okay. AVIR: And no Bifid. LULU: Okay. AVIR: Scandinavia, Switzerland. No—no Bifid. LULU: Okay. AVIR: But then they get to Gambia. LULU: Huh! AVIR: Bifid. It's there in the poop. Cambodia, it's there. Rural China, Bangladesh. They have Bifid. LULU: Huh! AVIR: Weirdly, the only people in the US? Mennonites. LULU: Mennonites have the Bifid? The babies have it? AVIR: Very strange. LULU: Why some places and not others? AVIR: Well, that's the question. At this time, they don't really know why here, why not there? LULU: Yeah.

19:32 AVIR: It's a mystery. I mean, it certainly could beꟷyou know, maybe this bacteria survives in a certain climate. Maybe it's genetic differences, maybe it's lifestyle differences. It's an open question. LULU: Okay. Does he have any guesses ofꟷlike, there's obviously some bacteria we like that are great for gut health, some we don't want. Is itꟷdoes he have any sense of what it's actually doing? AVIR: Right. That's the next question is Bruce and the team, guy by the name of David Mills, all these amazing scientists want to figure out, what is this bacteria doing?

19:59 LULU: Yeah. AVIR: So what they do is they do another experiment. They basically take some cells from the gut which you can take. You can culture them and you can put them on a plate. And when you put gut cells on a plate, they actually automatically form themselves into a wall. They just self assemble into a wall. LULU: Huh! AVIR: Which is pretty cool. LULU: That is really cool! AVIR: Yeah. And so it's kind of cool because, you know, gut cells, what they're supposed to do is basically form a wall, and anything you eat or drink has to basically go through those cells to get to your body. So it wants to make sure all the food is the right food. It's all broken down properly. All the good stuff comes in, all the bad stuff stays out. That's what the gut cells do. So they form into this wall.

20:36 Yeah. Question in the audience? LULU: If I threw up hard enough... AVIR: That's a good question. LULU: And itꟷlike, the gut cell went on the rim of the toilet? AVIR: Would it just automatically...? LULU: Would the toilet become a gut? AVIR: I think no, but I don't know why not because I want that to be true. LULU: Okay. AVIR: I think it's a... LULU: In the sequel. Okay. Next time on Viscera. Okay. AVIR: Yeah, we'll try that. LULU: Okay, but the point is guts have rulesꟷfor the experiment, you're sayingꟷsorry. So it's like a gut's being formed in a Petri dish, though, kind of? AVIR: Exactly.

21:10 LULU: Okay. AVIR: Gut's being formed in a Petri dish. They throw some Bifidobacterium on the petri dish and see what happens. LULU: Yeah. AVIR: And right away they notice that the bacteria are able to sort of latch onto the walls of the gut, just, like, hang there like mountain climbers. LULU: Huh! AVIR: And they start proliferating really fast, and basically coating the whole wall. LULU: Whoa! So this Y-shaped bacteria that likes alien sugars with enough time willꟷit's almost like wallpaper on the inside of the baby's gut? AVIR: Yeah, exactly. It's like wallpaper on the walls. LULU: Okay.

21:39 AVIR: Okay, so they notice that and that's interesting. Another thing they notice is well, just like babies eat and they poop, while these bacterias are eating these alien sugars and they have to poop, too. Yeah, so they actually... LULU: Totally! What? I never thoughtꟷI mean, it's like you hear about the microbiome and you have all these friends inside, but you didn't think about them needing to poop. Where did their poop go? AVIR: It just goes into the gut, you know? It goes out with the rest of the baby's poop.

22:03 LULU: Okay. AVIR: But what they're seeing is that the poop that these bacteria are creating are acids. So they're creating acidic poop. LULU: Huh! Okay. Is thatꟷis that bad? Will it burn a parent's fingers? I don't know. AVIR: Yeah, that's what youꟷyeah, it sounds bad. I'm not gonna lie, okay? Acid poop sounds bad, but what I will say... LULU: AVIR:... to be fair to acid, there's a reason, like, when you go to a cookoutꟷlike, when you go to a cookout, what are the condiments you bring? You bring, like, mustard, ketchup, relish, onions.

22:31 Why? Because those are acidic. And the thing is bacteria can't really grow that well in acid, so it'sꟷyou don't have to put it in the fridge, basically is the idea. So acid prevents bacteriaꟷ most bacteria from growing. LULU: Oh! AVIR: But it turns out that Bifidabacterium is totally chilling in the acid, but the idea is it may be keeping other bacteria away. LULU: Okay, so it's thisꟷit's this bully wallpaper that shows up, shoots acidic poop that maybe makes it harder for other bacteria? AVIR: Right. Exactly. LULU: Okay. Okay, so I guess I ask again, is this a goodꟷis this a good thing? AVIR: Right. Well, we definitely know this bacteria is being territorial. LULU: Okay.

23:11 AVIR: It's taking over the gut. It's saying, like, "This is my wall. I'm taking over, and here's acid." We know thatꟷexcuse me. But we don't know, like, if it's good or not. LULU: Okay. AVIR: So to answer that... LULU: Yeah. AVIR:... I gotta tell you a story. LULU: Okay. I love a story. AVIR: All right, so Dylanꟷguys, I'm gonna need a little bit of, like, rogue, don't try this at home type of science music. Like, yeah we're gonna talk about a science story where—just don't try this type of stuff at home. LULU: Okay. AVIR: So our story centers around Dr. Shara Sheldon, who at the time is a PhD student, okay? Now she's studying this stuff. She goes to a lecture where Bruce is talking about these results, and it sticks in the back of her mind. Meanwhile, her father is a professor at the vet school, and he works at a lab like, at theꟷnot at a lab, at a barn that's raising these thoroughbred horses.

24:02 LULU: Ooh. Okay! AVIR: So thoroughbred horses, if you don't know, you know, those are those really expensive horses that, you know, they eat way better food than you and I. LULU: Yeah. AVIR: Their lives are definitely more valuable than ours. LULU: For sure. AVIR: Like, these are expensive... LULU: Fine. Yeah. Okay. AVIR: But there's a problem at the barn. Every new foal that's being born to these horses, after a few days is getting diarrhea, fevers, and then dying. LULU: Oh! AVIR: Yeah. And that's sad because we like horses, but also sad because they're losing, like, hundreds of thousands of dollars every time this happens.

24:33 LULU: On every foal. Okay. Okay. AVIR: And the problem is next week there's gonna be, like, 20 more foals being born. LULU: Oh, no! AVIR: And yeah, so basically what they do is they find out what's going on, and it turns out these horses are infested with, like, one of the worst diarrheal bacteria that we have. And if anyone worksꟷdoes anyone work in healthcare or anything like that? I mean, what's the one bacteria diarrheal illness that we don't want to deal with? AUDIENCE MEMBER: C. diff. AVIR: C. diff, exactly.

25:01 LULU: C. diff. AVIR: You know it. Once you've smelled C. diff once you'll never forget. I mean... LULU: Okay, it looks likeꟷof like a dynamite stick, like, exploding corn dog situation. AVIR: Yes, the corn dog dynamite stick. This bacteria is terrible. LULU: Okay. AVIR: Like, you can'tꟷif you spray this with antiseptic, if you spray it with Purell, like, it won't die. Like, this thing doesn't die. LULU: Yikes! AVIR: It's really hardꟷneeds very strong antibiotics. LULU: Yeah. AVIR: It kills people all the time. LULU: Oh, no! AVIR: We see this every time in the hospital. And it was killing these horses. LULU: And it's all over this barn.

25:31 AVIR: It's just all over the barn. LULU: Okay. AVIR: You can't exactly sterilizeꟷyou know, even a hospital can't really sterilize this stuff, let alone a barn. LULU: Okay. AVIR: So it's not a good situation. LULU: Famously dirty. AVIR: Yeah, exactly. So these foals infested with C. diff. The dad, who's the professor who works there, is talking to his daughter about it and commiserating. And the daughter goes, "Wait, like, I just heard a lecture by this guy, Bruce German." LULU: Oh, no. AVIR: "And he was talking about this bacteria that coats the walls, produces this acid, is territorial. Like, why don't weꟷI don't know. Maybe we should try it."

26:00 LULU: Try it meaning? AVIR: Like, let's give this to the horses. AVIR: Soꟷso the dad goes, "Yeah. I mean, they're desperate. What else can we do, you know? So let's try it." So lo and behold, they take the bacteria from Bruce, they culture it, they mix it up with some milk. LULU: Okay. AVIR: And then when the foal is just born, they squirt it into the foal's mouth. LULU: Like with a little baby bottle? AVIR: Yeah, a little baby—squirt it in. LULU: Hope for the best, it's only $100,000 on the line. AVIR: Right. LULU: Okay. AVIR: And lo and behold, what happens is sure enough, 20 foals are born, none of them get C. diff, all of them do fine.

26:33 LULU: Whoa! AVIR: Incredible. LULU: We goꟷcan we get a round of applause for Shara? AVIR: Rebel science. LULU: Again, don't try it at home. Like, clinical trials are good, but ingenuity, okay. AVIR: So I want to play my interview with her, because I wish I could tell you the story stopped there, but it continues on. LULU: Oh. AVIR: All right. Let's see. [ARCHIVE CLIP, Shara Sheldon: I was like, "Good job, brain, for remembering the random lecture with Bruce German."] [ARCHIVE CLIP, Avir: There are so many random lectures I had in med school that I will never remember. Like, I don't know how you did that.]

27:06 [ARCHIVE CLIP, Shara Sheldon: I loved it, though. I thought it was the neatest thing. I don't know.] [ARCHIVE CLIP, Avir: Okay, so that's an amazing story, but I know that the story doesn't end there. What happens next?] [ARCHIVE CLIP, Shara Sheldon: So time goes on. I'm still doing my PhD, and got married, got pregnant, and then I had my babyꟷhealthy baby. Everything's going great and then the change comes. And we started dealing with a lot of gas, a lot of crying. Just like, he looked like he was in pain. We were trying everything for the gasꟷthe little gas drops that are natural, the bicycle kicks, all kinds of things. And I'm just thinking in my head my parents told me I had colic for nine months and was just screaming and crying constantly. So I was just thinking, like, this isn'tꟷthis is not good.] [ARCHIVE CLIP, Avir: What are you feeling at this time?] [ARCHIVE CLIP, Shara Sheldon: I

28:03 was very worried. I was already super tired, and exhausted. And I could tell, you know, Connor wasn't feeling well with it as well. And so I just was getting quite desperate to find something that would work. And we kind of hit the breaking point when my husband was out of town. And so I'm alone with the baby, and it was so bad. He was up, like, all night, just in pain, gassy. And I was like, "This is not going to work." And I said, "We need something." And so I remembered the Bifidobacterium. And I said, "I'm going to email Bruce." And so I sent a desperate email saying, "Please, please, I know you have some of this Bifidobacterium still. Like, I'd really like to try it."] [ARCHIVE CLIP, Avir: Okay, and so does he email back? Like, does he take a week to email back?] [ARCHIVE CLIP, Shara Sheldon: He got back to me right away. And he was such a dream. He said, "You can drive up and get it." And I loaded up

29:08 in the car, drove to Davis, and went in. And we got, like, a little bag, just a brown paper bag, with samples in there and this syringe.] [ARCHIVE CLIP, Avir: No way. What, they're in, like, little vials or something, or like...?] [ARCHIVE CLIP, Shara Sheldon: No, they're in little sachets. Like a little rectangular packet that you, like, can rip across and pour out.] [ARCHIVE CLIP, Avir: Oh. Okay, yeah, I got it.] [ARCHIVE CLIP, Shara Sheldon: So, I was like...] [ARCHIVE CLIP, Avir: Like a bag of drugs, basically.]

29:30 [ARCHIVE CLIP, Shara Sheldon: Yeah. You know, you're using stuff that's being tested for research, so it's not very pretty.] [ARCHIVE CLIP, Avir: Right.] [ARCHIVE CLIP, Shara Sheldon: I get home, I'm very excited to try this. I grab one of the little sachet packets out, and I open it and I see there's, like, a powder in there. It had kind of an interesting odor, I noticed. And then I mix it in with the breast milk and then suck it up in the syringe. And then my mom helps me hold Connor, and we hold his head and we put the syringe into his mouth, squirt it in. So we did that. And they said, "Just do one dose a day." So, you know, I'm sitting there with bated breath, waiting to see if anything happens, watching him like a hawk. We didn't really see any changes right away, so I was a little disappointed because you're desperate at this point, right? I want results. I'm so tired.]

30:25 [ARCHIVE CLIP, Avir: Right.] [ARCHIVE CLIP, Shara Sheldon: And it took two days. Soꟷand then it worked.] [ARCHIVE CLIP, Avir: Oh, wow. Okay. What do you mean it worked? Like...?] [ARCHIVE CLIP, Shara Sheldon: Itꟷ the change was just so drastic. It was like a switch had clicked. And he just was so much happier. He was sleeping. He wouldn't have the gas constantly, and just seemed so much more relaxed. And I justꟷI was like, "This is working." And this is exactly what was missing from his microbiota.] [ARCHIVE CLIP, Avir: Well, you know, the scientist in me has to ask, like, you know, could this have just been a coincidence, you know, like, or placebo effect? You know, obviously you really wanted to see some results. Like, how do you knowꟷ how do you know for sure that this did that?] [ARCHIVE CLIP, Shara Sheldon: I would be doing the same thing, right? "Oh, this is just a placebo." But the amount of dirty diapers

31:23 had been very consistent. I had been keeping track because I love data and I'm a nerd, so I was keeping track of all of these things. And to go from, like, that eight to eleven down to two, I knew it was doing something.] [ARCHIVE CLIP, Avir: Wow, that'sꟷI gotta say I mean like, was there ever a part of you that felt, like, afraid to essentially be, like, experimenting on your firstborn child? Or did you just feel that confident?] [ARCHIVE CLIP, Shara Sheldon: I mean, I felt really confident with it. And there's a small part of you that's like, "Oh yeah, I'm giving this novel thing to my baby." But when I saw all the benefit, it was like, "This is right, and it's working and everything's good." But it is scary.] LULU: Oh, wow! As aꟷI just have to say, is there any other, like, better image of sleep deprivation than, like, "This thing smelled a little weird, but let's put it down." Wow! Okay, go Shara. I mean, whatꟷokay,

32:26 but to follow up on yourꟷyour question there, like, do we know what itꟷlike, is there still a chance that could have been placebo? Do we have any clue about what's actually happening at the cellular level? Like, what is going on? AVIR: Yeah, so Bruce sort of made a deal with Shara. Like, "I'll give you the bacteria, you give me his diapers." LULU: Okay. AVIR: Common theme we're seeing emerge here. So that's what he does. He sort of collects Connor's diapersꟷand a bunch of other kids' tooꟷ and he's sort of seeing what's going on. "Let's check the microbiome, let's check the stool, see what's happening. What influence is it exerting." LULU: Yeah.

32:59 AVIR: Because, you know, you think about it, let's look for a subtle change, like a change of five, ten percent in your microbiome when you're talking about 37 trillion, I mean, that's huge. LULU: Yeah. AVIR: But what he finds is actually kind of insane. Like, Connor's diapers went from having zero Bifidobacterium to being 80 percent Bifidobacterium. LULU: Whoa! AVIR: This is a graph right here. You can see, the blue is Bifidobacterium. It just crowds everything else out pretty instantly. And this is, like, insane, because, you know, it's notꟷwe're not evenꟷthis isn't normal microbiome stuff. This isn't, like, diverse ecosystem. This is just like domination by one bacterium. LULU: It's like a monoculture in there.

33:38 AVIR: Yeah, exactly. LULU: It's all Bifid. Wow! AVIR: Yeah. And the other thing is, you know, we talked about these bacteria, they poop themselves, they poop acid. And there's just so many bacteria in there that the baby's poop is literally becoming acidic. LULU: Huh! AVIR: Which is kind of crazy, right? Because if you were to look, like, onꟷgo to Labcorp and say, "What's the normal pH for, you know, baby stool?" they would say seven, which is water, which is, you know, neutral. LULU: Okay. AVIR: Neutral. They're finding the acidity is, like, getting down to, like, five, you know, on the stool, so it's a little concerning. So... LULU: Five's like what?

34:11 AVIR: Five's like maybe likeꟷlike vinegar or something like that. LULU: Okay. Oh, okay. AVIR: I don't know, actually. Something like that. So it's kind of concerning. So they decide to look into it. The team looks into it. A student by the name of Bethany Henrik, who's now a well-established PhD herself, she decides to sort of go back in time and say, like, well, where did thisꟷwhere did baby stool being seven, being neutral, being normal, where did that come from? LULU: Hmm! AVIR: It's like, who said that? LULU: Okay.

34:38 AVIR: So she decides to basically go back and look at every scientific study that ever put a pH probe into a baby's poop. LULU: Okay. Does she have much to work with? AVIR: Right. I mean, that's how manyꟷI'm just curious with the audience, like, how many times would you think that's happened? This was invented in 1909. LULU: Okay. So we can measure pHꟷokay. AVIR: Like, twice? Three? LULU: Twice? AVIR: I don't know. 200? Well, that's good. It actually happened 18 times in the past hundred years. So 1909, this is invented. It took until 1917 for the first scientist to put that into poop, to babies' poop, and they've done it 18 times since, okay? And here's what they find: When she goes in through the data, looks at, like, every baby and maps it out and graphs it out, is that there's this very clear line, and it's showing that basically our babies' poop used to be acidic. LULU: Okay.

35:30 AVIR: So a pH of five, which is acidic. LULU: Okay. AVIR: And it's slowly been working its way up to neutral. And it's like this very clear thing if you map it out. LULU: Huh! AVIR: And yeah, it's kind of crazy. It doesn't sound like much, you know, this line doesn't look like much, but that actually represents like, an 80-fold difference in the amount of acid that's in baby poop. It's huge! LULU: And again, you said the Bifid makes the acidic poop, so watching it get less acidic, is that like watching a disappearance?

35:57 AVIR: Exactly. LULU: Okay. AVIR: At this point, Bruce and the team is sort of being like, wait, this is a sign. LULU: Hmm! AVIR: This is the marker of Bifid, and it's going away. That's what they see. LULU: Huh! AVIR: So they want to figure out okay, there's these acids, blah blah blah blah blah, that's kind of crazy but, like, what exactly is going on? What acids are they actually making? LULU: Yeah. AVIR: And I'm gonna geek out for a little bit; the chemistry people will like me or else might hate me, but just stick with me because I think this is cool. All right, they find out that the bacteria's producing two main acids. One's called acetate and the other's lactate.

36:33 LULU: Okay. AVIR: Okay. So acetate. Acetate is known as a short chain fatty acid. LULU: Okay. AVIR: All right? And what that is is basically a small, miniature fat that we can't make, but we can't really get it in many places in nature, but this bacteria is making it. And it just so happens that those gut cells that we talked about, that wall of gut cells, like, this is their favorite food. LULU: The gut cells like to eat? AVIR: Yeah. LULU: Okay. Okay. AVIR: Like, they want to eat this themselves. Like, I mean, if you took the gut cells to their favorite Michelin-star restaurant... LULU: Yeah, this is what they'd pick?

37:08 AVIR: Like, they wouldꟷthis would be the calamari. This will be the thing they want. LULU: Yeah. You don't think about them eating. You think about them serving you, like, breaking down and giving you the nutrients you need, but they need to eat, too. AVIR: Exactly. LULU: So that's what they eat to do their job. Okay. AVIR: Especially in babies, you know? These gut cells are growing so fast in a baby, theyꟷthey get very hungry. So as they take in food to give to the body, they like to take a little for themselves.

37:30 LULU: Yeah. AVIR: So when there's acetate, they love that. LULU: Okay. AVIR: The next molecule is lactate, also known as lactic acid. LULU: Okay. AVIR: So this is also interesting because it turns out that your nerve cells, your brain, nerve tissue, nerve tissue that exists on your gut, in your brain, they actually can't use glucose. LULU: Huh! AVIR: I don't know if you knew that. They can't really use it. LULU: Your brain can'tꟷcan't do anything with normal sugar? AVIR: Yeah, it's too busy thinking to use glucose. It doesn't have the time for that. LULU: Okay.

37:57 AVIR: So that's why brain cells are always surrounded by support cells. In the brain, they're called "glial cells," whatever. There's these supporting cells. LULU: Okay. AVIR: It just so turns out, by the way, side note... LULU: Yeah? AVIR:... is, like, the only thing that made Albert Einstein's different than ours? LULU: Yeah? AVIR: Was not the amount of brain cells, but the amount of support cells that they had. LULU: Huh! AVIR: Glial cells. LULU: It was the scaffolding. AVIR: Exactly. LULU: Okay. AVIR: So what these support cells do is they take the glucose, they do some chemistry.

38:22 LULU: AVIR: They change it into lactate and pass it to the nerve cell. LULU: Okay. AVIR: So lactate is a nerve or a neuron or a brain cell's favorite food. LULU: Okay, I'm feeling a recap. Okay, so really quick. So we were talking about breast milk, the weird alien sugars which feed the bacteria, the Bifid, the Y-shaped thing, which itself poops acid specifically, which is these two things, which fuel the baby's digestion and thinking? AVIR: Yeah. LULU: Okay. AVIR: Yes. LULU: Thank you. I listen! AVIR: Let me just summarize it, too. LULU: Okay.

38:58 AVIR: Let me just draw out a picture of what's actually going on in the gut. LULU: Oh, okay. AVIR: So this is a baby gut under normal circumstances, like my gut, you know, because I don't have this or whatever. LULU: Okay. AVIR: So when you haveꟷthis is the wall, this is inside, that's outside. LULU: Okay, wait. The top's like the tummy where stuff's coming in? AVIR: Yeah, exactly. LULU: Okay. Okay. AVIR: So this is the gut cell when there's just normal adult bacteria, E. Coli, your regular stuff there. Those bacteria secrete toxins that basically poke holes in this wall. LULU: Ow!

39:25 AVIR: And allow things to pass through. Instead of going through the cells, they sort of go in between the cells and around the cells. So bacteria can get in, toxins can get in, undigested food particles could get in. LULU: Ugh! AVIR: And that's called "leaky gut," okay? Those things get into the body, and for this baby that just got an immune system, like, two months ago, it's trying to figure out what the hell is going on, and it gets very overwhelmed and confused. It gets inflamed, the immune system is hyperactivated and it causes a lotꟷyou know, it could cause a lot of problems. Now on the other hand, when Bifidobacterium's here, the Bifidobacterium sticks to the walls, prevents any other bacteria from coming there, and the food it's releasing is just strengthening these cells, making them super strong and super tight so that basically nothing bad gets into the body, and the immune system

40:15 can actually, like, learn and do its thing. LULU: Like, learn itself versus other. Okay, so the top there, that's our wallpaper. That's the Bifid wallpaper. And everything just seems to beꟷlike, the gut cells are more well fed and they're able to distinguishꟷlike, the bad leaky gut isn't getting in, and the immune system is maybe having an easier time because there are less foreign things. AVIR: That's the idea. LULU: It is soundꟷI don't know if it's sounding this way to anybody else. It's sounding like Bifid is good? AVIR: Well, that's the idea, and that's certainly what Bruce thinks. At this point, Bruce goes from being like just a normal scientist, show up to work, do your research, to becoming like a borderline evangelist.

40:53 LULU: Okay. AVIR: Like, heꟷyou know, his daughters won't take him to the family dinners because this is, like, all he talks about. He told me that. LULU: Okay. AVIR: You know, he'sꟷlike, he sees a baby in a stroller across the street, he's gonna, like, sprint over to the baby, throw some Bifidobacterium at them. And he actually mortgages his house and gets his co-workers to do the same. They sell the boat, do all these things to start their own startup to sell Bifidobacterium. LULU: Whoa! AVIR: Right. LULU: Okay. AVIR: Which you can buy and which we may or may not have... LULU: Ooh!

41:23 AVIR:... for you to try. LULU: And this is just like he's selling bacteria in a jar? AVIR: Bacteria in a jar. LULU: Okay. AVIR: Yeah. AVIR: So that's where they're at. And he's telling everyone he can find, and so is his team. So someone on his team eventually runs into a guy by the name of Brian Scadalini. LULU: Okay. AVIR: Brian Scadalini is an MD/PhD, overall genius. And he's a neonatologist who works at OHSU in Portland. LULU: Okay. AVIR: Okay. So he's working there, and as a neonatologist, it's a beautiful thing because you get to see these little tiny preemies grow into, like, full-fledged adults. But there is one thing that's, like, the worst thing that happens in NICUs, and basically that's this.

42:04 LULU: Hmm. AVIR: Okay? LULU: Okay, what areꟷwhat are we looking at? AVIR: So what we're looking at is a preemie's belly. LULU: Okay. AVIR: And it's filled with gas, it's very distended. And this baby's not doing well. This is called "necrotizing enterocolitis," also known as NEC. And basically what's going on is, like, a bacteria, an adult bacteria has somehow made its way into the baby's gut, has sort of bloomed and taken over, and is, like, completely destroying the gut wall, producing all this gas and all these bad things. LULU: Huh. That looks painful, scary. I mean...

42:36 AVIR: Very scary. LULU: Yeah. AVIR: Yeah. I mean, when I was a resident, I rotated in NICUs, and it's terrifying, because these preemies can go from being normal, they're doing well and then overnight they can totally crash and get this. And the mortality is very high once they get this. LULU: Oh, yikes! AVIR: So Brian gets sort of wind of this bacteria, and they both have this thought, "Well, maybe we could try Bifidobacterium." LULU: Inꟷin the preemies? AVIR: In the preemies. LULU: Okay. AVIR: So he makes a move that's pretty, I think, gutsy. LULU: Yeah?

43:06 AVIR: No pun intended. LULU: Okay. AVIR: I honestly didn't just... LULU: That one was not tested in rehearsal. LULU: When we were in a heavy situation. Okay, keep going. AVIR: So... LULU: Avir's gonna drop a pun in there. Okay. AVIR: Yeah. So he makes this move. He basically goes back to his hospital. He gets some of the Bifidobacterium from Bruce and the team and the company, and he just startsꟷhe tells the nurses, "Hey, we're gonna start giving this to the babies, like, tomorrow. This is what we're gonna do." LULU: Without checking with parents or... AVIR: Right. Pretty much like, "This is on formulary now. We're gonna give it to them." LULU: I'm having mixed emotions about this idea. But... AVIR: Sure.

43:45 LULU: Okay. AVIR: Yeah, I agree. LULU: Okay. AVIR: So he does that. And, you know, you gotta think he's not just waiting until they get NEC to give it to them. He's giving it to all the preemies, like even the ones that would be fine without it. LULU: It's like a preventative measure. AVIR: Preventative. Exactly, preventative. LULU: Okay. AVIR: Okay, so he does that, and lo and behold, he finds that the incidents of NEC goes from 11 percent down to 2 percent. LULU: Whoa! AVIR: Insane! LULU: That's huge. AVIR: Yeah. LULU: Okay.

44:09 AVIR: And this goes on for years. LULU: Yeah. AVIR: There is, in fact, years that go by that they don't see a single incidence of this. LULU: Of NEC in the NICU? AVIR: Right. In the NICU. He publishes about it, gains some momentum. LULU: And he's sprinkling Bifid this whole time? AVIR: Yeah, just sprinkling. LULU: Okay. Okay. AVIR: This was inꟷwell, he'sꟷ we'll get to that. Just a second because I don't remember, but he will. So he does this and yeah, pretty incredible. And yeah, he finds that it's working. Other NICUs are starting to take this up at this point. Like, at this point, as it's going along, up to 15 percent of NICUs are doing that.

44:45 LULU: Wow. Okay! AVIR: So anyway, I've been talking about Brian enough. LULU: What happened? Wait, what happened? AVIR: Well, I want to bring Brian up himself. So Brian, if you're here, let's bring you up. LULU: All right. Let's get some play-on music. Come on down! AVIR: Thank you, Brian. BRIAN SCADALINI: Hi everybody. AVIR: You just flew in today, just landed. BRIAN SCADALINI: I did. AVIR: So you had this really incredible result when you studied Bifidobacterium. I mean, truly incredible, and it seemed like it was spreading. But I guess I wanted to ask you, like, what happened next?

45:25 BRIAN SCADALINI: Well as—as Avir was saying, for years our incidents of necrotizing enterocolitis was quite low. And as a scientist I was waiting for a day or a week when maybe it would start happening again and that the result that we thought we were seeing wasn't true. But it just went on for five years. So we started in 2018 to answer that question, and then we had to stop in 2023. AVIR: Tell me about that. BRIAN SCADALINI: So for years, even well before me, neonatal intensive care units throughout the world, in Europe and in some places, like in Australia, almost every premature baby gets a probiotic, gets a bacteria that is like this, including this one that we were using, Bifidobacterium infantis, to prevent necrotizing enterocolitis. So I wasn't as crazy as it might have sounded to start using it in our NICU.

46:19 AVIR: A little crazy. A little crazy. BRIAN SCADALINI: But we were the first ones to use it alone. So our team decided this bacteria makes sense because of its symbiosis with milk, because it's for millions of years co-evolved with milk. It's stitched antibiotic resistance, it's stitched invasiveness, pathogenicity. It's given over 15 percent of its genome to do symbiosis with milk, And so we thought we should use this to prevent necrotizing enterocolitis. But what happened, as you might expect, whenever you introduce a bacterium into somebody, whether it's us or babies, and especially babies with an immature immune system, there is a risk that it will find its way into their bloodstream. BRIAN SCADALINI: Now if you ask me if I'm gonna choose between a pathogen and Bifidobacterium infantis, which has no antibiotic resistance, it doesn't have sex with other bacteria, and is meant to be in milk or

47:15 in the gut to metabolize HMOs which cannot be metabolized by us, remember that I will choose B. infantis. And so unfortunately, some babies got B. infantis in their bloodstream and had positive blood cultures, meaning that when they looked ill, they had a blood—a sample of blood taken and then was grown to see if the infantis was there. BRIAN SCADALINI: I might add that other bacteria that have been used as probiotics have also found their way into the bloodstream. The FDA knew that NICUs throughout the United States were using this to prevent necrotizing enterocolitis, and decided with the instance of a bloodstream infection with B. infantis, that all the NICUs in the United States needed to stop using probiotics to prevent necrotizing enterocolitis. This is essentially what's like a cease-and-desist letter. You can read this letter and see. There isn't a hospital in the United States, a risk department in a hospital that's gonna continue to use this

48:14 with the FDA saying, "You shall not use this without an investigational new drug status." AVIR: So you get this letter, and I imagine you have some complicated feelings, because it's likeꟷI don't know, we could understand where the FDA is coming from. LULU: I'm a little onside FDA. AVIR: But at the same time, you're working hands on with these babies and you're seeing amazing results. So, like, what's going through your mind? BRIAN SCADALINI: The first was, "Oh, crap," but a stronger word than that, because we know in the risk-benefit, we saw necrotizing enterocolitis, we'd get two or three babies die per year, and for several years, no baby that was born in our hospital died from necrotizing enterocolitis. And we had no baby get bacterimia—having bacteria in their bloodstream that was B. infantis. LULU: Hmm.

49:07 BRIAN SCADALINI: Even though we knew that that was a risk. So on one hand, I felt like babies were gonna die now, throughout the United States, not just at OHSU. MyꟷIꟷI hate this disease, I can't tell you how much I hate this disease, and I hate seeing babies die in four hours, six hours, they're dead. And the impact it has on their parents and their whole lives have been lost, versus a rare risk like this. So that was going through my mind. But on the other hand, it was sort of like what you were talking about, Lulu. It was sort of like, well, we were using something to treat, prevent or mitigate a disease, which is a drug. And therefore I see the FDA's point. So I was of split minds. LULU: Yeah.

49:51 AVIR: What happened once you removed this bacteria? BRIAN SCADALINI: Unfortunately, we are working on reporting this, but our necrotizing enterocolitis rate has come right back to where it was before, in fact, probably a little bit higher than it was before. AVIR: So I guess where do you go from here? What are you trying to do now? BRIAN SCADALINI: Well, we suspect this is happening throughout the United States, so we hope to be one of the first to report this. But since that time, we've been working with the FDA to try to have this become a drug, which is not the most simple pathway. And for some in the audience, you probably understand that, like, it costs a lot of money to develop a drug—and that's for adults. And adults vote; premature babies don't vote. Investors are scared of premature babies. They're afraid of pediatrics in general, and they're really afraid of preterm babies, and so it's a struggle to try to make this continue

50:48 to move forward. And the only thing that keeps the folks who work on it working on it as a large team is the fact that, at least in our hands, it works. AVIR: Amazing. Okay, Brian, stay here on stage. Thanks, Brian, for being here. LULU: Yeah. AVIR: Okay, so just to advance the story from here, Brian gets this result. Bruce has this company. He still really believes in it, but unfortunately his company sort of now has a scarlet Aꟷyou know, it's not doing so well. They're basically heading towards bankruptcy, and they have to sort of short sell to a private equity to stay afloat. And so they lose—Bruce and his team sort of lose stake in the company. They're stillꟷyou know, he still has his job. He's not, like, on the streets, but things aren't looking too good. Soꟷbut Bruce stillꟷand I've spoken to Bruce for hours. He is never negative. He's still positive about it, he's still hopeful. And I'm like, "Bruce,

51:49 like, what?" He still feels like this is the right thing, I gotta do it. And so anyway, I've been gatekeeping this guy Bruce long enough. Let's bring him up to the stage. Bruce German. LULU: Bruce! AVIR: Hi. I met you for the first time today, but I feel like I've known you because we've been talking so much, texting all night long like we're teenagers or something, you know? It's been kind of crazy. Daughters warned you. LULU: Okay, Bruce, I've got a question. Going all the way back to that global poop huntꟷI don't know if that's what you called it in your papers, but our shorthandꟷdo we have any clue, like, why in the places like Denmark and most of the US, except the Mennonite communities and Switzerland like, whyꟷwhere was the Bifid going? Why did we lose it if it seems like it is such a harmonious thing in a baby gut? BRUCE GERMAN: Excellent question. First, I should say thatꟷthat this is the work of literally over a hundred people for 20 years. And I know I'm

53:05 obviously distractingly tall and good-looking. LULU: BRUCE GERMAN: But really, it's this diversity of scientists from around the campus of UC-Davis who have brought this science forward. And that's one of the critical questions where you need multiple disciplines. Because remember the genius. It's a mutualism, what we would call a synergy. It's one plus one isn't two, it's ten. It's truly a complementation. And that means you need both. Oligosaccharides don't do much by themselves. The baby poops them out. Bifidobacterium infantis doesn't do much all by itself. The baby poops it out. But you put them together and that's the magic, and away it goes. AVIR: But where did it go?

53:56 BRUCE GERMAN: We didn't invent it. It's been in babies, but babies are born sterile. LULU: Completely? No microbiome in there? BRUCE GERMAN: They're sterile. Mother, you are keeping your baby sterile. LULU: Huh! BRUCE GERMAN: But needless to say, the minute they're born, they are being inoculated from bacteria all over. LULU: Wow. BRUCE GERMAN: If there is no Bifidobacteria infantis in their environment, they cannot get Bifidobacteria infantis. LULU: Hmm. BRUCE GERMAN: And so now we begin to look: Where could it go? Well, if mothers can't breastfeed, then they don't get the oligosaccharides. They don't survive. No Bifidobacteria in the baby.

54:35 LULU: No fish food for the bacteria. BRUCE GERMAN: No. Nothing. If the mother gets antibiotics, kills Bifidobacteria, and that mother will never have Bifidobacteria again, unless she somehow gets re-inoculated. So it's one step in any of those directions ends the story. And it's been happening over a century. So gradually, as the pH results indicate, mothers are losing the ability to pass on the bacteria. AVIR: You know, youꟷanother part of this is formula doesn't have these alien sugars. BRUCE GERMAN: No. AVIR: And it's not able to feed these bacteria, so the bacteria get starved. And I will say, you won't admit this but, you know, part of his evangelism was that he would email all the formula makers, and be like, "Can I meet with you?" And he would get some meetings with these formula makers and just go on and on in these boardrooms about putting HMOs back into the bacteria. And my impression was they were sort of like, "Thank you, sir. Here's security, please leave."

55:39 AVIR: I'm exaggerating. But lo and behold, a few years ago, all the major formula makers have added these alien sugars into the formula. LULU: Okay, you told me to bring formula. I didn't know why. Okay. AVIR: They spelled it wrong. They spell it QHMO. LULU: Oh, HMO, that's the alien sugars! AVIR: Yes. Exclusive. LULU: HMOs. AVIR: Yeah. LULU: Whoa! AVIR: I'm crediting you with that. BRUCE GERMAN: I mean, it turns out that there are dozens. LULU: That's great. That's great! BRUCE GERMAN: There are dozens of different oligosaccharides. And so far, industrially they can only make a couple. And so formula has not got the diversity that you'd like. And you need a lot. Remember, you pointed out there's more of this than protein. Evolution is saying it's as important to feed the bacteria in the baby as the baby.

56:41 AVIR: Right. BRUCE GERMAN: Soꟷso we need to get a lot more to be able to match. I mean, breastfeeding is the genius. If you look, it's a mother's ability to breastfeed that makes all this possible. AVIR: And another thing that changed is the pH scale for baby's stool also changed as a result of all this work that now normal is not just considered seven, it's anywhere from five to seven. LULU: Ah! AVIR: So science is starting to catch up. Anyways, side note. AVIR: Okay. Well, I think one question I had is sort of, you know, you look at this graph of the pH changing and the poops changing over the centuries. Like, I can't help but think this correlates so well with the rise of, like, childhood autoimmune diseases and, like, these chronic diseases.

57:22 I just wanted toꟷis there something there? BRUCE GERMAN: Yeah, we've been studying that, and it turns out that our immune system is just a magical system. The strength of the immune system is it's so personal. You're not born with an immune system; it has to develop. And the benefit of that is your immune system can learn to attack diseases your parents never had. So the ability of the immune system to develop that individual capability? Magic. There's a flaw is your immune system has to develop, be educated in the first few weeks of life.

58:02 And the immune system is basically located in your gut, for sort of obvious reasons. It's paying attention to the environment through the bacteria. If the bacteria are appropriate— Bifidobacterium infantis—then it's clear that the immune system is developing appropriately. But if the gut is full of inappropriate bacteria, and negative, gram negative and our bacteria aceE are blooming occasionally, now the immune system is being miseducated. The result of that is, with Bifidobacterium infantis, it's clear it's an intelligent immune system. If it doesn't, then it's not an intelligent immune system. AVIR: What does that mean, "intelligent immune system?" BRUCE GERMAN: It makes mistakes. So an immune system can make two kinds of mistakes. It can say, "There is danger. Don't worry about it." The other kind of mistake is, "It's perfectly benign. I should attack it as if it was dangerous." And

59:00 that's what autoimmune disease. There's over 70 autoimmune diseases, but it's sporadic chaotic. When someone doesn't have Bifidobacterium infantis, their immune system is not developing appropriately. That means it's greater risk. Doesn't mean they're gonna get autoimmune disease but they're at greater risk of having it. But that means at a particular point in time when they should be deciding this is perfectly appropriate part of me, self, a bloom of the wrong bacteria, danger. And for the rest of your life, you think that's dangerous. If it's peanut butter, it's peanut butter. If it's pollen it's allergy. AVIR: Oh, pollen. Gets me every time.

59:39 LULU: Yeah. BRUCE GERMAN: So we now have very convincing data that a part of the problem with autoimmune disease is the bacteria in your gut in this early developmental stage and lo and behold, throughout human history, Bifidobacterium infantis, that's been the one. AVIR: Wait, I gottaꟷcan IꟷI'm having a deep thought. Can I share? LULU: Yeah. AVIR: Can we get some, like, deep thought music? I need some, you know? AVIR: Let me go back, you know? Okay, okay. This isꟷI'm just putting thisꟷtrying to put this together.

1:00:10 LULU: Soliloquy it up. Go on. Full stage. Go, go! AVIR: Oh, I feel like I'm in middle school, like, giving a presentation. But, you know, I just think it's crazy that there's this, like, Y-shaped bacteria, right? That no one ever paid attention to, that we almost wiped off the face of the Earth by accident, that basically has this completely symbiotic relationship with us. I mean, like, you know, we obviously in school we learn about, like, the birds and the bees and pollination and coral and algae. But, like, who knew that, like, our babies have symbiotic relationships with this random bacteria? Like that's Sylvie. That's Lulu's baby.

1:00:53 LULU: My baby. AVIR: Like, Sylvie is a symbiote with these bacteria. I mean, it's blowing my mind. And if you really think back, like, if you really go back in time, let's go back 500,000 years, which is when we broke off from primates to become human. Bruce was telling me, if you go back, you know, to trace the genetic lineage of Bifidobacterium infantis, it broke off from its predecessor at exactly the same time. Which to me is crazy, because that means, like, we have literally co-evolved with this bacteria. I mean, like, come on! Like, this is our best friend. This is, like, our oldest and best friend that we've ever had.

1:01:32 LULU: Okay Avir, can weꟷcan weꟷsorry, can we scratch the emo music? Okay, I mean, youꟷyou put a picture of my baby up, and it's a beautiful thought but we're tellꟷyou've gathered, like, a sad story here. I mean, Brian was shut down, the study was shut down, who knows how long if it's ever gonna go. I mean, Bruce is eloquent, but his business sounds kind of on the rocks. LULU: And I feel likeꟷand then, even if we could get it back, there are all kinds of parents who can't breastfeed for different reasonsꟷeconomic reasons, body reasons, whatever it may be. So, like, aren't we just being kept away from this majestic, beautiful friend? Aren't we justꟷisn't this just sad? And we're doomed to be unhealthy?

1:02:14 BRUCE GERMAN: Got it. At this point in time, no. LULU: Okay. BRUCE GERMAN: If you look back at the history of scientific discoveries, especially related to health, they're always turbulent. This is a fundamentally different way of thinking. Historically, the way you treat your baby is you keep it away from bacteria of any kind. AVIR: Yeah. BRUCE GERMAN: You keep pathogenꟷyou scrub them. And we now realize that that wasn't the whole story. But if you look back how science moves, it's moving inexorably forward. It's just a matter of time. And if you look at all the things that milk has taught us, and now we're realizing that mothers are doing this remarkable thing. What you're doing is feeding the baby and feeding this bacterium, which acts like the perfect nanny. Itꟷ it nourishes the baby. It guides the development of the baby. It protects the baby. It fuels the baby. All those are clearly benefits that not only did we not know about, we didn't measure babies

1:03:19 enough to be able to say, "Whoops!" LULU: Hmm. BRUCE GERMAN:... years. 18 papers on poop pH. AVIR: That to me that seems like a lot. Like, I would've been fine with five. I don't know why they did 18. But I mean, I guess you are you seeing, like, this like, are we gonna live in this future where instead of taking, like, antibiotics, getting a prescription for antibiotics, we're gonna be getting a prescription for bacteria? Like, you need, like, 10 gallons of this bacteria stat. BRUCE GERMAN: Yeah. Well, think of what this is doing for the baby. It's nourishing the baby, protecting the baby from pathogens. It's guiding the immune system in ways we didn't even think about before. It's now been shown that babies with Bifidabacteria infantis respond better to a vaccine than babies who haven't. So that's not just protection, that enhancing helps in ways we didn't even think about before, that this is just plain healthier. Now we know what "healthier"

1:04:24 means. You immune system is exposed to a pathogen, it builds antibodies with—if the gut is helping, the bacteria are helping that immune system, then it makes more antibodies and more diverse antibodies. You're better protected. LULU: Okay, this guy can milk hope out of any situation, I guess. AVIR: Another pun. Well, I guess with that, you know, we only have one thing left to do, honestly, is we gotta start this now. We have the Bifidobacterium here. We're gonna try some. LULU: Yeah. AVIR: No pressure obviously, but if you guys want to try some we can all cheers to Bifid together. Just talk to your bartender. They're gonna be bringing them out. LULU: Okay we're gonna start passing it. Raise your hand if you want it. Once again, you do not have to. Radiolab doesn't necessarily condone it. This is gonna take a second. AVIR: This is not my medical advice. You can't sue me if something goes wrong. LULU: I kind of think we need

1:05:15 music for this section. AVIR: We need some music. LULU: And I think we need to bring in an instrument that has never been played on Radiolab ever before. Hold on. Can you mic me? Okay. LULU:... my breast pump! LULU: Okay. So, okay. AVIR: Breast milk remix. LULU: Come forward. Because it does make a noise. I don't know if you guys know this noise. Ready? Three, two no, put it there. Yeah. Go! AVIR: It's very goth—industrial goth vibe. LULU: Yeah, it's a little steampunk. Oh my God, this sound, again and again. Why capitalism, why?

1:06:01 AVIR: Don't drink it yet. We're gonna drink it together. We're gonna drink it together. LULU: We're gonna do it together. LULU: Lay down that funky beat. I promised I wouldn't freestyle. AVIR: Oh, really? LULU: And yet I'm feeling a little bit cheeria because we're about to all eat bacteria! Hands up, who still needs a bacteria? AVIR: I should get you on Soundcloud.

1:06:43 AVIR: All right. Everyone got a drink? One more. One more. One more in the back. LULU: One more hand in the back. Everyone get your bacteria ready. Okay, we got ours? Okay, we're gonna just keep the music going? Okay. Now everyone... AVIR: Turn that music down. All right. LULU: All right. The music is everywhere, so let's raise a toast to—use a microphone because I'm an audio professional. Okay, let's raise a toast to humanity's oldest friend. AVIR: All right. Cheers, everyone! LULU: Cheers! Okay, we really do it? Okay. AUDIENCE MEMBER: What did we actually drink just now? LULU: Straight up bacteria. Who just asked? Yeah, you just ingested, like—I don't know is it powder? Dried bacteria? It's those little Y-shapes. What did we drink, Bruce? BRUCE GERMAN: Yeah, Bifidobacterium longum, subspecies infantis. LULU: Okay. Okay, so now we're gonna...

1:07:49 AVIR: We gotta open it up to questions, I'm sure. LULU: Now we're gonna do a brief Q&A before we get out of here. So okay, I guess I should bring a microphone around. So I heard one over here, which was... AUDIENCE MEMBER: Is it effective with adults as it is with infants? LULU: Is the bacteria as effective with adults, or at all effective with adults? I'll come to you. BRUCE GERMAN: No, it's a great question. In order for the bacteria to grow and stabilize and start producing the acids, et cetera, it needs human milk oligosaccharides. AUDIENCE MEMBER: Which this did not have, right?

1:08:20 BRUCE GERMAN: Which you did not have. AVIR: If you want to start drinking breast milk every day. Folks have—folks are examining it together with milk oligosaccharides to prevent C. Diff disease, as we talked about earlier. LULU: Okay, we got one over here, Bruce? And Brian. For both of you. AUDIENCE MEMBER: So at the beginning, they were talking about the, like, thousands and thousands and thousands of bacteria. And the researchers were going along and checking each one that they found until they ran into this one. Is there a chance that there's more that we haven't gotten to yet, or did we just stop there and that was the end of that process? LULU: Great question!

1:08:59 BRUCE GERMAN: That's a wonderful question. We have a job waiting for you. BRUCE GERMAN: In fact, we have broadened it. Back in 2004 and 2005 when this was starting, the tools to examine bacteria were nothing like they were today. Intelligence itself was stupid. Now the capabilities to look at entire clades of bacteria simultaneously for their ability to digest these oligosaccharides. So it is as rare as we just got lucky. We found it. It was in a library from a breastfed infant. It's been predicted that if we had not found it, it would probably have been extinct within the next generation. And then we found something that wasn't there. In a Sherlock Holmes sense, it wouldn't have been findable at all in a few years. So just—but—and again, this is the consequence of evolution of mothers and milk.

1:10:03 They get the credit, not us. AVIR: Any other questions? LULU: We got one over here? AUDIENCE MEMBER: So if the bacteria needs the HMO to live and the baby is born sterile, where between the stage where they're born—getting mother's milk and the stage in which the mother is passing it on, how do they survive? BRUCE GERMAN: The bacteria? AUDIENCE MEMBER: Yes. BRUCE GERMAN: I mean, the bacteria itself, we think throughout the last 500,000 years has been living in babies. Remember, throughout human history, no diapers, no hygiene, no antibiotics.

1:10:47 And what's the first thing you do with a baby? You pick it up. We were all, anthropologically speaking, pretty much covered in B. infantis all the time. So there wasn't a problem of moving it along. And within hours, every baby was acquiring Bifidobacterium infantis. And as soon as they do, as long as there's breast milk, then away they go. It is an amazing thing to watch. BRIAN SCADALINI: You can also find B. infantis in the vaginal tract of women in the countries that have an abundance of it in the baby's poop. So they get inoculated with it as they are born.

1:11:30 AUDIENCE MEMBER: What do they survive on in there? BRIAN SCADALINI: It can metabolize other carbons. It's just the only one that we know of that can metabolize all of the dozens. There are somewhere around 90-ish HMOs of different types. LULU: I got the note that we only have time for one more and it's gonna be right here, but because I have the microphone, I'm gonna sneak one in. Okay, so this wallpaper idea, that it's helping the baby sort of understand what is self and not self, that with immunity, the wallpaper, the barrier, makes that a little easier as it's trying to learn so much.

1:12:05 So this is sort of an emotional question, but in this moment of breastfeeding—which I have found to be one of the most connecting experiences of my life—you're saying what's happening is the baby, which used to be inside me, is learning, it's building itself away from me, from other things. Like, it's actually a physiological moment of a wall being built of disconnection? BRUCE GERMAN: Well, it's true, but... LULU: Okay. BRUCE GERMAN: But you're paying forward so that that infant can be successful. The genius of milk is we tended to think milk is protective, of course. Darwin, survival; it's more than that. Evolution is driving not just survival, it's success lifelong. What you're doing is providing the means for your baby to be successful its whole life. LULU: Yeah, blah, blah, blah, give them roots and wings so they can fly away. I only heard the first part. I'm sad. Go evolution. Okay.

1:13:12 For our last question here. AUDIENCE MEMBER: Hi, thank you. This is so wonderful. I'm curious, since your efforts were sort of thwarted with, you know, distributing Bifida as a treatment, have there been any clinical trials that you're aware of that are trying to get Bifida passed by the FDA as a drug, as a treatment? BRIAN SCADALINI: So there is a reason why there is an FDA if you think about things like snake oil or other things that have been sold in the past to do things that they don't do. So the FDA is it may sound like I'm just shilling for them, but my interactions with them thus far—and I'm a biochemist, like, I have not interacted with the FDA before this, but there is a reason why they exist. They're there to make sure that what we have as drugs are efficacious and safe, and that we understand what the risks are with those drugs. We were in this position where we knew something might work to prevent a disease that's horrible, and knowing that in general it

1:14:20 was gonna be extremely hard, if not impossible, to get the money that's necessary to do that. It always comes down to dollars, unfortunately. Even the research I do has to be resourced by that. So the field found itself using it as a food because it's used as a food elsewhere in non-medicine. I mean, there's people in the room who are probably taking probiotics right now. And so we thought, we're gonna do this because there's a signal that it could be efficacious. Now in the setting of risks that are somewhat defined, but need to be defined, that's where the FDA came in and said, if we're gonna do this, we gotta do this the right way. And so we're working towards that.

1:15:06 It's a very long process; it's kind of exhausting. There's some confusion about where we go right now because there's been such change in the FDA. But we will continue to bore forward to get clinical trials put together that will see whether or not this is efficacious and safe. And we won't give up very easily. LULU: That's great. The—dare I say, the perfect cocktail of risk and safety. Okay. Well, it is time now, as we said, this is a live podcast taping, so we gotta do the credits. Someone once said if you want to hide a piece of information, put it in the credits to a podcast because no one will listen. And yet you're all stuck here! So okay, so huge thank you—he's not even on here, but to Avir Mitra for bringing us this story.

1:16:02 LULU: To Bruce German, to Brian Scadalini, right here on stage. To Shara Sheldon and all her hijinks. To our musicians, Dylan Keefe and Iván Barenboim. Biggest thank you to the Radiolab team lurking in the background. Stand up: Harry Fortuna, Sarah Sandbach, Soren Wheeler, Pat Walters, Anisa Vietze, Jeremy Bloom, and George Wellington. Speaking of Radiolab, I would like two OG members, Robert Krulwich and Ellen Horne, to stand up. Our original executive producer. They are here. We love you. None of us would be here without you. Everybody here at Caveat, thank you for bringing us here. Tip your waiters, order more drinks. We would love to come back.

1:17:00 LULU: And finally, of course, to our Radiolab members. So there are people watching us on a screen. Hi, if you're still there. Thank you. You make everything we do possible. And now, Avir, you have a couple. And I need someone else to read the very last thing—we need a listener. Anyone? An audience member willing? Okay, come on down. AVIR: So quick thank yous. This story actually came to me from a Radiolab listener named Tim Brown. So cool. So thanks to him for sharing this story. David Mills, Carlito Lebrilla, Bethany Henrik, Danielle Lemay, Katie Hinde, Jennifer Smilowitz, Angela Zivkovic, Daniela Barile and Mark Underwood. All the scientists involved in this research that I wasn't able to show. LISTENER: Hi. I'm Alexa Petrie and I'm from Halifax, Nova Scotia and here are the staff credits. Radiolab was created by Jad Abumrad, and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts. Dylan Keefe is our

1:18:00 director of sound design. Our staff includes Simon Adler, Jeremy Bloom, Becca Bressler, W. Harry Fortuna, David Gebel, Maria Paz Gutiérrez, Sindhu Gnanasambandan, Matt Kielty, Annie McEwen, Alex Neason, Sarah Qari, Sarah Sandbach, Anisa Vietze, Arianne Wack, Pat Walters and Molly Webster. Our fact-checkers are Diane Kelly, Emily Krieger and Natalie Middleton. LULU: Well done! Thank you all! AVIR: Thank you so much! LULU: Have a great night!

Questions about this episode

Who speaks in "Radiolab Presents: Viscera - The Elixir of Life"?

Lulu Miller (Host), Avir Mitra (Guest), Iván Barenboim (Guest), Bruce German (Guest), Brian Scadalini (Guest).

What is "Radiolab Presents: Viscera - The Elixir of Life" about?

"Viscera - The Elixir of Life" delves into captivating stories about the human body, featuring ER doctor Avir Mitra as the main storyteller. The event combines engaging narratives with live musical scoring, offering a unique and immersive experience that explores the intricacies of our physical existence.

What is mentioned in this Radiolab episode?

10 people, works and ideas are mentioned, including Bifidobacterium infantis, Avier Mitra, Bruce German, HMOs, Brian Scadalini, Shara Sheldon. Each one on this page links to its own page with every episode that mentions it.

How long is "Radiolab Presents: Viscera - The Elixir of Life"?

The episode runs 1 h 19 min; the transcript is about 13,971 words in 113 timestamped sections.

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