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In Keeping It Real, Jillian Michaels hosts Dr. Sabine Hazan, a gastroenterologist who has spent three decades in clinical trials and microbiome research. Hazan describes how her lab shifted focus during the pandemic to study the gut microbiome’s role in COVID-19, including attempts to detect the virus in stool and to understand how microbial balance might influence disease severity. She explains writing 57 research protocols and building standardized methods for sample collection and analysis, likening protocols to screenplays that guide experiments from stool collection to data interpretation. Hazan argues that the microbiome not only reflects health but can shape immune responses, potentially affecting asymptomatic cases and vulnerability to infection. Hazan recounts the suppression she perceives around certain treatments and findings, such as vitamin C and vitamin D protocols, hydroxychloroquine early in the crisis, and especially ivermectin. She describes censorship on social media and hesitation from institutions, arguing that political polarization interfered with scientific discourse and patient care. The discussion moves to her ivermectin work, including a personal clinical pivot from hydroxychloroquine to ivermectin and doxycycline, observations about how gut bacteria like Bifidobacteria relate to COVID outcomes, and hypotheses about how the gut-lung axis might mediate inflammation and recovery. She details a controversial arc of hypothesis, retraction, and subsequent data, contending that journals and researchers are influenced by broader forces, while insisting that listening to patients and pursuing open inquiry are essential to medical progress. The conversation then broadens to vaccines, adverse events, and the idea that mRNA technologies require careful, independent scrutiny. Hazan discusses observing changes in patients’ microbiomes after vaccination, concerns about persistent effects on beneficial microbes, and the need for transparent reporting of adverse events. She advocates for independent, nonprofit scientific work and emphasizes collaborative, global learning about the microbiome’s diversity. The episode closes with Hazan’s call for humility in medicine, a push for open dialogue, and a vision of a microbiome-informed future where different cultures’ microbial ecosystems enrich our understanding of health rather than divide it.

The microbiome is a mutable ecosystem of microbes, including bacteria, viruses, fungi, and yeasts, residing in and on the human body. Colleen Cutcliffe, with a background in biochemistry and molecular biology, discusses her journey from academia to founding Pendulum, a company focused on microbiome-based products. She emphasizes the potential of microbiome interventions, particularly through fecal microbiome transplants, to improve health outcomes. Cutcliffe explains that the gut microbiome is established at birth, primarily influenced by the mode of delivery and early exposure to maternal microbes. The diversity of the microbiome peaks in early adulthood and declines with age. While the idea that microbes outnumber human cells is debated, the functional importance of these microbes is clear, as they contribute significantly to bodily processes. The conversation shifts to the differences between prokaryotic bacterial cells and eukaryotic human cells, highlighting that bacteria can replicate independently and evolve rapidly, which is a factor in antibiotic resistance. The relationship between humans and their microbiota is generally symbiotic, although some bacteria can become pathogenic under certain conditions, such as *Clostridium difficile*, which can proliferate when antibiotics disrupt the balance of the microbiome. Cutcliffe discusses the Human Microbiome Project, which revealed significant variability in microbiomes across individuals, influenced by factors like genetics, diet, and environment. The complexity of the microbiome makes it challenging to draw definitive conclusions about specific strains and their functions. The conversation also touches on the role of different microbes, including the potential benefits of *Akkermansia muciniphila*, which is associated with metabolic health and glucose regulation. Cutcliffe describes how *Akkermansia* can stimulate GLP-1 secretion, a hormone that helps regulate blood sugar levels and appetite. Pendulum's product, Glucose Control, was developed based on clinical trials showing its efficacy in lowering A1C and blood glucose spikes in individuals with type 2 diabetes. The formulation includes multiple strains to enhance metabolic function. Cutcliffe notes the importance of rigorous scientific validation in the supplement industry, which is often plagued by unsubstantiated claims. The discussion highlights the challenges of studying the microbiome, including the need for longitudinal data and the difficulty of controlling for dietary factors. Cutcliffe emphasizes the importance of understanding individual microbiome responses to interventions, as well as the potential for future research to uncover more about the gut-brain connection and the impact of diet on microbiome health. Overall, the conversation underscores the evolving understanding of the microbiome's role in health and disease, the potential for targeted microbiome therapies, and the importance of scientific rigor in developing effective products.