How A Mother's Letter Inspired A Scientist To Revolutionize Consumer Microbiome Testing

This article originally appeared on Forbes

By Afif Ghannoum

He called me with the big news. “CBS News just called me about the paper!” My dad couldn’t believe it. In his 40 plus years of research on fungal disease, he’d never had a study truly garner worldwide attention.

Sure he was the scientist who’d named the mycobiome (the fungal community in our body), and his worked had been cited over 18,000 times by other scientists, but at the end of the day, it wasn’t very often people beyond the medical community were that interested in fungus. But his discovery that fungus exacerbated Crohn’s disease symptoms was spreading like wild fire.

The interest was mostly driven by the fact his discovery had implications for anyone dealing with gut health issues.

Briefly, discovered that disease-causing bacteria and fungi in our guts work together to protect each other. They do this by creating digestive biofilms, building up along the intestinal wall, and disturbing the balance of the gut’s microbiome.

For Crohn’s patients, digestive biofilms seemed to intensify the devastating symptoms they experienced. It also suggested that biofilm was a likely culprit when it came to many digestive health issues.

The applications of the study were tremendously exciting because it meant that my father, and other scientists, could potentially create therapies based around controlling the growth of digestive biofilm in the gut (side note, digestive biofilm is also sometimes called digestive plaque. In fact, every plaque, from those found on our teeth to our arterial veins, are biofilms).

As a result, not only was the Crohn’s community very excited, but so were millions of others trying to optimize their digestive health.

Within hours of the publication going live, he literally heard from thousands of people that either had Crohn's disease, or had a family member that was suffering from it.

Very quickly my father went from elation to frankly being overwhelmed. It wasn’t so much the attention, but rather the seemingly unending stream of people that were reaching out, desperately hoping he could somehow help them or someone they loved who was suffering.

We were grabbing lunch at a Lebanese restaurant near his lab when I looked at him. He was absolutely beat. This is a man who bounds out of bed at 430am to work out for an hour and be at the office by 7am, working furiously on a thousand things, while laughing half of the day. I remember how excited he was when he first showed me pictures from his study a few weeks before. Now his ever-ready smile had been replaced with a look of weariness. This just wasn’t him.

“What’s up?”

He unloaded. Over the next couple of hours we talked about the study, the interview requests that continued to trickle in, which ones he should respond to, which he shouldn’t, and the countless people that had reached out to him.

Hearing the very personal stories of how Crohn’s and other chronic digestive issues impacted peoples lives was really weighing on him. Here he had made a major breakthrough in digestive health, but he felt useless when it came to being able to actually help these people.

But…he had an idea he wanted to talk about.

He took a folded piece of paper out of his shirt pocket and handed it to me.

It was an email from a woman in Sweden. Through several paragraphs, this poor mother shared how her two sons, both suffering from Crohn’s disease, were wilting before her eyes. Her once robust sons, had been reduced to shadows of themselves, with one of them being admitted to the ICU nine times.

She was desperately seeking my father’s help after talking to doctors all over Europe to no avail. She even offered to fly her sons to meet him in Cleveland.

I noticed my father had highlighted a sentence at the bottom of the email. "Or maybe there's a possibility to have tests sent to you...?"

“What do you think?” My dad said.

“What do you mean?” I wasn’t quite getting where he was going.

“What if we could send her test kits? What if we could make it so anyone who wanted to have their microbiome sequenced in our labs, could have a test kit sent to them through the mail?"

“Here we go.” I thought.

You see, my father and I are business partners, and over the last several years we’ve combined his scientific expertise with my biotech background to launch about a dozen products that have been sold in over 25,000 retail stores and online.

Our specialty is turning hard science into health products that consumers can buy directly.

In fact, in the weeks after his discovery, we had decided to launch BIOHM, a probiotic that addresses both bacteria and fungi in the gut (I’ve been writing about that process here).

So here we were, sitting with a couple of half-eaten falafel wraps in front of us, and my dad was now talking about taking a massive leap, and creating a consumer microbiome testing kit.

My first thought was that I had definitely seen companies popping up that offered kits that supposedly sequence your microbiome. How would this be different?

Dad had thought about that. From his computer bag he took out a tattered manila folder stuffed with highlighted website pages.

“It’s like probiotics! Everyone else…they only talk about bacteria and ignore fungi in the gut! It makes no sense! We could sequence people’s bacteria AND fungi!”

Perusing the print outs (a few of which had now accidentally been dipped in hummus), it did seem that over and over these companies only talked about bacteria. No one appeared to address fungi at all.

So concern number one was answered. Actually, it seemed like there was a lot of potential based on one key advantage I knew we had: My Dad!

He is widely considered the leading fungal scientist in the world, with incredible expertise in sequencing both bacteria and fungi in the gut. He literally lectures the National Institutes of Health on the latest innovations in the microbiome, and what they should be funding. Add to that the fact that over the last few decades, he’s assembled a library of over 30,000 clinical strains of fungi, one of the largest collections of fungi in the world (some people collect cars, he collects fungi. What can I say). Point being, there were not many, if any, companies that had could rival our level of in-house expertise and resources.

So the idea was that with a few simple taps on their phone, consumers could access the exact same genetic sequencing testing that powers my father’s global clinical trials. We truly had the chance to create the most advanced microbiome sequencing test available. In fact, we didn’t even have to create it. It already existed. In my dad’s lab!

But… that brought me to concern number two. How the hell do we figure out the logistics? This wasn’t as simple as creating a product. Once you’ve created a formulation, you just make more of it, and when people order it, you just put a bottle in a box and send it away.

Here there were (what seemed like) a thousand moving parts. A few of the things we’d have to figure out:

• How do we create an intuitive kit that consumers would find easy to use?
• How would the lab track the kit once it arrived, and process it?
• How do we make it easy to order?
• How would we make the results easy to understand and informative to the average consumer, while not being a diagnostic test? (a critical distinction with regulatory implications)
• How would we handle fulfillment, when each kit would have to be personalized for the individual person?

These were no small tasks. For example, lets take making the report easy to understand. If I hand you a list of the bacteria and fungi in your gut, assuming you’re not a bioinformatics expert, it’s basically going to be meaningless without any context. Are these species good? Not good? Are my levels too high? Too low? You’ll be lost and ultimately frustrated.

So to that end, every test would have to not only include a person’s specific results, but also how they compare to the levels found in people with normal gut balance.

So we needed comparative data to create a baseline. For the bacteria, it made sense to use data from the National Institutes of Health Human Microbiome Project, which is the largest microbiome study ever conducted. As part of the study, the NIH was able to measure the normal levels of gut bacteria in people who are healthy.

For fungi, we were lucky in that my father’s lab had generated baseline data, measuring the fungal species and levels that are found in normal guts.

Of course, we’d have to organize it all into a digestible report (no pun intended), but having comparative data was a start.

Long story short, the logistics involved were highly intricate. But….that also represented an opportunity. If we could master it, we would have a process that was pretty hard to replicate.

The other tremendous advantage we had was that we didn’t have to tackle the biggest obstacle of all: creating a world class lab that had the expertise to perform the delicate process of genetically sequencing the microbiome of bacteria and fungi. Dad’s lab has been sequencing bacteria and fungi for years at the highest levels of scientific rigor for not only their NIH funded clinical trials, but also for many of the largest pharmaceutical companies in the world.

Lastly, just in the last couple of years, we had officially entered the age of DIY personalized health, with people wanting to “own” the process of accessing their genetic information. Thanks in large part to companies like 23andMe and Ancestry.com, consumers were already used to the idea of buying DIY genetic tests online.

In fact, people were buying products online, that just a few years ago would have seemed crazy. Want a mattress? No problem, Casper will send you one. Want a car? No problem, Tesla will send you one.

That made me feel comfortable that selling a microbiome testing kit directly to people online wasn’t a far fetched idea, that is...if we could crack the code on the logistical issues I mentioned.

Then it hit me. There was actually a bigger opportunity here. When you look at the world of consumer health companies, they generally fall into one of two categories: They either sell products (like OTC drugs and supplements), or they sell services (like genetic sequencing tests).

There really didn’t seem to be many that did both. To me, that didn’t really make sense. The same customer would likely be interested in both products and services for their health needs, so why wouldn’t you offer them both?

I also saw it as a substantial strategic advantage on a couple of levels:

First, with BIOHM probiotics, we would be competing with some of the largest consumer packaged goods companies in the world. While we definitely had a significant differentiator with fungi, as well as our scientific expertise, the reality was they could likely outgun us due to their sheer size alone.

But…what wasn’t really in their wheelhouse was the genetic sequencing side of the equation. It was one thing for them to go after our probiotic, but it seemed highly unlikely that they would get into the genetic sequencing game. That meant setting up labs, getting the expertise, and setting up a fulfillment process they were just not accustomed to doing. So by offering both probiotics and sequencing, it felt like we had a pretty sizable moat around us.

The second advantage involved competition from other sequencing companies. Aside from the fact that they seemed to only sequence bacteria (giving us an instant substantial differentiator), their entire business model revolved around building incredibly expensive genetic sequencing labs. That meant building teams, and raising money around that model. It also meant that they had to charge consumers a pretty penny for their tests in order to make their business model viable.

We were in the exact opposite position. By partnering with my father’s labs, and paying them only when testing was performed, we weren’t burdened with the overhead of maintaining and staffing our own labs.

On the product side, we had years of experience manufacturing OTC drugs, so we were very familiar with how to create the supply chain, and had already been working on that for the probiotic.

But what would truly set us apart, was a business model that seemed like it would be pretty hard to beat by either mega companies or sequencing companies: Consumers could buy either the probiotics, or microbiome testing by themselves. But, if they bought a certain amount of the probiotic, we would give away the genetic sequencing for free.

Either way it was a great deal for consumers: If they were interested in probiotics, they could get a very sophisticated microbiome test for free, but if they were more intrigued by the test, they could get a highly engineered probiotic basically for free (when you factored in what it would cost them to just buy the testing kit alone).

Business model in hand, and a ton of challenges to figure out, we set off in the fall of 2016 to create BIOHM Health, a microbiome company that offered both products and services.

So almost six months to the day after we came up with the idea, we did just that, launching our website with BIOHM probiotics, the first probiotics engineered to address the critical role of fungi in the gut, and the BIOHM Gut Report Kit, the first microbiome test that allowed consumers to access the same labs used for ground breaking NIH clinical trials, and big pharma genetic sequencing studies.

When we went live on March 1^st, 2017, my dad came down to the office with a bottle of champagne for the team. He thanked us all for the hard work, and said “let’s hope for the best!”

Would it work? Who the hell knew. Sipping champagne, I was hopeful, but more importantly, I was proud of us.

It was awesome working with my father, and we were actually doing something important by providing access to testing that could potentially help millions of people. We had raised some money from angel investors, but we had also put our money into it. I joked that worst-case scenario, my wife and I still had enough in savings to send our kids to community college for a semester.

It drove me crazy reading stories about companies raising tens of millions of dollars to “change the world” through solving problems that either didn’t really exist, or did exist….for the 0.1% that reside in Silicon Valley. That wasn’t us, so whatever happened, I felt good.

And so far…it seems to be working. Since March, we've been inundated with consumers buying both BIOHM probiotics and the BIOHM Gut Report Kit. In the first six months, we’ve generated millions of data points of microbiome sequencing, which is more data than my father has generated in a decade of clinical trials.

Since then, we’ve continued to grow out the product line, and we recently introduced the BIOHM Candida Report, which allows consumers to get readings of both the types and levels of Candida in their microbiomes.

It’s truly been a whirlwind and to be honest, the best part has been seeing how exciting it’s been for my father.

And it all started with an email from a mother in Sweden. Someone reaching out in desperation, who ended up inspiring us to create a way to potentially help millions. By that measure alone, we’re already a success.

Afif Ghannoum is the CEO of BIOHM Health, makers of BIOHM Probiotics and the BIOHM Gut Report. 

BIOHM is the first company to engineer products and services around the critical role of fungi in digestive health.