 interviewed Ismail Lourido Ali, the director and counsel of policy and advocacy at the Multidisciplinary Association for Psychedelic Studies (MAPS), on psychedelic medicine policy and current advancements in the field.

During the discussion, Ali addressed whether there are continuing education opportunities for pharmacists and other health care professionals to get trained on the proper use and administration of psychedelic drugs.

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Ismail Lourido Ali, the director and counsel of policy and advocacy at the Multidisciplinary Association for Psychedelic Studies (MAPS), discusses continuing education opportunities for pharmacists to get trained on the proper use and administration of psychedelic drugs.

Continuing Education Opportunities for Pharmacists on Proper Use, Administration of Psychedelic Drugs

 interviewed Ron Aung-Din, MD, the clinical medical advisor of Pyscheceutical, and Chad Harman, the CEO of Pyscheceutical, on a novel approach to administering psychedelics for the treatment of brain disorders that does not induce hallucinogenic effects.

Aung-Din explained that the term psychedelic came about to identify compounds that can cause out-of-body experiences and even psychosis when consumed.

“Many drugs that we use in neurology which are now authorized to be used by the FDA can have those mind-altering effects too when used in high doses, but the term psychedelic specifically applies to things like LSD and psilocybin and such, which are known for their psychiatric and psychogenic properties, and which have been used in religious rituals or by people who want to have that experience,” Aung-Din said.

Aung-Din noted that the hallucinogenic effects of psychedelics are due to their presence in the blood when administered, leading them to hit receptors in the brain that can induce out-of-body experiences.

However, the traditional drugs being used pharmaceutically for conditions such as PTSD, severe mood disorders, and psychosis continue to have limitations in relation to efficacy, leading people to turn to alternative treatment avenues, such as psychedelics, to meet their unmet need.

“Just like what happened with cannabis and CBD use, which came about as a result of the inability for traditional pharmaceuticals to treat seizures, for instance,” Aung-Din said. “We're looking to psychedelics because of the potential use in medicine. They have certain characteristics which traditional pharmaceuticals do not have.”

However, Aung-Din explained that the hallucinogenic adverse effects of psychedelic medicine remain a limitation for its widespread adoption for therapeutic use. In order to address this, Aung-Din developed an administration method that does not get into the blood stream.

“This allows drugs to be used non-systemically. They are applied as a cream or a patch at the back of the neck of the hairline, where there are free nerve endings in the skin under the surface, which go right to the brain,” Aung-Din said. “We have therapeutic results within 5 to 10 minutes without evidence in blood flow or systemic side effects, and this makes it ideal for the use of drugs such as psychedelics where we don't want the systemic effects.”

Ron Aung-Din, MD, the clinical medical advisor of Pyscheceutical, and Chad Harman, the CEO of Pyscheceutical, discuss a novel approach for administering psychedelics for the treatment of brain disorders that does not induce hallucinogenic effects.

Novel Psychedelic Treatment Approach Bypasses Hallucinogenic Effects to Allow Widespread Adoption

 interviewed Ray Tancredi, RPh, MBA, divisional VP of specialty pharmacy development and brand Rx/vaccine purchasing at Walgreens, on his presentation at the Asembia 2021 Specialty Summit on specialty pharmaceuticals in development.

During the discussion, Tancredi addressed key drugs in development that are slated to launch in 2022, key drugs in development that are slated to launch in the future of note, and some of the promising and unique medications to keep an eye on that are expected to be approved in the specialty pharmacy space.

Ray Tancredi, RPh, MBA, divisional VP of specialty pharmacy development and brand Rx/vaccine purchasing at Walgreens, discusses key drugs in development that are slated to launch in 2022.

Key Drugs in Specialty Pharmacy Slated to Launch in 2022

. In this series we are exploring some information about a variety of over-the-counter products that both affect consumers and provide opportunities for pharmacists to share their insights.

Products featured in this series come from the 

®. Now in its 25th year, the guide features pharmacists’ top recommended products and brands, covering more than 800 specific products from 148 categories based on a national survey. 

, an authority in rankings and consumer advice, to bring these pharmacist recommendations to consumers nationwide.

With that said, let’s see what’s on the shelf.

Today we are going to talk about immune support and ways that we can promote immunity and keep our bodies healthy. A healthy immune system is the first step of attack against outside invaders such as bacteria or viruses. When your immune system is strong, you are more likely to be able to ward off sickness. During this time of cold and flu season, the best things that we can do to prioritize our health and immune function are getting enough sleep, consistently exercising, staying hydrated, managing our stress, and not letting ourselves get too worn down. And of course, the best way to prevent illness is by washing your hands and avoiding contact with those who are sick.

There are also several supplements that people take to strengthen the body’s immune response either by taking them regularly or at the onset of cold symptoms. These supplements usually contain ingredients like vitamin D, C, zinc, elderberry, echinacea, or garlic.

, it is estimated that there are over 822,000 recommendations made by pharmacists for immune support vitamins and supplements each month. Among immune support vitamins and supplements, Emergen-C was the brand pharmacists recommended most often.

Emergen-C has long been the go-to supplement for travelers and others who needed to get some additional immune support. Packed with vitamin C and other essential nutrients, Emergen-C is a powder that dissolves quickly in water and comes in a variety of flavors. Airborne is another product that 31% of pharmacists recommend for immune support. Airborne contains Vitamin C, zinc, herbals, and amino acids and is best taken proactively before the signs and symptoms of a cold appear.

A healthy, balanced lifestyle is one of the key preventative things we can do to support our immune function. By exercising regularly, eating a nutritious diet, getting enough sleep, and managing our stress, we will be better fortified to head into cold and flu season.

When you do feel that your diet may not be giving you all the essential nutrients that you need, or you are looking for an extra boost, there are some things to look for when grabbing an immune support product.

Zinc taken orally may help to treat colds, but it can cause side effects and interact with medicines. A 2015 analysis of clinical trials found that oral zinc helps to reduce the length of colds when taken within 24 hours after symptoms start. Oral zinc can cause nausea and other gastrointestinal symptoms. Long-term use of zinc, especially in high doses, can cause problems such as copper deficiency. Zinc may interact with drugs, including antibiotics and penicillamine (a drug used to treat rheumatoid arthritis).

Vitamin C does not prevent colds and only slightly reduces their length and severity. A 2013 review of scientific literature found that taking vitamin C regularly did not reduce the likelihood of getting a cold but was linked to small improvements in cold symptoms. The results can vary greatly from person to person. People with kidney disease should not take Vitamin C supplements unless directed by a doctor.

Echinacea is an herbal supplement that some people use to treat or prevent colds. Research is not conclusive if it prevents the duration or severity of a cold, but we do know that echinacea has anti-inflammatory, antiviral and antioxidant properties. Echinacea products vary widely, containing different parts of the echinacea plant. In addition, echinacea has not been shown to reduce the number of colds that adults catch. Only a small amount of research on echinacea has been done in children, and the results of that research are inconsistent.

Elderberry is also a supplement that has been used for centuries and Sambucol (which contains elderberry) was the third most recommended supplement for immune support in the OTC guide. Some preliminary research suggests that elderberry may relieve symptoms of flu or other upper respiratory infections. Elderberry has antioxidant and anti-inflammatory properties as well.

B vitamins, Vitamin D and garlic are other supplements that pharmacists often recommend to support immune function.

Most of all, when choosing a supplement, stick to the package dosing and make sure that you talk to your doctor or pharmacist if you are taking prescription medications (to avoid interactions).

That’s it for this episode of “On the Shelf.” Thank you for watching. Keep an eye out for our next episode. In the meantime, check out more pharmacist recommendations and practical information at 

Joanna Lewis, PharmD, MBA, presents data from the Pharmacy Times’ OTC Guide and explains the pharmacist recommended options for over-the-counter immune support supplements.

On the Shelf: Immune Support

In this series we are exploring information about a variety of over-the-counter products that are helpful to consumers and providing opportunities for pharmacists to share their insights.

®. Now in its 25th year, the guide features pharmacists’ top recommended products and brands covering more than 800 products from 148 categories based on a national survey.

Today we are talking about eczema care and relief products. 

 is a term used to describe a group of conditions that cause inflamed, irritated, and itchy skin. Eczema affects up to 15 million Americans each year, and as many as 15% to 20% of people experience it at some point in their lives (infants 10% to 20%).

Eczema appears most commonly on the face, inside the elbows, behind the knees, and on the hands and feet. It has been linked to genetic and environmental causes; however, the cause is unknown.

There is no cure for eczema, but most cases can be controlled with a customized skin-care plan that may include moisturizers, prescription medications, and strategies to eliminate triggers.

 it is estimated that there are over 748,000 recommendations made by pharmacists for eczema care and relief products each month. Also from the 

among eczema care and relief products, CeraVe was the brand pharmacists recommended most, followed by Eucerin and Aquaphor.

CeraVe products are formulated with ceramides, which are lipids that help restore and maintain the skin’s natural barrier. Eucerin is also a highly recommended product that acts as a moisturizer and skin protectant, and Aquaphor was 1 of my personal favorites when my infant had patches of eczema.

These products are gentle and fragrance-free.

Eczema can often be managed by good, consistent skin care, avoiding triggers, and managing stress.

Try not to scratch the inflamed area or rash, and relieve itchiness by using moisturizers, topical steroids, or prescription creams.

When choosing a moisturizer, choose a cream or an ointment as a moisturizer instead of lotions because they don’t work as well to penetrate the skin barrier. CeraVe, Eucerin, and Aquaphor make products that are good to try. Make sure you buy the formulations that are fragrance-free and have a low alcohol content to avoid additional irritation.

OTC antihistamine products can be used for severe itching and OTC steroid creams and ointments can also be applied to help with itching and redness.

Children and adults with eczema should avoid long, hot baths or showers that can dry out the skin and be sure to apply cream as soon as they get out of the bathtub. Moisturizers work best when they are applied to skin that is wet or damp. These products soften the skin and help it retain moisture. After washing or bathing, pat the skin dry, then apply the moisturizer right away.

If air is contributing to the dryness of skin, use a humidifier.

Wear loose-fitting clothing, and avoid scratchy fabrics like wool.

Avoid things that you are allergic to, like animals, foods, dyes, and pollen.

Manage stress and other triggers that may cause flares.

Sometimes eczema requires a prescription treatment, so be sure to contact your physician or health care provider if you need further support or if you have signs of infections, such as fever, redness, and pain.

. Thank you for watching. Keep an eye out for our next episode. In the meantime, check out more pharmacist recommendations and practical information at 

Joanna Lewis, PharmD, MBA, gives an overview of eczema and its symptoms and provides details on the best available over-the-counter medications.

On the Shelf: Eczema Care and Relief

 interviewed Rita Wise, DEd, MSN, RN, the program director of the Masters in Nursing Education and Nursing Administration programs at Pennsylvania College of Health Sciences, on the national nurse staffing crisis, which is not only effecting hospitals, but also nursing faculty at academic institutions.

During this discussion, Wise explained her hopes for how the country and US health systems will respond to the national nurse staffing crisis in order to support the ongoing needs of the COVID-19 pandemic, as well as future health crises.

Rita Wise, DEd, MSN, RN, program director of the Masters in Nursing Education and Nursing Administration programs at Pennsylvania College of Health Sciences, discusses her hopes for how the country and health systems will respond to the national nurse staffing crisis.

Expert: During the Nursing Staffing Crisis, ‘Pharmacists Have Been a Godsend’ for Nurses

Minority researchers and investigators from underrepresented communities often have access to less clinical research funding than other clinical researchers, according to Barbara Goodman, MBA, president and CEO of Cures Within Reach.

In an interview with Pharmacy Times, Goodman said new funding from the organization is aiming to improve these access issues specifically for clinical trials of repurposed drugs. Because repurposing trials often have fewer hurdles than de novo trials, the much-needed treatments could reach patients sooner. In order to support this research, Goodman said Cures Within Reach is in the process of selecting researchers to fund, both in the United States and internationally, and those selections will be completed by the end of the year.

Minority researchers and investigators from underrepresented communities often have access to less clinical research funding than other clinical researchers.

New Funding Opportunities Support Researchers, Communities of Color

. In this series we are exploring information about a variety of over-the-counter products that both affect consumers and provide opportunities for pharmacists to share their insights.

Today, let’s talk about cough, cold, and flu products. The common cold leads to more health care provider visits and absences from school and work than any other illness each year. More than 200 viruses contribute to the common cold, and people in the United States suffer from 1 billion colds annually.

The common cold and the flu are spread by airborne droplets and are more prevalent in fall and winter months for several reasons: people are indoors more and in closer proximity, schools are in session, and lower humidity causes dry air passages and makes them more susceptible to viruses. Symptoms of the common cold are runny nose, congestion, scratchy or sore throat, sneezing, mild fatigue, headache, and low-grade fever. Symptoms of the flu can be similar to a cold; however, the flu more commonly presents with a higher fever, body aches, fatigue, and headache. Mild to moderate cases of the cold and flu are usually treated with rest, fluids, and symptom management with OTC medications.

Based on the 2021 OTC Guide® provided by Pharmacy Times®, it is estimated that there are over 2,395,000 recommendations made by pharmacists for daytime cough, cold, and flu combination products each month. That’s a lot! Among the recommendations for daytime cough, cold, and flu combination products, DayQuil was the brand pharmacists recommended most often. Also from the OTC Guide®, it is estimated that there are over 2,949,000 recommendations made by pharmacists for nighttime cough, cold, and flu combination products each month. Among nighttime cough, cold, and flu combination products, NyQuil was the brand pharmacists recommended most often.

Whether you are looking for a cough, cold, or flu combination product, it is important to pick a product based on your symptoms. Most products are specific for cough; or cough and runny nose; or cough, runny nose, and fever. There may be several formulations for each brand. For example, Dayquil’s cold and flu product contains acetaminophen, dextromethorphan, and phenylephrine, while Dayquil’s severe cold and flu product contains dextromethorphan, guaifenesin, and phenylephrine.

If you are looking for a product that targets cough only (Delsym, Mucinex DM, and Robitussin were the top picks), some of these, like regular Delsym, will have dextromethorphan only (a cough suppressant); some, like regular Mucinex, will have guaifenesin only (an expectorant that breaks up mucus); and other products will contain both dextromethorphan and guaifenesin (Mucinex DM and Robitussin DM).

For congestion, Sudafed and Claritin D are the top recommended nasal decongestants with pseudoephedrine as the active ingredient. Phenylephrine is also a decongestant that is in many cough and cold products. If you or your patient has high blood pressure, avoid pseudoephedrine, and look for a decongestant like chlorpheniramine in Coricidin or a product labeled for high blood pressure or ask your pharmacist for a recommendation. There are also decongestants that come in nasal sprays, with Afrin being the most commonly recommended.

To dry up a runny nose, choose a medication with an antihistamine, such as Claritin, Zyrtec, or Allegra. These products should be fine for daytime use. Chose a product like Claritin, Zyrtec, or Allegra-D when you need the combination of an antihistamine (dry up) and a decongestant to relieve nasal congestion.

Nighttime formulations will have a sedating antihistamine, like diphenhydramine (Benadryl) or doxylamine. These make you tired and drowsy, so it’s important that you do not operate heavy machinery or drive after taking these medications and do not use them during the day.

People with certain conditions may need to avoid some products. For example, patients with diabetes may want to pick a syrup formulation that is sugar-free. As we talked about earlier, people with high blood pressure will want to stay away from decongestants like Sudafed.

Joanna Lewis, PharmD, MBA, discusses practical considerations when selecting over-the-counter medications to treat common cough, cold and flu symptoms.

On the Shelf: Cough, Cold, and Flu

 Moving along, we described the pathophysiology and prevalence. Let’s talk about treatment. How do you treat patients? Is it the same? You watch and wait, and I’m sure there’s maintenance therapy. Amit, do you want to take that question?

 Yes, Bhavesh. As I was mentioning, marginal zone lymphoma is low-grade lymphoma, so we generally follow the same treatment guidelines for low-grade lymphomas. I discuss with my patients that low-grade lymphomas aren’t curable, especially if they’re advanced stage. Early stage, there’s still the potential for cure. We also follow the same guidelines for indication for treatment. Most of the time, these patients have accidental diagnosis of lymphoma. They were going for something, and they found a lymph node and a biopsy came back as marginal zone lymphoma. About 15% to 20% of patients with marginal zone lymphoma have symptoms. Once you diagnose, if they don’t have symptoms or don’t meet some of the criteria, as you mentioned, wait and watch is a very good approach. I don’t like the phrase 

 means, “We’re going to wait for something to happen.” I’d rather say active surveillance. I’m going to actively look to see if something happens and then jump on the treatment.

For early stage, there’s still the potential for cure. You could achieve that by giving radiation. You’re always going to have a risk-benefit in that situation. It depends on the site you’re going radiate. If it’s axillary lymph node, you can radiate and have a patient cured with a low-grade lymphoma. For advanced stage, following the same guidelines, if they meet the indications for treatment, that’s when you jump in and do systemic therapy. CD20-directed therapies are the mainstay of frontline therapies if there’s low bulk and no B symptoms. But if they are advanced, have bulky disease, have total fusion, or have low blood counts—what we call cytopenias—that’s when you say, “You need chemoimmunotherapy.” In that setting, CD20-directed therapy, which is rituximab, is combined with either bendamustine or CHOP [cyclophosphamide, doxorubicin, vincristine, prednisone]– or CVP [cyclophosphamide, vincristine, prednisone]–based regimen.

 Thank you for that insight in terms of treating it. Understanding how powerful B-cell depletion therapies are in this disease, I recently read an article that said some of the patients with low-grade disease 7 years out can still be under remission just from having 4 doses of rituximab, which is amazing. The other question I had was in terms of maintenance therapy. What’s the strategy of maintenance for this patient population, especially if they’re getting single-agent rituximab, and then if it’s combination for the other patient population?

 Great point, Bhavesh. Highlighting the importance of type is also important. Whether this is nodal vs a mucosa-associated marginal zone lymphoma or splenic marginal zone lymphoma, all would have different goals of therapy. Among this, I feel that advanced-stage nodal marginal lymphoma is the 1 that’s going to give you trouble. The others have relatively better outcomes.

You brought up a very good point about maintenance. We know that maintenance therapy improves progression-free survival for low-grade lymphomas, but we haven’t seen the impact on overall survival. That also applies to marginal zone lymphoma.

I want to highlight in the current time, especially in a pandemic, that when you put these patients on maintenance therapy, there are 2 disadvantages. The first is that they have to come more frequently to the clinic to get the infusion. That’s why they’re at relatively high risk of catching COVID-19. Hospitals are the main source. The second, which is important, is chronic B-cell depletion. That leads to hypogammaglobulinemia, which puts them at high risk of infections in general. Pneumonia and sinus infections are most common, and they also have a high risk of catching COVID-19 in that situation. Multiple recent short-term studies have shown that patients who are on maintenance or even vaccinated patients with lymphoma don’t import as much strong immune response from the vaccine compared with other patients.

 It’s important to highlight for our audience that we had identified that there was a very high mortality rate for patients who are on B-cell depletion therapy who developed COVID-19. We also eventually identified that if the vaccine isn’t timed appropriately, in terms of initiation of B-cell–depletion therapy, then you don’t mount adequate antibodies to fight, so patients would end up with COVID-19. They think they’re fully vaccinated and protected, but because it wasn’t properly timed, we saw failure of the vaccination. We were very proactive in identifying patients on B-cell depletion therapy for not just lymphoma but also rheumatoid arthritis and even MS [multiple sclerosis]. It’s really important to highlight that.

Thank you for sharing the COVID-19 perspective. Because on top of COVID-19, if you have limitations in how many chairs you have and how many patients you can treat in a day because of social distancing and timing of the fusions, it’s beneficial if you’re able to not do maintenance sometimes, because then you’re reducing that footprint for the patient and maybe even helping to improve efficiency in your clinic.

 That’s true, especially when you don’t have survival benefit. The other thing I want to mention, which I emphasize for my patients, is to make sure they’re vaccinated. Especially if I have the luxury of planning the treatment, if they’re not vaccinated, I emphasize that. Even though the immune response is not great in patients with lymphoma, especially when they’re on therapy, they still get some immune response, and that may help in terms of COVID-19 infections.

Shared insight on treating marginal zone lymphoma with the current treatment armamentarium.

Management of Patients With Marginal Zone Lymphoma: Current Treatment Options

Carl, help me understand. You were talking about the structure, and you said it’s easy and hard. It seems as if the diversity of organisms is what trees are in our forest. The structure is what they do, and the resilience is how they do in drought periods or others. Is that a fair analogy?

Correct. It’s about how they come back. The simple part is you have this core. The more complex part is this diversity, and we don’t know what that true diversity should be from individual to individual. When we think about an organism like 

], we think about how it exploits the loss of biodiversity as well as some of the core functions. Two of the core elements are the firmicutes and the bacteroidetes. In the setting of destruction of the rainforest, for instance, if someone is exposed to an agent like antibiotics, you lose a lot of those core functions. Some of those core functions, as Dr Khanna mentioned, are immune regulation and colonization resistance. 

 will exploit that loss, and it will overgrow and begin to cause disease.

The concept is that in addition to when we talk about diversity results, the concept of richness within diversity, richness is the number of species that you have. Then we talk about diversity within richness and the fact that a lot of these species have redundant functions. It’s not that you’ve got 1 species or 1 bacterial species that has all the functions that are going to be not present with other species. There’s redundancy that we see among different bacterial species and different bacterial taxa. That redundancy is what keeps us healthier for a long period of time. It’s very difficult at times, and disrupts the microbiome in certain individuals, especially when you do have a richness along with the diversity because of the redundancy of functions out there. That makes it more complex, so you can’t attribute the entire disease mechanism to 1 bacterium because several bacteria may have similar functions with the redundancy that we see among the bacterial taxa.

What are the human conditions that result in disruption? You were talking about destroying the rainforest, which I like as an analogy. But what is it in the human condition that results in these changes? Either loss of species, which is part of it; loss of function; or loss of resilience? How does that occur? Where do we see that damage? We’ve mentioned antibiotic exposure. Is that the only 1 to worry about? Are there other things to worry about too?

There are lots of things to worry about. Antibiotic exposure is 1. How our microbiome is shaped is based on antibiotic exposure, but it starts at birth. It starts at the mode of delivery. It starts during childhood. It starts with environmental exposure during childhood and genetic conditions that we’re predisposed to. We could all probably rattle out diseases from head to toe that are impacted or associated with the gut microbiome. The big question is to distinguish between association and causation. In the prime example we understand the causation is primary and recurrent 

 infection. There are other disease entities, and I’ll name a few gastrointestinal [GI] diseases that are associated: inflammatory bowel disease, irritable bowel syndrome, nonalcoholic fatty liver disease, obesity. Then there are neuropsychiatric and other autoimmune diseases implicated.

It’s not just diseases and exposures. Even our diet plays a huge role in how we shape our microbiome. There are some superinteresting studies, primarily animal models, where animals are fed a traditional Western diet—high fat, high processed sugar—and compared with plant-based diets, which have fruits, veggies, high-end fiber. Those are completely different microbiomes. Plant-based diets tend to be anti-inflammatory, so they enrich for those health-promoting bacteria compared with Western diets, which are enriched for some of our poor-health-associated microbiota and pro-inflammatory microbes.

A superimportant question is to talk about the diet. That’s a big 1. Do you guys have any comments?

Dieting is important. If we think about 1 of the other functions that Dr Khanna had mentioned before was the metabolic functions of the microbiota. If we think about what fuels them, they’re fibers or complex carbohydrates. Depending on what kind of diet 1 consumes, you can shift the balance within days, within sight of the gastrointestinal tract. If we think about the role of fruits and vegetables, we’re always told that they have an important function in maintaining human health inside of the GI tract. When we move away from that, we start to think about all the ultra-processed foods and some of the high-protein and high-fat diets. It also shifts your floor away from the dominant species of the firmicutes as well as the bacteroidetes. Diet plays an incredible role in how we maintain our own health. It’s often overlooked because we tend to blame antibiotics all the time. Under the right antibiotic stewardship, it’s the appropriate thing to do, but there’s so much more that we can do going forward with how we manage our own health. The key is to maintain that biodiversity by fueling ourselves with the right complex carbohydrates and fibers in our diet.

For fueling ourselves with this healthier diet, with more complex carbohydrates, break it down on the clinician level. I’m just a doctor, so what does that mean for my patient? How do I explain that to my patient? What’s going to be different? We mentioned inflammation. Is there anything else, or is inflammation the key to that dynamic?

Both inflammation and overall health. A common question that clinicians get asked by patients is what can I do to improve my gut microbiome on a sustained level? Not for today, not for tomorrow, but how do I improve my microbial diversity or improve my gut microbiome? A lot of the work comes from Stanford from Dr Justin Sonnenberg’s lab, where they’ve looked at the effects of diet. Other centers have looked at that too. What I talk to my patients about is the age-old advice from my grandma: you’ve got to get at least 25 to 30 g of fiber in your diet or use the fiber supplement without simple sugars. If I look at a packet of something on the grocery store, and it says 8 g of added sugars, think 4 times before you buy it. That’s simple advice that I give to my patients. That works in a lot of patients, barring some diseases where you must use a low-fiber diet. For the vast majority of patients, it works very well. That age-old advice is what we’ve learned over 10 or 15 years of microbiome research, sparing FMT [fecal microbiota transplantation] for 

 infection, is how do you change or maintain a healthy microbiome is the advice that I give my patients.

Listen to your grandmother. That’s what I just learned. That’s fantastic. Kelly, any comment?

I agree. Although it can be difficult to get patients to change their diet, it’s a simple intervention that we know can improve not only our microbiome but also our overall health. When we talk about fiber, you’ll hear the term 

. These are our substrates of the microbes that essentially act as food for the microbes, so that’s something that you can talk to your patients about because they may hear that term. We hear a lot about probiotics, but prebiotics are these dietary substrates that can help feed the microbes in the gut.

: If I’m understanding this correctly, the prebiotic is what we’re feeding our gut, almost like fertilizer for our garden.

Then the probiotics are the plants we’re putting in our gardens so you can supplement with the probiotics. Does that fit?

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Shared insight on how disruption of the gut microbiome may occur based on antibiotic exposure, environmental factors, and diet.