• Why We Eat: The Science of Appetite, Nutrition and Weight - Prof Alexandra Johnstone
    Jul 23 2026
    Professor Alexandra Johnstone joins Dr James McIlroy to explore what makes us hungry, what helps us feel full, and why healthier choices are rarely a matter of willpower alone. A conversation on chrononutrition, protein, food inequality, GLP-1 medicines and the future of public health. The big idea: Our bodies, habits and surroundings all influence how we eat. Better health therefore needs more than individual resolve: it needs practical advice, supportive environments and policies that make nourishing food easier to choose. Breakfast, body clocks and the timing of food Is breakfast really the most important meal of the day? Professor Johnstone’s answer is an emphatic yes—but not because breakfast has any magical property. Her research focuses on chrononutrition: the relationship between what we eat, when we eat it and the body’s roughly 24-hour circadian rhythms. The timing of the largest meal may not dramatically alter how much energy the body burns, but it can change how eating feels. A larger breakfast appears to help people feel fuller and may make a calorie-reduced diet easier to follow. The body also tends to be more sensitive to insulin earlier in the day. There is no universal clock-time definition of breakfast. A useful way to think about it is the first meal within two or three hours of waking. Fasting is a tool, not a loophole Intermittent fasting and time-restricted eating can be useful for some people, but they are behavioural strategies rather than shortcuts around energy balance. Professor Johnstone favours including the morning meal and offers the practical reminder: eat breakfast like a king and dine like a pauper. What does a healthy breakfast look like? From traditional cooked breakfasts to fortified cereals, the conversation explores nutritious options while highlighting the difference between everyday foods and occasional treats. Hunger and appetite are not the same thing A clear and helpful distinction between true hunger and appetite, and why reducing eating behaviour to willpower alone is so misleading. Why protein is filling Protein is the most satiating nutrient. The episode dives into the science of satiety, the importance of whole-food sources, and why solid protein tends to be more filling than liquid forms. Fibre does a different—but equally important—job While protein excels at satiety, fibre is essential for gut health. The trade-offs and benefits of both are explored. The obesity paradox and fixing the food environment Obesity is strongly patterned by inequality. The discussion covers food insecurity, the obesogenic environment, retail promotions, and the need for policy changes that make healthier choices easier. Ultra-processed food: a debate that needs more evidence A nuanced look at ultra-processed foods, their role in the diet, and what the current science can – and cannot yet – tell us. GLP-1 medicines: powerful treatment, unanswered questions The benefits, limitations, and challenges of GLP-1 medications, including muscle preservation, long-term use, and access/inequality concerns. Alcohol, Mediterranean patterns and the value of connection The role of social connection, shared meals, and balanced enjoyment of food and drink. A practical takeaway: build patterns, not perfection Realistic, compassionate advice for building sustainable eating habits without shame or moral judgment. What comes next Professor Johnstone shares her vision for the future of nutrition science, including better guidance for shift workers, updated protein recommendations, and improved food systems. About the Conversation In this episode of Inside Matters, host Dr James McIlroy speaks with Professor Alexandra Johnstone, Chair of Nutrition at the University of Aberdeen. Timestamps: 00:00 Meet Professor Alex Johnson01:53 Breakfast and Chrononutrition05:13 Fasting and Eating Windows07:59 What Makes a Healthy Breakfast10:42 Hunger vs Appetite Explained15:49 Protein and Satiety Science18:20 Obesity Paradox and Poverty19:53 Fixing the Food Environment23:11 Gut Brain Axis and Weight Defense27:06 Obesogenic Retail and Policy Changes31:16 Alcohol Mediterranean Diet and Blue Zones38:05 Why Protein Fills You Up38:52 Protein Satiety Mechanisms39:32 Amino Acids vs Whole Protein40:48 Liquid Meal Replacements43:49 Ultra Processed Food Debate50:41 Scotland Diet Reality Check52:37 Red Meat and Cancer Risk53:47 GLP-1 Weight Loss Challenges55:07 Microdosing and Inequality01:04:19 Muscle Loss and Nutrition01:05:50 Fibre Deep Dive01:08:21 Sweeteners and Microbiome01:10:44 Future Vision and Wrap Up
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    1 Std. und 13 Min.
  • The Importance of the Reproductive Tract Microbiome: Insights from David MacIntyre
    Apr 2 2026
    For years, the spotlight in microbiome research has been firmly on the gut. We’ve learned that diversity there is generally a good thing—linked to resilience, health, and better outcomes. But what if one of the most important microbiomes in the body follows completely different rules? In a recent conversation, Dr James McIlroy sat down with Professor David MacIntyre, Director of the Robinson Research Institute, to explore a rapidly emerging field: the female reproductive tract microbiome. What they uncovered challenges many assumptions—and could transform how we think about pregnancy, birth, and early life health. 00:00 Show Returns 01:34 Why Reproductive Microbiome 05:15 Low Diversity Health 09:24 Lactobacillus Protection 12:06 Human Uniqueness 14:17 Population Differences 16:31 Oral Probiotics Myth 19:25 Vaginal Biotherapeutics Trial 22:11 Host Immune Response 27:03 Dysbiosis Triggers 30:42 Microbiome and Preterm Birth 33:06 Labor Inflammation Pathways 38:10 Pregnancy Microbiome Shifts 39:11 Screening and Group B Strep 40:57 Microbiome Screening Potential 42:06 Global Data Predictive Signatures 43:23 Limits of Current Risk Tools 45:30 Point of Care Profiling Vision 46:50 Swab Mass Spec Barcoding 48:27 Composition Versus Host Response 49:58 Metabolic Dark Matter 52:13 Beyond Bacteria, Viruses, and Fungi 55:48 Vaginal Probiotic Trials 57:39 Phase Two Trial Endpoints 01:01:28 Vaginal Microbiome Transplants 01:05:46 Birth Seeding After C Section 01:10:57 Do Vaginal Strains Persist 01:14:05 Ten-Year Personalised Medicine 01:17:45 Wrap Up And Where To Find A Different Kind of Microbiome When we talk about the gut microbiome, diversity is often considered a hallmark of health. The reproductive tract? It’s the opposite. In healthy women, this environment is typically: Low in diversityDominated by one key group of bacteria: Lactobacillus This might sound counterintuitive—but it’s by design. Why low diversity works here Certain Lactobacillus species—particularly Lactobacillus crispatus—play a protective role by: Producing lactic acid, keeping the environment acidic (around pH 4)Preventing harmful microbes from growingBlocking pathogens from attaching to tissueProducing antimicrobial compounds In short, they create a stable, protective ecosystem. When this balance is disrupted and diversity increases, it’s often linked to: InfectionInflammationPoor reproductive outcomes A Unique Human Feature One of the most surprising insights? Humans are the only species known to have a Lactobacillus-dominated reproductive microbiome. Even our closest primate relatives don’t share this feature. That suggests this system evolved relatively recently—and likely offers a meaningful biological advantage, particularly in pregnancy and childbirth. The Link to Preterm Birth Preterm birth—defined as delivery before 37 weeks—affects around 1 in 10 pregnancies globally and remains a major medical challenge. The microbiome appears to play a key role, particularly in early preterm births. What’s happening biologically? In a healthy pregnancy, labour is triggered by controlled, sterile inflammationThis process helps: Break the membranes (waters)Open the cervixInitiate contractions But if inflammation starts too early, it can trigger premature labour. Where the microbiome fits in A Lactobacillus-dominant microbiome helps: Keep inflammation lowMaintain a strong mucosal barrierReduce infection risk When this balance is lost: The environment becomes less acidicInflammatory molecules increaseThe barrier weakensRisk of infection—and preterm labour—rises Once inflammation starts, it’s very difficult to switch off. That’s why prevention is so important. What Disrupts the Balance? Several factors can shift the microbiome away from its protective state: Antibiotics (even when used for unrelated infections)Sexual transmission of bacteriaHormonal changesMenstruationHygiene practices like douching Even small changes in pH or environment can allow harmful bacteria to gain a foothold. Can We Predict Risk Earlier? One of the most exciting areas of research is using the microbiome as a predictive tool. Scientists are working towards: Identifying microbial “signatures” linked to higher riskMeasuring both: Which microbes are presentHow the body is responding to them New technologies can now analyse a simple swab and generate a metabolic “barcode” in minutes—potentially enabling rapid screening. The long-term vision? Routine testing that identifies at-risk pregnancies early—before symptoms appear. Can We Change the Microbiome? If we can measure it, can we fix it? 1. Oral probiotics: limited impact Despite widespread marketing, there’s little evidence that oral probiotics reliably reach or colonise the reproductive tract. They may have indirect benefits—but they’re not an efficient delivery method. 2. Targeted vaginal probiotics More promising is direct delivery of ...
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    1 Std. und 19 Min.
  • Gut Health, Celiac Disease & the Future of Microbiome Medicine — With Dr Debra Silberg
    Dec 4 2025

    Dr Debra Silberg joins Inside Matters for a deep, wide-ranging conversation on gut health, drug development, and the future of microbiome therapeutics.

    Dr Silberg is the Chief Scientific Officer at Beyond Celiac, a former global clinical leader at Shire/Takeda and AstraZeneca, and one of the most respected figures in GI medicine and microbiome science.

    In this episode, we explore: • How she moved from basic science to medicine to pharma leadership • Why the GI field needed so much research — and how it transformed • The real science behind ulcers, H. pylori, and the Barry Marshall story • What she teaches in her popular “Understanding Your Gut” course • Prebiotics vs probiotics — what actually matters • The truth about gluten, celiac disease, gluten sensitivity and rising incidence • The microbiome’s role in inflammation, autoimmune disease, mental health & IBS • Whether microbiome drug development is finally turning a corner • Why the gut–brain axis may be the most exciting frontier in medicine

    Dr Silberg also shares insights from her work with Finch Therapeutics, her role at Beyond Celiac, and her experience advising the team at Biotics.

    If you’re interested in gut science, the microbiome, diet, or how modern medicines are built from the ground up, you’ll get a huge amount from this conversation.

    Be well, trust your gut — and thanks for listening.

    00:00 Introduction to Dr Debra Silberg

    00:54 Dr Silberg's Career Journey

    02:26 Insights on Gut Health and Microbiome

    04:05 Understanding GI Diseases and Treatments

    07:41 The Role of Diet in Gut Health

    15:59 Celiac Disease and Gluten Sensitivity

    25:04 Exploring the Microbiome

    27:43 Exploring Therapeutic Approaches to the Microbiota

    31:36 Challenges in Microbiome Drug Development

    34:22 The Gut-Brain Connection and Mental Health

    39:13 Transitioning from Academia to Pharma

    41:45 Insights into Drug Development and Success Stories

    44:55 The Long Journey of Drug Development

    52:01 The Role of AI in FDA Reviews

    55:04 Quick Fire Round: Future of Microbiome Research

    You must not rely on the information in this video as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of the information in this video.

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    59 Min.
  • Unlocking Gut Health: FMT, MicroRNAs, and the Future with Dr Tanya Mongan
    Nov 20 2025

    In this episode, Dr James McIlroy chats with Dr Tanya Mongan, clinical associate professor and gastroenterology consultant at the University of Nottingham. Dr Mongan specialises in gut health, particularly the gut–brain connection and faecal microbiota transplantation (FMT).

    She talks us through the current state of FMT, why it works so well, and how it’s becoming an increasingly important treatment for conditions like inflammatory bowel disease. We also explore her cutting-edge research into microRNA-based medicines—a new field examining tiny molecules that can help protect the gut and may one day be used to treat conditions linked to an unhealthy microbiome, including cystic fibrosis and neurodegenerative diseases.

    This episode breaks down the complexities of the microbiome in an easy-to-understand way, covering everything from the limits of current testing to the promise of personalised gut treatments. Dr Mongan also shares insights into exciting new tools such as organ-on-chip models, nano-delivery systems for microRNAs, and even zebrafish models used in gut research.

    If you want to understand where gut science is heading, what’s real and what’s hype, and how future therapies may become more precise and personalised, this is a must-listen.

    Chapter Markers

    00:00 Introduction to Dr Tanya Mongan and gut health 01:51 Has the microbiome “bubble” burst? 03:45 The big challenges in microbiome science 06:13 What the future of microbiome testing could look like 12:45 Understanding faecal microbiota transplantation (FMT) 19:22 How FMT works and what current research shows 26:29 Why the microbiome is so complex 34:57 MicroRNAs: a new frontier in gut health 37:41 Where microRNAs come from 38:18 How microRNAs help protect the gut 39:00 Why delivering microRNAs is difficult 39:19 Nano-formulation: new ways to deliver microRNAs 40:37 The advantages of organ-on-chip models 42:02 Personalised “gut avatars” 43:58 Zebrafish and other models used in gut research 49:27 Clinical applications and future directions 53:17 Microbiome therapy and FMT in clinical practice 56:57 The future of microbiome research and treatment 01:01:23 Diet, supplements, and the microbiome 01:04:34 Weight-loss drugs and how they affect the microbiome 01:07:52 Fascinating facts about the microbiome 01:09:24 Final thoughts and wrap-up

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    1 Std. und 10 Min.
  • Fatty Liver, Gut Health, and Functional Medicine - Dr Guy Neff
    Nov 6 2025

    Revolutionising Liver Health: The Link Between Gut Health, Genetics, and Lifestyle

    In this episode, we dive deep into the intricate connections between liver health, gut health, genetic predispositions, and lifestyle factors. Our guest, Gary, a seasoned physician and entrepreneur, shares his extensive experience from pioneering liver disease research in the 90s to running a successful metabolic clinic focused on functional medicine today. Learn about the evolution of understanding fatty liver diseases like NASH and MASH, the impact of processed foods, and the groundbreaking treatments emerging, including the promising effects of GLP-1 therapies. Gary also discusses the pivotal role of a clean diet, exercise, and quality sleep in managing liver health, and the challenges of implementing these changes in a clinical setting. Don't miss this insightful conversation packed with practical advice and forward-thinking approaches to improving liver and overall metabolic health.

    00:00 The State of Food Quality in America vs Scotland 02:39 Understanding Fatty Liver Disease: Past and Present 05:29 Genetic and Environmental Factors in Fatty Liver Disease 08:13 The Evolution of MASH: From NASH to Metabolic Health 10:46 Emerging Treatments and Medications for Liver Disease 13:35 The Role of GLP-1s in Managing Liver Health 16:18 The Gut–Liver Connection: A Historical Perspective 19:07 Building a Successful Liver Clinic: Insights and Challenges 33:52 Understanding Metabolic Health and Genetic Testing 35:13 The Importance of Gut Health 37:39 Transforming Workplace Wellness Initiatives 45:48 The Future of Functional Medicine 51:30 Addressing Liver Health and Alcohol Consumption

    Takeaways

    • The quality of food in America is declining, impacting health.
    • Fatty liver disease is increasingly common, especially among those with higher body mass indexes.
    • Genetic predisposition plays a significant role in liver disease.
    • MASH is a critical condition that combines fatty liver with inflammation.
    • Advancements in GLP-1 medications show promise for treating liver disease.
    • Gut health is essential for overall wellness and liver health.
    • Guy Neff's journey reflects a blend of medicine and business acumen.
    • Building a successful liver clinic requires navigating numerous challenges.
    • Functional medicine is gaining traction as a holistic approach to health.
    • Routine testing for liver health is crucial for early detection and intervention.

    You must not rely on the information in this video as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of the information in this podcast.

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    1 Std. und 10 Min.
  • Decoding the Microbiome: Genetic Discoveries with Dr. Ran Blekhman
    Jun 26 2025

    In this episode, Dr. James McIlroy interviews Dr. Ran Blekhman, an associate professor at the University of Chicago, about the microbiome and its role as 'our second genome.'

    Dr. Blekhman shares his research findings on the genetic and environmental factors that shape the microbiome, the heritability of microbial genes, and the relationship between the human genome and microbiome. They also discuss Dr. Blekhman's groundbreaking research that analysed over 168,000 samples to understand global microbiome patterns, the influence of early-life microbiome development, and the potential of microbiome-based diagnostics and therapeutics. Tune in for a comprehensive dive into one of the most promising areas of genetic and microbial research.

    00:00 Introduction to Dr. R Blackman and the Microbiome 01:23 Podcast Growth and Listener Engagement 01:56 Starting the Conversation with Dr. Blackman 02:04 Exploring the Second Genome 02:24 Human Genome vs. Microbiome 03:23 Genetic Interactions with the Microbiome 04:02 Understanding Microbial Genes and Functions 05:40 Heritability and Environmental Factors 06:53 Microbiome Diversity and Heritability 08:57 Research on Microbiome Heritability 17:18 Baboon Model System for Microbiome Studies 18:56 Population Scale Microbiome Research 25:27 Global Patterns and Data Integration 33:36 The Untapped Potential of Microbiome Data 35:08 Hypotheses and Discoveries in Microbiome Research 36:46 Geographical Variations in Microbiome 49:18 Technical Challenges and Methodologies 52:20 AI and Machine Learning in Microbiome Studies 54:59 Future Directions and Clinical Applications 01:00:38 Exploring Early Life Microbiome 01:03:30 Conclusion and Further Reading

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    1 Std. und 5 Min.
  • Exploring the Frontiers of Microbiome Science — A Conversation with Dr Johan van Hylckama Vlieg
    Jun 12 2025

    In this episode of Inside Matters, I'm joined by Dr Johan van Hylckama Vlieg, Chief Scientific Officer at Freya Biosciences. As a global leader in microbiome research, Freya is pioneering innovative approaches to women’s health through biotherapeutics that are rooted in groundbreaking microbiome science.

    00:00 Introduction to Dr. Johan van Hylckama Vlieg and Freya Biosciences 01:39 The Potential of the Microbiome 03:08 Challenges in Translating Microbiome Science to Treatments 05:29 The Rise and Fall of Microbiome Hype 08:58 Immunotherapy and the Microbiome 20:37 Women's Health and the Microbiome 35:01 Tools for Measuring Vaginal Dysbiosis 35:31 Intervention Studies and Donor Programs 36:23 Engraftment and Immune Response 37:39 Strain-Level Analysis and Engraftome 39:08 Vaginal Microbial Transplantation 44:13 Single Strain vs. Consortia 47:15 Freya's Development and Future Vision 50:04 Lessons from Kaleido 01:00:47 The Gates Foundation and Global Health 01:03:45 Predictions for the Microbiome Field

    A Hidden World with Huge Potential

    Dr van Hylckama Vlieg has spent more than 20 years exploring the vast and complex world of the microbiome — the trillions of microbes that live in and on our bodies. These tiny organisms play a huge role in our health. Over time, science has moved from simply identifying these microbes to understanding how they influence our immune system, metabolism and overall wellbeing.

    Yet despite this progress, turning those discoveries into real treatments remains a challenge. Dr van Hylckama Vlieg explained that while the science is compelling, the industry needs solid clinical data to bring investors and pharmaceutical companies on board. He sees microbiome-based immunotherapy as a particularly exciting area where transformative breakthroughs could lie ahead.

    Why Women’s Health Matters

    Freya Biosciences has chosen to focus on the female reproductive tract — a part of the body where the microbiome is less complex than in the gut but just as important. Dr van Hylckama Vlieg spoke about the key role of lactobacilli in maintaining vaginal health. When these helpful bacteria are dominant, they protect against infections and support fertility. When the balance is lost, a state known as dysbiosis, the risks rise significantly.

    He also highlighted a wider issue — the historical lack of funding and focus on women’s health. This is something Freya and others in the field are determined to change, and their research is already moving things in the right direction.

    A Bold New Treatment: Vaginal Microbiota Transplantation

    One of Freya’s most innovative developments is vaginal microbiota transplantation or VMT. Inspired by the success of faecal microbiota transplants for gut health, this approach involves transferring a healthy vaginal microbiome into someone with dysbiosis. Early results are promising. Many women show a successful shift to a healthier microbial state.

    Looking ahead, the goal is to leverage the successes of these natural transfers and develop targeted microbial treatments that can be scaled up. This could lead to safe and widely available therapies that restore balance and improve reproductive health.

    Challenges and the Road Ahead

    Reflecting on his previous experience at Kaleido, another microbiome venture, Dr van Hylckama Vlieg spoke about the need for strong links between science, clinical design and commercial strategy. Though Kaleido faced setbacks, the underlying science remains solid and is being explored by others in the field.

    His outlook remains positive. With more trials underway and deeper understanding of how microbiomes influence disease, there is hope that these therapies will move from the lab into everyday medicine. Particularly in areas like immunotherapy, the potential to address root causes rather than just symptoms could be a game-changer.

    Final Thoughts

    Dr van Hylckama Vlieg’s insights offer a compelling look into a rapidly evolving area of science. As researchers and companies like Freya push forward, the possibilities for transforming healthcare through the microbiome are growing fast. From improving fertility to preventing infections, these tiny organisms may hold the key to better outcomes for millions — especially in areas of health that have long been underserved.

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    1 Std. und 8 Min.
  • The Future of Nutrition: Exploring Gut Health and GLP-1 Agonists with Dr. Chris Damman
    May 29 2025

    The Gut-Health Revolution | Dr Chris Damman on Nutrition, Microbiome & the Future of Wellness

    Dr Chris Damman brings decades of experience from the biotech world and leading global foundations to share his vision for the future of health and nutrition. In this episode, we dive deep into the transformative power of gut health and the emerging science shaping how we eat and live.

    Gut Health: Ancient Wisdom Meets Modern Science Dr Damman explains why gut health is central to well-being, describing it as a “full-circle” return to ancient wisdom where food is medicine. Backed by science, he shows how whole foods can prevent disease and support healthier lifestyles, without being restrictive or unrealistic.

    Next-Generation Nutrition: The 4 Fs We explore the idea of “next-generation nutrition” — simple, practical ways to improve your diet with fibre, polyphenols, healthy fats, and fermented foods (the “4 Fs”). These ingredients, found in traditional diets around the world, play a key role in promoting longevity and gut health.

    GLP-1 Agonists: A Promising Yet Cautious Path Dr Damman discusses the potential of GLP-1 agonists — groundbreaking drugs that help manage appetite, weight, and blood sugar. While powerful, he emphasises the importance of pairing them with real dietary change to avoid over-reliance.

    Weed, Seed, and Feed: A Gut Health Strategy Using the analogy of gardening, Dr Damman breaks down how to support your microbiome: weed out the harmful bacteria, seed the good ones, and feed them with the right foods. This holistic model offers a sustainable approach to digestive health.

    Fermented Foods & Probiotics We also cover the role of fermented foods as natural sources of probiotics and why they may be more effective than many commercial supplements. These foods are vital for balancing the gut and reducing inflammation.

    The Future: Nutrition Tech & Smarter Choices Dr Damman is now focused on innovation, developing a smartphone app that helps people make smarter food choices by understanding nutritional quality at a glance. His work blends science and technology to make healthy eating both accessible and personalised.

    Conclusion Dr Damman’s insights are a refreshing mix of practical advice and scientific depth. From diet to digital tools, he shows how we can all take charge of our gut health and live longer, healthier lives. Look out for his upcoming book and app, designed to change the way we think about food.

    Chapters: 00:00 – Introduction to Dr Chris Damman 01:36 – What is Next-Generation Nutrition? 05:01 – How the Microbiome Journey Began 10:20 – Malnutrition and the Four Fs 17:59 – The Truth About Ultra-Processed Foods 23:22 – GLP-1 Agonists: Are They a Game Changer? 28:45 – The Future of Nutrition and Health 35:49 – Smarter Choices with Nutrient Profiling Tech 40:38 – How to Balance 'Red' Foods in Your Diet 42:11 – Healthier Baking: Tips That Work 43:25 – Personalised Diets for Your Microbiome 46:12 – Understanding FODMAPs and Gut Symptoms 51:51 – Microbiome Therapeutics and Supplements 01:01:38 – What’s Next for FMT (Faecal Microbiota Transplantation)? 01:05:00 – Gut Health Technology on the Horizon 01:10:55 – Final Thoughts and Takeaways

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    1 Std. und 14 Min.