Ep 159: Microbiome Health and Fertility with Cheryl Sew Hoy
Fertility Forward Episode 159:
Could the secret to better fertility and lasting health be hidden in the tiny world of your gut microbiome? Cheryl Sew Hoy, CEO and Founder of Tiny Health, shares how her children’s health challenges inspired her mission to empower families through microbiome testing. Tiny Health offers the first-ever at-home gut and vaginal microbiome tests for mothers and babies during the crucial first 1,000 days. In this episode, Cheryl explains how microbiomes shape fertility, pregnancy outcomes, and a baby’s immune system. She offers practical tips for addressing imbalances through diet, probiotics, and lifestyle changes, while highlighting links to conditions like PCOS, endometriosis, and gestational diabetes. Cheryl also reveals how personalized health decisions can help prevent chronic issues and improve outcomes for future generations. Tune in for this informative conversation and discover how understanding your microbiome could transform your family’s health journey!
Rena: Hi everyone. We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Dara: I'm really excited today to have Cheryl Sew Hoy on our podcast. She is the CEO and founder of Tiny Health, the leading microbiome health platform for families. Launched in 2022, ‘Tiny Health's Gut Health Test’ is the first ever at-home gut microbiome test for moms and babies in the crucial first thousand days using shotgun metagenomic sequencing. Cheryl's mission is to improve the health outcomes of our future generation and reverse the pediatric chronic condition crisis by empowering individuals to make evidence-based, personalized, informed dietary, nutritional and lifestyle choices. Cheryl's perspectives and Tiny Health success stories have been recently featured in the Washington Post, TechCrunch, Forbes Fit Insider, Fortune, and many more. Cheryl is an accomplished and repeat founder of multiple companies, including a successful consumer software startup that was acquired by Walmart Labs in 2013. In 2020, Cheryl founded Tiny Health to take charge of her family's microbiome health after giving birth to her two children when she realized that early life microbiome imbalances are linked to many chronic conditions. Wow. I cannot wait for our listeners, as I mentioned before to Cheryl prior to recording. I'm just, I'm super excited to learn more about your company, to learn more about our microbiome health and first and foremost, like, how you got into this space and kind of what was the initial spark that really wanted you to start a company like Tiny Health?
Cheryl: Yeah. Thanks for having me. I'm really honored to be here and sharing my story. So yes, as you made the intro, I started the company out of my two different birth experiences with my two kids. I am actually pregnant with my third right now. I'm due in a couple of months
Dara: Congratulations!
Cheryl: Thank you. So very inspired by my own kids, but even though we kind of focus on reversing and preventing chronic conditions in peds, it goes upstream because the baby gets their microbiome from the mom. This is what I learned when I was researching at birth through labor. They first get inoculated with the mom's vaginal microbes. So there's the vaginal microbiome in case people don't, aren't aware of and 'cause the baby's passing through the vaginal canal through a vaginal birth and then some fecal fluid from the birth and labor process gets swallowed by the baby. And that's how they get the gut micros. If the mom and then past that, if the mom is breastfeeding, she is able to continue transferring her gut microbes through her breast milk. Apart from many other benefits of the breast milk with the growth hormones and antibodies and things like that, you, you're also transferring gut microbes to your baby. So my story was that I had a c-section with my daughter, my first child, so she didn't pass through my vaginal canal.
Dara: I was gonna ask if, if feel like that changes if you have a C-Section.
Cheryl: I did, and you know, she was breached and I, I did try to labor, I labored for 16 hours and you know, I know that laboring is actually really healthy because the baby is sterile in a womb. So there's no microbiome in for the fetus in the womb. The major colonization process happens at birth. So, and it is really influenced by the water releasing. So water breaking, that's how the baby's getting flush with the mom's microbes. So laboring is actually healthy. The water releasing and covering baby with, with those healthy microbes are part of the process. So even though you might have labored and ended up in C-section, some moms are like, I, I should have just opted for an elective C-section. But there are some benefits. So I specifically researched that during my, my journey 'cause I was trying to figure out if, if there was a difference between laboring and electing for a C-section. There is, or you know, there's a hypothesis that it would help. And also laboring. I dilated to 10 centimeter and my baby just couldn't come out 'cause she was breached. That helped with my vaginal birth post C-section, my son. So if I'd not gone through that laboring process, then it might have been harder to do a VBAC post that. So my son had a very different birth story. He was a, a VBAC at home, born at home. He was also breached, but we turned him around at the last minute. So the reason why I bring their stories up is because my daughter ended up getting eczema around six months. Food sensitivities to sesame. She's gluten, dairy intolerant. She had constipation as a toddler. A lot of gut issues. A lot of skin issues. Now she's getting, you know, a little bit of a seasonal allergy. Thankfully she didn't get asthma because tend to get get eczema, tend to get food allergies and an asthma by age six and respiratory allergies. There's a whole progression of allergic diseases called atopic march and it's very correlated with c-section birth or any major imbalances at birth that could also be caused by, you know, like antibiotic use during labor, during pregnancy, early life in NICU or you know, just from ear infections and things like that can lead to an deficiency in the, the child's microbiome and may lead to these chronic conditions. So my son, he was vaginally born and I also looked into my pregnancy microbiome, both my vaginal and my gut microbiome to make sure it's in good shape. Because if my microbiome was in a good shape, even if I had a vaginal birth, I might not be transferring the right, right microbes, right? And so for him, he didn't have any of these conditions that said, when I checked my microbiome, my vaginal was okay. My gut was not okay. My gut was deficient of bifidobacteria that was quite crucial to pass on to my infant. So I knew from the tests that I needed to supplement myself with the bifida bacteria probiotics, specific strains of it. And then when my son was born, I gave him a short course of just three weeks of the right kind of probiotics that he needed 'cause I was deficient. You know, so, so there's a lot of reasons why you would want to test. So even though I talk a lot about babies and, you know, their early life immune system is being trained by these bug. So when you think about, again, eczema, allergies, asthma, they're kind of immune intolerance conditions that are in your immune system, haphazardly responding to skin allergens and then food allergens or dietary allergens and then respiratory allergens, right? So they're all kind of immune related, which shows that the baby didn't get the right microbial training at birth. So it's all very much linked back to, can be linked back to major microbiome imbalances at birth and in or the first 1000 days, which technically starts in conception. So I know this podcast is a lot on fertility. I would love to actually go upstream, you know, to talk about not just the pregnancy microbiome, but also conception and its correlation with fertility, infertility, IVF success. There's a lot there. And even female conditions like PCOS, endometriosis and all that, there's still a lot of connection with the gut microbiome and the vaginal microbiome too.
Dara: It's so fascinating. I'm even myself as a dietician, I don't think I've really heard about the microbiome prior to, I dunno, 10, maybe 10 years, 15 years. And it's, it's so nice to to see that we're really getting more informed. And for those of you, Cheryl did mention, but you know, that the microbiome is the, the whole amount of the bacteria that we have in our GI tract. And it could be predominantly, it could be in the vaginal area. We've had a talk on how it could also be in the oral cavity. We often think of the gut, but it's the, I think that, you know, we were speaking before how, like, it's very interesting how it's not just what we think about that the good bacteria in the gut. It's really, yeah, I
Cheryl: I can kind of wind back. So there's, we have 38 trillion microbes living in and on us. And there are different sites, right? Again, so there's the oral, there's the vaginal microbiome, there's the skin microbiome. They all have different microbes. They're not comparable. And you need different sequencing methods to test different parts. Like you might use a 16s for oral and you might use 16s for skin, but you wanna use a shotgun sequencing method for the gut. And the reason why you hear a lot about the gut microbiome or the gut health is because it's the most accessible from the stool. So sometimes we get people asking us, what do you measure to measure your gut microbiome? Is it urine? Is it blood?
Dara: I was gonna ask.
Cheryl: Yeah, it's the stool. So it's makes sense, know kind of your GI tract, right? So the only representation from the stool is the large intestines. So as you may know, your digestive tract starts with actually the saliva that, you know, digesting food and you need to, like, start there. And then it goes through your esophagus and then your stomach, your small intestines is responsible for absorbing a lot of the nutrients, right? So, and then when it reaches your large intestines, that's where a lot of the gut function is performing, that immune system balance and your metabolic health. You have your, your microbes that are in charge of metabolic health and your gut can produce GLP-1 chemicals. So, you know, there's a lot in your gut, like, 80% of your immune system is in your gut actually, and influenced by what bacteria is or isn't there. So, you know, again, like it's representative of your large intestines, you know, sometimes we talk about Candida and H. Pylori. Those tend to live more upstream. So stomach and upper tract, like small intestines. So you may not see those bugs as much in the large intestines, but in the large intestines there are a lot of bugs that we now know through a lot of research coming out. 'cause We have better sequencing methods and better way of sampling stool and kind of extracting the DNA from the microbes and then looking into what functions they perform. So there's a lot more science and research around, you know, kind of it's correlation with health or disease. And now, you know, like why I, I was so compelled to start at companies because when we're talking about our kids and chronic conditions, one in two kids today have that one chronic condition
Dara: That's crazy. Oh wow.
Cheryl: Not normal. That's not normal. That is unprecedented. Why are we raising such unhealthy kids? And it's really then if you look at then the mom, if again, I talked about my microbiome being deficient, it's influenced a lot by our diet. You know, our lifestyle changes and modernization. A lot of maybe interventions at birth even that we're not, you know, meant to experience that is causing a higher c-section rate. I think half of of pregnant women go through antibiotics during pregnancy or labor half.
Dara: Wow.
Cheryl: Yeah. And…
Dara: That’s wild.
Cheryl: More than 50% and over half of those are not necessary. They're, they're just in case. And if you think about how our healthcare system is set up, it's in a way set up to de-risk the liability to the physician. Right? So it's not that it's there for a purpose. I mean, sometimes it's lifesaving antibiotics is lifesaving, but we know it's over prescribed. We know from studies being published that over half of antibiotics is really not necessary. Over half C-sections are really not necessary. It's an maybe overreaction by potentially the medical system to avoid liability. So I've learned through my two kids and now my third to be your own advocate in your own healthcare journey, your fertility journey, your pregnancy journey and your, your your your kids' health. Right?
Dara: Yeah.
Cheryl: And this is where Tiny Health was born out of a need to seek what the conventional medical community couldn't help me with. They're really gonna be acute conditions. If you break a leg, you need an operation and you have this acute condition, that's great. But if you have a chronic condition, less so. And I found that there are a lot of research coming outta academia that, again, sometimes as a lay person, not a scientist, not a medical person, is that research ready, you know, to be adopted. And most of the time it's not. Right. But then again, it takes 10 to 15 years for groundbreaking academic research to get into medical practice. I knew that my child's lifelong immune system was being informed in the first 1000 days. I can't wait 10, 15 years for it to be adopted. So for me, I decided to take, take my, my kids and my family's health into my own hands. And of course we are really careful about what's validated, what has sufficient evidence. And I wanted to turn this into a company. 'cause It was just before this, it was just me reading papers and like, I'm like, I think this is, you know, right now we have a whole bunch of scientists actually validating each paper and each evidence reviewing each action item. Whether from a dietary perspective, a supplement perspective, or a lifestyle perspective, what can we really suggest to people to do to course correct their microbiome if it if needed.
Dara: I think it's important that it's great that you have the scientific team alongside your, your business sense and your drive and your passion for this subject. Also, connecting with the experts who can help extract the most important points from the research. I think it's important to have that collective approach to really make sure you're covering all fronts. So I think that's, that's phenomenal.
Cheryl: Thank you.
Dara: I really do. Yeah. And I'm interested. It's, it's so fascinating. So like even back to your, you know, your birth stories with, with the first one you said, typically with, with VBAC, so it's, you know, vaginal birth after a C-section. How the good news is because you labored your daughter's, your firstborn, correct?
Cheryl: Yeah.
Dara: Your daughter still was able to have some of your microbes because of the, the long labor process. However, you said your own health or maybe your own microbiome health wasn't necessarily where it needed to be. Correct. So it goes to show you having a a vaginal birth can be great, but if, again, if your, if your health, if you don't have that, that robust microbiome, having that vaginal birth can only help so much. Having a VBAC can complicate it or make it somewhat worse. But again, it's not necessarily, if you have a, a robust microbiome and are able to, to labor a little bit longer, that's another level that can help. But what I love in terms of, it sounds as though with your company, this can be something that could even be worked on earlier, prior to a pregnancy or during beginning stages of a pregnancy to really help ensure that if your microbiome is not robust, that you, there's time to work on it. That's
Cheryl: Correct. Yes. 100%. I mean, as with a lot of things, right? Like where human biology is complex and multifactorial to every step of the way from trying to get pregnant. I had two miscarriages right before this third one. So I have had my, recently my own fertility journey kind of questioning. Mm-Hmm. Am I maybe just too old? Is it an age thing? Is it genetics? Is it my microbiome? I checked my microbiome, it was fine. So I knew that wasn't entirely a contributing factor. But you know, for me it, my head, it might have been age I'm over 40 and it might have been a genetic thing. So I think all this is to say it's multifactorial and the microbiome we believe is a big component, but if it's in good shape, then you can check it off and focus on something else. If it's not in balance, then you should definitely course correct. Right. So every step of the way from preconception and then when you conceive and you're pregnant, you know, keep it up and then down to like, when your baby is born. And even through that first year, there's just so many things that can happen with school, starting daycare, ear infections and medications, vaccinations, like traveling and, you know, so many types of exposure. And then when they're starting solids between six months, meaning from maybe breast milk to formula, choosing the right formula. There's just a host of reasons that why what, you know, all these factors can influence the microbiome. So you just wanna, at least, you know, with our technology available to us today and at a an affordable price, why wouldn't you check in just to make sure. And the reason why, you know, some people are like, oh my baby, it's fine. You know, and then when they get symptoms, they come running back and like, oh, I need to do your test now. I think what I'll say here, and PSA frankly is you check in early because what's brewing in your microbiome, especially in your gut, because it's so linked to immune training in the early life and even in our age, it's so linked to immune health and overall wellbeing and longevity. So many things like women's health issue, hormone issues, thyroid autoimmune issues. Most of things, even recurring UTIs is in your gut. Like, it, it is, the inflammation in the gut is a brewing thing. It's like you don't get symptoms when you finally get symptoms and conditions. I, I don't wanna say it's too late, but it means maybe there's a leak gut and the microbes, the unfriendly pathogenic microbes have leaked into your bloodstream and then now you get blood inflammation that can be measured through CRP and some other blood markers, right? And then you have health issues, like really apparent health issues. So it's like you, you wanna check in and again, take care of your gut health before you have symptoms as an adult. But even more pressingly as a baby. Like you never get that microbiome back because your baby's microbiome changes so rapidly in their first year. Now with my third child, I'm gonna measure, because it's my company, I'm gonna measure him every single month, you know, but you know, obviously it's a limiting thing. For finances, I would do three, at least, you know, three tests if you can, to track
Dara: Each trimester type of thing?
Cheryl: Postpartum. Yeah. Like when your baby a postpartum in the first three months, maybe at two months. So you see if you're breastfeeding, how your breast milk is, is changing your baby's microbiome. So I would do that first. If you can only do one sample in the first three months due the second month sample, and then one more around six to eight months when the baby's starting solids, the microbiome's gonna change again from that. If you're weaning and then at 12 months, you know, again, most babies have weaned, eye breastfed for two and a half years, but everyone's different, right? So like, check in again around 12 months and then after that, maybe every six months, you know, again, like if you can afford it, I would check in closer, especially if your baby has symptoms or conditions, right? But if not, I would still just check in just in case. And I want to almost my baby's microbiome changes over time 'cause as new research comes out, our report, retroactively updates, we offer a little bit like the 23 and Me kind of like, oh, you get new updates and when new research comes out, so you could find answers to maybe touch what, like future maybe health problems or future discoveries. And you're like, oh, well my baby was born with this set of microbes. This explains X, Y, Z. Right? So
Dara: That's what I find so fascinating with the microbiome. Like there's still, I feel like in some ways, I wouldn't say it's at its infancy because I, it is something that we've been aware of for quite some time now. But the fact that there's so much more research coming out, that there's, I love how that your company really is, is all about adding. If there's new information out there and that may change your result or give you more information. Based on your past or current results, that's phenomenal.
Cheryl: Yeah. And in a way it is still in its infancy, but I think that is a factor of the sequencing technology. So when we first cultured microbes, or like little bacteria, we use the culturing technique. You put bacteria in a Petri dish and grow it in a lab, and then you see them under a micro, you look at them under a microscope. So that was the original culturing method. And then you get PCR, which you set primers and you might have heard of a covid PCR test. And you know, we use, you kind of detect certain limited set of microbes. And then that became 16s where you can, this might be too in the weeds, you can sequence the whole microbiome, this next gen sequencing, but it's low resolution and now we're in this, I don't know, fourth inning of shotgun sequencing, which is the tech we use.
Dara: I wanted to ask what that was all about. Yeah, I haven't heard of that.
Cheryl: And all the latest microbiome research coming out right now is using shotgun sequencing, which means it's high resolution. And you see all the microbes and all the functions in your gut. So it's not enough to see who's there. It's also important to measure what's actually, what they're performing, what they're functioning 'cause they could be there, it could be dead, they could not be functioning as intended. So if you think about a, a photo, it's like DSLR, you know, you can see really sharply your aunt and your uncle in this family picture who is smiling, who's frowning, are they like a mean character or not? Whereas 16 s is like a blurry picture. You kind of, you don't know exactly if this is Uncle Tom or Uncle Harry if they're smiling or frowning. So the tech has come a long way in the past 10 years. So I think this was not available 5 to 10 years ago. And now, like we're here now and I am confident in our tests that we're, like, for adults. Like I think we, there's more evidence coming out of what are the features of a healthy microbiome, vaginal or gut. And then more so in infants, the science around infant gut is so much stronger because when the baby's born, again, they're sterile in the womb, they don't have any microbiome. So you think about an island is a barren island with 10 coconut trees, but sometimes there's an absence of coconut trees and it's all weeds. But when you have such a small island and 10 weeds, it's easy to uproot it, right?And then plant it, right? Coconut trees and the right ecosystem. And ours by now is a rainforest. It's like, so talk about un weeding our microbiome. It took me, remember I said my microbiome is deficient. It took me eight months to course correct mine. Like 2...
Dara: I was gonna ask how long it took because I, I didn't think it would be overnight.
Cheryl: No. I was missing bifidobacteria and cia. So one is important for immune system, one's important for metabolic health and important for me to transfer to my kids for their lifelong health. It took me, yeah eight months of supplement regime, like taking the right strains of probiotic. The right prebiotic, which is the fiber to keep the food.
Dara: The food.
Cheryl: Yeah. To keep them there. Because if you only take probiotics that you buy from a supermarket, you might be taking the wrong strains. You might have spreading it with the right food. So it might be conferring a transient effect for your microbiome and your health. You might notice a difference, but it's transient, so you have to keep taking it. And who wants to keep taking a probiotic, right? Like it's expensive, it's something for... Ideally, you wanna know exactly what you're missing and what functions you're really looking to fill. Take the right kind support it with prebiotics and that could be even a form of supplement or diet. Long-term I prefer whole foods. You're a dietician, you know, like, you know, eating the right foods is a major majorly impacts your gut and your wellbeing. So I choose to do the supplement again, like short term, ideally a few months, and then support it, maintain it through diet.
Dara: I was gonna ask you about that because I was wondering if you just tackled it from the supplement component or if you did it in conjunction with food. So it's interesting you started with the supplement and then kept it going through the changes in your diet. So I would think, I believe bifidobacterium, like it has to do with, it's interesting. I, I wonder if we see a lot of people somewhat deficient in it because a lot of people go dairy free. And I believe, I could be wrong, but I thought bifidobacterium was something that's typical, typically found in yogurt.
Cheryl: Actually you get more lactobacillus strains in yogurt But sometimes
Dara: Good to know.
Cheryl: But sometimes you get, you have to look at it. Right. Different yogurts in the market, again, they're culturing it and adding cultures into these yogurts. So you gotta see, you gotta read the labels and, but they have have Yeah. But also like keffir, I make my, my kefir at home and keffir, when you sequence keffir, you can't even find those strains. They're all wild strains, which is great. And ask diversity into market biome. Yes. That are like on the label are basically because someone's manufactured the strain and they have to produce it in a, in a industrialized format Right. For food companies add it. Right. But if you make homemade kefir, it's gonna be wild strains. It's still gonna diversify your microbiome and create that rich robustness, resilience and diversity you wanna see. And it's funny 'cause like I actually, when I tested my microbiome, I found a lac of bacillus something, something keffirstrain. I'm like, yes.
Dara: Oh wow. So that helped, that helped with your,
Cheryl: My babies have it because I started giving my, my daughter and my son kefir at six months. I knew kefir is actually the most superior for mef fruits perspective.. And then next is yogurt. Like you have to get low sugar, don't get the Dannon, you know, sugar laden fruit. That's pretty bad. It counteract the effects of the yogurt, of the probiotic 'cause of the sugar contents. We always look at sugar content. We like Greek yogurt 'cause it's high, higher in protein. And we like keffir because it has the most diverse
Dara: See that's interesting. I have some dairy issues, so I, I try to, I do have dairy, but I minimize it. But Coconut Cult makes a great plain yogurt that has a whole lot of strain. And I'm so happy that you said that. 'cause I think when I have patients who come to me and say, oh, I'm on a probiotic, I often ask how long have they been on it? And is it just one strain? And you made a great point is if our microbiome is made from so many different strains of these microbes, we want a diverse microbiome. We don't wanna just have a lot of one type of strain. We really, and so when I see people taking something long term as opposed to like, and also I'm assuming it depends on what's going on in your body. If you have immune issues, you mentioned, you know, endometriosis, PCOS, thyroid conditions, certain strains may be better for those conditions. But the, the notion of sometimes we just wanna focus in on one thing as opposed to looking at all different ways that we can really diversify our, our microbiome to make it supercharged or super healthy in a way.
Cheryl: Yeah, Yeah. For example, like antibiotics. Right? So the reason why, actually, coming back to your original question, why we don't see a lot of biffs maybe in adults, which is true, the western population we’re increasingly missing the two ones that I was missing - Bifidobacteria and achy mencia - are increasingly missing in the western population. Not just in the US but you know, in Europe and things like that. Very westernized countries. It's because it's very sensitive to antibiotics. And you'd think that antibiotics is just the medication, but it's actually, you know, you can also get antibiotic exposure through food. Right. Because, you know, guess what our meats, the
Dara: The Animals. Yeah.
Cheryl: Animals. And even the feed of the fish can be laid in with heavy metals and antibiotics. Even the plants, you know, even if you do a plant-based diet, they're laid in with herbicides and GM like, you know, like glyphosate, which ruins your microbiome too. So I think it's unfortunately you have to look back at our food system in America, it's not great. A lot of the, the foods that come to our grocery store are deficient in nutrients. Kind of like the roots. So we try to have our garden here and plant more vegetables here. We just got chickens. We are getting the chicken eggs, you know that are orange because I comes from paprika, like an organic herbs I add to their feed and you add the more orange and it kind of keeps the parasites in the Un out of the, the chickens I'm learning too. Yeah. It's fascinating.
Dara: It's fascinating. Well, because you know, on top of that, it's so true with these sprays and the glyphosate, the nutrients in our food are not as good. And then on top of that, you know, we don't even know how long things have been at the grocery store or in holding from the time that they've left the farm until it gets on our plate. So there's so many various reasons. So
Cheryl: Apples, apples sit one year, one year, and then
Dara: One year!
Cheryl: Kind of in the state of unripe steep. And then they like, when it's time to, like, that's why you get apples all year round. Yeah. Why else Apples in December or whatever, you know, it's been sitting there for a while. So we try to say, you know, not everyone can afford organic, but actually more important than organic is local 'cause It's the distance farm. So you sometimes go to the farmer's market. And also it's not always accessible to, we don't shop at the farmer's market every week. Like occasionally we do. You do the best. Right? But I think just being aware of these things, oh, like how come my microbiome's so deficient? I've been so healthy and everyone thinks they're healthy, but when you really look into it, you know, there are things that you can still improve and it's really overwhelming, right? It seems like when I, you know, then when I tested my water, my water supply in Austin, Texas has arsenic and lead and uranium. So
Dara: Wow.
Cheryl: I had to do, I already do ro but I'm showering with it. I'm brushing my teeth with it. So then we had to do a whole house filtration so we're not getting exposed through steam. And when we had skin issues, like maybe the sources are. So it's pretty overwhelming. What I like to tell people is that how I tackle it is you pick one thing to tackle a season at a time. So this quarter I tackled the whole house filtration and for me, I, I'm in the sleep, you know, optimization zone. So I do like blue light. I just replaced light with red light and orange light. I got rid of all my blue light. My husband thought I was crazy, like, I'm wearing blue light
Dara: I wear my glasses!
Cheryl: I look like Bono!
Dara: Little things you can do, make a big difference. Little thing. And, and I think sometimes we feel overwhelmed that we have to do it all at once. But I think you made a great point is, is you know, tackle one thing at a time and doing the best that you can. I think sometimes we put so much pressure that it has to be perfect. Yeah,
Cheryl: That's right.
Dara: But I think awareness is great. I think what's great about, and I wanna hear more about, so you already mentioned that when the, the kit comes to you, it is, you know, it's tested through fecal matter and you send it back. I'm sure there's a whole process. You send it back? Yeah.
Cheryl: Here. A little Q-tip, I'll, I'll open it for you. It's like a Q-tip. It's stratus, no liquid. Some other stool companies make you do scoops of it. It's kind of gross. And then you have to,
Dara: I've done one with the scoop before. Not fun.
Cheryl: Yeah. That's
Dara: For different purpose. But
Cheryl: Not using PCR technology by the way. Like it's, it's a very limited view of your gut. This is very comprehensive. And sometimes, like you, you swab directly from a soil toilet paper or if you're a little bit constipated and you might need a stool collector, and then you kind of just swab a little bit and then you hear a click, it keeps the oxygen out, it's pretty airtight, and you throw it into a prepaid envelope, send it to our lab, and within a few weeks you get a report back on everything in your gut and, and your vaginal,
Dara: That's, that's very fast.
Cheryl: Yeah. And the vaginal microbiome is slightly a similar swab longer. That one has the liquid 'cause for the vaginal microbiome, it needs to be preserved differently. So that one you have to just kind of clasp it and then kind of click to release the liquid that comes in and comes out and preserved. Once it's like you always have to hear the click or I think in the vaginal microbiome, the vaginal swab, you have to twist it close and then you, you send it in.
Dara: Oh, great. So I wanna go back just to review. When is the best time, where would you suggest a woman who is, you know, is it best to get checked when they're thinking about conceiving, when they're attempting? What is the, I guess there's many answers, the optimal time, but what would you suggest?
Cheryl: Yeah, I mean, as early as possible. If you are, you know, thinking about kids five years out, do it now because, you know, it took me eight months, right, to course correct my gut microbiome, several imbalances in your vaginal microbiome, which means your, your vaginal microbiome should be in a, in an acidic state, so low pH to keep the pathogens out if it's too alkali. And when you go to the doctor's office to do your regular pap smear, I think some doctors, or most doctors do a pH as well. It's very easy to tell if you have vaginal infections, you tend, you would tend to have a, a more alkali vaginal microbiome. But still at the doctor's office, they're not gonna know your vaginal microbiome and why you have low pH or high pH and stuff like that. So when you do a vaginal microbiome test, we can tell you that you have a lactobacillus dominated vaginal vaginal microbiome or not. And then within lactobacillus, what specific species do you have dictates even IVF success or like, which is a proxy for fertility.
Dara: Wow. Yeah.
Cheryl: So it's not, I think it's not enough to just take the pH and, and do a pap smear for one microbe. Usually they check for yeast or not . So many other things around the vaginal microbiome, right? So if you're getting sort of like recurring vaginal infections or what you think is yeast infection might actually be other bugs that are there. So again, like I think it would take time for the medical system to adopt this technology for a vaginal, vaginal microbiome test. But it's available now. Like, you do have to pay cash to get access to it. You know, our, our vaginal test is about $249 for the consumer that comes to the consult call. If you are a practitioner, we offer it at $179, so you can offer it at a cheaper rate to your patients. We train practitioners how to interpret them as well. We wanna eventually want conventional doctors to also be trained. So I would say, yeah, like coming back to your question as early as possible. The reason why the vaginal microbiome, if it's imbalance, it takes a longer time, is you think about, again, the food system, right? A lot of your microbiomes influenced by diet, supplements and lifestyle. The route from food to your gut is closer than to the vaginal track, right. So it's a much longer route. There are vaginal suppositories that you can, you can do that we think, you know, we know from data is, is a more direct route to change your vaginal MI microbiome.
Dara: Wow. I did not realize that.
Cheryl: A dietary, like an oral vaginal MI probiotic. Okay. Diet and a suppository, a vaginal support, a suppository. Correct. Yeah. So, and some people it takes months, you know, it's just hard.
Dara: I'm sure. Yeah. So I guess the, the earlier the better and you said, so if it doesn't go through the doctor, so if you went through the doctor, the doctor would be the one analyzing the report and giving the recommendations. If you're going directly through your, to yourself, it does also, the part of the package also provides recommendations or kind of an analysis?
Cheryl: Yeah. For all just, you know, I started this company for parents with, with babies with all these conditions and we're moving upstream now to prenatal and preconception. I didn't wanna report that scary and you're like, what do I do with this information? Right? So I really wanted to include evidence-based recommendations for what you can do about course correcting if, if there's imbalances. If there's not, then you don't need to focus on it something else. Right. You can, you can focus on something else and have peace of mind that your microbiome is in good shape and that's not influencing whatever kind of challenges you're facing at the time. But yes, like, you know, I, I would do the vaginal microbiome test and the gut microbiome test just for overall well-being. And you know, like whether or not you have symptoms or conditions. I like why, why not check in? You know, so if you check in and everything looks fine, then great. Then sustain and you know what to maintain. If you are having some conditions, so, like, for example, PCOS, there are associations in the gut endometriosis as well. Recurring UTIs is usually a function of high e coli in the gut. People think it's a vaginal microbiome thing. It could be, but actually the gut influences recurring UTIs a bit more. overgrowth of bacteria or specific of e coli that then get into the vaginal tract and cause recurring infection is coming from upstream. Right? So there's a link between the two of 'em. And, and then when you do get pregnant, gestational diabetes or preeclampsia, like, can be influenced by the gut. So you can check in to see if we have a gut that is even pre-diabetic. A lot of Americans are pre-diabetic and not aware when they get pregnant, your metabolic function changes and it triggers gestational diabetes. So you can even check in, there's a, if you check on our survey that your TTC, trying to conceive, you get the gestational diabetes biomarker to see if you could have a microbiome that could be at higher risk.
Dara: More predisposed. Yeah.
Cheryl: More predisposed to it. And then you can start your course correcting journey through diet supplements and exercise. So you don't actually get diagnosed with that when you are pregnant 'cause Then if you are, you take medication and there's just, you know, then you're categorized as a higher risk pregnancy. And then, you know, any medication during pregnancy could have side effects to you and your baby. Right. So you wanna avoid that as much as you can. So that's why there's just so many reasons why you should check in earlier. And then, so that's the gut and the vaginal microbiome I already mentioned, if you don't have lactobacillus in your vaginal or very low, it's a, it creates a, a less acidic environment. The acidic environment keeps disruptive bacteria out of your vaginal canal. So a lot of bv, bacterial vaginosis bacteria has been published to be connected with IVF failure. So higher rates of IVF failure, which again, there's no direct studies showing fertility, but we think that the IVF success rate is a proxy to fertility. Right? So also know that if you have these BV bugs in your vaginal canal, you are at higher risk for STIs, STDs, or recurrent vaginal infections. So you really wanna course correct. And if you are in that state of low no daca bacillus, which is, we call it CST4, community state type four community state type CST is just like a categorization. Like you're either in 1, 2, 3, 4, or 5. So CST4 is what you don't want to have. That's what's correlated to lower IVF success. And then if you do get pregnant with CST four, you are at higher risk for preterm labor. So not great, right. So there's a lot of correlation between vaginal health and overall like fertility and like lower risk in pregnancy basically.
Dara: Interesting. And then I also saw, Cheryl, that you also offer, like, a family membership type of, which is great too. So you know, it's something to consider of your health when you're trying to conceive during your pregnancy. But beyond it's, so it's great that you offer that. You can also see the continuity of care.
Cheryl: Continuity of care, but also the, we didn't talk about the partner microbiome.
Dara: You're right. That's important too.
Cheryl: There's so much weight on the mom, which is true. You know, I mentioned the mom's microbiome is connected to chow and the primary colonization is from the mom. However, the dad, and you could talk about fertility too, right? There's some research showing that there's the sperm microbiome. So like, you know, that can also be, there's some, again, initial research. I think we have a blog post that I can send to you that you can share with your followers that even there's no, like, real sperm microbiome test. Maybe eventually we'll create one. We know that I think sperm should be also left asus dominated. If it's not, it could have these BV bug. So if you're having intercourse with man who has, you know, kind of not a really, I think again, it comes upstream, right? The gut kind of transfers to the downward tract or reproductive tract. So it's all linked. So if say the women has a healthy vaginal microbiome and if the male partner is doesn't and you have intercourse, unprotected sex, you could be transferring that. I'm, I'm waiting for someone to try. Well someone has to, to be willing to spend that money, do a vaginal test without intercourse for weeks or like a week and see what it looks like. And then do one a day after intercourse and see if the vaginal microbiome is different. And you know, it's,
Dara: I'm sure it would be, yeah, it would be interesting to see,
Cheryl: It would be really interesting to see if your partner's contributing to that, right. So that, and then even the male microbiome, right. So say like, okay, my example, I like to share my personal story. I mentioned I don't have BiVs and Archamensia. Well, well I was a formula fed at two months old in the eighties. You know, I had antibiotics in my early life. I had a terrible diet in college. My husband grew in New Zealand, so very different breastfed for a long lot longer. He has BiVs and arcia. So when our son was born, I'm like, you know, why don't you pre chew these, this meat and give it to our son? And it sounds gross, but I'm like, I want you to actually kiss my son more and transfer RK to him. So both my kids have BS and archamensia now.. Of course I course corrected mine as well. But earlier on when I was still working on mine, I'm like, it's from you, the CIAs from you dad
Dara: Yeah. Well if the first thousand days are the most important, that's the key time to really make those changes.
Cheryl: Yeah. Yeah. So I think the family membership is great because even kind of like past the conception phase when you do have kids, like we always tell parents who come to us, 'cause their babies we're called a key or has cows’ milk protein allergy or you know, all these sensitivities. And then the parents are so focused on course correcting their child's microbiome. And then we're like, well what does your microbiome look like eventually Your kid, your six month old is gonna grow to two years old. They're gonna eat the same diet you are eating, get the same sun exposure. You maybe you're lacking nature and, and you know, sun exposure. So you should, it's a lifestyle thing, right? You should be taking care of your own gut health
Dara: Collectively. Yeah.
Cheryl: Collectively. Correct. So, and that habit starts as early as possible as a couple, as you know, even you're not even married yet, you know, living together and you're cooking together. I like to see it as like a, a lifestyle change.
Dara: Oh, for sure. I think it's great that you've really tried to tackle all different fronts. So it, you know, it started with your own personal experience, but it's evolved over time and expanded to involve, you know, testing in different time periods for different people. And you've already briefly mentioned like you, you would love to see down the road somehow to have a sperm test. You have the vaginal test, but down the road perhaps, you know, with with advancements that there could be a sperm test. I would also love to hear if there's any other things you hope to see with your company down the road. Do you have any visions of what you like to see? Or even maybe in the research down the road?
Cheryl: We get a lot of requests for a lot of tests. Like, you know, adding an oral test 'cause it is correlated with pregnancy outcomes. But it's, it's just different pipeline. It's, it's harder. There's a lot of human DNA in saliva that we don't want, you know? Similar to semen microbiome, it's really hard 'cause there's just a lot of stuff in there that we have to remove. And you have to pay a really high price to get the microbiome piece. One more achievable thing is a pet microbiome 'cause Everyone, you know, has, like, a lot of people have a dog,
Dara: I have a cat.
Cheryl: And your dogs, your pets are licking you or share food with their pets, right. And they do influence your gut. Right. And there are, there is emerging research around that, the different kinds of breeds. Some dogs have skin issues and is there a correlation with the human skin issues?
Dara: Wow. I was thinking about that. Literally, my husband and I just the other day were speaking about like, I wonder if our kids are much healthier because they've been licked from our cats.
Cheryl: Probably. I mean, you know why? And, and the mechanism for that is because coming back to nature, when we give advice in our action plan, sometimes we are like, oh, get more diversity, get out, get a, you know, more pet exposure or more nature and then parents are like, this advice is so generic, but I'm like, look, you know, we, we used to spend 90% of our time outdoors in the sun and farms, like centuries ago. Yeah. Now we spend 90% of our time indoors here. Like, you know, and so we’re not spending enough time outdoors in nature. But pets can help because you know what? Yeah. I mean, you're not living in a condo in New York City. Your cats and your dogs go out and they bring outside in. And that's why pets have a way of diversifying and influencing our microbiome to be more diverse, right? So there is a really a solid reason why pets help with, you know, your, your microbiome. However, the science does show, again, very emerging. And we're, we're just, you know, like digging into it now is that different breeds have different, you know, kind of proclivity to different microbes and they harbor different bacteria. There's a lot of, you know, so I don't know if we will launch a pet microbiome test. Our families want us to. The reason is because there's so much in the gut and the vaginal that's yet to be explored, especially as it relates to conditions or associations with conditions and course correcting that, like I, I'm not sure that if I just skimm through the surface and go to the next one and the next one, then I, I would prefer to go deep, really deep just, just because the gut, again, 80% of immune system is in your gut and maybe sticking to these two tests and being really good and catching up with the research just every day, being published. Right? So do we really wanna launch a new test? I, I'm not sure, I think
Dara: it's a lot
Cheryl: But we are doing, we launch a, we partner now with companies trying to investigate stuff. Like I mentioned, there's not a whole lot of research around fertility actually. So we launched with partner recurrent IVF failure specifically. So not just one time recurrent. Is there a connection with this might be too deep, not just the back, the microbiome, but the viruses that attack the bacteria. They're called phages. So another level of science deep, right? It's kind of like mind, but there's so much within the gut and the microbiome and the vaginal microbiome piece that is barely, we're barely scratching the surface. I'm such a geek and I really, like, we're doing a lot of research with partners and universities and we're publishing papers, so we really wanna double, triple down in that, in that space.
Dara: That's exciting. I think there is so much research that's coming out in and around this topic of the microbiome. So I, I'm really excited to see the research that you do, that you partner with. We would definitely love to have you back on. And I would love our listeners, you know, if they want to learn more about Tiny Health, what's the best way to learn more about the company?
Cheryl: I mean luckily our name Tiny Health is pretty easy to remember. So it's just tinyhealth com. We have a pretty robust IG Instagram. Our handle is Tiny Health. Again, if you think about tiny, it's like, it could be the tiny microbes, tiny invisible microbes, gut or vaginal microbiome. It could mean little babies. You know, it's pretty expandable.
Dara: Great name.
Cheryl: We have very robust adult stool tests. We have a practitioner function if you are practicing and want to learn more and use it in your practice between practitioners for free, because we just wanna spread your word, the word out. And if you have a doctor who has never heard of microbiome testing and wanna learn more, refer your doctors to, you can also reach us at [email protected] through email. Like I read a lot of these emails too 'cause I wanna keep in touch with our customers and their sentiment and their feedback. So I'm very, like, reachable and approachable.
Dara: Wow, Cheryl, I, I am really, I've learned so much today. I wish I had this in my toolbox through my fertility journey, but I'm so happy that hopefully this will be something that our listeners, you know, they have access to and a lot more knowledge on. And again, we would love to have you back on when there's more research, when there's updates for the company. But we're just, you know, I'm so grateful to, to learn something new and to spread the word to our listeners and how we like to end our podcast is always with words of gratitude. So I'm asking you, Cheryl, what are you grateful for today?
Cheryl: Oh man. So many things. I'm grateful for just my health and really, like, I mean, in this season, having gone through the two miscarriages, I just think didn't think that there was possible. So I'm very grateful for this baby and everything, you know, is uneventful right now, which is what you want. So hope for the health that I have. And then also my whole team, you know, at Tiny Health has just been amazing with our customers. We, in two and a half years, we've served over 55,000 families now. So it's, it's huge.
Dara: Wow! That's a huge accomplishment. That's incredible. I you know, after hearing all this information and you know so much about your company, I'm grateful to learn, I think I've said this before, but especially today, I feel like there's so much, so many new things that I've learned just from you. So I'm really grateful to have this opportunity to learn from people in such interesting fields with, you know, you have so much passion and it really came across like the fact that you, you saw that there was something missing and you've created that gap. You help, you're helping to fill in that gap through your own experiences and through what you're passionate about is, is really impressive. And I'm also gonna add, I'm, I'm, I'm grateful I have my holiday party tonight, so I'm grateful to, to reconnect with my colleagues during the holiday season, which is very exciting.
Cheryl: Awesome. Well, I wish you really happy holiday party tonight.
Dara: Thank you. And I'm wishing you continued success with Tiny Health and with the growth of your family. And thanks again for coming on.
Cheryl: Thank you, Dara.
Dara: Thank you so much for listening today. And always remember: practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.