Gut health & the microbiome: improving and maintaining the microbiome, probiotics, prebiotics, innovative treatments, and more | Colleen Cutcliffe, Ph.D.

**Peter Attia** (0:11)
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My guest this week is Colleen Cutcliffe. Colleen received her bachelor's degree in biochemistry from Wellesley College and a PhD in biochemistry and molecular biology from Johns Hopkins University. She then completed postdoctoral training at Northwestern Children's Memorial Hospital and subsequently began working as a scientist in the pharmaceutical industry. She's currently the CEO and co-founder of Pendulum Therapeutics, a startup that is working to develop treatments for a variety of diseases by targeting the microbiome. Although given that Pendulum has been around for about a decade, it seems a little odd to refer to them still as a startup. I wanted to have Colleen on the podcast because, quite frankly, she was the first person I met and had deep discussions about the microbiome where I really felt like the person knew what they were talking about. Now, I don't say that to be disparaging of the many other people who have a lot to say about the microbiome, but my mind works in a particular way, and I guess I've just never had that connection with a person where when I ask questions, they seem to have answers that make sense to me.
So much of the work that I've seen around the microbiome has been interesting, but it's been very difficult for me to understand how one could operationalize and make real causal effect from the science that is being presented.
And so over the course of many months, Colleen and I had a number of discussions. I became quite interested in some of the products that her company sold, and I even began to see some of the benefits in my own blood work, something that I was incredibly skeptical of at the outset. In fact, we realized after our first meeting that many people had been telling me about some of these products over the previous four or five years, and I had been generally quite dismissive without looking more deeply at the data behind them. In this conversation, we really dive into all things related to the microbiome. We talk about what it is and how it changes over time and how you can measure it if that is something that is important, and we'll talk about the importance or lack thereof. We talk about probiotics versus prebiotics versus postbiotics, and how much bacteria actually make it into various products that one can buy. We speak about fecal transplants and the importance of fiber, as well as artificial sweeteners and antibiotics as it relates to the gut microbiome. We then speak specifically about acromansia and Colleen's work at Pendulum around creating products that focus on not just acromansia, but creating substrate for it and other tools that will enable the gut to be fed in the best possible way to improve metabolic health. This is a really interesting discussion on many levels. And again, I just want to stress how skeptical I have been of this topic for at least a decade. In fact, there is probably no area of medicine that I have been more skeptical of than this one. And of course, with some of the high profile failures of companies in this space, I have somewhat smugly felt vindicated in my skepticism. But I must say that I feel like that is changing. And I think that the work that Colleen and her team have shared with me along with work that has been shared by other people have began to make me think that there may indeed be something to this gut biome. In other words, it's not that I don't think that the gut biome matters, but the question is, can we change it using tools other than our nutrition? And to me, that's one of the most important questions we dive into in this discussion. So without further delay, please enjoy my conversation with Colleen Cutcliffe.