I tried out a new medical Large Language Model (LLM) API, https://www.drgupta.ai/ to see what it would suggest for a simple microbiome shift compared to what the Expert System(ES) (NOT LLM) AI system does on microbiome prescription. The first significant one Expert System for Medicine was called MYCIN and was written by Stanford University in 1972.
The main business differences between LLM and ES are costs. LLM run heavy computer costs, ES runs heavy human costs. An ES often require article by article review with suitably skilled reader (or example, a grad student). LLM are easy targets for getting venture capital funds — often based on pie-in-the-sky beliefs of how easy it would be to do that is sold to venture capitalists. Earlier I had several sessions with folks at the The Allen Institute for Artificial Intelligence exploring machine analysis of the literature. Their conclusion was that existing AI is still incapable of good analysis of medical and clinical studies.
LLM Report
I tossed a simple, three taxa problem at the API. Reality is that typically we are seeing 40-80 taxa of interest.
Expert System Response
Compared to:
We do not have vague “probiotics” but provide their specific names and dosages. We also include probiotics to avoid.
With information on suggested dosage for probiotics with links to sources.
As well as the names and links to studies used to make these suggestions.
Nothing in the LLM indicates that Pectobacteriaceae was considered. The Expert system does consider it:
And provide background
Bottom Line
This post intent was to contrast the difference between LLM and ES systems. Both can have data entry/text interpretation issues. With a suitable ES system, the suggestions can be audited and issues addressed. With LLM, this does not seem to be available with common code bases.
The table below from PubMedQA shows that accuracy is barely over 80% for the best models out there. Expert systems can exceed 95%. Is 80% “good enough” for treating patients especially if the ability to audit the logic is missing? By Audit, I mean provide links to all source studies).
This is a follow up on the prior post below. The reader’s comments are “I am feeling much better but still very fatigued and lately been quite achey. The recommendations have changed significantly except for whole grain barley.”
Let us first do the simple numbers. A lot of values are the same (typical) but many of them show improvement. 😃 indicate significant reduction is out of range values See Technical Note: Lab Quality Versus Bacteria Reported We would expect a 15% drop from lower lab quality, the drops shown are well below that).
Criteria
Current Sample
Old Sample
Eubiosis Index
62.8%😃
59%
Lab Read Quality
4.3
8.4
Outside Range from JasonH
8
8
Outside Range from Medivere
20
20
Outside Range from Metagenomics
10
10
Outside Range from MyBioma
8
8
Outside Range from Nirvana/CosmosId
18
18
Outside Range from XenoGene
42
42
Outside Lab Range (+/- 1.96SD)
9😃
16
Outside Box-Plot-Whiskers
38😃
98
Outside Kaltoft-Moldrup
56😃
139
Bacteria Reported By Lab
494
752
Bacteria Over 90%ile
20😃
82
Bacteria Under 10%ile
66😃
232
Shannon Diversity Index
1.465
1.701
Simpson Diversity Index
0.035
0.028
Chao1 Index
7474
17093
Shannon Diversity Percentile
28.5
61.4
Simpson Diversity Percentile
30.2
21.5
Chao1 Percentile
28.9
87.7
Lab: BiomeSight
Pathogens
18😃
39
Condition Est. Over 90%ile
4
4
Kegg Compounds Low
969😃
1242
Kegg Compounds High
5😃
23
Kegg Enzymes Low
272
284
Kegg Enzymes High
17😃
75
P or P Chi2
.9999245
.999999999
Percentages of Percentiles Chi2 is a proxy for severity of abnormality, it has decreased.
Health Analysis Comparisons
I have not created an automatic compare yet (on to do list). Many values were similar, some interesting ones with improvements are below. Jason Hawrelak Criteria got worse, but I have deep reservations on using his criteria on Biomesight tests (he based them on a very different test method).
A review of the Health Analysis was done above, with the two items: Mood Disorders and COVID-19 (a proxy for ME/CFS IMHO). A secondary review of all the items on [Changing Microbiome]/[US National Library of Medicine Studies] for high items not flagged. Nothing added.
Doing what is becoming a regular pattern: “Just give me suggestions” and then using given symptoms under Special Studies using these items:
Note: items like age and gender are omitted as well as any other symptoms that we do not have sufficient data.
First the filtered PDF suggestions. The list is much longer than usual:
And the to avoid list is more typical.
Let us go over to viewing the consensus to get some priorities
The highest value was 485 (so 240 for cutoff), lowest value was -574 ( so-287 for cutoff)
So in summary, shift a diet to low sugar, gluten free with moderation in meat (no guidance on chicken or fish). If your MD is willing, I would suggest reviewing Cecile Jadin📚 approach with antibiotics and rotate with those suggested above. IMHO Continuous on a single antibiotic is more likely to complicate the microbiome.
Postscript – and Reminder
I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”. I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.
I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.
The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.
A reader asked me to evaluate their offerings. Remember, I do NOT sell testing, I offer a free citizen science analysis on over 3 dozen different microbiome tests using Artificial Intelligence. One of the first thing that strikes me is false and misleading statements on some sites. The following is from Jonas Health for illustration purposes. A few are below, taken from their site in November 2023.
This is incorrect. They cannot identify ALL organisms, they can only identify the items in their reference library. For example, there are 30 new fungi species being added every year in 2004 ( Biodiversity of Fungi, 2004) and I would expect that rate to be increasing. NCBI currently lists over 2.5 million taxa. In 2012 it was just 235,000. That’s a 10 fold increase in 10 years.
As for research, we see two papers, neither titles suggests that lactose was the focus of the study. One seems focuses on Rice and oats. The article is here – the word lactose is never mentioned in the article. As this is a demo report, I would expect correctness. Also, the journal was Front Immunol. 2021; 12: 787797. and NOT Nature.
Next we see what may be correct per the sample, but no guidance on how to:
Increase Faecalibacterium Prausnitzii WHILE CONCURRENLTY Decreasing Faecalibacterium .
Bottom Line
Based on this sample report, I see ugly problems. Thorne Gut Testing is 40% of the cost and much more useful, especially if used with Microbiome Prescription. I attach a copy of their sample report below.
A reader asked me to assemble information from studies on Low Dosage Naltrexone. For conditions like Fibromyalgia, we have 49 studies with good or no effects. I speculate that the effectiveness is dependent upon the microbiome prior to starting.
A lot of the published literature are case-reports (i.e. on individuals). My general impression from larger studies is that it is a 50-50 toss of the coin if improvement will happen. There is an absence of literature on its impact on different bacteria in the microbiome.
“Seven (23%) reported side effects. LDN was associated with a statistically significant reduction in PEG in adult chronic pain patients, however the clinical significance is unclear as over 75% of patients discontinued LDN due to lack of benefit.”
“The relative hazard of improvement for those taking low-dose naltrexone was 5.04 (95% CI, 1.22-20.77; P = 0.02) compared with physical therapy alone. Both fatigue and pain were improved in patients taking low-dose naltrexone”
“The use of LDN was associated with a fewer number of symptoms, improved clinical symptoms (fatigue, post-exertional malaise, unrefreshing sleep, and abnormal sleep pattern), and a better functional status.”
“One study reported baseline erythrocyte sedimentation rate (ESR) predicted LDN response (≥30% reduction in fibromyalgia symptoms) and a second study showed plasma concentrations of inflammatory biomarkers were lower after LDN treatment.”
“The patient was ultimately deemed to have other associated conditions including a mast cell-mediated disorder as well as joint hypermobility due to her response to antihistamine and mast cell stabilizing agents. Final outcomes include immense improvement upon mast cell stabilization with ketotifen, and remission of SIBO with low-dose naltrexone (LDN).”
“it was clear she was stable and well, and could walk, and more recently, cycle, without problems. Prior to starting LDN, her intellectual and cognitive functioning was very limited. “
“She no longer requires acupuncture for symptomatic pain relief. However, her functional level did not improve with LDN. also continues with other symptoms of myalgic encephalomyelitis including postexertional neuroimmune exhaustion, periodic muscle weakness, orthostatic intolerance, symptomatic sinus tachycardia, urticarial rashes and susceptibility to bacterial infections”
“His functional level improved from being mild–moderately limited on a daily basis (60%–70% on a functional activity scale) to mild limitations (80%–90% on a functional activity scale). “
Three adverse events included insomnia, diarrhea, and self-limited headache. Marked improvement was seen by 53% of the 15 patients. Low-dose naltrexone regulates lymphocyte responses, reduces cytokine production, and likely reduces mast cell activity.
“When used in doses of 1 to 5 mg it acts as a glial modulator with a neuroprotective effect via inhibition of microglial activation. It binds to Toll-like receptor 4 and acts as an antagonist, therefore inhibiting the downstream cellular signaling pathways that ultimately lead to pro-inflammatory cytokines, therefore reducing inflammatory response. Low-dose naltrexone (LDN) may also have utility in improving mood disorders and the potential to enhance the quality of life”
“Currently, evidence supports the safety and tolerability of low-dose naltrexone in multiple sclerosis, fibromyalgia, and Crohn’s disease. Fewer studies support the efficacy of low-dose naltrexone, with most of these focusing on subjective measures such as quality of life or self-reported pain. These studies do demonstrate that low-dose naltrexone has subjective benefits over placebo, but evidence for more objective measures is limited.”
“The results of the study in adult patients suggest that low dose naltrexone may provide a benefit in terms of clinical response (i.e. an improvement in disease symptoms) and endoscopic response (i.e. a reduction in inflammation of the gut as shown by examining the gut with a scope)”
A reader that does microbiome analysis of her ME/CFS daughter’s microbiome using Microbiome Prescription expert system sent me this note with some literature. The daughter has Celiac Disease and ME/CFS.
Your wonderful system recommended beta-glucans [also written β-Glucan] for my daughter, and when I looked further, I found this. I’m trying her on them for a month-, after testing her for reactions for three days- the first week has been hopeful. Will keep you posted if you wish.
Reader
β-Glucan is a nonstarch polysaccharide having documented health benefits and industrial applications. It can be extracted from various sources, including cereals, bacteria, molds, and fungi. The chemical nature of extracted β-glucan from these sources differs slightly. This variation in chemistry defines its industrial uses and health benefits.
There is not much literature available for ME/CFS.
“The findings showed that the beta-glucan supplementation significantly improved cognitive fatigue (assessed with FIS-40 scores) after the 36-week treatment compared to the baseline (p = 0.0338). Taken together, this study presents the novel finding that yeast-derived beta-glucan may alleviate cognitive fatigue symptoms in ME/CFS.” [2023]
β-Glucan Improves Conditions of Chronic Fatigue in Mice by Stimulation of Immunity [2020] Reduces TNF-α (which is connected to mast cell issues)
Effects of β-(1,3–1,6)-d-glucan on irritable bowel syndrome-related colonic hypersensitivity [2012] “β-Glucan did not affect the pain response in general but specifically affects the visceral pain response.”
Serum concentrations of 2′,5′-oligoadenylate synthetase, neopterin, and beta-glucan in patients with chronic fatigue syndrome and in patients with major depression. [1994]
“ the dosage of supplementation ranged from 2.5 to 1000 mg daily [of beta-glucan] for up to 6.5 months … The primary physiological outcome of the majority of the interventions was immunomodulation, which resulted in (a) strengthened immune defense that reduces the incidence and symptoms of cold, flu and other respiratory infections and (b) improvement of allergic symptoms.” [2021]
β-glucan attenuates cognitive impairment via the gut-brain axis in diet-induced obese mice [2020]
Often the expert system on Microbiome Prescription comes up with Barley as a strong recommendation for ME/CFS people. Barley is an excellent source. Personally, I have oats or barley porridge a couple of times every week. The impact of the β-Glucan in the Barley may be the mechanism — we just do not have as many studies as we do for Barley.
“The primary sources of food β-glucan for humans are cereals (especially oats and barley), fungi, algae, and yeast ” [2023] A table from this article is below
“β-glucans bind to specific receptors on immune cells and initiate immune responses…. In vitro study found that the fermentation of barley and oat β-glucan by human fecal samples show variations in SCFAs production and the bacterial populations of Clostridium histolyticum and the ratio of Bacteroides–Prevotella species. Absorption of these SCFAs by the gut epithelial cells helps in regulating cell differentiation, proliferation, apoptosis, and gene expression (210). Butyrate increases the protein expression of tight junctions such as ZO-1 and claudin-1, resulting in enhanced intestinal barrier function.” “β-glucan is an essential food ingredient in controlling metabolic dysregulations linked to metabolic syndrome. β-glucans have a very minimal probability of having any unfavorable side effects and are reasonably inexpensive.” [2023]
Bottom Line
Real simple: Barley or Oats porridge for breakfast each day! Since there are some chemical differences between the β-glucans in these two grains– rotate between these (and different brands) at least monthly.
Using the generic suggestions for me/cfs we see both barley and B-glucan are positive (but oats are slightly negative). The more detailed citizen science suggestions are still be worked on, but I expect similar.
Reviewing Clinical Trials, my impression is 1 gram/day of β-glucans which translates to 20 grams of Barley or 40 grams of Oats per day.
“30g uncooked oats or barley will make a fairly small bowl of porridge whilst 70-80g will provide a particularly large serving for one person. Traditional porridge recipes tend to use oatmeal with approximately 200ml of water per 50g oats, and a pinch of salt.”
University of Aberdeen
Some people will advocate just eat mushroom. While correct that it contains beta-glucans, we need to be careful not to slip into homeopathic dosages!
Among those, mushrooms feature a particularly high level, so it’s no exaggeration when we say “for beta glucans, look to mushrooms!” The amounts of beta glucans found per 100 g of raw mushroom include 2.3 g (maitake), 2.0 g (bunapi), 1.9 g (eryngii), 1.8 g (bunashimeji) and 1.5 g (shimofuri hiratake) (Hokuto data).
When we go to typical US mushrooms (i.e. Button), we drop to .75 g/100 grams [FDA]. So we are talking about 5-6 oz of mushrooms per day. That 3/4 of the typical mushroom package per day per person.
Celiac and Gluten Sensitive Issue
Most beta glucan supplements are produced from Saccharomyces cerevisiae (thus gluten free). For example the item below is about US$17.00 and gives 100 days at 1 gram per day.
I should note that there are different forms of beta glucan, for example above it is the 1,3/1,6 forms. Another product has 1,3/1,4 and is derived from Oats (you will have to write the company to see if it is gluten free or low gluten).
The cost per gram is much lower as bulk powders than with pre-filled “premium” capsules – the same volume of beta glucan can be as high as $250 (12x more) with some products.
I got COVID in Feb 2022. Over the next few months I developed long COVID symptoms. Within 6 months I was severe (bedbound), and within a year I was very severe (24/7 dark silent zero stimulation bed rest). About six months ago I progressed back to being severe and have stayed there. I’ve been officially diagnosed as having ME/CFS as well as long COVID.
I have basically all the symptoms but the worst are light and sound sensitivity, post exertional malaise, brain fog, fatigue, and cognitive and sensory processing issues.
I have severe episodes of d lactic acidosis when I eat dairy. D lactic acidosis was actually my very first long COVID symptom.
If it’s relevant – all “mitochondria boosters” make me significantly worse. Ubiquinol/CoQ10 is what pushed me into being very severe. [Editor note: We have limited information on Coenzyme Q10 and cannot propose reasons for this response – it was not listed in the suggestions]
A few months ago my GI symptoms (diarrhea, bloating, stomach pain, etc.) got more severe, I think as a result of taking Pepcid[Famotidine] daily for MCAS. I tested positive for H Pylori and was off the charts for methane and hydrogen SIBO. [Famotidine is a weak positive, but positive]
I did a GI Map before starting treatment, which is uploaded to my profile. I then did 2 weeks of metronidazole + doxycycline + pepto bismal to try to tackle the H Pylori. My histamine intolerance and d lactic acidosis got MUCH worse during treatment. I did my BiomeSight test a week after finishing antibiotics.
Then I did 2 weeks of Xifaxan + Nitazoxanide + PHGG for the SIBO. I just finished this. My bloating is a little better but my histamine intolerance and d lactic acidosis worsened even further and now my cognitive function is the worst it’s been in months.
I’ve just started Mutaflor and have also obtained Symbioflor-2, Miyarisan, and Equilibrium, and am planning on cycling through those (in addition to whatever recommendations pop up from my BiomeSight test).
Analysis
The Eubiosis index and percentages of percentiles show quite dramatic (and a typical) results. We have a large number of bacteria which I am inclined to described as “pedal to the metal”. These are all at extreme levels. Chao Index and Shannon Index are at 0%ile and Simpson Index at 83%ile.
Some of these extremes bacteria ( > 90%ile) with known health impacts are:
The Bacteria deemed unhealthy is an impressive list.
Going Forward
The joy of using an expert system is that despite a very complex microbiome, the system will grind thru all of the data and produce a better results than a human doing so. A human will typically pick one or two bacteria to address “and see what happens”.
The person has marked their symptoms so we have five sets of suggestions going into our consensus.
The top suggestions have a few antibiotics but a lot of items are intermixed between them. In such a scenario I favor not doing antibiotics.
The following are items picked above 400 or below 300. The reason to do 50% of the extreme button is not to overwhelm the brain with too many suggestions. Check the site for dosages[Click here].
So, for breakfast every day: Barley porridge with soy milk with slices of bananas/apples?
One at a Time and Rotate
We want to identify items that help or hurts you specifically. Tossing everything in at once denies us this knowledge. My general guidance would be:
Spices and Herbs with meals
Probiotics at bed time
Break the suggestions into 4 groups and take them for a week at a time. After 8 -12 weeks (2-3 cycles) get a new microbiome test to see changes. Keep up this pattern until you have new test results.
Remember our goal is to destabilize a stable dysbiosis. We effectively want to do a guerilla war against it — constantly hitting it from different places.
Questions
Q: Question about herbs/spices. Is the recommendation to take them at the same time as probiotics? Or do a week of herbs, then a week of probiotics, and keep trading off? You’ve posted before about how some of the herbs can nullify the probiotics so I’m not sure how to stack correctly.
Answer: If you click on one the herbs and spices you will be taken to a detail page where the first section is on the impact on probiotics. For the first item, we find that clove and clostridium butyricum have no interactions — so taking both on the same day is fine.
So there is a manual process to identify what is neutral or helpful. If a herb or spice impacts every suggested probiotic, then either just do the herb, or keep 8-12 hours between them.
At a high level, Small Intestinal Bacterial Overgrowth (SIBO) appears to have low levels of Streptococcus and Rothia.
SIBO is accounted for primarily by 2 E coli strains and 2 Klebsiella species. This remarkably specific group of microbes account for 40.24% of duodenal bacteria in SIBO subjects, compared with 5.6% in non-SIBO subjects.
Of special note is mutaflor escherichia coli nissle 1917 (probiotics) which to some may appear to be a contradiction to the results. It is not, this is a beneficial probiotic that is aggressive in pushing out bad E.Coli strains.
I would do only one at time for one week each — because a “herx” type reaction (temporary worsening of symptoms) may happen.
NOTE: Probiotics in capsules should not be used. The capsules may not dissolve until after the targeted area. Custom Probiotics sells powders of many of these probiotics with instruction to dissolve in a glass of water and then consumed. That process is likely to produce the best results.
Postscript – and Reminder
I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”. I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.
I can compute items to take, those computations do not provide information on rotations etc.
I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.
The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.
A colleague gave me a list of bacteria producing different metabolites according to studies. The question arise – how accurate are making estimates. I am going to focus on one of them: Methane. The reason is simple that the microbiome data set that I have access to has self-reporting of SIBO which typically is an excess of methane.
I intend to do a three way analysis:
Using the list of well documented bacteria he provided
Using data from KEGG: Kyoto Encyclopedia of Genes and Genomes
Using data from self-reporting.
This is a rough, on a paper napkin, analysis to explore this issue.
The methane list from studies is very short:
Methanobrevibacter smithii
Methanosphaera stadtmanae
From KEGG, we use C01438 (CH4) and have a list of 622 taxa capable of producing it. A few examples are:
Serratia sp. AS12
Serratia sp. AS13
Sinorhizobium sp. CCBAU 05631
Bradyrhizobium arachidis
Cytobacillus kochii
Cupriavidus sp. USMAA2-4
Halarcobacter anaerophilus
We have 88 annotated samples with SIBO with a total population of 2461 samples. In the table below, units are cells out of one million detected.
Method
Average
Std Dev
Incidence
Studies
1378
4416
24% has some
KEGG
3432
10264
98% has some
Studies with SIBO
709
1753
29% has some
KEGG with SIBO
6901
36649
98% has some
The obvious conclusion is that KEGG is definitely superior with the count of bacteria doubling for SIBO samples while the studies approach resulted in the count count of bacteria being halved. Incidence of detection was unchanged KEGG and we notice an increase with studies, but only 29% of people with SIBO will have any methane estimated.
A second gas for SIBO is hydrogen Sulfide (C00283 H2S). Applying the same process.
Method
Average
Std Dev
Incidence
Studies
3635
5533
92% has some
KEGG
253720
155882
100% has some
Studies with SIBO
3689
4461
89% has some
KEGG with SIBO
289389
186070
100% has some
The results are not as dramatic as with methane. There was no change with Studies and a 14% increase in count using KEGG. The incidence rate went down slightly with studies.
Bottom Line
This drill down suggests that I made the right decision to deprecate the computations of metabolites using study data and shifted to using KEGG data.
The questions raised by this napkin computation is that the above process should be done with actual measurement of methane and hydrogen sulfide in samples to definitely identify the better process.
In the last 24 hours I saw/got two similar messages:
Has anyone heard of Tim spectrum who works in the uk, a scientist study’s the microbiom currently offering the Zoe app. Was thinking of trying this to see if he can help my blasted gut issues. Plus his based in the uk we’re I’m from as has study in a uk hospital kings college. And wondering if maybe just maybe my own gps might be able to jump on board and help me a little more . Paying for all these tests? Doing all these protocols? Paying all these naturel drs? Loosing a heel of a lot of weight in bank account? Looking ill? Diet after diets. And still friggin unwell . Absolutely sick to death of the whole thing . Anyone else out there feeling the same
Facebook
And from a direct email:
Tomorrow I have an appointment with a Gastroenterologist and had intended to share excerpts from my XXXX test and from my upload of the same to MicrobiomePrescription.com. However, over the last few days I’ve spent a significant amount of time analyzing and comparing the two reports/data, and there’s such a discrepancy between them and their respective “Take/Don’t Take” suggestions that I don’t feel comfortable sharing the data from either report with the doctor.
First, I want to make sure you know that I am well aware that XXXX and MicrobiomePrescription are never going to ‘match’, nor do I expect them to. However, the data is so contradictory that I’m losing trust with it.
Are you willing to look into these contradictions?
XXXX does not provide this– often many sites references are pathetic, missing or based on a dietician’s / naturopath’s personal experience. I favor data from a clinical study with 100 people over what worked for 1 person.
Example from one site that I have access to. I have seen the same on other sites.
So we have advice without any evidence being provided.
Other sites, push their high profit margin products.
They provide bulk citations but nothing on which of the 9 overgrown pathogenic bacteria each will impact.
Their support people will reply per script… “It is well studied, look at all of the studies…”
MicrobiomePrescription would suggest an increase [opposite!].. and give links to the studies
And we provide links to the actual article on line (when possible). Not just the name of the study. We also identify exactly what will be impacted and how.
One would likely be dismissed by your Gastroenterologist, the other — because of the full evidence trail, would be considered
You need to ask why they do not provide the same!!
MicrobiomePrescription was created by one person working in spare-time (full time work and supporting family). The other sites are for profit with paid employees. Often, venture capitals care not about quality or completeness — just sales. Hire 10 more marketing people instead of a caring scientist/researcher. I refer to this as “thirty pieces of silver” science.
A reader messaged me because Hesperidin (polyphenol) was the top of his list and several friends. It was there also for me! It was up with antibiotics!
For all suggestions, there is the magic evidence button, 📚. Clicking it, I see 219 citations!! Priority is based on the number of citations.
The literature cites 74 different bacteria that it impacts. Since we infer a reduced impact to the parent and children, we end up with 2,300 bacteria influenced by it.
I double checked the database that were was not a typo and if it’s impact was not entered more than normal. It was not (I have checks in the database to prevent those typos, and they appeared to have work).
So WHY is it so common?
The reason is very simple, we have more information on what it impacts. We have 74 different bacteria. If we go to others, we see much fewer bacteria:
Tulsi 17
Olive Leaf 22
magnolia bark 2
The priority is determined by how many bacteria it influences in a desired way x number of studies for each bacteria x number of each bacteria desired to be shifted. For example, if it takes just 100 to shift a bacteria to normal for Hesperidin, and a different bacteria needs 1000, the priority will be higher when they are more unless there are more studies showing the first bacteria is shifted (but not the second).
We use the term priority — and could use confidence, but confidence has too many different meanings in common speech.
. Paying for all these tests? Doing all these protocols? Paying all these naturel drs? Loosing a heel of a lot of weight in bank account? Looking ill? Diet after diets. And still friggin unwell 
. Absolutely sick to death of the whole thing 
. Anyone else out there feeling the same
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