The Melanie Avalon Biohacking Podcast Episode #240 - Danny Grannick (Bristle)

TRANSCRIPT

(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)

Melanie Avalon:
Friends, welcome back to the show. I am so incredibly excited about the conversation that I'm about to have. It is a part two update conversation, which is one of my favorite types of episodes to have on this show. And it is with the co -founder and CEO of an incredible company called Bristle that I had back on the show. We were just looking back in September of 2022. So it has been quite a while. And friends, I was so enamored with and fascinated by this company, Bristle actually provides at home testing for your oral microbiome. It's so cool. And we'll put links in the show notes to the first episode that we did with Bristle because we dived deep, deep, deep into how Danny created the company and everything that they were doing. And basically I did the kit myself and you get this really comprehensive profile of what's going on in your oral microbiome because people are talking about the microbiome all the time, but normally they're talking about our GI microbiome. I feel like so few people are talking about the oral microbiome. And it has so many implications for health of your body overall, as well as dental issues and things going on in your mouth as people might assume. So in any case, I really wanted to have Danny back on the show for a few reasons. One, it has been so long. So I wanted to hear about the updates with Bristle and hear what they're doing now and provide another chance opportunity for you guys to get a kit of your own. And also I asked the audience for questions for Danny and oh my goodness, it's funny whenever I ask for questions for different topics, I'm never quite sure how many responses I will get and it's really hard to predict, but with this one I was pretty sure I was gonna get a lot of questions and I got a lot of questions. People wanna know what's going on in their mouth. So Danny, thank you so much for being back on the show.

Danny Grannick:
Yeah, thanks for having us. It's great to be back.

Melanie Avalon:
And you and I were just talking right before this because I was logging into my account for my initial results. I was saying I really wish that I retested right before this show because then I could have compared how things had changed in my mouth. But two, just quick comments slash questions about that. One, I've tried to decide which one I should do first. Well one is logging in right now. It was really cool because I realized in Danny clarified that as Bristol gets new developments in their algorithm and new findings, they actually update your report. So when I was logging in right now, there was new information that I had not seen. And the second question, which is more practical, which maybe I should say for later, but how often do you recommend testing with Bristol?

Danny Grannick:
To your first point, I think you hit on a really exciting piece about the oral microbiome. And really, I think microbiome research in general. But when we think about the oral microbiome in particular, there is so much research that's being done. We're really kind of on the forefront of understanding not only the role of oral microbiome and oral health, but the role of the oral microbiome and overall health as well. So as these new findings come out, because our test is really comprehensive and uses a technology called shotgun -metatonomics, we're able to update users' results with new discoveries as they're made in both academia and kind of more formal research as well as what we're finding through our own data and research internally. So an example is there was a new species of bacteria that was discovered. I believe in June or July of 2022 or 2023 as playing a major role in CARES. And most people, when they think about the bacteria implicated in cavities, kind of jump to streptococcus mutans. But we're finding that more bacteria play a role in that disease. And we were able to incorporate those findings into the results for our users and update everybody's scores to reflect it. So it's been a really exciting time for the company there. Your second question. So it really depends on what the results are for an individual and what kind of behavioral and clinical factors they have as well. So an example, if somebody takes our test and they're not experiencing any disease, they don't have any oral symptoms, all of their scores come back and they're all in the green. We really don't recommend testing. Somebody doesn't need to retest more than once every six months, maybe in conjunction with your dental checkup or once a year for users that are experiencing an oral condition, maybe gum inflammation or chronic halitosis. They're implementing changes. They're really trying to make progress. We recommend more frequent testing somewhere in the vein of two to three months after implementing our recommendations. And then when we get to a more homeostatic place with their oral microbiome, they can reduce the frequency of testing again, back to every six to nine to 12 months.

Melanie Avalon:
Okay, awesome. So question about the first part that you were talking about with updating it for findings. So you don't have to relook at the saliva sample. Like if you find a new bacteria, you don't have to go specifically look for that bacteria in the sample. You can just figure it out with the algorithms.

Danny Grannick:
Yeah, it's really, it's a software question for us. So the technology that we use for our test is called shotgun metagenomics. And all that that really means is when we take a saliva sample, we use DNA sequencing technology to identify all of the microbes that are present, even the ones that maybe we don't have an identity for yet, but we're storing all of this oral microbiome data. And as new discoveries come out, we're able to revisit that data, make associations, or if somebody identifies a completely new species, we can see if there's anything in somebody's sample that matches up to that species without having to go back and collect another saliva sample.

Melanie Avalon:
That's super cool. Would there ever be anything that would require a new saliva tool? That's a theoretical question.

Danny Grannick:
No, it's a good question. I think the oral microbiome, if we think about saliva, the oral microbiome, the bacteria, the fungi and viruses in our saliva are one set of biomarkers that we're analyzing. If we wanted to look at another biomarker, maybe an inflammatory marker or human genomics or something like that, then in that case we may go back to the saliva sample or develop a new test for those. But when it comes to the oral microbiome and the sequencing that we do, we try to collect as much data as possible so that we can continue delivering value and insights to our users over time.

Melanie Avalon:
Just to give listeners an idea of what they'll see in their report. So again, like I said, right after we finish this, I'm going to, because I have a kit here, I'm going to, well, I can't do it right after this because I don't think I will qualify for, because don't you have to have not eaten or drank for a little bit? I might have to do it tomorrow is the point. But in any case, what listeners will see because I'm logging into my account right now. So last time I did it, which was a while ago now, I had average and like this is just the overview and then you click and you get a more detailed granular look. But I was average for beneficial bacteria, average for gum inflammation, undetected for tooth decay, average for heliotosis, average for gut impact, optimal for nitric oxide, and too low for diversity. So I seem very average. Yeah, those are good results. I'm going to have to all be green though. So actually, that's a question. What really is the spectrum of what you see with everybody? Like, so these averages scores, is that average compared to other people? Yeah.

Danny Grannick:
Yeah. So it's going to be, well, it's going to be based on two populations depending on what scores you're looking at specifically. So when we say average, we are talking about in comparison to other oral microbiome samples that we've analyzed specifically for the oral health scores. So for the beneficial, as it's shown in your dashboard, the beneficial bacterial score, the gum inflammation. So those are bacteria and other microbes related to periodontal disease and then tooth decay, you know, same thing, bacteria and other microbes, but related to cavities. There are two populations that we incorporate. So the first is what you touched on all of our users over time who we've sequenced. And then the second population is actually a clinical population that we did in a study with the University of the Pacific dental school. And the way that we structured that study is patients would come into the clinic, they would consent to take the test, we would analyze the oral microbiome, and then we would contextualize their results to the clinical notes that were taken that day, right? So if a patient came in and the dentist who was examining them saw that they have periodontal disease, they're looking at your scores in comparison to those patients as well. So those are clinically diagnosed patients who we ran through Bristol and your scores in comparison to those diagnosed patients for periodontal disease. And then when you look at beneficial bacteria, we're looking at patients who were diagnosed as healthy in the clinic and for the tooth decay score, patients who are diagnosed with cavities.

Melanie Avalon:
It's interesting because my tooth decay was actually one of the ones that was undetected, which I thought was interesting. I'll be really interested to retest for this. Actually, speaking of correlations, what have you found with the results of people's findings and how the person themselves feels about their mouth microbiome? Do people who anticipate having a, quote, healthy microbiome tend to pan out that way and people who seem to have issues tend to pan out negative or can it be like, surprise? Like different. Because actually, because like Teresa, she wanted to know, how do we know if we have concerns with our oral microbiome and what can we do about it? So like the overarching question is, like, should everybody be testing this to find out what's going on regardless of if they feel like they have, quote, issues or not?

Danny Grannick:
Yeah, that's such a good question. So let me, I guess, let's back up and we'll talk about what, maybe we'll start with what your dentist looks for in a normal checkup and then we'll come back to the oral microbiome and kind of the differences between the two. So, you know, as a patient, when you go in for a dental checkup, the typical dental checkup involves some observational screening, somebody, you know, looking and poking and prodding inside of your mouth. There's a couple of measurements that are associated with that that I won't get into. And then the other very typical kind of, you know, dental checkup procedure is an x -ray and that is looking for decay in your teeth. And that's pretty much it. Like, that is the standard of care today. And in both situations, your dentist is looking for active symptoms, right? If you have decay, it shows up in the x -ray or diagnosed with a cavity on the periodontal side, you know, there's a measurement, it's called bleeding on probing, where a dentist or periodontist is literally measuring how much blood is coming from your gums when they poke at them with a tool. So, very symptomatic approach looking for existing disease. With the oral microbiome and our test, we're looking at the root cause of those symptoms. We're looking at the bacteriophongi and viruses that are either actively contributing to symptoms that somebody experiences or in a lot of cases, we're looking at the very earliest presence of those microbes that can lead to those symptoms. So, we're talking about early detection of disease, potentially before symptoms have ever shown up. And when we talk about something like that, you know, to get back to the question of, like, do all of our users who have a high abundance of pathogenic bacteria have active symptoms, it's not necessarily like that. I would say it's probably, you know, this is very rough math, but a 70 -30 split, 70% of our users have active oral conditions, it's clearly reflected in their results. And 30% of our users maybe have mild to no conditions, but they have underlying dysbiosis. And what that means is they're at increased risk to progress to more severe symptoms of disease. And it's actually beneficial for us because the earlier we detect the dysbiosis, the more addressable it is, the more effective our recommendations are in really preventing the onset of disease later. In terms of, you know, if somebody's not experiencing symptoms, should they take the test, I would highly recommend it because that's the kind of care that everybody's looking for. It's the proactive, preventive oral health and care, and that's really accomplished through the oral microbiome test.

Melanie Avalon:
similar question because a few people wrote in with experiences where they were seemingly quote fine and whatever issues they were looking at and then a Bit of time passed and then they were surprised. So like for example, so Kimberly She said she had a she follows a very clean two meal a day diet mostly protein She has SIBO and other digestive issues She had not had cavities since she was a kid And then she had a cleaning done and had six cavities and she was wondering why this would happen And she said the only sugar she has is from berries and that she does drink coffee And then Felice said she'd been keto for almost six years and for the first few years She was told that she had no plaque or tartar and then the past three to four visits She was astounded by the amount of tartar and she said she uses electric toothbrushes water picks flosses and it's still bad And I know those are really specific questions, but I guess a more broader question is if people You know this theme of people seeming fine and then all of a sudden they have these issues Do you believe that a lot of that could be like because you were just talking about the preventative nature of all of this Could that be like oral microbiome? imbalances that just pop up later or is it more Lifestyle choices in the moment like what do you find with the time aspect of all of this?

Danny Grannick:
Yeah. I mean, I think it's going to be multifactorial, no matter how you're looking at it. But in the case, Kimberly, I would venture to say that if we separated into like two dental visits, right? Dental visit one, you can imagine that Kimberly was asymptomatic. You know, they didn't find any decay in the x -rays and she was diagnosed as healthy because they're diagnosing based on what they can see. But it's very possible that she had a high abundance of cavities causing bacteria during the visit. They just hadn't done the damage yet. And fast forward six months, those bacteria have had a chance to build up over time. You know, you throw in other factors. You mentioned SIBO. So potentially something with the oral gut connection, which I'm sure we'll get into, throw in coffee, a highly acidic liquid that is potentially feeding those bacteria, helping them replicate. And you know, you're growing the abundance over time. Those bacteria are producing more acid. It's eroding the enamel. So come the second dental visit, you're seeing kind of the result of those bacteria manifested in the x -ray.

Melanie Avalon:
That answers Kate's question a little bit. She was curious if strong coffee might be hard on the mouth microbiome. She says it's all she drinks besides water during her fast. And it seems that her gums tingle more after a good strong cup. Although I know you were talking about the acidic nature on the actual teeth. Have you found coffee in the microbiome specifically has an interaction?

Danny Grannick:
I mean, the acidic nature of the coffee can shift the pH balance in your mouth. It creates an environment that's more favorable to pathogenic bacteria. All that said, I'm drinking coffee right now. So we have to be realistic, right? There are going to be some things that people don't want to or can't change in another vein, right? You could have somebody that is taking a prescribed medication and a side effect of the medication is dry mouth. It has the same effect. It shifts the environment in your mouth. It favors pathogenic bacteria. It puts them at higher risk for oral microbiome dysbiosis and disease, but it's not something that they can change. So, you know, I'm not imagining that everybody's all of a sudden going to stop drinking coffee because of the effect on the oral microbiome, nor would I advise that somebody stop taking medication because it has a side effect of dry mouth. We just have to be aware of those things and then take other steps to mitigate the effect and monitor, again, our oral microbiome, our oral health to make sure we're getting ahead of any problems that might arise.

Melanie Avalon:
In that same vein, what sort of research, this is just me asking, what sort of research are you guys doing looking at the connection between diet and the microbiome? Like, do you do testing on specific foods or anything like that? Or what have you, yeah, what have you found in your research?

Danny Grannick:
It's been pretty exciting. So we actually are in the middle of developing a pretty powerful tool to start doing a deep dive into our data. We've passed this threshold of sample volume where we can start asking some really interesting questions about the connection between metadata. So when you take the test, you fill out a survey and we ask you questions about your oral hygiene, your diet, your medical history. And that's what we call metadata. And then our microbiome data, so what we're actually testing for. And we're starting to look at things like Middle Eastern diet or Mediterranean diet, sorry, vegan versus vegetarian and even getting into the effects of things as specific as coffee in the oral microbiome. It's not something that's really been studied before and that goes back to our original point around how little research has been done across oral health and the oral microbiome. But we're hoping to have some at least preliminary findings that we're going to share with the community in the next couple of months.

Melanie Avalon:
is the majority of that type of research that you're doing more correlational, so looking at users' existing data and matching it up to what they have, or do you anticipate doing any studies with randomized controlled trials with actual food changes or anything like that? Yeah.

Danny Grannick:
So the way that we think about it is, again, because so little research has been done, we want to start with hypothesis generation. And that is kind of looking at our data and looking at the metadata and going in with open eyes, just saying, what can we find? What kind of signal can we see across all of these different data points? And that is going to be correlational. It's just telling us, out of all of this data, can we pull out three to four things that look interesting from the surface that would justify us doing a deeper dive. And then we would want to put together a more robust study to really prove out whether that hypothesis is correct or incorrect.

Melanie Avalon:
So cool. When did you pass the benchmark for the amount of data collection that you needed with users?

Danny Grannick:
It depends on the depth of the question that you're asking, but we felt like 5 ,000 samples was a really good threshold to start asking a lot of questions. We passed that, I want to say, maybe halfway through last year, maybe a little earlier.

Melanie Avalon:
Cool. Congratulations. Thank you. Do they all have to be unique samples or do the People's Repeat Samples help as well?

Danny Grannick:
The repeat samples are incredibly helpful, understanding what somebody's implemented between testing, if any changes have occurred clinically or otherwise. It just allows us to ask a whole new set of questions that we wouldn't be able to do just with one sample at one time point for everybody.

Melanie Avalon:
Is there a question that's most haunting you right now?

Danny Grannick:
You know, it's been interesting. There are, and we might have talked about this in the last podcast, there are so many practices that I think people see as fundamental, that don't have a lot of oral microbiome data or research behind them. So something as simple as what is the impact of flossing on the oral microbiome has never really been asked. And we actually have a blog article where we did a deep dive in our data because we wanted to understand, you know, our dentist, you know, you can look online at everything tells you that you should floss twice per day. And we're not saying that it's not helpful, but nobody had ever really looked at how is it helpful? Is it helpful for, is it more helpful for certain people than others? You know, it's flossing five times per day, better than flossing once per day. You know, one of the things I've been most excited about is just our ability, and it sounds boring, but our ability to look into those like basic oral hygiene questions and get some really interesting answers from it. So that's been cool to see, and I want to continue doing that. You know, another kind of like haunting question to me, I think starting to uncover, there's a lot of anecdotal evidence behind interventions in oral care. So, you know, emerging things like oil pulling, some older higher Vedic interventions like tongue scraping. Again, there's not a lot of oral microbiome data. So these are things that I want to look into and really understand, again, who is it most helpful for? What does it really impact? Not to prove or disprove it, but to really make sure that the people who are adopting those things are the people who it's going to be most helpful for. The same can be true for probiotics. We're starting to really understand, you know, how certain strains within oral probiotics, which is an emerging field, impact certain pathogenic species in the oral microbiome.

Melanie Avalon:
I have a comment on the flossing bit. I interviewed a few months ago, Dr. Dome, he wrote a book called It's All in Your Mouth. It was fascinating because it was a really comprehensive overview of, I mean, a lot of stuff that we're talking about on today's show with the microbiome and all of that. But he made the controversial statement that he doesn't think we should floss at all. He thinks it's not natural. So I never even heard that perspective, which was completely different from the conventional perspective. And I'm not saying that that's right or wrong, but it kind of just speaks to what you were just talking about, how I guess we don't even really have data surrounding it. It's just something that we do. Yeah, we got so many questions about kind of what you were just talking about with these different modalities that we do. Just brushing our teeth, for example. Do you guys have findings and data on that? Because we had a lot of questions. People want to know, Ivy wants to know when to brush her teeth before or after eating. Stacy wants to know which products to use. Reagan wanted to know about prebiotic toothpaste, which I've wondered about those as well. And you kind of hinted at those a little bit with probiotics, but I know that's different. Teresa says she uses a $30 toothpaste and wants to know if it's worth it. Benoit wants to replace his toothpaste with one that doesn't have microplastics. Amanda wants to know about xylitol, which is in a lot of toothpaste. And she heard it is an antibiotic killing good and bad bacteria by starving them. So, OK, so basically questions are all over the board about toothpaste. What have you guys found with toothpaste?

Danny Grannick:
Yeah, so those are all amazing questions. And again, I think it just speaks to how little research and how little research has been done. And I think the industry hasn't been very effective about educating consumers and professionals about a lot of the findings that have happened. So toothpaste, there hasn't been a ton of innovation in toothpaste over the last 50 years, at least. The majority of toothpaste is fluoride based, as I'm sure a lot of people are aware. One of the most recent and recent is probably like 20 plus years old. Innovations in toothpaste is there's a new compound that is being used called hydroxyapatite. And it comes in nano and microforms. It has been shown to be a very viable substitute for fluoride based toothpaste. And our research has shown that it is just as effective as fluoride based toothpaste. So that's been exciting to see it starting to come to market. One of our advisors, Dr. Mark Burhana, who I'd love to introduce you to, by the way, I don't know if we had done that before. No. OK, I'll connect you guys. But he runs two companies. One is called Ask the Dentist, which I would highly recommend. Anybody with questions about functional oral health, the oral microbiome, he is one of the foremost authorities and educators around oral health and the oral microbiome. So I would highly recommend that people visit his website, Ask the Dentist. And he actually just launched a new toothpaste company called FIG, FYGG, that they use hydroxyapatite in their toothpaste and it's been shown to be highly effective. It's one of the latest innovations in the space. So it's been exciting to see.

Melanie Avalon:
Yeah, I would love to be introduced to him. I, as well, was really wondering about the hydroxy appetite. So I'm glad you really talked about it. And people were asking about it, too. Maria wanted to know if it was a good substitute for fluoride. Jennifer wanted to know if it was superior, if combined with fluoride. So I was actually listening to recently a Huberman podcast about this. And he was saying that the hydroxy appetite, which I never knew how to pronounce, so I'm glad we're talking about it. He was saying that it's the actual, and like I think you just mentioned, the actual ingredient in your teeth, in a way. But then he was saying fluoride, the bonds that fluoride creates, is actually stronger than what the hydroxy appetite bond would be. So I guess that's why, one reason there might be a lot of confusion out there surrounding it. I actually ordered a hydroxy appetite toothpaste myself that I use at night. Do you use one yourself? I do. Have you made any changes in your recommendations for how you recommend products in the report review?

Danny Grannick:
Yeah, I mean, similarly to the way that we update the results as we have new findings around the most effective products or what would be most beneficial to one person versus another, we'll update the care plan logic with that new information.

Melanie Avalon:
Do you have thoughts on water flossers? Mariah was wondering if flossing or water flossing was better.

Danny Grannick:
I use a water flosser for, well, so I guess there's two ways to think about it. I use a water flosser because I just think that it's easier for me to use. So from an adherence perspective, like I do a better job with the water flosser, so I prefer to use it over something like string floss. And the water flosser is also really nice because you can, for lack of a better word, customize it. So, you know, in some of our recommendations, we would recommend that somebody put dilute hydrogen peroxide inside of their water flosser, inside of the water basin. So it's kind of this like targeted delivery of an antimicrobial while you're flossing your teeth. So it really hits the gunline while and can flush out those pathogenic bacteria.

Melanie Avalon:
Oh my goodness. Okay. I'm going to have to get one. Also, I've been struggling with flossing because I have some veneers. Oh, that's a question I have for you, but I have had issues with messing them up with floss. Have you seen or done any studies on people who have dental work, like veneers or crowns and its effect on the microbiome?

Danny Grannick:
We're starting to see that. We haven't done any active studies, so I'll talk to our team and I'll get back to you.

Melanie Avalon:
I wonder about that every time I would get new dental work like that. I was like, I wonder what this is doing to my actual, you know, community in my mouth. Well going back to the oral microbiome and the findings that you are finding, you mentioned earlier in the episode, the connection to the gut as well as whole body health and wellness. So what do you think is the biggest misconception compared to the way things actually are as far as, I think a lot of people might just think the oral microbiome and all that's effects are local to the mouth, but what is the broader connection to our bodies beyond that?

Danny Grannick:
Yeah, I mean, you hit the nail on the head. I think that this theme of the mouth being this separate component from the rest of our bodies extends way beyond just the oral microbiome. Obviously, dental care is entirely separate from medical care. The two systems aren't connected. We see two completely different people. The data doesn't connect to each other. The insurance systems are completely separate. It is a systemic and societal theme that are melts for whatever reason are this completely separate thing. Biologically, I think for a long time, it was also seen as very localized. It's evolved in phases for decades. I would say that there have been clinical correlations. What I mean by clinical correlations is we would be able to say, hey, a lot of our diabetic patients have higher rates of periodontal disease. The association would stop there. As a lot of our patients get older, they tend to have more frequent or more severe periodontal disease. Age and the emergence of oral disease was connected. There would be these associations that were made. It really hasn't been until the last couple of decades that we've been able to look at it from a biological perspective and really start to understand that the oral microbiome, the foundation of oral health and disease, is highly influential in a lot of those associations. I would say that some of the biggest buckets in terms of where the focus is today is in the connection between periodontal disease and Alzheimer's or cognitive decline, diabetes. Also, cardiovascular disease has been another really big area of research in terms of the connection between oral disease, the oral microbiome, and systemic disease.

Melanie Avalon:
And do you think it's more causative or so like for example with the periodontal disease and the Alzheimer's, do you think it's more causative? Do you think it's more correlational? Is one creating the other? What came first, the chicken or the egg? I think in the

Danny Grannick:
In the case of Alzheimer's, Alzheimer's for now is kind of an umbrella term. It describes a set of symptoms, but we're still trying to figure out what the cause or potential causes are. I think that there are maybe a subset of cases where it is causal, where the presence of these pathogenic bacteria in the oral cavity reaches a certain threshold and they're able to make their way to other parts of the body leading to a cascade effect that eventually becomes Alzheimer's disease. I have no idea what the frequency of that is, but I would venture to say that there is some subset of Alzheimer's disease that did originate from that. Then I think that there's probably another bucket where it is contributing to the progression of Alzheimer's disease. Then I think there's a bunch of cases of Alzheimer's that are driven by other causes that have nothing to do with oral health and oral disease. Another really good example, and I think the recurring theme here is multifactorial things can go in both directions. When we think about oral disease and digestive health, we report on bacteria. We have a score in the report that you touched on earlier. It's the gut impact score. That score looks at the abundance of bacteria in the oral microbiome that are able to translocate to the gut microbiome and have been connected to dysbiosis there, leading to conditions like IBS, IBD, Crohn's disease. The thought behind that biomarker is that if you have IBS, IBD, Crohn's disease, other digestive disorders, and you also have a high abundance of those bacteria in your oral cavity, addressing your oral health, improving your oral care, they actually help alleviate some of the symptoms that you're experiencing in your gut because you're eradicating those pathogenic bacteria and you're not swallowing them anymore. That's one direction of the relationship. On the other hand, patients who have acid reflux or GERD, they're introducing acid into their mouth because of their digestive disorder. Again, that's shifting the pH. It's creating a more pathogenic environment in their oral cavity and it leads to oral disease. You have this completely bi -directional relationship across your body, mental health, digestive health, oral health that is constantly influencing each other.

Melanie Avalon:
really interesting when you think about it that we first made the frontier into the gut microbiome, which seems much more inaccessible compared to the mouth.

Danny Grannick:
I've been asking myself the same question since we started the company. I don't know why the gut microbiome seemed to accelerate so much quicker than the oral microbiome other than kind of going back to what I had mentioned earlier. I think a lot of people, oral health is just such an overlooked component. And for whatever reason, I don't think it gets the same amount of attention or recognition that other parts of our bodies do.

Melanie Avalon:
I'm always reading random books about the random history of different things in health and medicine. And it's just so interesting why or how we discover different things related to health. And a lot of it has to do with just because they happen to develop a certain technology to detect whatever. But yeah, the mouth, you know, it's like right there. Seems like we would have been doing more research on it to related questions to what you were just talking about. So we did have a specific question from a listener. Sonya wanted to know if there are any findings on oral microbiome dyspiosis and rheumatoid arthritis. Are they related? Do you have information on that?

Danny Grannick:
Yeah. So there's actually been a lot of exciting research over the last, I want to say, like, two to three years looking at rheumatoid arthritis and the oral microbiome. There was a paper that came out maybe one to two years ago that had connected pathogenic bacteria making their way into the bloodstream with autoimmune response in rheumatoid arthritis patients. I'll have to track it down. But all that to say, I think that in the case of arthritis in particular, it is starting to cross that chasm that I had mentioned earlier of these clinical associations where patients with RA tend to have higher rates of periodontal disease and patients with RA who have periodontal disease actually tend to have, I believe, more frequent and more severe symptoms of RA than those who don't. So we're starting to evolve from this clinical association to a biological connection.

Melanie Avalon:
So very interesting. And the second question, OK, I'm so excited about this question. And what's funny is I read it originally from the listener, and I had no idea what she was talking about. And then I was listening to a Huberman podcast, and he was talking about this. So I think she might have listened to that episode, and that's why she asked this. But you kind of mentioned it just a moment ago, the effect. And it's kind of the opposite of what I'm about to ask. But you were mentioning the potential negative effect of swallowing these, quote, bad bacteria. Maureen wanted to know, is there benefit to swishing and swallowing your morning saliva to help populate your stomach microbiome as well? And I don't know if you heard Huberman talking about this, but he was saying a good practice was the first, like when you first wake up to do what she just said, you swish and then you swallow your morning saliva. Have you heard about this practice? I have.

Danny Grannick:
If you haven't heard about that, I'll have to listen to the Huberman podcast. I think that that one came out not too long ago.

Melanie Avalon:
Mm -hmm. Yeah, I'll send it to you.

Danny Grannick:
Yeah, because I mean the number of species that can survive in the digestive system in the stomach because of all the acid, it's pretty low. You have to be pretty tough to survive those conditions. Most of our research has been around pathogenic bacteria that can survive. I don't know if we've actually looked at the commensal bacteria.

Melanie Avalon:
Oh, that can survive in this stomach? Yeah. This is me just brainstorming now because when I first heard him say that, I was thinking, well, what if you swallow, what if your oral, and it's funny because I knew I had this episode coming up, but I was thinking, well, what if your oral microbiome is not ideal and then you swallow that? How is that helping? I guess we don't know, but is there the potential that good bacteria might be more able to survive? Then the bad depending. And they got microbiome? Yeah, like swallowing the oral microbiome.

Danny Grannick:
It's possible. I think, so I'm just thinking out loud. There are, I'll have to look into it. Yeah. I've never thought about the idea of seeding the gut microbiome with commensals from the oral microbiome. There are a few bacteria that are beneficial in your oral cavity and can be pathogenic in other environments. So, maybe a bacteria confers health benefits when it's in your oral cavity, but if it's in your gut, it actually can be harmful. I'll have to look into that. That's a really...

Melanie Avalon:
Huh? He says that he reads all of his YouTube comments. I think I'm gonna use this as an opportunity to try to track him down. I'm gonna comment.

Danny Grannick:
And I think that podcast was with Mark Burr -Hana, if I'm not mistaken.

Melanie Avalon:
who you were just talking about? Yeah. Oh, wow. Come full circle. Another question. I know listeners probably have a lot of questions surrounding this, but, and we mentioned it a little bit before, but breath. Teresa wants to know why do some people have bad breath, like quote, unreal bad breath. She says, even right after brushing with chewing gum, et cetera. She says she has a friend who has tried all the things and nothing seems to help. She feels like it could be a digestive issue or something or a sign of another health concern. So what have you guys found? There is the haliotosis score in the results. What have you guys found with bad breath, which I know is a concern for a lot of people? Yeah.

Danny Grannick:
that we love bad breath. So there's, and I know that sounds weird to say, but bad breath, it's been so interesting for us. Bad breath is a condition that millions, I mean, there's morning breath, right? Or there's coffee breath, or there's bad breath after you just ate garlic, and then there's chronic bad breath. So I'll call that halitosis for the purpose of our conversation. Millions of people suffer from halitosis. And for the most part, halitosis is completely unaddressed in today's standard of care. So for the consumer side of Bristol, something like 70% of our users come in specifically to identify and address the root cause of halitosis. Because the typical journey is somebody starts experiencing symptoms, they go to their dentist, and there's really, until our test, there has been no real way to test it or diagnose the root cause. And there are a whole plethora of treatments. It's hard to understand what's gonna work best. So they'll go to their dentist, it becomes a dead end. A lot of them will maybe go to an ENT, and similarly, it's a dead end. They will then do a bunch of their own research, try a bunch of things, maybe nothing works. Eventually they find Bristol and they take the test. So we've actually done a lot of research into halitosis. And we have uncovered kind of like six distinct oral microbiome signatures, six buckets of halitosis or types of halitosis within the data. Some halitosis we find is driven by the same bacteria that cause periodontal disease. So for those patients, it's actually kind of like a, it's an early symptom of periodontal disease. In other patients, we found that the halitosis is driven by Candida fungi, so the same kinds of fungi that can cause oral thrush. In other patients, we found that they are bacteria growing in the grooves of the tongue, but we've identified these six subtypes of halitosis, and in your results, we'll tell you what kind we've identified in your oral microbiome, and then there are specific recommendations that we have depending on what subtype you fall into.

Melanie Avalon:
Is one type easier to address? Is one more difficult? Like is there like one that you don't want to get because it's like the hardest to eradicate?

Danny Grannick:
Yeah, there is one bucket. We don't call it the unknown bucket, but there is one bucket of helitosis that we're still doing a lot of research on. And we have been able to help some of our users address it, but it is much more of a guessing game than the other kind. So I believe that the helitosis associated with those periodontal pathogens, the ones that cause scum disease, that care plan is extremely effective. We tend to see really amazing results in one to two months for those people. For other buckets, we've kind of got to go through the gauntlet of testing things out, seeing how they're working, making some tweaks, revisiting the care plan. It's similar to, I think, the odyssey that a lot of people go on when they start experiencing digestive issues, which isn't to say that it's impossible to address, but it just takes a lot more work. And then there's some kinds of helitosis that originate. And it's really the minority that originate from areas outside of the oral cavity. So they're driven by digestive conditions. And that's where the negative results of our test may actually be helpful. You can think of it like a differential diagnosis where you're experiencing helitosis. Maybe you were diagnosed with IBS or IBD, but you haven't done a gut microbiome test. And if you took our test and your helitosis score was really low, it won't tell you what's causing it, but it will kind of rule out that helitosis is originating from your oral cavity. So you can start investigating other options.

Melanie Avalon:
with the product recommendation, and I might have talked about this last time, but a product I know, actually, I still use, and I've been fascinated by because it was one of the really, like, only products I've seen where at least what they said they were doing was directly affecting the oral microbiome, which was their breath because they say that one of the ingredients in activates, I think, like the sulfur producing bacteria in your mouth. Is that one of the ingredients in one of your recommendations, the compound that he works with, do you know? I can take a look. He has the oxy, I'm looking at it right now, the oxyd8. It's his patented version of oxychlor, oxychlor compounds. I was always fascinated by it because in the description, and I'd have to find it right now, but let's see what he says about it. I remember he was just saying that it deactivates that bacteria for a little bit, and it has so many reviews. So like on Amazon, 42 ,000 reviews with four and a half stars.

Danny Grannick:
Well, if it weren't, yeah, I mean, if that many people say it works.

Melanie Avalon:
But I've always just wondered what's actually happening with that ingredient. Yeah, I'll take a look. Something I personally have found, you mentioned this earlier, well, the oil pulling and the tongue scraping, I do those every single morning and can't really imagine not doing them. Brooke wanted to know about the benefits of tongue scraping for the oil microbiome. And then Karen wanted to know about oil pulling. That actually makes me think of another question as well from me, which is, those seem to be very mechanical interventions. Well, I guess the oil pulling, you're using oil, but the tongue scraping, you're literally like scraping out your tongue. And with the oil pulling, they say it's like pulling stuff out of your bloodstream as well. They say a lot about the oil pulling. How much change can you make to your oral microbiome with mechanical effects like that, like with the tongue scraping?

Danny Grannick:
Yeah, I mean, mechanical interventions are really all that we've been working with. So brushing your teeth, maybe with the exception of fluoride and nanohydroxyapatite, which do serve purpose in remineralizing, it's still a mechanical intervention. You're literally brushing plaque off of your teeth and flossing your physically removing pathogenic bacteria. So I would say 90% of what we can do in our mouths is mechanical, and it certainly works to remove pathogenic bacteria. I think the the important question is for how long, right? Like how effective is it in really like improving your oral health and keeping those bad bacteria at bay? So the issue with mechanical interventions, yeah, it helps remove the pathogenic bacteria. But if you're not really eradicating it, it's going to come back. And that's why there's, you know, I'm sure that there's going to be people listening to this podcast who resonate with the idea of like, I see the dentist and I have cavities, and then I spend six months and I'm brushing my teeth every day, and I'm flossing every day, and I go back and I have cavities again. Like why isn't that working? And it's because, you know, sometimes the bacteria just aren't where you're focusing your efforts. So maybe they're growing on your tongue or somewhere else. And the other reason is because those are, I don't want to call them like temporary, but the bad bacteria will regrow, they'll repopulate the open space that you've removed them from, unless you're reintroducing or introducing beneficial bacteria to take up that space and kind of crowd out the pathogen. So, you know, one of the really exciting pieces in oral health, I think, is the emergence of probiotics and prebiotics. And I know it's been a really controversial set of interventions in the gut microbiome space. But to your earlier point, I think it's really promising for oral health because we are able to mechanically intervene, and we can introduce more therapeutic options in the form of probiotics. We can, you know, you can't like reach into your gut and scrape it clean with a brush, but you can do that in your mouth. And then you can introduce a localized probiotics that can start to take hold and move into that open space and crowd out the pathogens.

Melanie Avalon:
Wow. And I know when we talked last, you had hinted at potentially doing developments with your company and probiotic toothpaste for different products. Are you guys still developing things like that?

Danny Grannick:
Yeah, so in, I want to say, in May of last year, we actually launched an Oral Probiotic. It's a mint, so kind of like a, yeah, probiotic breath mint. And we, it was our first product launch. We developed it, we looked back at our data. And, you know, I mentioned like 70% of our users come in for helitosis. So we wanted to develop it based on, you know, kind of the most common kinds of imbalances that we were seeing across our database. And then we sourced the most effective probiotic strains and kind of came up with a formulation for this V1 probiotic. And I would say that, you know, for around 40% of our users, based on their results, they fall into this bucket where the probiotic is incredibly, incredibly effective. You know, you take it twice per day for two to three months, and it has significant improvements in reducing the abundance of the pathogenic bacteria. It's actually, you know, I mentioned this earlier, the helitosis users with periodontal pathogens. It is incredibly effective for them and really anybody with a high abundance of periodontal pathogens. And then for the rest of our users, it, it is effective. Like it's a great complement to your oral care routine. So we included xylitol in it, which is great for combating karyogenic or cavities causing bacteria. And, and for anybody else who's just looking to improve their oral health, like if you take one per day in combination with your normal oral hygiene routine, it's a great way to just kind of reseed your oral microbiome and homeostasis prevent the onset of disease. And in the future, we're, we're continuing to look at the data, you know, we're talking to some partners because we want to help other companies innovate and create better products as well. So I don't know what our future looks like in terms of oral care products, but I think no matter what, like we want to leverage our data to create or help create better oral care products for everybody.

Melanie Avalon:
Oh my goodness. Okay. Questions slash thoughts. So that oral meant probiotic, which I'm looking at right now. Do you know will my code for listeners work on that?

Danny Grannick:
It should, and if it doesn't, then I won't make it.

Melanie Avalon:
Okay. So friends, because I'm looking at this right now, this is so cool. The coupon code Melanie Avalon will get you 15% off site -wide at bristlehealth .com, which thank you so much for that by the way. So that will be good for the testing, which is super amazing that we've been talking about as well as this oral health probiotic. Okay. So a question about this probiotic, which might be a silly question, but do you get the effects immediately from it being in your mouth? Because I'm looking at the strains and there are a lot of strains that we think of as associated with the gut. So like Alplantharum, Bifidobacterium lactus, lactobacillus, rudorary or rudorii, two different streptococcuses. So do those strains immediately have the effect when it's in your mouth or are they going into your gut and then back to the mouth or retroactively affecting the mouth?

Danny Grannick:
No, so we keep them localized. That's actually why it's a breath mint. The idea is that you're sucking on it, you're keeping that probiotic localized to your oral cavity. Obviously, if it makes its way to your gut, it's not a big deal, but we do want to keep it localized.

Melanie Avalon:
Awesome. This is so cool. Oh my goodness. I want to create a product that That works with you guys in my avalanx line. I'm like, what what could we do? This is so cool another question just about the future of all of this We did get some sort of biohacking ish related questions again. Sonya wanted to know About red light and blue light therapy devices Do they actually work to kill bacteria and or whiten teeth and DD wanted to know about red light in the mouth? Should she use it regularly or just for dental work and I have actually so when I've had dental work done I've used sexually Kenny on is the brand they make a red light laser device that's More concentrated and small and you can target parts of your body and it's a game changer for me that but that's recovering from That's more about the inflammation recovering from you know, oral health procedures But in general light red light blue light can blue light whiten teeth red light Does it have an effect on the microbiome or inflammation or or is this not something you guys have looked at?

Danny Grannick:
we are looking at it. It's a pretty new technology. It's still kind of in that like, I don't want to call it anecdotal in the symptomatic area where I think people are seeing at the symptomatic level improved outcomes. So maybe reduced and kind of backing up like most of the clinical trials that have occurred for oral care products look at outcomes related to symptom reduction. So, you know, this patient had less inflammation or their teeth are like visibly wider, whatever measurement they used to look at that. The oral microbiome as a component of those outcomes like hasn't really been standardized. So we're starting to look at it from that perspective. The clinical data looks interesting. Like I think anecdotally, a lot of people have seen improved outcomes. So it's definitely helping a lot of people. I think we just want to confirm that again at the microbial level, it's also beneficial or at least not doing any damage.

Melanie Avalon:
Chris did want to know if there was a good gum for the oral microbiome.

Danny Grannick:
Xylitol -based chewing gum is beneficial for the oral microbiome, certainly better than anything that contains a bunch of sugar that you would find in the grocery store. There's a whole host of companies that make Xylitol chewing gum.

Melanie Avalon:
I would love to make it similar to the ment thing. And I think we talked about this last time, but I would love to make something that is not sweetened because I think for all the intermittent fasters out there, something may seem to deal with is bad breath and it might not necessarily, it might just be like keto breath from being in ketosis. But we get questions all the time about people wanting something to freshen their breath that doesn't have anything sweet. And normally they're sweetened with silatol like you just mentioned. So I would like to make a non sweetened like peppermint spray with probiotics in it. Although I think last time we were talking about the issues about having that in an oral form might be difficult, like a liquid.

Danny Grannick:
Yeah, yeah, it's tough to integrate probiotics into like a liquid medium. Okay, that makes sense. But I'll do some more research. Things are evolving all the time.

Melanie Avalon:
I can tell. So what is your day to day life like with the company as far as research and everything that's happening? Are you actually the one like doing the research?

Danny Grannick:
No, our CSO, David Lin, one of the most intelligent people I know, does the majority of our data science. And then from a day to day, you know, we're still a small company. So everybody is wearing multiple hats. It is, it's everything from fulfilling orders and dealing with customer support to investigating these really cool data science questions to doing product design to taxes. Yeah, it's, it varies every day, but that's what keeps it exciting. You know, I think for us, it's, yeah, it's challenging and, and exciting to kind of balance like the day to day parts of running a business with the, the amount of innovation that we know that we can do and like really wanting to be at the forefront of the oral microbiome and oral health.

Melanie Avalon:
Well, you guys are definitely doing that. I've just been so impressed with everything that you're doing ever since meeting you. I mean, I guess it was like three years ago because when, when did you launch? I think you had recently launched when we first met, maybe.

Danny Grannick:
It's like November 21.

Melanie Avalon:
one, I think? That makes sense because it looks like I did my kit. I sent in my kit in March of 2022. So I think you had just recently launched. And I just remember being so impressed by, because there are so many companies out there innovating and doing incredible things with incredible people. And often times or sometimes the people who are creating the companies, they're more just like innovating companies or creating incubators or think tanks or seeing an opportunity. But for talking with you and connecting with you, you get this and you're so passionate. And this is your thing and you guys are doing so much incredible research. And like I said then, and I'm saying now, I'm just, and we were saying, I'm just shocked that more people aren't talking about this and doing this. And so I really applaud you for being at the forefront of this revolution that we need in the microbiome world. So yeah, so thank you. Thank you for what you're doing.

Danny Grannick:
No, thank you. Yeah, I mean, I think it's been exciting for us because I think because oral health has been so overlooked, like there's such a big opportunity to make a substantial change. You look at so many other areas of health care, and I agree there's a lot of innovation, but it's hard to get and drive radical change, but we have this opportunity in dentistry, right? We work with, I believe, like 60 or 70 dental offices that are using our test in care. And you talk to anybody else who works in the clinical segment, it's incredibly hard to get health care professionals to adopt new technologies to really shift. And it's not their fault, right? Like they have a million things going on. It's a ton of education, it's a ton of work, but with dental care, there's, yeah, we can completely change the script on what, and I'm using air quotes, but like what the standard of care looks like. You can imagine your dental checkup five years from now is not going to be this going in every six months, getting your x -ray, getting your observational screening, finding out you have disease and you need 10 fillings. It's going to be preventive, personalized, proactive, incredibly convenient, painless. It's an incredible opportunity. And because oral disease is so ubiquitous for better, for worse, our entire team has had, everybody's had some kind of personal experience with their oral health, I think. So we're all coming at this from a personal history, like a problem that we want to solve for ourselves and for other people. And I think that's been really big in creating the team that we have and creating the product that we have and helping the people that we do.

Melanie Avalon:
It's so exciting just to see the development since last time we talked. So I can't even imagine where it's all going. And again, you guys are so kind. So listeners can go to bristlehealth .com. That's B -R -I -S -T -L -E -H -E -A -L -T -H .com. And you can use the coupon code MelannieAvalon to get 15% off site -wide, which is amazing. And you guys do have, so again, you have that ment probiotic, that oral health probiotic. And then you can get the bristle oral health test. Like I said, it is so cool. You will learn so much about your oral health microbiome, a really comprehensive report. And then like we're talking about, it gets constantly updated with their new findings and advances, which is super cool. I cannot recommend it enough. So yeah, use the coupon code MelannieAvalon to get 15% off. And wow, this has been incredible. Is there anything else you wanted to share with listeners about bristle and what you're doing, or just anything we didn't touch on?

Danny Grannick:
No, I think that's everything. These interviews are always so fun with you.

Melanie Avalon:
Oh, likewise. I so, so appreciate it. We're going to have to have you back again. We'll have to make this a tradition. Yeah. Thank you so much, Danny. So the last question that I ask every single guest on this show, hope I asked you last time. I don't know if you remember it, but it's just because I realize more and more each day the important of mindset. So what is something that you're grateful for?

Danny Grannick:
I mean, I'm grateful for our community and our team. I touched on it earlier. Hearing from our users how much we've helped them is such a big motivator for us. And it's so rewarding. I guess I'm grateful that I am able to be in a position where I'm able to help people and hear about the help that we provide. It's like an incredible feedback loop. And it's such a good motivator. And I think maybe more personally, I'm grateful for my dog Lola, who is just the light of my life. My partner Nicole, she's been incredibly supportive throughout the company. It's an amazing position to be in. I'm just grateful that I've been able to do everything that I've been able to and been supported by the people in my life. I know that's probably a very cliche answer.

Melanie Avalon:
No, I love it. And actually, now I just have to ask, do you think there's the future for pets with oral microbiome or yeah, oral microbiome testing?

Danny Grannick:
There may be a pet oral microbiome test that's already out there. There's a really interesting, or not interesting, there's a high frequency oral disease in cats that we, somebody had approached us about doing some research on, we didn't have the bandwidth at the time. But yeah, huge kind of like unmet need. I think that there's a company called Animal Biome that does, I know that they do microbiome testing for pets, and there may be an oral microbiome test. I'll have to look into it.

Melanie Avalon:
It's super cool. Yeah, it's really interesting to see how things progress in that sphere as far as advances with humans and like biohacking and technology and testing and, you know, seeing it in our pets. So, awesome. Well, Danny, thank you so much. This has been so amazing. I can't wait to see all of the updates with you guys and have you back again in the future. Of course.

Danny Grannick:
I guess, yeah, I can't wait to be back.

Melanie Avalon:
Thanks so much. Have a good rest of your day. You too. Bye.