#110: Afif Ghannoum (BIOHM Health)

Afif Ghannoum (BIOHM Health) [00:00:00]:

We call ourselves the Microbiome Innovation Company. We want to be the intel within for the microbiome, where we're powering innovation not just for ourselves, but for others in the industry.

Jeffrey Stern [00:00:10]:

Let's discover the Cleveland entrepreneurial ecosystem. We are telling the stories of its entrepreneurs and those supporting them. Welcome to the Lay of the Land podcast, where we are exploring what people are building in Cleveland. It I am your host Jeffrey Stern, and today I had the real pleasure of speaking with Afif Ghannoum, a Biotech attorney by Background, and the CEO of BIOHM Health, which he co founded with his father, Dr. Mahmoud Ghannoum, a leading microbiome researcher and recognized for naming the microbiome, which is the body's fungal community. With over 30,000 citations and 500 published papers, dr. Ganub is one of the top 5% of cited microbiologists and top 2% of all scientists across all disciplines and has been continuously funded by the National Institute of Health since 1991, including just receiving his latest NIH grant at the age of 72. Leveraging his own background launching and selling consumer products in over 27,000 stores and licensed IP to companies around the world. In addition to holding several biotech patents, a FIFA partnered with his dad to commercialize research and the science into world class consumer products through their company, BIOHM Health. With state of the art science and one of the largest microbiome datasets in the world that combines bacterial land fungal sequencing, BIOHM was the first to address the critical link between fungi and bacteria and gut health. Over the last year, BIOHM has expanded its role with some of the largest global ingredients companies to offer a worldclass suite of services, including product development, leveraging its industry leading database, bioinformatics testing and clinical trial support. Their first BiomeFx Probiotic supplement was designed to specifically help reduce digestive plaque found in the gut. BIOHM is currently embarking on a clinical extension directly for medical practitioners and is quickly expanding into retailers across the country as it not only manages one of the most comprehensive gut health datasets, but also has access to one of the largest collections of fungi strains, second only to the center for Disease Control and Prevention. In late 2022, Afief secured 7.5 million in funding for BIOHM to support their broader vision going forward. BIOHM is a fascinating company based here in Cleveland, and I really loved learning more about a fifth journey building it, so please enjoy my conversation with a Fifth gnome. One of my favorite parts of doing this podcast now at this point is the community around it, and I love that. A few weeks ago, Mac Anderson from Cleveland Kitchen tagged you in this comment on one of the Lay of the Land post, and maybe the next day after that, I see that you've publicly closed on, I believe, a seven and a half million dollar round, and now here we are to share your story. And so I've been very excited to hear all about it, having not really had yourself or herBIOHM Health on the radar. So thank you for coming on.

Afif Ghannoum (BIOHM Health) [00:03:12]:

Yeah, thanks for having me. I really appreciate it.

Jeffrey Stern [00:03:15]:

So the more and more I'm hearing about the importance of the microbiome land sort of as like the next great bio frontier where we can potentially, I don't know, unlock some of the greatest knowledge about not just digestive health, but human health and disease at large going forward. And so with that, I am also very excited just to learn more about the work you're doing in the space, but would love to start with how you found yourself down the rabbit hole of fungi and bacteria and the microbiome at large. Where does that actually come from?

Afif Ghannoum (BIOHM Health) [00:03:52]:

Yeah, great question. So I'm a biotech attorney by background. I was a lawyer at two MLA 100 law firms here in Cleveland. And at the end of the financial recession, like 2008, 2009, I was working like crazy as a corporate lawyer. And as a lawyer, you make other people's dreams come true because you do a lot of important legal work for them. At the same time, my dad had this really cool technology out of his lab at Case Western School of Medicine and he was telling me, oh, this is really cool. These guys want to start a business with it. And he was really excited about it. But at the end of the day, because he's academic scientist, he really did not get to do a lot in the business side. He really ended up with almost no equity out of it. And I was sitting here thinking, I'm helping all these people, I'm part of these legal teams that are helping people realize their business aspirations. And my own dad is feeling slighted and basically ripped off in the situation of something that was out of his own lab. So we started in 2010, really working for ourselves. We're on the regulatory land, business and legal side. I understood that. My dad understood the science, and we first did that with an oral care company. But then in 2016, my dad was doing research on biofilms in the gut and really how bacteria and fungi really create these aggressive plaques in your gut. Have you heard of a biofilm?

Jeffrey Stern [00:05:26]:

No, I was just going to ask.

Afif Ghannoum (BIOHM Health) [00:05:27]:

Okay, so the biofilm you've likely heard of is the plaque on your teeth, right? So the plaque is a biofilm. So what that does is it puts a hard shell over germs that start working against your teeth, your gums, and because it's really hard to remove, can cause a lot of issues. So there are actually biofilms all over your body. And biofilms you'll see is like if you see a pier and you see that sort of scsy stuff where the water meets the pier, that's a biofilm, right? So he found that biofilms that were fungal and bacterial were actually forming in the gut. So his paper got all sorts of notoriety, and I thought, that's kind of interesting. I've never heard of fungi in the gut. And so what I went to work doing was looking at, well, how can I actually break down that biofilm through utilizing probiotics? So came up with a way to do that, and it was the formulation of microbiome. So that's how I got into it. And so since then, we've launched a number of different products. We do a lot in the microbiome data space. We have a testing platform. So we have thousands and thousands of gut health samples, which is a fancy word for we take DNA out of people's, poo that they submit to us. Land we analyze it and we see what's going on, what organisms are in your gut, and we help people nutritionally figure out how to feel better from their digestive issues. So started with a couple of people, and now we're up to a team of, I don't know, probably 20 people.

Jeffrey Stern [00:07:01]:

Wow. But before we kind of delve into the business land, the crux of the work that you're doing today, I think that was some helpful context, but perhaps going a little bit deeper in terms of I just feel that the depth of biological understanding required to fully understand the nature of your work and your father's research. I want to start maybe with a rudimentary baseline of explain it like I'm five kind of overview of perhaps a little bit of the history into how our understanding of what microbiomes even are and how that's changed over time and just kind of set the stage for the conversation 100%.

Afif Ghannoum (BIOHM Health) [00:07:43]:

So the simplest way to think about it is germs. When we were growing up you're a lot younger than I am, I think, but especially when I was growing up, germs were viewed universally as just a bad thing. Like we wanted to get rid of germs bad. What science has shown us is that one, not only are not all germs bad, but there are what we call native organisms that live on our bodies. And microbiome now is synonymous with the germs that live in your gut. But your skin has a microbiome. Your gut obviously has a microbiome. Your mouth has a microbiome. My dad actually identified 101 native fungal organisms that live in your mouth natively. And so the microbiome, when we talk about that is understanding that there's a native community of organisms that lives in a specific part of the body. So when we talk about the gut microbiome, we're talking about the bacteria, the fungi, even the viruses that live in your gut. And what we found is, while it is complicated, it's also pretty simple. What the science has shown is that you want a balanced microbiome of the good guys, the bad guys. And when you have that homeostasis, it seems to benefit your health. So the analogy I really like is the ocean, right? You wouldn't want to be stuck in a pool with a shark. But you don't want to get rid of all sharks because then there's going to be unintended consequences where the prey they keep in check are going to overgrow and they're going to eat too much of the algae and then without more of algae, blah, blah, blah, on down. So it's like anything you really want homeostasis in the way you balance your gut. And when you do that, that seems to be connected with all sorts of areas of wellness, everything from what we call the gut brain axis to obviously digestive issues to even things as crazy as the intensity of pain or your ability to properly metabolize drugs is impacted by the balance of your microbiome.

Jeffrey Stern [00:09:41]:

And perhaps it's too difficult in the time. We have to give a full, comprehensive overview. But what's kind of an overview of the nature of your father's research at large land and some of the, like, big takeaways from it. Yeah.

Afif Ghannoum (BIOHM Health) [00:09:56]:

So he's the scientist that named the mycobiome, which is the fungal community in the body. So when you talk about the myco, which means fungi, mycobiome are just the fungal organisms that live in our body. So his research really has been deeply into how the microbiome interacts with other parts of our body, but also how biofilms interact with our body. So that's probably the easiest way to look at it is basically how fungi, both good and bad, impact our health and then how biofilms, good and bad, impact our health. And again, biofilms, the simplest way to think of them are just plaques.

Jeffrey Stern [00:10:30]:

Why have fungi been ignored for so long? I feel like the more I learn about mushrooms at large land, their kind of real importance, obviously, within ourselves, but just in nature at large. I feel like they're underrated. Have we just not turned our lens towards them very much so.

Afif Ghannoum (BIOHM Health) [00:10:53]:

There's a couple of reasons. One, when we call, like, medical fungi, like the ones that grow in your body, part of it is become and my dad's actually written about this, it becomes self fulfilling. Where national institutes of health were funding all sorts of virus research, bacterial research, but they weren't funding a whole bunch of fungal research. So guess what happens? The innovations around fungi start to lag behind the areas that are highly funded. It's really only the last decade where that funding. It's still way favored on viral and bacterial research. But fungi is starting to be seen in all sorts of papers that it's got a tie to cancers, it's got a tie to as we're doing gut health, it's got a tie to all sorts of things. Land now, there's shows like the last of us showing that, hey, fungal pandemics, these things, and those are real. But fungi is also one of those things that the more you explain to people, the more they actually have heard of it. So an easy example is a lot of women, when they take an antibiotic that kills all the bacteria, they'll have yeast infections. Well, yeast infection is fungal infection. The reason is when you get rid of all the bacteria, the fungi grows out of control. Right. Or babies with what is often called thrush is candidiasis, where they get it in their mouth that's because they're so little, their immune system is still developing. Same with HIV patients or really immunocompromised people. So we've seen fungi creep up more than people kind of realize, but it really has just been overlooked just because it hasn't been a huge area of research compared to bacteria and viruses.

Jeffrey Stern [00:12:29]:

So the kind of pieces to the puzzle coming together here, when we think about the founding of BIOHM Health and the work you're doing today, I imagine the potential implications of the research and the learnings from it. There are a lot of different directions that you could have gone at the onset. So when you began to think about commercialization, I guess, how did you decide where to focus in this whole problem space?

Afif Ghannoum (BIOHM Health) [00:12:58]:

So we decided to focus on dietary supplements because instead of as like an FDA approved therapeutic, because it's just a simpler regulatory schema and dietary supplements are a huge proven market land. We thought if we brought better science to this space or very good science, we would be in a very good position. So that's where we decided to focus. And everybody listening to this, and obviously I assume yourself is more than aware of dietary supplements. Right. So that's why we decided to focus on that. Is it's very hard to get things approved through FDA? You need hundreds of millions of dollars. We just didn't think that made sense.

Jeffrey Stern [00:13:42]:

So I think it might be helpful just painting a picture of where the company is today, how it's gotten to the point where it is. We mentioned the funding round that you guys were able to close recently. Maybe just kind of walk us through the path to today and we can pull on a few threads from there. Yeah.

Afif Ghannoum (BIOHM Health) [00:14:06]:

So we launched honestly, we bought 500 units of the probiotic from a manufacturer. We knew a magazine called Goop was going to be running an article about fungi and digestive health and biohm. And we thought, I hope we sell these 500 bottles. And it really started with that. And we did. And then we stern adding additional products. And then really it was a team of three of us doing it when it first started. And so we went from that to offering microbiome testing to slowly but surely getting into the data analytics game and then partnering with other companies to actually launch products powered by our technology. So along the lay, raised angel financing. Then we did a venture capital round in 2000, land 18, and then just did another venture capital round this year. So the other thing is where we were essentially a Cleveland company in all aspects. Employees, funding, all those things when we initially started. Now most of our team, not most probably half of our team actually is not in Cleveland. And we've raised capital from all over the US. That's because in the supplement and like microbiome space and supply chain space, there's a lot of expertise outside of Cleveland. So what the Pandemic showed us is you can kind of hire people from wherever and it's still as effective. So that's kind of been the evolution of the business. It's been pretty interesting to see.

Jeffrey Stern [00:15:42]:

So I definitely want to talk about the supplement, the microbiome testing, the whole data platform. Maybe if we start where you had started with supplements. You mentioned that you imagine most of us are familiar with supplements. And I feel like there is kind of a perennial problem with supplements in how I feel. People trust is really at the heart of that. Given somewhat of a regulatory opacity, you're not always sure the efficacy of these kinds of supplements. Can you just kind of take us through how supplements work at kind of like a high level as an industry and then how you guys are approaching trials efficacy? How do you actually build trust and what is the intended outcome from a supplement perspective?

Afif Ghannoum (BIOHM Health) [00:16:33]:

So dietary supplements at the end of the day should be a supplement to what you're doing with your diet. People often overlook that and they'll see products that make all sorts of wild claims. So one of the things I always say to people is you are responsible as a consumer to understand a few things. And more and more, it's easy to get this information. One, I like to know who's making this product? Who's actually behind the product? Where is it made? Especially when you can buy stuff on Amazon, like this is being made in someone's basement. How do you know this is actually made in an FDA audited facility? That sort of thing. I want to know what is the science that they're actually doing on the product? Did they actually do any clinical trials? Are they just making wild claims off something they read on the Internet? And then I also like to know what is the quality of the ingredients? Right? So those are simple things. It may take a little bit of effort, but honestly, for things that you're ingesting and putting your body land, these products are often not cheap. It's honestly worth taking a half hour or so just to look up, because any reputable company, you should be able to get a lot of that information just from their website. So with us, we ferment all our probiotics in the US. We package all the products in the US. We've done clinical trials, multiple clinical trials. We've published several papers in peer reviewed journals. We just had a paper published in the leading GI journal Gastroenterology, because that's another problem. People say, oh, we published a paper. And it's like Uncle Jimmy's, Nutrition Journal. You know what I mean by whoever. Land so a lot of it really comes down to understanding what is actually going on behind the scenes. That's one of the ways we really stand out, is really taking not quite a pharma level, but we approach things with extremely high quality, extremely high science. But that's something that you really have to pay attention to. The other thing a lot of times people don't understand is if you're buying a product at retail, just assume the retailer probably paid 50% of that, and the person buying paid 50% of that. So if you do the math quickly, when you see things that are very cheap, just do a little bit of mental math. And it's like for them to make this, they are paying almost nothing, right. And there are these little signals of quality that you can look at.

Jeffrey Stern [00:18:57]:

Just to clarify, because I've always been curious about this as well. Is that the clinical trial and the efficacy studies, those are self imposed or are those required from a regulatory standpoint when a supplement makes a claim?

Afif Ghannoum (BIOHM Health) [00:19:13]:

That's a great question. So where people get things twisted is if you have a prescription drug or FDA approved drug, you have to go through FDA approval and there's all sorts of crazy high levels of clinical trials. You have to do like years and years of development, but that's mandated in order to get FDA approval to sell a drug. Simple example, something like Tamiflu, right? In order to get that through all sorts of things. Where people get it wrong is they think dietary supplements are not regulated by the FDA. They're very much regulated by the FDA. Land. Even the FTC. So where clinical trials come into play is if you're claiming the product can do certain therapeutic things, you need to be able to support it. Land there's some nuance there, but that's generally what it means. So, for example, with our probiotic, we talk about it being able to help reduce mild Bloating. We can say that because we actually ran a clinical trial that showed with statistical significance versus placebo, we actually improved Bloating. Right. So that's where that comes into play when we're talking about doing clinical trial and there's rules of thumb, like it should be placebo controlled, should be a third party doing it, things like that, just to kind of keep the rigor of the science where it needs to be. But that's generally what you mean when you're talking about clinical trials.

Jeffrey Stern [00:20:35]:

So in addition to Bloating, what are some of the implications and intended outcomes of ingesting this supplement?

Afif Ghannoum (BIOHM Health) [00:20:47]:

Yeah, so first, I always say this any product, whether it's our product, anything that's a dietary supplement, it's never intended, nor should it be taken to treat, cure, prevent any condition or disease. They're just not designed to do that. So what we're doing is essentially supporting your digestive health. Now, we have done clinicals with things that I would call like mild therapeutic, things like Bloating, supporting reduced abdominal pain, things like that. But any probiotic should be done alongside what can you do with your diet if you're really not feeling well, you need to talk to your doctor first thing. That's a step that most people don't want to take because it can be annoying, but you really have to do that. But more and more probiotic is kind of like a multivitamin for your gut. So think about it this way. If you cut your skin, you can put some antiseptic, put a bandage on and it won't be sterile. But you'll pretty much keep it isolated from being reinfected with your gut. You're putting food in there. There's all sorts of liquids, there's acid, there's all sorts of things impacting the organisms in your microbiome. So when that happens, that can be challenging to keep it in homeostasis, right. Like stress can throw it out of balance if you are feeling under the weather. So what a probiotic can do is really just supplement, helping maintain that balance.

Jeffrey Stern [00:22:19]:

Got it. Starting with the supplement, we'll layer on those two other that you mentioned, what does microbiome testing actually entail? And we'll start there and we'll work our way to the kind of the data play.

Afif Ghannoum (BIOHM Health) [00:22:36]:

Yes. So what microbiome testing do is think about it like a 23 ANDME for your gut. So what you do is you sell us a very small sample of your poo. And what we do is we send you a swab and we say if the swab is white, the testing is not. Right? It's got to be brown for the testing to go down. Right? So once we do that, we extract the DNA from that what we call fecal sample, and we look at what organisms are in your gut land. Then we compare that to the thousands of people in our database and we tell you, are you high low compared to other people? And we start seeing where you're at. Now, what's important is it's a tool, right? Once you see where you're at, you can say, okay, I'm really low on this beneficial one, I'm really high on this one. That's pathogenic. You can start making some adjustments.

Jeffrey Stern [00:23:26]:

Right.

Afif Ghannoum (BIOHM Health) [00:23:26]:

Useful. Because digestive health is very confusing. A lot of times it's hard to know, why do I feel like this? Is it something in my gut? Is it stressed? So it can be a really useful tool to get an idea of what organisms are actually in your gut, what levels are at. And then you can start implementing things like dietary changes, looking at different supplements, that sort of thing. And then on the data, when we have just a large data set, it allows us to really analyze and see what's going on in different cohorts of people. Right? So what does the typical microbiome of a healthy person look like versus an unhealthy person, versus a stress person, versus someone with lactose intolerance. There's all sorts of ways we can look at that data. That's really cool because then the idea is that we can rationally, design, probiotics and microbiome solutions to try and optimize a certain kind of gut. The gut of a 50 plus person, the gut of someone, like I said, with stress, all sorts of things. So that's where it gets pretty cool.

Jeffrey Stern [00:24:27]:

And that feels to me like a relatively unique data set when I go to a physical on a regular basis. I don't believe the microbiome test that you just outlined has ever been part of a normal checkup.

Afif Ghannoum (BIOHM Health) [00:24:42]:

Yeah, no, you're right. So there are a few companies that do this. We are really specialists in the way bacteria and fungi interact in your GI and aside from selling it ourselves, we power microbiome tests sold in about 1100 practitioners offices across the US. So slowly but surely it is becoming more and more mainstream. But yeah, again, it's one of those things that a lot of times these are people that they're just dealing with digestive issues and they want to understand why land again, it's not going to diagnose or prevent or treat anything, but it's just a useful thing to know. What are these organisms? Are they high, are they low? We'll often have people who swear they have candida overgrowth, which Canada is one of those organisms that is connected to a number of health issues and they'll take the test and turns out they're not. Right. That their candidate levels are perfectly normal. Right. That's useful for people. So it's just a way to measure your nutritional health basically.

Jeffrey Stern [00:25:48]:

Right. What would be some of the things that you could gauge triage from this diagnostic snapshot? Understanding it's not a diagnosis of anything, but what are some of the things that you could take away from it?

Afif Ghannoum (BIOHM Health) [00:26:03]:

Yeah, you could understand that we have people that they have digestive issues, they eat perfectly well, they exercise very regularly, but their microbiome is a mess. And what we're able to help them isolate is that it's stress causing them issues. Right. We have other people that they really don't understand that. I'll give you an example. We had a cluster of women that were having all sorts of digestive issues when we tested them, they were really high in something called zygomycoda, which is a very aggressive fungi. Usually you only see that in really immunocompromised people like cancer patients, HIV patients. So we were like very suspicious that this many women would have that. So when we looked at their data and their diet, they were almost entirely cutting out carbs, land, dairy and those can be very good for your gut in reasonable levels. They would never think to do that if they didn't realize that they were actually causing this fungi to overgrow. They're thinking cutting out dairy and carbs is actually helping them. Right. So it's funny because I'll tell that story and people are like, what if I'm gluten intolerant or I'm lactose intolerant? It's like, well, that might not work for you then. Right. Like, not everybody is, right? Land a lot of times we kind of live in a culture of extremes, right. It's not that someone ingests dairy. They ingest 18 pints of ice cream. Right. And the view is, well, then you got to entirely cut it out. Land it's like no, shockingly. It's usually the boring answer, which is like something called moderation. Right? Just be reasonable. Now, again, I'm not talking about people that have actual intolerances. Then at least you're aware of it and you can make some adjustments. Right. That's the kind of insight that you're not going to get unless you're looking at the organisms in your gut.

Jeffrey Stern [00:28:01]:

The product manager and me is very curious about the microbiome testing onboarding process because I know how hard it is to get someone to just make their way through a few steps in a mobile application. I'm kind of fascinated by what is the onboarding process and friction involved there? How do you get people comfortable doing something quite invasive on themselves?

Afif Ghannoum (BIOHM Health) [00:28:27]:

Yeah, so usually these people are pretty motivated because they're either optimizers or curious. They just want to know what's going on in their gut and more and more because you take it off like a piece of toilet paper. It's really not that big. But listen, it is poo. There's a little bit of an ick factor, and it's definitely a niche product. Probiotics are mainstream tests. Like, this is still not mainstream. That's why one of the things we did is we developed Guttest.com, which is powered by our microbiome data, but it's an online quiz that takes two minutes. It's free. You do not have to put Poo on your computer to use it. Land it will tell you with statistical significance if you're likely to have an imbalance Gut. Right. Those are little innovations to get people slowly but surely going down the path. And if they are imbalanced, it's like, look, if you really want to know, then, yeah, maybe it's worth taking a test. But, yeah, it's definitely iterations and iterations over the last six years. Land getting people to understand not only the test, but then removing, like you said, friction to make it a seamless process.

Jeffrey Stern [00:29:38]:

So both from a business perspective and from, I don't know what you call it, health impact perspective. I would love to understand, as you went to Fundraise, what was the vision that you kind of painted from the investors perspective for where this company can go and what is the impact that you hope to have in retrospect and maybe just layering onto that how you think about what success might ultimately look like?

Afif Ghannoum (BIOHM Health) [00:30:11]:

We call ourselves the Microbiome Innovation Company. We want to be the intel within for the microbiome, where we're powering. Innovation, not just for ourselves, but for others in the industry. As you said at the top of the program, it's an area of increasing importance, understanding how to optimize the microbiome. So that's where we see where it is we're agnostic, whether it's through our brands, through partners brands, and then where we see it going is probably a strategic acquisition to someone else in the space. But who knows, right? It's still early days, but that's really what we're communicating to investors. That's our vision, that we think we can power a lot of innovation in the space.

Jeffrey Stern [00:30:57]:

So I feel like a lot of the dialogue conversation that happens around the development of new kind of innovations like what you've been working on is between treatment and cures. Land I'm curious, from the research perspective, maybe what's coming down the pike? What has you most excited in terms of the potential implications for how this can actually improve health outcomes for people?

Afif Ghannoum (BIOHM Health) [00:31:34]:

You're saying in the microbiome generally or what we're doing?

Jeffrey Stern [00:31:37]:

Both.

Afif Ghannoum (BIOHM Health) [00:31:38]:

So the microbiome generally, I think the way I say is we're in the 1960s of cancer research where we know the microbiome is very important, but it's very early days, right? So we're seeing a lot of correlation. We have to be very careful about how we tie causation to. And I'll give you an example. There's a big tie between autism and the microbiome, and we see that a lot of children with autism have GI issues. Now there's a question is, are autism and the microbiome tied together? Is there some signaling going back or is there a third factor? Like a lot of autistic children are very specific with their diet. Could that be impacting their microbiome? So their microBIOHM Health is actually a side effect of the way they eat. It's not actually tied to their autism symptoms, right? So it's things like that where a lot of interesting signals, but right now they're just signals that we have to unwind. So that being said, it's very clear that where there's smoke, there's fire. The microbiome is going to be a critically important area of innovation over the next hundred years because we're just at the precipice of understanding. So right now what we know is if we are able to help you balance your GI, it's tied to a number of optimal health outcomes, but you have to be very careful about how you tie correlation and causation. But I think it would be foolish to discount the space. I just think you have to be wary of anything being seen as a silver bullet. Does that make sense?

Jeffrey Stern [00:33:20]:

For sure. And the question comes particularly in the context of having heard about it recently, it feels like it's becoming more popular. I've heard it described as the next frontier. And so to me that kind of paints the picture of some potentially really important outcomes that could come from this kind of research.

Afif Ghannoum (BIOHM Health) [00:33:43]:

Land development, I think that's 100% going to be the case. It'll be a question of how and when.

Jeffrey Stern [00:33:49]:

Yeah. So how do you think, on the company side of things about what the next stage of development looks like in terms of you have these kind of three offerings from a product perspective, how do you think about prioritization and the strategy of the go to market from here?

Afif Ghannoum (BIOHM Health) [00:34:14]:

Well, there's two answers to that. The one is the button up answer, which is, look, we're going to continue to innovate, and we are in the middle of big distribution in a number of different areas that over the next couple of months are going to be unfolding. We're really excited about that. So we'll continue to innovate, look for different ways to utilize our data for new products, all sorts of things. The less polished answer is, you've been involved in a startup until you're in the clown car. You don't understand what it's like to just grow a company. There's a lot of moving parts. You're reliant on 80% effort and 20% luck of things going the way you want them to go, and just crazy stuff like, we had an enormous term sheet over the summer that at the last second kind of evaporated when the economy started to change. What can I do about that? There's nothing I can do about that. Right. So it's things like that where the more I do this, the more I've realized that entrepreneurism really is 80% you control, and then there's that 20% that it just has to go your way.

Jeffrey Stern [00:35:23]:

What has it been like to professionally work with your dad? How has that dynamic played into this whole journey?

Afif Ghannoum (BIOHM Health) [00:35:31]:

Honestly, it's great. I think it works for us because we're in completely different lanes and he also doesn't work full time at the company. He still is that case. So part of it is you have to know if it works for you. Right. I know plenty of people that it would be a disaster if they worked with their family. I know my dad and I have great sympodico. We respect each other. We know our land in what we know, and that's how it works. But listen, he's also we will scream and shout at each other sometimes like, you know, like anybody does in the family. Right. So it's but it's very rewarding, and I get to talk to them every day, and a lot of people don't have that, so it's a lot of fun.

Jeffrey Stern [00:36:16]:

I want to go in a quick I don't know if it'll be quick, actually, but a little detour here, actually, back at the founding, something you'd mentioned was this tension that your dad had felt about the kind of technology transfer process. And it's something I've spent a little bit of time thinking more about is how much maybe latent opportunity there is for all the research that's done in academic institutions and how hard it feels like it is to unlock that. Wearing your lawyer hat, wearing your entrepreneur hat. How does the technology transfer process actually work? And how did you actually facilitate a structure where your dad felt comfortable about the arrangement relative to what he had been working through?

Afif Ghannoum (BIOHM Health) [00:37:02]:

Yeah, so, look, it's really well known that getting technologies out of universities is typically not easy. It's very tricky and take a long time. So with this, part of it is I went to Case undergrad I went to Case Law School. I've been around the ecosystem a long time. Our previous company, we had done studies of Case. I know the really well, and there's mutual respect and all that good stuff. Even with that, it would still took like a year to negotiate a know how license for my father's know how around the microbiome. So it's not a fast process. Most universities, probably all universities, but we'll say most, they want nothing more than someone to be a good steward of their technology and hopefully they make some money from it. Right. I think sometimes where academic institutions get in their own way is they worry way too much about stuff that is not the value creator, but they think it is. Right. So the publication rights, the things like the intellectual property, and I think sometimes when that's what academic centers have been built around, developing IP, developing publications, all those kind of things, is that you start to think that that is the only thing that creates value for the entity. And that's the reality, is it's not. You have to commercially turn that IP. So I think sometimes that's where there's a lot of back and forth, there's negotiating rights around that stuff when it's like, guys, the reality is, if this works, it'll go well for everybody, and if it doesn't, it won't. Right. So why don't you get many shots on goal and see what sticks? Right, so that's the reality. It is a huge, untapped area of innovation. There are some really cool stuff sitting at universities, but sometimes I think you just have to know to go look for it. Right. I knew just because it was my dad's research, but right. There's a ton of researchers that have interesting things. And I think sometimes people just don't think to pick up the phone and.

Jeffrey Stern [00:39:03]:

Ask, yeah, I have thought about because it's been a pattern through actually a lot of conversations on this podcast is how much of it seems to be able to come from a university. And I don't know how an average person not involved with that university could have the insight to know that there's something there and the how you marry the business acumen with the research acumen. But it's a fascinating space. So as this whole space has grown and proliferated in popularity, how do you think about competition and the market? Has that dynamic even come into play yet? Is it still too early?

Afif Ghannoum (BIOHM Health) [00:39:50]:

I don't worry about competition, not because I think we're utterly superior to everyone. I think it's such a massive pie that there is plenty of room for a lot of winners. Right. So I worry about what we're doing to execute on because I always tell the team, hey, you can talk about that stuff all the time. If this truck doesn't get to this distribution center, we don't have a business, right? So let's worry about our stuff. So honestly, it's good to be aware of what people are up to, obviously, but we've been able to collaborate with a lot of our competitors especially that honestly comes down to also being confident that we have very good technology.

Jeffrey Stern [00:40:31]:

When when you reflect on the the journey that you've had so far transitioning from from law to entrepreneurship, what has been, you know, the the most surprising parts of of the journey? What what have you learned that that you haven't expected to encounter? What are some of your reflections on building BIOHM the toughest part of building?

Afif Ghannoum (BIOHM Health) [00:40:54]:

Let me take a step back. I think as an entrepreneur, you have to understand what type of entrepreneur you are. Are you an ignition person? Are you a burn person or are you an exit person? So what I mean by that is ignition is like, I have a great idea and I can zero to one that idea in a really meaningful way. So kind of like the innovator, the burn is like, okay, can you put the processes in, build out the team, build out the workflows, all those things that will make a business successful or not, ultimately? And then do you have the M and a shops or whatever your exit potential is to get a deal done? It doesn't mean that when you come in, land out of a different phase, that's the end of your journey. You just have to be aware of that and then supplement yourself with people that are good at the other parts of the journey. So for me, I know I love the ignition part. I really like the innovation coming up with the idea, actually getting execution, selling it to partners, or if we're going to be retail or something. I love that part. I despise the process piece and all those. It's just not what I'm very good at or where I want to spend my time. Right. But even with that being said, I spend a lot of my time there just because it's the nature of any business, right. So I think that's the first is really understanding that you got to know the other is it's almost impossible to be very good at every single thing that's necessary. You have to be able to innovate, raise money, do sales, be a team builder. Just any one of those is a skill you could spend an entire career on. Right. But as an entrepreneur, you kind of have to do those things, especially to get going, right. So I think sometimes people get frustrated with themselves. I'm not good at raising money or whatever, and it's like nobody's good at it. Everybody's trying to figure it out. So I think those are the things that you just have to get comfortable with or it's not going to work.

Jeffrey Stern [00:43:02]:

On the team building side. Does the technical underpinnings of the product make it hard to find people to work on this? Because I imagine the mission land, all that feels like incredibly inspiring. And so I don't imagine that there's a lack of interest. But do you need a certain it.

Afif Ghannoum (BIOHM Health) [00:43:23]:

Depends on the role. So, for example, we have a woman starting as in our product development arm running product development. She was with a company called Smarty Pants. That is a huge gummy supplement business out of La. She hasn't done that much in probiotics, but honestly, she knows how to innovate in products. She has a proven record in this space. Same with someone who's running quality systems, you know what I mean? So those skill sets are transferable. Now, some of the stuff that's really niche, it can be challenging, but those people are out there. Especially when you can recruit outside of just Cleveland.

Jeffrey Stern [00:43:59]:

What are the maybe the biggest misconceptions that you've heard people have about the space, generally, that you wish people knew?

Afif Ghannoum (BIOHM Health) [00:44:09]:

The one that dietary supplements, when they're applications actually really do work. I think that's something that you either have people that are big believers, probably too much believers, they think it can solve anything. Land, then people that are just totally dismissive. And like many things, it's somewhere in the middle. That's the reality. So I'd say that's the first thing. And then the second thing is that running a startup is glamorous or exciting. It's a grind. But to me, the potential payoff is why you do it. Not just like, financially, but I get to work on really interesting area of science with people that are world class. That's cool. But like anything, it has its moments where it just sucks. And you have to understand that a lot of people don't get that the.

Jeffrey Stern [00:45:00]:

Highs are high and the lows are low. I think we've covered a lot of different ground here. I'll Leave Some Space Here at the End, if you think there's anything really Important that we haven't touched on yet that You Would Like to kind of unpack a little bit More.

Afif Ghannoum (BIOHM Health) [00:45:18]:

I guess the only thing I'd say is I'll hear people like, oh, you can't raise money in Cleveland. That's just not accurate. If you have something that's good, there is money. Now you might have to dig. My first checks I ever got my first company were, like, $5,000. Investor checks, right? It took a minute. But a lot of people are quick to be dismissive of Cleveland. We're building a world class company in Cleveland. Like, you know, Mac Anderson. Those Guys are building a world class Company. Here in Cleveland. There's all sorts of really fantastic companies here. So that's one, just find people that early on are experts in what you're trying to do. And you don't even have to hire them. Even if you hire them for an hour of their time, those little things can save you months and months of time because it's not just that they can tell you what to do. They may be able to open up. Oh, you're trying to get a manufacturer from that. There are three people that do that. So that's something early on I just didn't know to do. Now we save all sorts of time by going to someone who's world class of what they do. Usually their company's exited and maybe they're the number two or three person at that company. There's all sorts of people like that. So that's another thing that I think can save a lot of time.

Jeffrey Stern [00:46:31]:

I appreciate both of those perspectives because I think they're worth knowing, particularly on the fundraising side. I think it's there if there's an underlying vision and product.

Afif Ghannoum (BIOHM Health) [00:46:46]:

You may not be able to raise $50 million here, but you can certainly raise a million, there's no doubt about that.

Jeffrey Stern [00:46:52]:

Right on. So we'll book end it here with our traditional closing question tied still to Cleveland, which is for not necessarily your favorite thing in Cleveland, but for something that other folks may not know about. A hidden gem.

Afif Ghannoum (BIOHM Health) [00:47:10]:

Well, I would say the hidden gem is the South Sugar Land reservation. If you come here, it's like walking in Colorado. There's waterfalls, there's amazing trees, there's awesome hiking.

Jeffrey Stern [00:47:24]:

So I'd probably say that beautiful spot. Well, thank you so much for coming on today and sharing your story. I'm really glad the dots got connected in the way they did and that we were able to have you on today. Awesome.

Afif Ghannoum (BIOHM Health) [00:47:38]:

Well, thanks for having me. I really appreciate it.

Jeffrey Stern [00:47:40]:

If anyone had anything that the wanted to follow up with you about or learn more about BIOHM Health, what is the best way for them to do so?

Afif Ghannoum (BIOHM Health) [00:47:51]:

The go to biohmhealth.com or if they want to connect. LinkedIn is probably the easiest. It's just AF I F and my last name is Ghannoum and I'm pretty active there.

Jeffrey Stern [00:48:05]:

Awesome. Well, thank you again.

Afif Ghannoum (BIOHM Health) [00:48:06]:

Awesome. I appreciate it.

Jeffrey Stern [00:48:09]:

That's all for this week. Thank you for listening. We'd love to hear your thoughts on today's show, so if you have any feedback, please send over an email to Jeffrey at layoftheland FM or find us on Twitter at @podlayoftheland or at @sternjefe. J-E-F-E. If you or someone you know would make a good guest for our show, please reach out as well and let us know. And if you enjoy the podcast, please subscribe and leave a review on itunes or on your preferred podcast player. Your support goes a long way to help us spread the word and continue to bring the Cleveland founders and builders we love having on the show. We'll be back here next week at the same time to map more of the land.