Interview with Hannah Kleinfeld, co-founder and COO of Omni-Biotic US — Gut Health, Microbiome, and Probiotics

Table of Contents

• Overview
• Interview (Q&A)
• Choosing a Probiotic: A Practical Checklist
• FAQ
• Final Practical Notes

Overview

Dr. Thais Aliabadi and Mary Alice Haney sit down with Hannah Kleinfeld to unpack how gut health shapes everything from mood and metabolism to hormones and fertility. Hannah brings both personal experience and clinical thinking to the table: she recovered from a severe Lyme disease episode that revealed how central the gut is to whole-body healing, and she helped bring Omni-Biotic’s targeted, clinically studied probiotic formulations from Europe to the US.

This conversation is practical and clinical. We move through what disrupts the gut, how to diagnose root causes, when food is enough, and when targeted probiotic supplements are necessary, and how to choose a product that actually survives digestion and does what it promises.

Interview (Q&A)

Can you tell us how your own health crisis led you to focus on the gut?

About two years into my first professional job in New York City, I started noticing a slow decline: persistent brain fog, increasing food sensitivities, workouts that felt harder, and progressive fatigue. Those vague but powerful symptoms finally culminated in a day when I literally could not get out of bed. A family member suggested testing for Lyme. I found a doctor who specialized in tick-borne illnesses and took a combined approach: multiple antibiotics to eliminate the infection and a parallel plan to rebuild my health through nutrition, acupuncture, and holistic care.

The antibiotics were lifesaving, but they also revealed a second problem: my gut. The infection itself, plus months of antibiotics, depleted my microbiome and left room for opportunistic pathogens like Candida and SIBO to take hold. That combination explained why I still felt like a shell of my former self even after the Lyme infection was controlled. Becoming my own detective—reading, asking questions, advocating for deeper testing—became central to my recovery and ultimately to what we do with Omni-Biotic.

How do Lyme disease, antibiotics, and gut disruption interact?

They compound each other. Lyme can provoke systemic inflammation and directly impact gut function. Antibiotics often kill broad swaths of bacteria, including beneficial strains, which reduces diversity and can suppress important microbial functions for weeks, months, or longer. That immune suppression and inflammation make it easier for unwanted organisms such as Candida or SIBO bacteria to flourish.

In clinical terms, we see a depleted microbiome, increased intestinal permeability, and dysbiosis that then perpetuate inflammation and symptoms. If the gut remains out of balance, persistent low-level inflammation becomes the driver for many downstream problems—from brain fog to metabolic and hormonal disturbances.

What exactly does the gut microbiome do beyond digestion?

The gut is a control center. Its microbes help digest food and extract nutrients, produce neurotransmitters that affect mood and cognition, modulate immune responses, and participate in detoxification pathways through the gut-liver axis. Gut bacteria influence metabolic rate, insulin sensitivity, and hormone processing. For women in particular, the gut microbiome helps regulate estrogen: certain bacteria can recycle estrogen back into circulation, while others help excrete it. A disrupted microbiome can therefore contribute to estrogen imbalance with wide-ranging consequences.

We like to think of gut health as fundamental to overall health. When the gut is inflamed, the immune system goes on high alert and low-grade systemic inflammation takes hold. Inflammation can interfere with insulin signaling, increase cortisol and stress responses, and even reach the brain as neuroinflammation, producing brain fog, mood changes, and cognitive decline over time.

How do babies get their microbiome, and why does early life matter?

Babies begin life with a microbiome seeded largely from the mother: during vaginal birth, they acquire maternal microbes, then continue to develop through breast milk, skin-to-skin contact, and environmental exposure. The first three years are critical; the community of microbes is still forming and is highly sensitive to diet, antibiotics, and environmental toxins. This early imprinting shapes immune development and metabolic pathways for life.

Anything that disrupts that development—unnecessary antibiotics, poor nutrition, or limited exposure to natural microbial diversity—can increase the risk of long-term dysbiosis. That is why we think about prevention and careful stewardship of antibiotics, especially in early childhood.

Is IBS, leaky gut, and SIBO the same thing? Do they require different approaches?

They are related but distinct. IBS is a symptom-based diagnosis that can arise from multiple mechanisms: visceral hypersensitivity, motility disorders, gut-brain dysregulation, or underlying infection. Leaky gut refers to increased intestinal permeability, where the one-cell-thick intestinal barrier becomes dysfunctional and allows larger particles or endotoxins into circulation, triggering immune activation. SIBO stands for Small Intestinal Bacterial Overgrowth; it is the presence of bacteria where they do not belong—bacteria that typically live in the colon migrating into the small intestine and proliferating.

In practice, these conditions often overlap. Diagnosis matters because treatment differs. SIBO usually needs targeted testing, such as a breath test and often a course of antibiotics or antimicrobial protocols, followed by careful rebuilding. Leaky gut and IBS might improve with dietary modifications, gut-healing nutrients, and targeted probiotics. The important step is proper testing—stool analysis, breath testing, and working with practitioners experienced in gut health—so we address root causes rather than masking symptoms.

What are the most common symptoms of SIBO, and why are prebiotics usually avoided initially?

SIBO typically presents with bloating (the most prominent complaint), abdominal pain or cramping after eating, excessive gas, reflux, nausea, and fatigue. Some people gain weight, others lose weight—symptoms vary.

Prebiotics are food for bacteria. If you feed an overgrowth, you can make symptoms worse. That is why clinicians often avoid prebiotic supplements and high-FODMAP foods during treatment. The sequence matters: first reduce overgrowth via appropriate antimicrobials or targeted therapies; then reintroduce probiotics and prebiotics to restore a balanced microbiome.

Why isn’t food alone enough to rebuild the microbiome after disruption?

In an ideal environment—organic, fresh food, minimal stress, optimal sleep—diet could be sufficient to support a healthy microbiome. Reality is messy: modern diets, environmental toxins, chronic stress, limited sleep, and frequent antibiotic exposure make a targeted approach more effective for many people.

Food-based strategies are foundational and must accompany any probiotic plan. But targeted probiotic supplements allow us to reintroduce keystone strains that serve as ecosystem engineers. These strains create conditions that encourage wider diversity to flourish. A well-formulated, multi-strain probiotic can be a precise tool in rebuilding the gut garden where food alone is too slow or inconsistent.

How can one probiotic help different people if everyone’s microbiome is unique?

Each person’s microbiome has a unique fingerprint, but there are keystone strains that most healthy microbiomes need to function optimally. Think of keystone strains as foundational species in an ecosystem. If you restore those core players, you improve the environment so other beneficial microbes can reestablish themselves.

That’s why targeted formulations matter. They combine strains chosen to support specific functions—gut-liver axis, gut-brain communication, post-antibiotic recovery—so many different people can benefit from the same product because it addresses common foundational needs.

How does gut inflammation connect with hormones, fertility, PCOS, and endometriosis?

Gut inflammation creates low-grade systemic inflammation that interferes with hormone signaling and metabolic processes. In PCOS, for example, a subgroup of women has inflammation-driven PCOS where inflammation stimulates increased ovarian androgen production, which then causes irregular periods, acne, and hair changes. Reducing inflammation helps normalize that pathway.

For endometriosis, we frequently see coexisting SIBO and gut dysbiosis. Inflammatory cascades in the pelvis and gut feed each other. Suppressing endometriosis and lowering pelvic inflammation—whether surgically or hormonally—creates a better environment to treat SIBO and promote gut healing. Because inflammation is a common driver, addressing the gut is a logical place to begin in the broader fertility picture.

How should someone choose a probiotic? What should they look for?

Start with evidence. Look for products with clinical studies on the actual formulation and human endpoints, not just one strain tested in a lab or in animals. Delivery matters. Many products lose potency in the stomach; what reaches the large intestine is what counts. A clinically validated delivery mechanism and proof of survival through gastric acid are crucial.

Also, choose a product targeted to your health goal. Omni-Biotic, for example, uses formula-specific clinical trials: post-antibiotic recovery (AB10), stress and cognitive support (Stress Release), and gut-liver-metabolism support (KetoX), among others. That targeted approach helps ensure you’re addressing the function you care about rather than taking a generic product because someone else recommended it.

Do probiotics survive the stomach? How can we know?

Not all probiotics survive equally. Many capsules and shelf-stable products show poor survival when tested in GI simulators. That’s a critical blind spot in the industry: a product can list billions of CFUs on the label, but if those strains die in stomach acid, they will not reach the colon and have no effect.

Delivery technologies matter. Powder-based sachets that are dissolved in neutral water before ingestion can rehydrate freeze-dried bacteria and activate them in a way that prepares them to survive gastric transit. In GI simulator testing, we’ve seen some leading U.S. brands average around 7 percent survival to the large intestine, whereas a sachet delivery of pre-activated strains reached survival rates closer to 83 percent in the same model. Look for brands that publish survival data or have independent studies on delivery and activity.

Is refrigeration necessary for a probiotic to work?

Refrigeration can preserve probiotic strains, but it introduces supply chain uncertainty. Many refrigerated products must maintain a cold chain from factory to retail to your home; if that chain is interrupted, potency can drop before you ever ingest the product. Shelf-stable products can avoid that problem if they use robust strain selection and manufacturing methods that protect viability at room temperature.

Whether a product requires refrigeration depends on how it was formulated and processed. Evaluate stability claims, third-party testing, and how the brand handles distribution. A refrigerated probiotic is not automatically superior; consistency, survival through digestion, and proven clinical effects matter most.

What should someone do during and after a course of antibiotics?

Antibiotics disrupt the microbiome, even in short courses. The common clinical approaches vary: some clinicians prefer finishing antibiotics first, then starting probiotics; others begin probiotics during antibiotic therapy to mitigate disruption. We find it sensible in many cases to begin supportive probiotics while on antibiotics and continue a higher dose for several weeks after completion to help restore diversity and function.

There are formulations specifically designed for this purpose. Omni-Biotic AB10, for instance, was developed to reduce antibiotic-associated diarrhea and lower the risk of opportunistic infections like C. difficile. Practically, a common regimen is to increase probiotic dosing during antibiotics and continue for two to four weeks afterward, then reassess.

How long does it take to repair the gut?

It depends. Minor disruptions can respond in days to weeks. More entrenched dysbiosis—years of intermittent antibiotics, chronic stress, recurrent GI infections, or conditions like SIBO or IBD—can take months or even years to resolve. We recommend thinking in terms of seasons, not single treatments. Sometimes people notice subtle improvements within days (better digestion, less bloating, clarity), but sustainable, long-term restoration requires consistent care: diet, sleep, stress management, targeted probiotics, and addressing underlying infections or inflammation.

Picture your gut as a garden. Pulling weeds is the first step, but you must also restore soil health, plant the right seeds, water them consistently, and protect the ecosystem from recurring stressors.

Should people stay on probiotics for life?

For many people, probiotics become part of daily maintenance—similar to a multivitamin—especially if lifestyle and environmental exposures continue to challenge the microbiome. We don’t always need to be on the exact same product forever, however. The beauty of having targeted formulations is that we can rotate based on current needs: post-antibiotic support, stress-release for busy periods, gut-liver support while traveling, or during heavy eating seasons.

Long-term use is not inherently problematic if the product is evidence-based and tailored to your needs. The goal is resilience. If a stable, diverse microbiome is restored and lifestyle supports that ecosystem, some people may reduce or cycle probiotics. Many, however, choose daily maintenance.

How does aging and menopause affect the microbiome?

Aging reduces microbial diversity and bacterial counts, and hormonal transitions like perimenopause and menopause further change the gut landscape. As estrogen and progesterone decline, the activity of beneficial gut bacteria often decreases, which can worsen intestinal permeability, insulin resistance, bloating, brain fog, hot flashes, and fatigue.

There’s evidence that hormone replacement therapy may help preserve aspects of gut diversity in some women, but the approach should be individualized. Supporting the microbiome during midlife is an investment in metabolic, cognitive, and hormonal resilience.

What about kids—should we let them play in the dirt?

Exposure to natural environments and animals correlates with greater microbial diversity and, in epidemiological studies, lower rates of allergic and autoimmune conditions. We balance hygiene with healthy exposure. Sensible play outdoors, pets, and varied diets are beneficial. The risk is over-sterilization, not cleanliness itself.

For children who must take antibiotics, judicious prescribing and a plan for microbiome support afterward are key. Building healthy microbial resilience early reduces the need for later repairs.

What practical steps should someone take if they suspect gut dysbiosis?

1. Start with testing when symptoms are persistent or severe: stool analysis, SIBO breath testing, and a clinical review with a practitioner experienced in gut disorders.
2. Address infections and overgrowths first. If a pathogen is present, treating it is usually required before meaningful rebuilding can occur.
3. Use targeted, evidence-based probiotics to restore keystone strains and improve survival in the colon. Choose products with clinical trials on the finished formulation where possible.
4. Pair supplements with diet quality, fiber diversity, sleep, stress reduction, and regular movement. Lifestyle supports are not optional.
5. Monitor progress and adjust. Gut healing is iterative; reassess after treatment to decide next steps—whether to rotate formulas or extend support.

Choosing a Probiotic: A Practical Checklist

• Clinical evidence: Look for human studies on the actual product.
• Targeted formulation: Choose a product designed for your primary concern (post-antibiotic recovery, stress-cognition, gut-liver support, etc.).
• Delivery and survival: Does the product demonstrate survival through stomach acid and into the large intestine?
• Strain selection: Multi-strain products with keystone bacteria are preferable to single-strain supplements for broad ecosystem rebuilding.
• Supply chain transparency: Understand whether the product needs refrigeration and how the brand manages distribution.
• Practitioner input: If symptoms are complex, work with a functional medicine doctor, naturopath, or nutritionist who knows gut testing.

FAQs

How do I know if my symptoms come from the gut?

Persistent bloating, brain fog, irregular digestion, chronic fatigue, recurring yeast infections, and new food intolerances are common clues. Because gut symptoms overlap with other conditions, testing (stool analysis, SIBO breath testing) and a clinical review help differentiate root causes and guide treatment.

Can a probiotic alone fix SIBO?

Rarely. SIBO is an overgrowth that typically requires antimicrobial therapy or specific protocols to reduce the excess bacteria. After that, targeted probiotics can help restore balance. In some cases, clinicians use select probiotics alongside antimicrobial treatments, but the sequence and strains matter.

Should I take probiotics during antibiotics or wait until afterward?

Approaches vary. Many clinicians begin supportive probiotics during antibiotics and continue at a higher dose for at least two weeks after completion. Specially formulated products for post-antibiotic recovery can reduce antibiotic-associated diarrhea and opportunistic infections.

Are refrigerated probiotics better?

Not automatically. Refrigeration can preserve viability but introduces supply chain risks. What matters most is whether the formulation survives gastric passage and reaches the colon alive. Seek products with survival data or independent testing rather than relying only on refrigeration as a quality marker.

How long does gut repair take?

Improvements can begin in days for some people, but thorough repair takes months. Longstanding issues may require a year or more of consistent intervention. Think of the process as gardening: removing weeds, restoring soil, planting, and ongoing care.

Final Practical Notes

We approach gut health with humility and curiosity. There are no one-size-fits-all quick fixes, but there are clear principles that guide effective care:

• Find the root cause with appropriate testing.
• Use targeted, clinically validated probiotics when needed.
• Prioritize diet, sleep, stress reduction, and movement as the foundation of any microbiome plan.
• Address infections before attempting to rebuild the ecosystem.
• Be patient and consistent. Restore the gut like tending a garden.

If you are navigating antibiotic recovery, hormonal imbalance, fertility challenges, or persistent digestive symptoms, start by consulting a clinician who specializes in gut health and consider evidence-based, targeted probiotic support as part of a broader plan.

For more resources and specific product information, consult qualified healthcare providers and look for formulations backed by human clinical studies and transparent testing. Our goal is to help you build a strong, resilient gut so you can feel better, think more clearly, and live with more energy.

This article was created from the video Gut Health Revolution & Understanding the Microbiome with Omni-Biotic COO Hannah Kleinfeld | SHE MD for Dr. Thais Aliabadi’s website.