Lylah Health, Your Microbiome, and You!

Many thanks to Dr. Bilal Ahmed for joining me on Episode #165 of The Art of Medicine with Dr. Andrew Wilner. Dr. Ahmed is a cardiologist and entrepreneur.

We began our 30-minute conversation discussing his day-to-day work as a interventional and structural cardiologist, which required five years of fellowship training after completing his internal medicine residency. He was recently recruited to develop the structural cardiology program in Columbus, Georgia. The cardiac procedures that Dr. Bilal has been trained to do can be life-saving!

In 2024, in his free time, Dr. Ahmed co-founded Lylah Health with his sister after recognizing a connection between cardiac health and the microbiome. He observed that a supplement containing prebiotics, probiotics, and postbiotics could lower LDL cholesterol by more than 20%—a result short of a high-intensity statin but comparable to some existing cholesterol-lowering medications. As a practicing cardiologist, he saw the potential health benefits for millions of people.

Dr. Ahmed is also writing a book about his journey in medicine, his multigenerational family history, and the life lessons he hopes to share with his young daughter. 

To learn more, please go to: www.Lylahhealth.com

#microbiome #hearthealth #cardiology #cardiologist @lylahhealth @bilalahmed

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Transcript

0:07

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. I've planned a great program for today, but first, a word from our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a locums 101 crash course. Learn about locums and get insights from real-life physicians, PAs, and NPs at locumstory.com. And now to my guest. Today, my guest is Dr. Bilal Ahmed, a cardiologist and entrepreneur. Dr. Ahmed is the founder of Lila Health, a microbiome therapeutic supplement company, which I'm sure he will explain. He is also the author of a forthcoming book about his journey in medicine and life lessons for his daughter. Welcome Dr. Bilal Ahmed. Thank you for having me. Yeah, this is great. So what are you doing now? Great question. I'm not sure. No. So I'm practicing medicine. I'm an interventional and structural cardiologist. And then as I have since late 2023, early 2024, when I started my startup, I used my evening and admin day hours to work on my startup. So really kind of juggling two very disparate careers. Right. So those are really two separate things. Now I would imagine. So you went to medical school, you did a residency in internal medicine, and then you did like a 17 year fellowship, right? Was it two years, two years or three for cardiology? Three for general, one to two for interventional, depending on which program you're at. I was one year and then one year for structural cardiology. Structural. I mean, isn't all cardiology structural? What does that mean? That's a great point. It is this kind of interesting phrase, but it's essentially, you know, TAVRs, transcatheter aortic valve replacements, valve repairs. So mitral valve repairs, tricuspid valve repairs, PFO and ASD closure or closure of holes between two chambers of the heart that are causing bad consequences from a health perspective. Things that used to be the purview of interventional cardiology, but as the valve replacement and repair space became more and more kind of technologically advanced and more rapid in its growth, the consensus was, which I firmly believe having gone through it, that you need additional training to be proficient in all aspects. Well, this is really fascinating. So this is, I mean, initially all of that was surgical. You need a new valve, you open up the patient, cut it out, put in a new valve. Then there was this concept, well, I don't know, we could snake this giant catheter up there and pop a valve in and scrape the other one out. And that was interventional cardiology, right? And so now this is like a subset of interventional cardiology to do these structural repair, mostly, right? It's always a repair. I mean, Peyton for Amenal Valley, I can't tell you how many, if I had a penny for every echo I've ordered looking for PFO, because I'm a neurologist, right? And so that's probably on a daily basis we look for that. And although we don't fix it too often when we find it, but every now and then I know the indication's changing. I mean, it's a very interesting area, but I think being able to do these things relatively non-invasively, in other words, without a sternotomy, you still have to make a hole and put a catheter up and then fuss with it. And patients under fluoro, you're wearing a mask, right? And sweating a little bit. I mean, it's pretty dicey stuff. So how often are you in the procedure suite doing something like that? Specifically doing structural work or? Doing a valve, doing a PFO. So it used to be my day-to-day up in the Boston area. I was at the Leahy Clinic in Burlington, Mass., which I think this year included for the last five years has had the highest volume of TAVRs in New England. And a TAVR is what? A transcatheter aortic valve replacement. So the equivalent from a catheter perspective of the surgical aortic valve replacement. So it's not a repair. It's a true and true, well, replacement is a misnomer because you use the native valve and the calcific apparatus as kind of struts, and you balloon open a new valve within that. And then that calcific kind of skeleton, if you will, gets anchored into the myocardium to hold the valve in place, the new valve in place. So you don't take the old one out. You just build on top of it. Exactly. Yeah. Build on top of it. You lose a little bit of space, but comparable outcomes to surgical aortic valve replacement, much, much lower upfront costs for the patient in terms of morbidity and also the amount of time spent in the hospital. So usually I discharge them the next day as opposed to three plus days in the ICU and also a large wound in the center of the chest to deal with and to rehab. You feel better like right away. It's almost immediate relief. Yeah. The next morning they're up and walking to the bathroom saying, I can breathe again. Yeah. Pretty phenomenal. So once a week you're doing one of those now or once a month, twice a week, or it just depends? It depends. So I was hired at this particular job, which I've been at since September of 2025 to start and grow a structural program. So exactly this started really. I mean, April 2025 sounds like a long time ago, right? But it was less than a year. So you're building the program. Exactly. So I'd say roughly once every two weeks. And more recently, really three data points last three weeks, it's been, you know, once a week. So kind of moving it along and growing it for an underserved population here that really needs it. Right. Right. Actually, years ago, I was hired to be the first epilepsy expert in Western North Carolina. And I was. So we had this backlog of people with intractable epilepsy that we were able to treat effectively with with newer medications, with the vagus nerve stimulator, which was brand new at that time, and epilepsy surgery, you know, because they had had no access or no easy access, I would say to that sophisticated care. And we had a neurosurgeon who was interested. So it's very exciting to come into Atlanta is hardly a backwater, but a place that has not had access to the service that you can now provide. So as soon as word gets out, hey, there's there's a new guy in town who can do these procedures, right? Then yeah, people will and they have to. And there's a window also, right? If you got if you're bad enough that you need a valve, you don't have 20 years to wait, right? Yeah, it's something you need to do relatively promptly before you get too old and decrepit, right? And so that you can benefit from having this valve. So I guess people cardio other so general, general practitioners and regular cardiologists who identify patients who are short of breath or limited exercise tolerance or all of those things they identify with an echo, right? Get an echo, aortic stenosis or insufficiency or something like that. And then eventually they wind their way to you. That's how it works. That is how it works. It's generally too late. And just to clarify, I say Atlanta because it's the nearest metro center. I'm actually in Columbus, Georgia. So it's definitely not a backwater either. It's the second largest city by population in the state of Georgia. But, you know, they don't have that service. Atlanta does. Probably a guy with you like you in Atlanta, right? Probably. Yeah, there are quite a few in Atlanta. So but as as you likely know, being in Memphis, the population in this general region in the southeast, and I can attest to this having grown up in Alabama, patients don't like to drive more than 30 minutes, a two and a half hour drive. It's asking a lot. And for these patients, once you develop severe symptomatic aortic stenosis, it's a mechanical problem requires a mechanical fix. And within two years, if people don't get a replacement, on average, 50% of them have died from the condition. So it is really a very time sensitive and kind of lifesaving measure that needs to needs to be done. Okay, so in your spare time, you managed to get married, you have a four year old daughter, maybe more, we're not sure yet, right? Not yet. But hopefully, fingers crossed. And you came up with Lila Health. Let's talk about what is Lila Health? Absolutely. So Lila Health is a company that I co founded with my middle sister. No, who's Lila? First of all, Lila must be some story there. I will I will tell you and I wish I could say I could plead the fifth but this is a podcast and will be widely released. So it's going to be in the ether. My daughter's name is Lila. And I spoke to my wife about naming the company Lila. And she said, Just follow me on a thought experiment. In 20 years when I was a teenager, and she sees that there's a supplement company named after her, will she necessarily be thrilled about it? And I said, Okay, fair, fair, my better half, you make a good point. And so Lila was the closest thing to I love that I could find, but it really was an ode to my my daughter. Nice. That's nice. All right. So there's you, your sister, and another sister. I've got Yeah, I've got a my youngest sister is our social media manager, because she's in the correct generation. She's roughly 10 years younger than me and much more facile and savvy than I am. She has free time, I might want to borrow her because I'm the social media manager of this podcast. So could use some help. By all means, she introduced me to TikTok. And I dug my heels in for months. And it's successful so far. So borrow her all you want. Alright, so we got two sisters you and what is the point of this Lila health? Yeah, great question. So this was never originally meant to be a supplement company. This actually started as a prospective study that I started in training in internal medicine with two colleagues at Brown University. We were wait, shout out to Brown University MD 1981. No kidding. Oh, right. Wonderful place to train. I went there for internal medicine didn't go there for medical school, but the medical students that rotated with us were sharp as can be. The quality there is amazing. And it's really the the big hospital in Rhode Island. So they're serving a large community. But that's a great connection. I wonder if there's any overlap for for some of the remaining staff over there. But anyways, not to get sidetracked. While I was a resident at Brown with some colleagues, we had started this prospective study. At that time, the gut microbiome space was still, you know, I'd argue it's still a nascent field, but was much more nascent. So the NIH is human microbiome project, the 10 year project to profile and characterize the normal spectrum of gut microbiome phenotypes, what still had not culminated. It finished about five to seven years ago, I believe. But we started this study where we essentially took patients who were going to get a procedure called a left heart catheterization to take a look at the coronary arteries and see if there's a blockage stratified by patients who had clean coronary arteries didn't need any intervention. And patients who had a significant blockage that needed a stent, we got a rectal swab before the procedure for all of them for what's called 16s sequencing and metabolomic sequencing, essentially looking at the types of bacteria that grew the diversity of bacteria, and then any downstream chemicals that were made as part of their natural metabolism, to investigate any kind of, you know, causative association that there may be between certain chemicals and disease entities. And so we had a an N of 50 for enrollment, and it or after patient 47 COVID hit in full effect, I actually took took care personally in the COVID in the medical ICU of the second COVID patient in the United States. So I hang my hat on that. But funding, as would be expected and appropriately so got diverted because there was a once in a lifetime pandemic. The idea stuck with me and was further bolstered by conversations I had with some of my mentors at Tufts while I was a cardiology fellow, specifically head of transplant who was really interested in what happens with dysbiosis or deleterious gut microbiome alterations and heart failure. And there was evidence coming out to that effect kind of supporting that dysbiosis does contribute to cardiac disease, and that alleviating it or targeting it is kind of the next frontier in addressing inflammation. There's actually a paper that came out when I was giving my seminal talk as a third year fellow and had this conversation with with my mentor, Dr. Vest in Jack heart failure, that was kind of narrating what we know so far what there is to know, and how this is essentially a very promising track in terms of addressing residual risk or the gap between what we can predict in terms of who will develop cardiovascular disease and who actually does. We've gotten better at it, but there's still that residual risks are still that gap. In Rhode Island, if you're going to look at the microbiome, you also have to control for who's eating quahogs and who isn't eating quahogs. I think that should have been part of, you know, your intake, because, you know, it might be disease related, but there's so many potential confounders. When I look at these microbiome studies, I'm always, I don't know, always a little suspicious that it may just be some random element versus really disease related, but who knows? And we're trying to find out, right? Yeah, so that's a wonderful point. So we, you know, as part of the protocol, we had a multi-page questionnaire that included exactly this, kind of borrowed from the GI space standardized kind of food intake or nutritional questionnaires, because I agree with you wholeheartedly. I think that environmental exposure has much more to do with deleterious alterations in the gut microbiome than, you know, something that's just de novo happening. And there's some evidence to that effect, you know, communities that have a less industrial way of living in Africa and in South Asia, when you profile their gut microbiomes, they're much different in the way that they look and in the diversity of bacteria than in the United States. And they're arguably closer to the healthy spectrum that was profiled by the NIH's 10-year project. Yeah, I think it's sort of, I think you used the word nascent. I agree. It's really early in trying to sort all this out. Nonetheless, you move forward with this company. What, and what is it you do? Yeah, great question. So it's, I essentially spent a little over a year kind of catching up because it had been a few years since I had done the literature review. And, you know, this is a nascent field and with a nascent field comes a lot of noise and a lot of data kind of quickly. And so to catch myself up, I did a comprehensive kind of dive into specifically in human studies with randomized control trials, getting the preference and looking at, you know, what kind of combination of ingredients. And I'll talk a little bit about what I'm talking about when I mean ingredients, actually address cardiovascular risk factors because the ultimate goal or vision for my perspective for Lyla Health is I don't want someone on the cath lab table in front of me who's coded three times. And now I'm rushing to meet door to balloon time and open up their artery. That's not a great way to practice medicine. Proactive medicine is arguably what all of us want on a deep level, but for reasons that are way above both of our pay grades, that's not the way that things work in the United States, at least. We've had that too on this podcast. I am sure you have. I have a personal interest in it, including health care policy. But that's another conversation for another time. But essentially, the ingredients are pretty simple. So it's prebiotics, which can be thought very simply as food for bacteria, specific types of fiber, short chain fructooligosaccharides are usually the most common. Certain kind of certain types of fiber will kind of preferentially serve as nutrients for certain types of bacteria. Probiotics are just helpful bacteria or bacteria that will contribute to either normal functioning or health in a positive manner. And then postbiotics, which are essentially the downstream chemicals that the bacteria will produce as part of their natural metabolism after eating the prebiotics. And the genesis of this was 13 randomized control trials in humans, not rats or mice, like some other companies, showing that there's an LDL reduction ranging from, depending on which trial you look at, 15 to 21 percent with a certain combination of probiotics and in a certain dose. That's on par with some of the antilipemic agents. Yeah, I was going to say, it's as good as a statin. Not quite as good. You know, a high intensity statin is about 50 percent reduction. But azetamide, benpedoic acid, they're both in that range and they're alternatives to statins that are widely used. So I found that very compelling and found that reason to dedicate my time. Yeah. So by lowering cholesterol effectively, you are potentially improving heart health and cardiovascular health in general. I mean, it's well known, for example, that exercise, right, exercise can lower your cholesterol, right? If your HDL goes up and your LDL goes down because you are exercising, right? Absolutely. Now, taking a capsule with bacteria food, I guess Lila Health sounds better than, you know, premium bacteria food, right? Because that's really what this is, right? It's food for the bacteria to encourage the good ones to grow. That's one aspect of it. And that's been the traditional approach from the business aspect of things. Most products out there are a combination of prebiotics and probiotics, a food for the bacteria and the constituent bacteria. Mine's a little bit different. It's got, you know, those two elements, but it also has the actual, you know, downstream chemicals or the downstream consequence of the bacterial metabolism that does the health action that you're looking for. You don't need the bacteria at all if you just took the postbiotic. Well, one would argue that it would be helpful to have the bacteria for a number of reasons. So, you know, when you look at the spectrum of bacteria that grow in guts of unhealthy people with a variety of conditions, my particular bias is cardiovascular patients, but there has to be some mechanism to also promote growth of bacteria that we know are helpful because it's a crowded space with limited resources, right? Those bacteria are all vying for what you put in your mouth. So diet plays a huge role in terms of developing that kind of bad profile versus having a good profile. But supplementing with the right bacteria and also nourishing them with the right kind of food for them is just as important, I would argue, as giving the actual downstream chemical. Downstream chemical is important and is currently being investigated by, you know, large pharmaceutical companies in an effort to bring this to the pharmaceutical space, which I think is inevitable. But I think you need all three, to be frank, in my humble opinion. Does giving the postbiotic, is there any negative feedback on the bacteria? It's like what they're producing is already there. So, you know what I mean? Maybe there's... Yeah. So it actually acts as a catalyst. So it catalyzes the process or speeds along the process of the natural rate of postbiotic production in vivo once the bacteria have made it to the small intestine. And kind of another differentiator is a lot of people don't take into account that we have hydrochloric acid in our stomach, which is meant to be caustic and bacteria often do not survive that environment and make it, you know, unperturbed. They're not mentioned, right? They're not mentioned. They're not mentioned, exactly. But you would be surprised. I mean, a bacteria in a capsule is usually how this is, this type of supplement is sold. We're actually in a stick pack formulation, but kind of like a crystal light or liquid IV or what have you. But the entire thing is micro encapsulated in lipid nanospheres that have been shown to survive that type of environment so that you actually get a complete kind of unperturbed combination of prepro and postbiotics to the small intestine. So do you have some staff in the basement that are making these micro capsules? Where does this stuff come from? Source them from other suppliers. So obviously vet them. They have to have, you know, compelling research behind it. There's a certain bar that I have, but we're not Amazon. We're not vertically integrated where we have a lab and also quality control. I'm funding this out of my own pocket and certainly don't have, don't work on Wall Street and don't have that kind of cash to fund it, but currently working with partners who help us with that. That's interesting. And then, so I guess it's an online shopping and, you know, it would be interesting, you know, when you're taking insulin, for example, you're monitoring your, your glucose, right? I need more insulin, less insulin, because you've got a number. And when you're feeding these bacteria, it would be, it would be great if they would glow more or glow less, or, you know, you could put your poop in this little, you know, when you check the water in the pool, right, you get squirted into something, it tells you what the chlorine is and the acidity, you know, you need some poop monitor that's going to tell you whether you're feeding them properly. You know, are they hungry? They're not hungry. They're overeating. You know what I mean? So there needs to be a number. Is that happening? I agree wholeheartedly. So a few things happening from that perspective or that general kind of concept, the technologies to really tell, you know, whether I've got no glowing bacteria, basically, but the downstream consequence that I'm intending, which is reduced LDL, you know, this is something that I'm, I'm challenging kind of openly on my website and on, you know, okay, so you can monitor with a blood test, hey, your LDL is improving. And now maybe you're exercising more and eating healthier also, which is not a bad thing. So a little hard to sort of make a one-to-one comparison, but if it is, if it stays the same, then you, then right, you're getting nowhere. So that, that would be a negative, but if it does improve, you can say, well, maybe, maybe it's the bionics. I got a healthier microbiome than I used to, right? That's what we need, a microbiome health, healthometer. We do, which, which does not exist yet. There are a lot of purported companies out there. I'm willing to invest if we can come up with a legitimate one, because you know, you weigh yourself every day, right? You want to monitor your weight. Is it glucose or, you know, there are things you want to monitor. We're all, we're big into heart rate, right? And steps. Why not? If the microbiome really is important and it's not just a poop generator, you know, if it really matters, then we should be paying more attention to it. Yeah, absolutely. I agree wholeheartedly. Kind of the, the second aspect of that, which we'll, we'll rely on a little influx of cash, unfortunately, but I spoke to two well-known trialists, cardiologists at the Cleveland Clinic. My mentor at Tufts, the head of heart failure and transplant is now the head of heart failure and transplant at Cleveland Clinic. So I messaged her and told her what I was doing and said, Hey, I want to prove this head-to-head against azetamibe and bempedic acid and show this in a trial setting. So both the trialists bought the idea, loved the idea. And the conversation stalled when we got to funding and they said, well, this is cardiology, you need $800,000. And I was like, I'll come back to you when I have that much free cash to be able to, to put into this. But that is, that is the Holy grail. And that's the way that I want to conduct this is to show proof in the pudding. All right. So let's say now, I think that was fascinating to your book. There's a book. There's a book. It may never be publicly released, but it's, it's a half written one. I'm about 275 pages in. That's a lot. Yeah. It's, it's, it's a decent bit. It's essentially a catalog. I like to think of it, you know, without comparing it to the giant that I'm about to mention, but I like to compare it to East of Eden. East of Eden is perhaps my favorite book. It's this, you know, for those who are unfamiliar, it's John Seinbeck's one of his great works. He won the Nobel prize in literature, partly because of this, but it's a multi-generational semi-fictionalized autobiography of, of his own family in the Salinas Valley. And so I followed that general theme with the idea that, you know, through storytelling, I'll illustrate, you know, things that went wrong in kind of the family history and things that went well as moral lessons for her when she's old enough. Nice. I think I have a project. It's a little different. We talked earlier, I have a young son, and so I've been doing videos of him and of me talking to him since before he was born. And so there's like a video diary of his growing, growing up and his, you know, achievements and challenges and family events that occurred that, you know, when he's in his twenties and might be curious, you know, there might not be anybody to tell those stories. So it's a way for him to access those. And of course it makes me pay even more attention to this sort of day to day than I might otherwise, because I'm thinking about how I'm going to frame this for him. Of course, it's an awful lot to keep up with. Children seem to accomplish a lot in a day. They do. I have multiple videos just from this morning before drop-off at school. It was better in the film days. You had to be a lot more, you know, picky about what you're going to film. Now it's just the data acquisition is the easy part now. All right, Dr. Tremont, this has been great. Is there anything you'd like to add before we close? No, I think it was a wonderful conversation. I wish you the best of luck on making that catalog or the video diary for your son. I will say AI tools are extremely helpful because I have done something similar. I use Gemini as my, or Google's offering as my go-to. It does a really good job of cataloging and putting it into kind of an episodic way, you know, different stages of life. So that may save you some time with all the data acquisition. Yes, I'm exploring AI, but every time I sort of start to learn about it, there's a new thing. And it's like, well, maybe I should learn that thing. And, but I will get there. I will get there. If people are interested in sampling these microbiome nutritional, I'm not sure what to call them. Not really supplements. They're just food, bacteria food. Okay. If anybody wants to buy bacteria food, where do they get it? They go to lilahealth.com. It's direct to consumer. That's the only place that we are and likely will be for some time. And, you know, L-Y-L-A-H, yeah. L-Y-L-A-H, right? Yep. Lilahealth.com. Lilahealth. And you welcome feedback. I welcome feedback. Absolutely. I, in fact, challenge, you know, patients slash consumers and get a baseline, you know, lipid profile, use it for three months. And assuming you didn't drastically change your life and start becoming a couch potato and eating cheeseburgers three times a day, tell me what the results are after three months. Yeah, this would be great testimonials. That would be terrific. That would be terrific. So by all means. All right. Well, Dr. Bilal Ahmed, thanks for joining me on the art of medicine. Thank you, Dr. Weller. I appreciate it. Thank you for having me. And now a final thanks to our sponsor locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory exists to answer your questions about the how-tos of locums on their website, podcast, webinars, and videos. They even have a locums 101 crash course. At locumstory.com, you can discover if locum tenens make sense for you and your career goals. What makes locumstory.com unique is that it's a peer-to-peer platform with real physicians sharing their experiences and stories, both the good and bad about working locum tenens, hence the name locumstory. Locumstory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free. Thanks again to locumstory.com for sponsoring this episode of the art of medicine. I'm Dr. Andrew Wilner. See you next time. This program is hosted, edited, and produced by Andrew Wilner, MD, FACP, FAAN. Guests receive no financial compensation for their appearance on the art of medicine. Andrew Wilner, MD, is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee. Views, thoughts, and opinions expressed on this program belong solely to Dr. Wilner and his guests and not necessarily to their employers, organizations, other group, or individual. 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