///Secrets of an Unseen World

Secrets of an Unseen World

Mahmoud Ghannoum, the son of a Lebanese plumber, is perhaps the world’s leading authority on the microscopic fungi in humans. He’s also an author and businessman who keeps reinventing himself while saving lives in the process.

By Joe Miller
Dr. Ghannoum in his lab

Photography by Angelo Merendino

It’s early on a chilly January morning, and Dr. Mahmoud Ghannoum –a renowned researcher and pioneer at Case Western Reserve University’s School of Medicine – is having one of those surreal moments that seem to populate his life.

His groundbreaking work on microscopic fungi spans five decades of lab experiments, academic conferences, and scholarly tomes. Yet on this day, Ghannoum is on local television plugging Total Gut Balance – essentially a cookbook and fitness guide.

For his first mass-marketed book, Ghannoum and co-writer Eve Adamson have put together a wealth of diet advice, complete with 50 recipes, that inextricably links personal health to the well-being of the millions of fungi, bacteria, and viruses living in our digestive system.

“Our gut is teeming with these microbes,” the 69-year-old Shaker Heights resident tells a Channel 19 reporter on the station’s “Sunny Side Up” show. “We need to nourish the good ones and keep those bad ones under control,” he says.

Our intestines are like “a garden,” he continues with an easy smile on his face and emphasizing each point with his hands. “We would like to have more roses and less weeds.”

Total Gut Balance – essentially a cookbook and fitness guide – was released in December.

Since the release of the book in December, Ghannoum is suddenly finding fame on the talk-show and podcast circuit doing what he’s always done best: unveiling the secrets of the unseen world inside our bodies. His intense focus and drive have led this son of a Lebanese plumber from the streets of Beirut to the labs of CWRU and University Hospitals and now to two Amazon best-seller lists (for “physiology” and “abdominal disorders & diseases”).

But for those who know him, that journey and Ghannoum’s latest entrepreneurial streak – he has also launched a line of probiotics with his son – is anything but a surprise.

“He keeps reinventing himself,” says Dr. Ashraf Ibrahim, a professor of medicine at the University of California, Los Angeles, and a former student of Ghannoum’s. “He has a vision. He can figure out what is going to be hot and what is going to be beneficial.”

The common thread throughout has been mycology: the scientific study of fungi. Ghannoum even coined the term “mycobiome” – a take on the more common “microbiome” – to describe the communities of fungi in the human body and their interactions with bacteria and other microbes. (His new book carries the subtitle, Fix Your Mycobiome Fast for Complete Digestive Wellness.)

Colleagues credit him with helping steer medicine away from the idea of fungi as alien invaders. Instead, Ghannoum wants people to accept the tiny life forms as native inhabitants of our insides and an integral part of our health, for better or worse.

“Our gut is teeming with these microbes. We need to nourish the good ones and keep those bad ones under control.”

“Everybody looks at bacteria. For me it’s very critical to look at both bacteria and fungi,” he says to me later that morning at the Center for Medical Mycology, a collaboration between UH and CWRU. Ghannoum has directed the center since 1996.

Fungus can be deadly. It’s one of leading causes of fatal infections in hospitals and can be linked to conditions such as Crohn’s disease, he explains. “But we should not look at the fungus like it’s all bad,” Ghannoum says. The good fungus “trains our immune system and helps us break down food,” he says.

If you ignore fungus, he says, “you are really missing half the story.”

From Kuwait to the U.S.

Ghannoum’s passion for fungi began in the early 1970s. He had just finished his bachelor’s degree at American University of Beirut and was ready to pursue advanced studies at Loughborough University of Technology in England. But he couldn’t afford the trip. His father understood that his son’s best opportunities lay outside of Lebanon. So he sold his plumber’s tools and bought Mahmoud a ticket.

“My mom and dad did not know how to read or write,” he says. “But they knew the value of education.”

At Loughborough, a professor encouraged Ghannoum to look into why test rabbits treated with antibiotics were developing fatal fungal infections. Ghannoum later noticed that bad fungi also flourished in women treated with antibiotics, leading to vaginal yeast infections.

Dr. Ghannoum and Marie at their Shaker home

Dr. Ghannoum and his wife Marie at their Shaker home.

The problem, he deduced, was that killing off both bad and good bacteria was providing an opening for another native microbe to run rampant: fungi known as Candida. Ghannoum today is recognized as a top expert on Candida and its various species. “It’s the most common fungal colonizer in humans,” he says.

Family and friends say a never-quit personality as much as his expertise has pushed his career, particularly when things look bleakest. After Loughborough and a short stint in Malta, Ghannoum took a professorship in mycology at Kuwait University. A colleague later encouraged him to seek better opportunities in the U.S., but Ghannoum and his wife, Marie, decided they were happy raising their family in tiny Kuwait. “It was a good life,” he says.

Saddam Hussein changed that.

In 1990, Iraqi forces invaded the Ghannoums’ adopted country. As it happened, the professor and his family were safely on summer vacation in northern England, where Marie grew up. But Ghannoum knew their life in Kuwait was over.

By chance, Ghannoum was already booked to speak at a conference in Washington, D.C., the perfect opportunity to hunt for a new job in the U.S. But when he got there he realized he needed an extra week to line up the right interviews, and all his money had been frozen by the invasion. There was no way to stay.

That’s when Ghannoum, with barely a dollar to his name, saw a sign for a travel agency in D.C. and thought he’d take a chance. Inside, he told the travel agent in charge his whole story. The agent, seeing Ghannoum’s plight, changed his plane ticket for free and even gave him $80 out of his own wallet. Soon after, Ghannoum found a job at UCLA and a new life for his family in the U.S.

“For Mahmoud there is always a way to fix something,” says Marie, his wife of 44 years. “To him, there is nothing that’s ever a done deal.”

I think he remembers being that kid in Beirut with zero opportunity,” son Afif says. “My dad sees options where there are none.”

Marie also believes the travel agent, recently rediscovered after an exhaustive search and identified as Cleveland native Jimmy Dorsey (see sidebar), saw in Ghannoum the same genuineness she saw in him years before when the young Lebanese student took her shopping for an engagement ring on just their second date.

“With Mahmoud’s personality, when he speaks to someone, they know he’s sincere,” she says. “When he says something, it comes straight from the heart.”

A Research Juggernaut

Ghannoum leads me on a brisk walk through the hallways of University Hospital to his office in the Wearn Building. On the way, a passerby congratulates Ghannoum on a recent podcast.

At 9:30 am it’s early enough for most, but for Ghannoum, who wakes up at 5 am each morning to work out on his elliptical trainer, it might as well be midday.

“He’s the kind of guy who wakes up early in the morning and beats everyone to the lab,” says UCLA’s Ibrahim, who has known him since his Kuwait years. Ghannoum’s crowded work day typically starts right here at the Center for Medical Mycology.

UH and CWRU hired him away from UCLA 24 years ago, betting that Ghannoum’s research and enterprise would be a recipe for success for the newly created center. Since then, Ghannoum has turned the center into a research juggernaut and the go-to lab for pharmaceutical companies testing out new antifungal drugs.

“First and foremost, Dr. Ghannoum is a risk taker and an innovator, someone who’s willing to try out new things and solve problems and go where other people might not even try,” says Dr. Mark Chance, vice dean for research at CWRU’s School of Medicine.

“He’s a force of nature.” Ghannoum walks me through a series of displays on the hallway wall outside his offi ce showing how his lab tests new medicines in the test tube, then in animals, and finally in clinical trials.

The center has more than 30,000 fungal strains on site. So when an infection hits the news, such as the discovery of a Candida auris fungus that is resistant to current medicines, chances are it’s already in Ghannoum’s freezer ready to be studied. The center is currently working with drug makers to gain approval for three drugs that have shown promise against Candida auris, he says.

Under Ghannoum’s leadership, the center has also set the standards for treating infections. Ghannoum says his proudest moment was learning that his work had helped save a baby’s life in Italy.

“As a scientist, you don’t always realize you’re having an impact on people’s lives,” he says.

But Ghannoum says he realized a long time ago that a scientist needs to go beyond grants and work closer with industry to move the needle in any fi eld.

“It’s helped me greatly to have this diversified portfolio (of funding),” he says. “It’s not about just your academic degrees. You need to be business savvy.”

He is now passing that wisdom on to the next generation. Ghannoum, who also has a master’s in business administration from CWRU’s Weatherhead School of Management, collaborated with Weatherhead two years ago to create a new class for medical students.

During a four-year concentration, Ghannoum teaches students how to take their health care innovations to market, exposing them to fellow innovators and funding sources.

“First and foremost, Dr. Ghannoum is a risk taker and an innovator, someone who’s willing to try out new things and solve problems and go where other people might not even try.”

At the end of the four years, students will present their business plans to a group of professionals, similar to the TV show “Shark Tank.”

“We are connecting them with experts in these areas,” he says. “This is really just to give them an idea of what it means to be an entrepreneur. If you don’t know how to run your practice, you’re not going to survive. You need to go beyond your medical experience.”

Seeing the Next Wave

Ghannoum’s son, Afif, guides me through the offices of BIOHM Health LLC in downtown Cleveland, a block from Progressive Field.

The company, launched three years ago, combines the scientific expertise of the father with the business experience of the son. Afif is a lawyer, formerly with Squire Patton Boggs, and an entrepreneur in his own right. CWRU is a minority partner in the company.

BIOHM has two main products. The first is a line of probiotics and supplements designed to balance a person’s microbiome. Afif shows me displays of bottles featuring the BIOHM name, including one co-branded with Ohio-based Discount Drug Mart that just shipped to market.

The company also offers a testing service using CWRU’s labs. Customers send in fecal samples and get a detailed report on their own microbiome plus advice from a nutritionist on how to get it into balance. So far, BIOHM has collected thousands of samples, creating a database that Mahmoud believes will lead to additional partnerships as other companies seek to develop therapies for the microbiome.

“That’s where he’s great as a scientist, his ability to see the next wave,” his son says.

Part of Afif’s role is being the voice of reason, his father adds. “He’s a lawyer, so he tries to restrain me a lot,” Ghannoum says with a laugh. “But we’re a close family. We have fun.”

Despite his workload, Ghannoum still finds time to spend time with Marie, three children, and four grandchildren. Often it’s leisurely walks with his dog, Prince, near their Parkland Drive home; sometimes it’s strenuous hikes in the Cuyahoga Valley National Park with the grandchildren. And once, three years ago, it was jumping out of an airplane with his youngest son, Adam, an avid skydiver.

“He’s going to turn 70 this year and he’s up for whatever,” says Afif.

Sidebar: The Kindness of Strangers

Afif Ghannoum had heard his father, Dr. Mahmoud Ghannoum, tell the story countless times: how a stranger’s kindness set in motion his family’s fortuitous journey to the United States some 30 years ago.

The stranger’s name, however, was a mystery. That is until last year, when Afif set out to thank him.

The younger Ghannoum knew the details by heart. It was 1990 and Saddam Hussein had just invaded his family’s adopted home of Kuwait, leaving his dad out of a job and money. When a trip to Washington, D.C. to find employment went awry, a local travel agent helped Ghannoum rearrange his travel plans for free and even gave him $80 out of his own wallet.

It was just what Mahmoud Ghannoum needed to set a pioneering career back on track. He got a professor’s post at the University of California, Los Angeles, and eventually worked his way to Case Western Reserve University. Ghannoum later tried to thank his good samaritan, but discovered the travel agency had closed. And he didn’t know the man’s name.

Plaque commemorating James Dorsey Memorial Scholarship

The scholarship targets undergraduates at Case Western Reserve University in financial need.

Fast forward to September 2019. Afif decided to post his father’s story on Facebook, hoping that someone could identify their benefactor. They didn’t have much to go on. Mahmoud remembered roughly where the agency office was located and that the man was African American. But then interest in the story spiked on social media and it got picked up by a columnist in the Washington Post on September 16.

Within days, Afif was getting leads pointing to one man: James Dorsey. “It was surreal,” he says.

However, the eureka moment quickly gave way to sadness. Dorsey, Afif learned, had died of cancer just months before at age 69. Soon Afif was talking to Dorsey’s widow, Elaine. It turned out Elaine still remembered her husband telling her the same story so many years before. Dorsey had told her he might get fired for what he had done, but he also knew he couldn’t turn away someone in need.

“Jimmy was always willing to help someone out. It was just how he was,” Elaine Dorsey says. Case in point, if someone at the local store didn’t have enough cash, Elaine says her husband wouldn’t hesitate. “He would just take the money out of his pocket and say, ‘I’ll pay for it.’”

Afif’s search had unveiled a man not much different from his own father. While Dr. Ghannoum was doing groundbreaking science at CWRU, Dorsey – a Vietnam veteran – was breaking barriers in Leesburg, Virginia, as the city’s first African American volunteer firefighter.

In a surprising twist, they also had a city in common. Jimmy and Elaine are Cleveland natives and graduates of John Hay High School, just blocks from Dr. Ghannoum’s office in University Circle. Jimmy’s daughter, Michele Maynard, still lives in Cleveland just a few miles down Euclid Avenue in the Collinwood neighborhood.

The story of her father – and lengths Afif went to find him – amazes Michele Maynard. “I never knew anything about it,” she says. “But I can honestly say that’s the man my dad was. My dad is my hero.”

In December, Mahmoud, Afif, and Afif’s wife and children visited Elaine and family at her home in Leesburg. “It was just like family getting together who hadn’t seen each other for a while,” she says. “It was like we had known each other for years.”

The Ghannoums surprised Elaine by creating the James R. “Jimmy” Dorsey Memorial Scholarship at CWRU with $25,000 in seed money. Since then, others touched by the online story have added to that total. The scholarship will target undergraduate students in financial need, says Dr. Ghannoum.

“That experience with Jimmy has made it very clear that one incident can impact your whole life,” Afif says. “We all have to pay it forward, because you never know the impact you could have on someone’s life.”

Originally published in Shaker Life, Spring 2020.

2020-04-14T20:00:39+00:00Brilliant Careers, People|