How to Resolve GI Issues: A Functional Medicine Approach

More time. Okay, so I'm Dan Kalish. I am excited to be here. I am going to talk about the GI FX test and just a quick introduction to myself. In addition to being somewhat audio technique impaired, apparently, can't get the sound to work now. I'm just so excited that the sound is working. I'm going to talk forever.

Okay, so I founded the Kalish Institute in 2006. I spent the last 10 years of my career working with Dr. Richard Lord, who is a scientist that developed the GI FX test. One day, Richard woke up and thought, "I want to test the commensal bacteria. I want to make this lab test that looks at the microbiome." And 10 years ago, I met Richard. And of course, I knew him already. Everyone knows Richard, but I started to work with him on a regular basis, two days a week for 10 years. Richard and I have been talking about this test and the other tests that he invented to basically invented organic acids, amino acids, fatty acids. He's a scientist that did all this original work. He's in his 80s now. He's retired. He's a good friend, a colleague. He's almost like, really, like honestly, a father figure, mentor for me. And I just talked to him the other day, and nothing makes him more happy than if I get out and talk about the work that he has taught me. So I'm excited to be here and be able to do this with you guys.

Okay. Um, now I've also done other stuff, you know. So I've been in practice for 30 years and I'm IFM certified. I've worked with IFM for many years, teaching practice implementation courses. I worked with the Mayo Clinic doing an adrenal and GI research study project for a while. Not took like a year of my life. I'm quite interested in the industry, and I think one of the main skill sets that we all need to acquire is how to interpret GI FX tests. Okay, this is like a super important thing. You have to be able to do this. Again, Genova is hosting this webinar today, so I want to thank them for that. And also, we're giving a 20% discount to Genova Diagnostics clients for our upcoming boot camp. It's the first time I ever taught this class, "Getting Started Interpreting Genova GI FX." And it's a month-long cramming together of the last 10 years of my work with Dr. Lord. And hopefully, you guys will sign up. You get a nice, hefty 20% discount. It's one month of your life. It's a crash course. It's very much interpretation-focused, as is today's little class. And if you really want to get deep into the GI FX test, it's worth taking a month of your life out to do this lab interpretation boot camp. And I promise, there are no frills or wasted time. It's just like, "Here's a lab that's interpreted. What does it mean? What do you do?" "There's another lab. What does it mean? How do you interpret it? What do you do?" And the lectures, as in today's talk, are just structured around how you can have a system for interpreting the lab. That's really all that we're looking at. Okay. And so if you're interested, you can register. It starts in March. March 9th. And again, I want to thank Genova for hosting this evening right now and for helping us support the lab interpretation boot camp that's coming up in March.

All right. So now we're just going to have to assume a lot of knowledge here. And I'm just going to have a few slides just to kind of remind everybody that the microbiome is really important, right? It directs and controls large portions of our immune system. It helps regulate our metabolism. And we can all kind of buy into this idea that the gut is super important. Okay. So I'm not going to talk too much about technical stuff like that. I want to get more into analysis and systems of analysis. And so if you look at the GI FX test with a hope, with a hope that you will be able to understand each marker, good luck, because it's too complex. Even if you spent five or six years full-time studying each marker on that test, unless you have the algorithms that Genova has in order to crunch numbers and compare these bacteria, that bacteria, you're not going to be able to generate the kind of data that you really need to. Okay. So there are portions of this test that you just have to surrender to and realize that there's a computer program that's looking at this for you because it's far too complex for any human being to understand. And there are ways that Genova creates graphic images for you that summarize all this complex data. Okay. So that's one thing. And for many of the microbiome-related factors on the test, it's computer algorithms comparing tens of thousands of tests to come up with a number that you can look at and explain to your patient. There are portions of this test that you really need to understand in great detail. And it's hard to separate out the things that you can just let the computers deal with and things that you should be dealing with on your own. So that's what we want to cover today. Microbiome disruption, GI organs that are impacted, and pathogens acquired. Those are the three things that you should be thinking of every time you grab one of these tests. Is the microbiome working properly or not? Yes, that's a yes or no question. Is there an organ in the gut that's not working? If there is, which one? And there's not that many to choose from. It's going to tell you about the stomach, the pancreas, the gallbladder, and the intestinal tract. And I just had a patient yesterday, in fact, this is a really good story. This is true, where he had, I was kind of surprised by this, but his whole GI FX test was pretty good except for the parts that related to the stomach, the pancreas, and the gallbladder. Yeah, I don't know if I'd ever seen such a clear-cut case like this before. It kind of surprised me. I talked to this guy yesterday for like an hour. And so he eats really well. He does all kinds of things really well, but he just doesn't make stomach acid or bile or pancreatic enzymes very well. That was his whole problem. It was a stage two. You're also going to find people who are in what I call stage three, which means that they have Giardia, Cryptosporidium, E. histolytica, a yeast overgrowth, or some kind of bug that you're going to need to get in there and kill. So every time you look at a test, you're trying to differentiate: Is there stage one, or two, or a three present? Okay. And if you can just come up with that, you're going to be in pretty good shape. You're going to be able to treat people super successfully.

So what are these stages? Stage one again is the microbiome has been disrupted. And there's a gazillion things that can cause that. Diet, obviously. Antibiotics, obviously. Stress, sleep, related, a lot of toxins. We're not going to talk about what causes that, but is the microbiome working well? Is it disrupted or not? Okay. And there's clear markers when we look at the test review at the end of the class here. So I'm going to talk about, let's go through these lecture notes for a little while, then we're going to get into lab interpretation. Okay, in the end of the class. And so stage two. Stage one again is microbiome. Stage two is now there's an organ that's involved. And again, is it stomach, pancreas, gallbladder, or intestinal tract? Is there a decrease in stomach acid secretion? Is there a decrease in pancreatic enzyme production? Is there a problem with bile production? Something going on with leaky gut or immune markers in the gut or inflammatory markers in the gut? So that's an organ that's involved. Microbiome can be involved. That's a one. Organ involved. That's a two. And then the third stage. And these stages are roughly in order in which they happen. So usually people get their microbiome screwed up first, then the organs are not doing so well, leaky gut starts to happen, and then all of a sudden the immune system is not doing great in the gut, and they have a pathogen problem. And that's our Giardia, Crypto, yeast overgrowth, all that kind of stuff. So to a certain extent, these stages are progressive. I don't think you can really have a chronic Giardia infection without it affecting the two other stages. You know, so like if someone has a perfect microbiome, they're probably not going to have a yeast overgrowth problem. Okay. So to a certain extent, people start off with a stage one where the microbiome is not working well, progress to a stage two where the organs, usually at least the gut lining, is involved, right? There's leaky gut. No, those things are happening. And then to stage three where the immune system is crashed enough that there's infections. And then you want to think about, as a clinician's perspective, which stage you're going to treat, especially if all three stages are present. Which one do you want to treat first? And so people have personal preferences around this. If you're relatively new to practice and you're a little nervous and the patient is really sick, just start with the stage one treatment. You can never go wrong with starting with a microbiome treatment. And I'll show you what those are at the second half of the class. Okay, we're going to go through protocols and lab review in the second half of the class. If you're a little like gutsier, if you had maybe a convertible when you're in your 20s and we're zipping around and you know, you know, and you're like a little bit more of a risk-taker kind of person, and the person's not super sick, then always start with the stage three where you, because you get a lot done by clearing out the infections first. But you don't have to do it that way. So just to get you out, you can treat any of these stages in any order. But the more of a beginner you are, the better it is to start with the earlier stages because they're easier and they're less side effects. The more advanced you are, the more of a risk-taker you are, the faster you want to get that person better, then you should go for the kill phase first. But you don't have to.

And then I just have one slide on this, which I have two slides on lifestyle because I don't, I don't like to talk about lifestyle because there's plenty of other people that talk about lifestyle. I do lifestyle coaching with all my patients, and I'm assuming you guys do too. So I just have this slide on here so I can say I'm not, it's not like we don't do that. But where this is a lab review class, and I do have this one little thing I talk about all the time. Patients seem to like this, although it's sort of silly. I call the cereal bowl diet. And I do this myself every day. I did it today. The cereal bowl diet is that before every meal, every meal, many meals, you have whether you have three meals a day or two meals a day or whatever you're doing with your life, you have a cereal bowl full of vegetables, no matter what. So usually for me, it's a big salad at lunch and then cooked vegetables in the evening, sometimes two or three types of vegetables, oftentimes two or three. And you always want to start your meal off with the salad or the cooked vegetables. And you can do fruit in the morning if you want. You could have fruit, but you know, it's a little better to do vegetables. But you could do for some berries or something in the morning. But you want to make sure you're not eating cereal in your cereal bowl. There's no cereal in the cereal bowl. It's that you want to get that much salad at least, or that much cooked vegetables at least, before you eat anything else. So at the beginning of the meal, that's what you eat first. Why do we do that? Because number one, it fills you up so you don't overeat the other stuff that's not as healthy for you as vegetables are. And then number two, if you don't have the salad or the vegetables, you can't have the meal because you got to start with this, right? So you can't just like sneak in a tuna sandwich or something. But without, no, no, you can't, because you gotta eat your bowl of vegetables before you have the tuna sandwich. So it forces people to eat vegetables with every meal. That's gotten a lot of benefit for my patients, just to kind of reorient their thinking. And of course, what sets the stage for the microbiome working properly are two important things: polyphenols in the diet and fiber in the diet, which you're going to get from your vegetables and fruit. So if you don't have enough polyphenols in the diet and fiber in the diet, over time you're going to end up with a disturbed microbiome. What you'll see on the labs is going to be low short-chain fatty acids. The famous one is called butyrate. So this is called butyrate. Low butyrate. That's a lack of fiber, okay? Lack of fiber, at least a low butyrate. And you're going to see commensal bacteria imbalances. And I'll show you those markers in a minute.

Now, in a stage two, remember, stage one is the microbiome. Stage two is now you've got a lack of HCL, so the stomach's not working properly, or you've got inadequate enzymes and bile, or you've got a leaky gut, damaged gut lining, or you've got a degradation of the immune response in the gut. All those are markers that you see on the test, and you're like, "Oh, that's not good. There's an organ involved." I'm going to treat the organ. If the microbiome markers are disturbed, you're going to treat the microbiome. And if you see, and this is the fun part, a pathogen. When I was first in practice, this is true. I would, the lab, this is a really long time ago, this is 30 years ago. So we, everything was done by mail, if you can believe it or not. They didn't even fax that stuff. It was, they would mail you your lab results. There's no online portal, there's no online anything. So the mail would come in the morning, like, I don't know, 7:00, 7:30. And I'd be in the back office, and Marianne would bring the mail to me. And I would always rip open the envelope from the lab. And then first grab the GI tests. And then first of all, look at the GI pathogen section of the test because I wanted to know, did that patient have an infection or not? If you have an infection in the gut, it's kind of exciting because it means that you're going to be able to help that person a lot. Infections come about because of a weakened microbiome and organ dysfunction. So stage one and stage two are still relevant. You can also have people who have an old infection, like maybe they picked up Giardia when they were a teenager and now they're 50, but now they're under a lot of stress and all of a sudden, for the first time in decades, the Giardia starts to flare up and cause a lot of symptoms. You can also have a new infection that's acquired because you're stressed out of your mind, right? You're going through a stressful divorce, you're in a custody battle, stressed out of your mind. You go to a restaurant and you pick up Cryptosporidium from, you know, some shrimp salad or something that you eat. But it's an infection that's a problem because you're stressed and your immune system is weak. So there's tie-ins here with the adrenal hormones, and we always test and correct the adrenal hormones as part of these gut programs, just to mention that. But we're looking for things like C. diff. We had a patient this morning in the mentorship class, and that's this one patient, one lab, had a C. diff, Giardia, Entamoeba coli, and a really nasty yeast overgrowth. Sometimes people have two, three, four bugs going on. You can have more than one problem. That's my favorite thing to tell patients. Okay. So stage one, microbiome. You're going to see the markers in a minute. Stage two, GI organs are impacted. We'll see the markers in a minute. And stage three are the pathogens. And you just need to decide which way are you going to treat. Okay. And so in terms of treatments themselves, on the one side, there under lifestyle are the things you can use for lifestyle. On the right hand side, you can see are the things you can use for actually treating the microbiome. You can do both, obviously. On the supplement side, prebiotic powders, probiotics, and butyrate. And don't get the old-fashioned butyrate, get the newer butyrate that's being made now. Okay? Not the old one, but the new one. So prebiotic powders, probiotics, and butyrate are treatments when you see a microbiome imbalance. Treatments for organ dysfunction, again, lifestyle, your food, don't drink a ton of water when you eat, breathe, relax, you know, get a healthy diet going. But on the supplement side, you've got betaine HCl and pepsin for the stomach, digestive enzymes when the pancreatic markers are positive, and glutamine or IGG-based powders for leaky gut repair. And then if you have a gallbladder problem, there's also gallbladder support you can use. Okay. So you're treating the organ directly. Usually, it's one or two organs. It's usually not all of them. And then for microbial balance on the pathogen side, you have a choice of antimicrobial herbs, antifungal herbs, you have a choice of antibiotics, antiparasitic drugs, antifungals by prescription. It's really a whole host of problems, solutions you can have for that. Okay.

Okay, a quick reminder. If you came in late, we have this boot camp coming up starting in March. If you want to sign up, you get a 20% discount, thanks to Genova helping sponsor that. All right. And then I have this thing I'd like to talk about called Labs to Lifestyle, which means that I have always done lab testing on every patient because, in my mind, that's what I think of this is being functional medicine is lifestyle medicine combined with lab tests. And so I have, I can't conceptualize of working with a patient without having a GI FX test. Well, Dr. Timmons taught me that 30 years ago. You couldn't schedule a consultation with Dr. Timmons until you had done your GI testing. You didn't even really want to talk to you because, I mean, I mean, that was just his entry point. So I kind of stuck with that in my practice as well. So we can use the lab test as a very powerful motivator to get people to make the lifestyle changes. And you know this just from your general experience, right? Where let's say you're like, "If I go see my regular doctor and she looks at me and she's like, 'I don't know, Dan, it kind of looks like you probably have high cholesterol. I think you should start taking a statin, be on that for the rest of your life.'" I'd be like, "I don't know. Like, that doesn't sound like a very good idea. Why do you think I look like? You know, isn't there a test?" No, nobody ever does it that way. You do a test, it shows you have high cholesterol, and then people are prescribed a drug to lower their cholesterol. So when there's a test, our culture is primed for this. When there's a lab test that is like a motivational force that is beyond anything that you could generate just by being a good doctor. So if I run a lab and I see that they have low butyrate, I've got the strongest argument in the world to talk to them about, "Oh, you have low butyrate. Oh, there's this butyrate supplement you can take. You can buy this bottle and stuff, you know, and I'm going to sell it to you, and you should take this for a few months." But long term, if you want to get off this butyrate supplement, we need to talk about how your body makes butyrate. Your body doesn't make butyrate. That was a trick. Did you miss? See how I did that? Does it? Who makes butyrate? The bacteria. Where they come from? Dietary fiber. They're living on the fiber, and their byproduct of the fiber, their waste product is the butyrate. So, and then the patient's like, "Oh, well, do I have to take fiber?" And I'll be like, "Yeah, but you could just eat it. Let's talk about the cereal bowl diet, right? Getting you to start to eat vegetables and fruit on a regular basis." Okay.

So now, the second one here, in addition to fiber, is the polyphenol. So low polyphenol markers. There's hints of them in this GI FX test, but they show up much more prominently in the neutral valve or metabolomics test. There's a whole section of in the neutral and metabolomics that talks about polyphenol markers. And you probably don't know them, but they're benzoic acid, hyperic acid, those ones. Okay. And so if those are low, it means there's not enough polyphenols in the diet. Why do we need polyphenols? What does your body do with polyphenols? Nothing. Your body can't absorb polyphenols. The molecular structure of the polyphenol is too big for you to pull it across your intestinal tract lining. I should say blueberries today. And I know when I was, I don't know, I think it was maybe in my late 20s, I didn't have much money and I was in school. I remember being at the farmers market, looking at this quart of blueberries, and it was, I don't know, it's like eight bucks or something like that. But to me, it was like a lot of money. And just thinking, "Man, am I gonna like spend all that money on blueberries?" And I bought it and I took the blueberries home and I ate them. And I always thought the blueberries were for me. But no, the polyphenols in the blueberries, and blueberries, cranberries, pomegranate, these are the top polyphenol foods of all time. The polyphenols in the blueberry are for the gut bacteria, the commensal bacteria, to grow to make your microbiome healthier. That's why they're so good for you. Okay. So again, polyphenol markers show up on neutral valves, metabolomics testing. Hippurate or hyperic acid, benzoate or benzoic acid are examples of that. And then you see hints of it in this test as well. So here we've got, I snuck this in here just so you can see. And there's a page on the GI FX test that has commensal bacteria by PCR. Okay. And, uh, we'll talk at the, uh, towards the end of the lecture part, a little bit about these different bacteria and how they work. But basically, this is, this information is summarized and combined with other information on the test to give you a dysbiosis indicator score. Okay. So you'll be able to see that. You don't have to worry about trying to interpret this test in great detail. And to think about this for a moment. Okay. I talk to patients a lot about mitochondria and mitochondrial function. And when you think about breathing, you take a deep breath in. You can all do this right now if you have a minute here. Take a deeper breath in, and then breathe all the way out, and then hold your breath out. Okay? Just hold it out for a minute, for a couple minutes. It's hard. And eventually, you're not going to feel very comfortable. And that is what happens when you get a little hypoxic. So if you translate that into the microbiome language, you've got fiber. It's kind of like the oxygen. This is a food supply. This is the nutrient for these bacteria. The short-chain fatty acid producing bacteria die without the fiber, just like we die without oxygen. Hydrogen producers die without the short-chain fatty acid producers. And then the ones that consume hydrogen, the good bacteria that consume hydrogen, die if you don't have the hydrogen producers. It's this perfectly balanced ecosystem. It's incredible. That starts with fiber triggering certain bacteria to grow, which then triggers other bacteria to grow, which then triggers other bacteria to grow. And that's what you're seeing on this page right here. Okay. Yeah. And we'll have time for questions at the end too, for those of you that are asking questions or making snarky comments. I won't even talk about hecklers. But anyways, so, um, improving commensal bacterial markers, determine the status of the major hydrogen producers and consumers. Seems like a good idea, right? There's three bellwethers. These are super important markers on here that you should just know. Akkermansia, you just gotta fill out. Nathaniel beverbacter smithii, and D. hyphae. And you know, this is like a couple years of study. We're just going through this again, introduce you to the topic, right? And then you should be familiar with these basic potential treatment options here. New, if you have a cell phone, you can take a quick picture of this so you don't come back and listen to this whole thing. Okay? But these are the general treatment stuff that you should be super familiar with on a day in and day out basis. I mean, I recommend everything on this page all the time, depending on what the labs show. Okay? And it may take you a couple months to learn about each of these things. But this is like a quick cheat sheet for you. Now, if you're wanting to support the commensal bacteria, and this is again, the stage one, you're going to want to figure out about fiber, polyphenols. There's some of these organisms that require sulfur. Sulfide. Cell fibrio, remember that one? Dysphagopyger requires sulfur. And then there's some of them that respond to, uh, berberine. Akkermansia will grow out more effectively if you give a person berberine. So just a generalized framework for understanding the microbiome. This is the highest level you could look at it. High abundance commensal bacteria respond to soluble fiber and polyphenols. There's a list of them. Not every, that's not completely, it's a good list, and it's right off the GI FX test. These are the bacteria that respond to fiber and polyphenols, and they convert the fiber, again, remember, into short-chain fatty acids. The very high end of this microbial food chain within your gut. They're going to then stimulate the other bacteria. The bacteria that are hydrogen, hydrogenetic, I can never say that word, hydrogenic and hydrogenotropic, the ones that make hydrogen and consume hydrogen. Are going to be stimulated by these other guys. I spent two years in a monastery in Thailand. I spent six months in a Zen temple in Japan. I spent the last 10 or 12 years with a Taoist meditation teacher. And when you look at spiritual practice, spiritual life, like you see holes, you see like completion, you see things that are amazing. The microbiome is kind of like that. The microbiome is, um, this expression of nature that is so perfect, it's hard for us to even understand. You know, and we're testing it, but still, it's hard to get to the depth of understanding of this. But the point of these kinds of talks is so that you have things that you can communicate to your patients about. That's the whole point of lab interpretation is having the ability to communicate to your patient. And then if you can successfully look at the lab data and communicate that effectively to your patient, and the patient gets excited and enrolled, what do they do? They start to eat blueberries and vegetables and fruit. They improve their microbiome, and they can start to reverse themselves out of this whole thing. Okay. So again, dietary fiber goes to the short-chain fatty acids. That stimulates the hydrogen producers. The hydrogen now is in the gut. That stimulates the hydrogen consumers, the bacteria that consume hydrogen. And then this whole process keeps going. So when you see a test result like this, that's what you're looking at. You're looking at this combination of these organisms that are feeding, literally feeding one another in this unique ecosystem that has developed in the human gut. Polyphenols, pretty familiar to all of us, right? Blueberries, pomegranate, grapes, all this kind of stuff. Fiber, pretty obvious solutions. Treatment-wise, and then we're going to be taking these fibers and turning them into short-chain fatty acids. So on the test, you'll see short-chain fatty acids, and there's butyrate there. If it's low, you can give butyrate. You can give fiber and you can give polyphenols. Okay. That's not worry about. Here's another list. These are kind of more academic, but you know, the hydrogen-producing bacteria, there's a list of them that's right off the GI FX test. Why do these bacteria make hydrogen in the first place? I think this is kind of interesting. When humans burn oxygen to make ATP, right? We end up having to use oxygen to do that. When bacteria are creating energy in an environment that has no oxygen, because hopefully your large intestine is anaerobic, the leftover hydrogen from their metabolism forms hydrogen gas and fatty acids instead of water. That's kind of funny, kind of interesting. And that hydrogen gas actually is very important for a whole variety of reasons in terms of overall health. Okay. And you can use butyrate in a supplement form. We talked about that already. These are the hydrogen-consuming bacteria. And then here's the list again. You can snap, snap a picture of this if you want, real quick, about, um, combinations of bacteria and then potential treatments diet-wise, and then prebiotics and probiotic agents, depending on which organisms are high or low. Okay. So that's like a little cheat sheet there. But I don't want to summarize the three stages here and then look at some labs. So, um, microbiome, we're going to look at labs right now for that. Gut, real, uh, gut organs, and then, uh, the infections themselves. Okay. So let's take a look now.

All right, let's take a look at some tests. So here's a GI FX test now. Okay. This is the dashboard. I always look at this, kind of take it in, you know, get your wheels turning a little bit. And then the right-hand column says infection. So now you know, okay, they have the stage three going. There's an infection. How's the microbiome? Well, look at the microbiome support/dysbiosis section. That's not doing very well either. So they have a microbiome problem, a stage one. And then over here, digestive support, fecal fats, pancreatic elastase, and products of protein breakdown. That'll tell you about gallbladder, pancreas, and stomach function. So let me just lay that out for you with a little pointer thingy here. This section here will tell you about organs, stomach, gallbladder, and pancreas. Uh, this section here, the inflammation section, will tell you about leaky gut, gut inflammation, gut immunity. So this would be, uh, GI organ related, but the intestine. This is GI organ related, but stomach, gallbladder, and pancreas. And this is microbiome support here. And this is microbiome here. And then this is stage three infection. So that's a way to look at the test. Stage one, I'm sorry, in a second, I have to circle that. Wait, that's wrong. Stage one is right here, microbiome support. Microbiome support here. Stage two is here. This is the intestinal tract. These are the other organs here. And then stage three is over here. So that's how I try to sort through this: Is there a microbiome problem, an organ problem, or an infection? And there's some overlap, and it's a little confusing. You probably have questions like, "But wait a minute, isn't dysbiosis an infection?" It's kind of an overgrowth, but not an infection. And you can get into some complex semantics there, but let's not worry about that now. Here is where the computer comes in and gives you all kinds of scores that you can never figure out on your own. Okay, patient total commensal abundance score, inflammation. You know, all these are crunching numbers for you. And just look at that, you can tell basically. And if you don't want to look at that, you can just look at the dysbiosis score at the top here and tell, "Okay, they have dysbiosis." So you know there's an imbalance there. And then again, as you're looking at the report, here are the areas of organ involvement. Pancreatic elastase, okay, that fat marker is out of range. You got a problem with pancreatic enzymes. Products of protein breakdown, if that marker is out of range, you start to think about stomach and stomach acid. There's also markers on the, uh, organic acids testing that indicate potential problems with stomach acid. Indican is the marker. And fecal fat, obviously, about gallbladder. So you get a lot of information there. And then here's our inflammation and immunology. That basically tells you, is the gut inflamed? Is the immune system in the intestinal tract lining compromised? So you got your leaky gut, immune suppression, inflammation. These are all intestinal markers. And then down below here, you see under metabolic, you've got the short-chain fatty acids. These are really microbiome markers when you think about it. Short-chain fatty acids, butyrate, butyrate, acetate, propionate. These are all markers for the microbiome. Okay. And then let's keep scrolling down. This is complicated. You could talk for hours about that page. That's the commensal bacteria. And then you kind of scoot towards the end here and you see, um, the various infections that can show up. Now, this particular GI FX, this person has Giardia. It's an all-or-nothing test. If you have few Giardia, you have Giardia. Few, many, whatever. You have the infection. If it's a chronic, long-standing infection that's caused a lot of damage, you might not have as many organisms show up as if you picked up Giardia, you know, four days ago from a camping trip or something. And then the Giardia shows up again here. And then I don't really even look at these pages. I don't really really want to say that in public, but I guess I just did. Kind of skipped this whole part because I've already found out what I need to know. You know, and you don't, you don't have to really like understand, uh, uh, too much about, I don't know, Nathaniel beverbacter smithii. You could study about it if you want, but you don't really have to. It's not going to help things that much. I like having a few of these commensal bacteria that I can just speak about with patients. And I have like three or four of my favorites, the bellwether ones I just showed you, Akkermansia muciniphila, with Nathaniel beverbacter smithii, D. hyphae. And since COVID hit, since COVID hit and long COVID hit, we should all, this is like super important. Let me circle this one so you guys can get it. You gotta read about this tonight. Fecalibacterium prausnitzii. And COVID, and long-haul COVID. That one has suddenly become really, really important since the COVID pandemic. Fecalibacterium prausnitzii. Fecalibacterium prausnitzii. And just Google it later on and long-haul COVID. You should know about that. It's a good talking point for patients because you're trying to, the whole point of this is to communicate well with patients. So now, if we're then going to do a program, you have two choices with Giardia. You can use antibiotics or you can use antimicrobials. And you know, we go around and around on this in the mentorship class. And in fact, I think we talked about it this morning. Oh, yeah. See, who was it? It was a patient. It was one of the mother doctors was presenting a patient that had two different parasitic infections and H. pylori. And the practitioner that was presenting the case is a chiropractor. And so I was like, "What do you want to do? Antibiotics or herbal programs?" And she said, "I'm a chiropractor. I'd rather do the herbs." And then I said, "Okay, let's do that." And then one of the MDs on the call said, "Hey, if you're a medical doctor, could you use antibiotics?" I was like, "Absolutely, yes." Even if you're a chiropractor, you could refer out for antibiotics. And my, my whole practice years, I've always had two or three medical doctors that I can refer out to for antibiotics. So I can give patients that choice. Okay. And so if you're an acupuncturist or chiropractor by training, you should have a medical doctor or nurse practitioner that you can work with. And if you get Giardia and Crypto cases, and the person has two infections, and they don't want to take all these herbs, you know, you can refer them out for the medications. If you want to do an herbal program, you can do that as well. And then the question is, you know, in terms of treatment sequencing. So for someone like this, I would like, I would personally, I would do the, uh, anti-parasitic program first. And that could be either antibiotics or herbs, depending on your goals. You know, and then you could do the GI, uh, repair, microbiome repair later. So let's look at the test again and see. And we can just go up to the summary page, probably, so we can do this quickly. Oh, they need some help with dysbiosis also. Okay. So many times, if not most of the time, if you get rid of the Giardia, you're going to be able to easily handle the dysbiosis problem because most of the time it's the Giardia that's causing the dysbiosis in the first place. Okay. And so you shouldn't have too much trouble with that. So I would treat the parasite first, and then address the dysbiosis for a month or two, and then stop. Give the patient 60 days after the killing phase is done, and then retest. Make sure the Giardia is gone. And as an effect of having a Giardia infection, you can have high secretory IgA. So let's look at that here. It is. I can zoom in here. So you don't need to treat high sIgA if the person has an infection. Treating the infection, and the infection should knock the sIgA down. Okay. So you don't have to treat that separately. And I would say in my practice now, about half my patients use antibiotics. I refer out. Half of them use antimicrobials. Maybe more like 60%. You can do it either way. I don't think one way is better, um, or worse than the other. Okay. And high secretory IgA, secretory immunoglobulin, that's the immune response in the gut saying, "Oh, there's Giardia around. This is not good. We're going to generate a lot more troops here to go after this thing and try to keep our immune system from fraying at the seams." Okay. So that's one example. Let's look, see what this one has to show. I don't like that one. Let's try this one. See, that's a different. Oh, yeah, this is good. Okay. So this has a bunch of variables on it. Well, let's look at this test from the highest view possible here. So microbiome imbalance. Remember, we're looking here and here because the short-chain fatty acids like butyrate are part of that. So this person has low short-chain fatty acids. And then we're looking at organs. Here's the intestinal, intestines as an organ. Here's the stomach, gallbladder, and pancreas organs. That's our stage two. Then over here is infection. So this one is kind of easy because their gut is not that, that bad. So there's no infection present. So we don't have to worry about stage three. There's a lot going on with the organs. It's an early stage, right? It's the early stage of development of the problem. There's not that much going on with inflammation, a little bit with high sIgA, but it looks like fecal fats and the products of protein breakdown and the short-chain fatty acids are the biggest problem. So now this kind of hunt around and look at the lab report. And you can watch me glibly skip whole sections of this test because honestly, not that I don't care, it's just that you don't need that on the short term. And then here, products like protein breakdown, hmm, fecal fat. So you're starting to think there's an organ problem. We could use pancreatic enzymes, HCl, or something that supports the gallbladder that has ox bile, taurine, glycine, those types of things. Again, many companies that we work with have combination products that have all three. In fact, all the companies that I work with have a combination product, and it'll be like enzyme boost or digest design plus ultra plus this, that, whatever, but it'll have HCl, gallbladder support, and pancreatic enzymes on one pill. I usually use those because it's easier. You don't have to like figure out exactly what combination of which ones is going to help. And most of the time, those combination products work really well. So just, whatever supplement company you're looking for, ask your sales rep, "Hey, what's your combination product that has HCl for the stomach, enzymes for the pancreas, and gallbladder support all in one pill?" And if they say, "We don't have one," then get a new supplement company, basically, because all the good ones have that. That wasn't even a joke. I was being kind of serious, but I started laughing. I don't know why I started laughing. All right. So, and if you want to get like high-techy about it, yeah, absolutely. You can use specific products that are just for gallbladder, specific products for pancreas, and specific products just for the stomach. And I do that all the time too. But I always try the combination products first because it's easier for patients, more likely to be able to do it. Okay. And then here's our commensal bacteria. And remember, I think it's worth learning three or four of these so you have something to talk about with people if they ask you. The one that you guys all already know, uh, here is Lactobacillus. Okay, everybody knows that. That's in all the probiotics that you use. So you can say, "Oh, your Lactobacillus tested low." DL means underneath the detected limit, the little arrow there with the L. So you're low on Lactobacillus. So I want you to take this probiotic that contains Lactobacillus, and I want you to take this prebiotic that will help these good bacteria grow better. And again, I don't, there's some of these I don't like. Like, who really likes to even like the name of this one? Odoribacter. I'm sure it smells really bad in the lab. I don't want to talk about that. You know? And again, these are talking points for educational purposes. You don't treat an individual bacteria usually, although there are some exceptions. And I'll mention a few of them. They're in the notes there, but we're going kind of fast today, so you may have missed it. Akkermansia, if it's low, you can use berberine specifically. D. hyphae, if it's low, you can use chondroitin sulfate because it's a sulfur consumer, consumes sulfur. So if D. hyphae is low, and actually, this is a good example. If this person is low in D. hyphae, so you can use, uh, your D. hyphae DL, underneath detected limit. The marker is a little confusing. It's out here, but it's in the gray area. The gray area is underneath detected limit. So D. hyphae is low. So you could use chondroitin sulfate, or if you have another favorite sulfur compound that you prefer to get the hyphae to grow out. And that is good for your heart, right? If you have D. hyphae, it's important to protect your heart. And so you can have it. I would suggest again, three or four of these that you kind of know that your favorite so you can talk a little bit about. But you certainly don't need to learn all 24 in detail. No one does. It's just too complicated. And then I'm just scanning tests for the problems. Okay. So let's go back up to the summary page so we can design one more program and we got time for this case. I'm going to design one more program, then I'll go for questions. So, uh, maldigestion and a little bit of dysbiosis and low short-chain fatty acids. So again, to keep it simple, I would use my all-in-one digestive product. And that's going to be one you're going to ask your supplement rep, like HCl, gallbladder support, and, uh, enzymes, all one pill. Most of the time, they're dosed at like one or two with a meal, depending what brand you use. So that knocks out that whole section. That's convenient. The person was low in short-chain fatty acids. You're going to use butyrate. And they make butyrate in liquids, they make butyrate in capsules. Get the newer kind. If you don't know, ask your supplement rep, you know, "When did you guys start carrying this butyrate product?" And if they say, "Oh, yeah, it's like two, three, four years ago," then it's the right kind. If they, "Oh, we've had this butyrate since 1972," don't use the old butyrate. Okay? It doesn't work. It doesn't get absorbed. So it's either going to be a teaspoon or one capsule, see here, three times a day. Butyrate is a very powerful product in a very good way. It can lead to some pretty significant improvements in people. So you should learn a lot about butyrate. Read about it. Just Google butyrate and or talk to your sales reps and say, "Hey, you know, send me all your literature on butyrate. Let's see all the research on this stuff." Dan said it's amazing. It leads to clinical changes in chronic GI patients like nothing I've ever seen besides, you know, prescription steroids. It's the most powerful supplement I've ever seen for gut health, this non-prescription, ever. So you should learn how to use that word really well. Okay. So, um, did you do that? Let me see if I missed.

Anything here I got on a Peter rate rant stretching fatty acids. We covered this whole section and a little bit of dysbiosis. You know, you might say, "Hey, this meiosis marker." I would say, "This Master's market." And look, that bad. Let's just give this two or three months with a healthy diet and see if the person turns around, okay?

And then to take a step back before we look at questions. Everybody that I work with and everybody in the mentorship class that I teach, we all do three labs. So we do a stress test for adrenals, right? We do the GI testing that we're talking about now, and we do organic acids. And that can be done by a Nutrival or a metabolomics. So we're looking at isolated cases here of gut treatment. I'm not spelling that right, sorry. Um, but for every case, a real case that I work on, there's an adrenal lab, a GI lab, and a Nutrival or metabolomic. So we're looking at a little fragment of that right now.

All right, so we got a couple minutes left. Let me just open it up for questions here and see where we're at. Two to two. Hang on one second. Too many windows open there. Oh, and not to forget, 20% discount for Genova Diagnostics people. Genova 23. We've got a first-ever lab interpretation boot camp on the GI Effects. I spent the last 10 years of my life studying this test with Richard Lord. I got a lot to say about it. Join us. It's only a month. It's not that expensive, and you get 20% off if you use that. So if you're at all interested in this test, sign up for that class and you'll learn a lot. It'll be totally worthwhile. We'll try to revolutionize your practice a little bit, okay?

So now I'm going to look at questions. See what I can do here. I'm not going to be able to get to them all, probably, but I'll try. All right. Uh, oh, good night, Lars. Lars is saying good night. He's in Germany. There, probably pretty late for him. Um, why do we get an adrenal test on everyone? So the adrenal test, to me, I mean, the point of lab testing is to have information to help you clinically with your program design and to give you information for, um, designing lifestyle programs and to give the patient a sense of reality about what's going on. And so the adrenal lab looks at our response to stress. And in my view of the world, the reason why people get sick in the first place is because primarily of emotional and spiritual disconnection from themselves, from their partners, from their kids, from the planet, from their spiritual life, from their emotional life. And that when we're spiritually and emotionally disconnected, it messes with our adrenal hormones. People don't do well. And so testing the adrenal hormones sets the stage for you to be able to address diet, exercise, sleep, and spiritual practices. And testing and correcting the adrenals is the first opening act in really getting the gut under control because if the person's stressed out of their mind, they're going to continually be doing two things. Two things. If your adrenal hormones are screwed up, you're going to be catabolic, which means you're going to be breaking down your gut lining. That's what happens with your catabolic. So if your adrenals are screwed up, you're catabolic, you're breaking down your gut lining. How are you going to fix the gut if it's being broken down all the time? You can't. And the second thing that happens is that cortisol, which is made by the adrenal glands, regulates, wait for this, it regulates what does anybody know? Type in the answer if you know. You should all know this one. What is cortisol regulate? We just talked about it for like 10 minutes. Cortisol regulates secretory IgA, okay? And that's the immune response in your gut. We had a mentorship student 10 years ago. She wrote her whole PhD dissertation with sIgA and cortisol. All right. So if you don't test and correct the adrenals, the person is going to stay in their HPA axis dysfunction with a leaky gut because they're going to be catabolic. Catabolic physiology means we break down our proteins for fuel, and the gut lining is full of proteins to break down for fuel. And you're going to have problems with sIgA or the immune response in the gut. So that's the connection.

Uh, C, uh, yeah. So in terms of SIBO, this, the GI Effects is not a SIBO test. However, there's many indicators on the GI Effects test that show you if the person, uh, has SIBO, right? You may then want to reflex and do a SIBO test also. But there's a whole series of indicators on there that talk that will point you in that direction if it is so required.

Um, yeah, if you, if you, you generally, let's see, you generally don't want to give patients large amounts of fiber in the very beginning of a program if you're worried about them being bloated from it, right? So you have to be a little strategic about how you plan this out, and you may use butyrate and prebiotics and probiotics to work with the microbiome first.

Um, let's see. The most frequent antimicrobial I use for dysbiosis, probably oregano oil extract and thalia. I'm not going to mention brands here, but for thalia, that's not a good form. I don't think that's a good form of butyrate, but anyways, ask the company if it's been around when they've when they developed that.

So the name of the stress test that is the adrenal stress test, right? So Genova has them. The ones that I use all the time. So just look at the Genova catalog under adrenals or endocrinology, and it's the adrenal stress test plus the CAR. You want to get it with a cortisol awakening response also. Cortisol awakening response also. And that combination, that's what I did for my first 10 years in practice. It's an adrenal and a GI test together. You know, let me just show you guys. It's adreno cortex test. Here's an image of it here, plus the cortisol awakening response. You want to get it with the CAR. It's worthwhile. So a few extra bucks, but it's really worth it. My computer's not playing that out for some reason. Sorry. Oh, there it is. Okay. Do you see there? Adreno CorticoStress Profile or Adrenal Stress Profile. Most people call it with the CAR, cortisol, cortisol awakening response. That's the one you want to order. And you do that in the GI Effects, and you're often running with a busy practice, okay?

All right, let's see. Uh, or questions. Let's see. Do you have any time left? Oh, we're one minute over. Okay. Um, yes, Julia, we have an adrenal boot camp. As a matter of fact, if you look at our website, you can see all that stuff. Um, we have adrenal boot camps. We have this. We have lots of. There's going to be like a boot camp a month going on until, um, until I drop dead, basically, probably. And that's going to be like in like another 50 years. So the answer is yes. And yes, I use the adrenal stress test from Genova. That's the main one I use in my practice. It's probably the most popular one that I see in my mentorship class, too.

So yeah, we have it. We have boot camps on GI Effects. We're going to have boot camps on Genova's, um, metabolomic/Nutrival organic acids testing also. We'll have later in the year, uh, boot camp on all things, you know, right? We just keep, just keep looking at the Chaos Institute website. You'll see us rolling these out throughout the year. You can sign up for them, and you'll also, if you're on this email list, you'll probably be getting messages too.

Okay, I think I'm going to have to wrap it up. So I'm going to stop for now, but I know there's more questions that are coming in.