Hey folks, welcome, welcome to a new conceptual framework we're going to try to present tonight. I'm pretty excited about this, and I've been working on this project for a good two years now. And I want to start to share some of the thoughts and discoveries that I've had working with some of the top scientists in the field on this specific concept of looking at the microbiome. And what does that even mean? And what are, you know, how is this changing our field of functional medicine? And I'm pretty excited to be able to talk about this now. And, you know, I think tonight is about proposing questions as much as it is about answers, you know. And so I'm just going to jump right into this now.

Let me just make sure my sound is working. Can you guys hear me? Can someone raise their hand if they can hear me? Let's make sure I'm not just talking into space. Yes, okay, great. So if you're having trouble with your sound, then, uh, it's probably on your internet side. Okay.

So what are we really talking about? There's a good question. Oh, who am I? What talk about? Who I am for those of you that aren't familiar. So that's me. I'm Dan Kalish. I've been practicing for a long time. I've trained over a thousand people in my mentorship program. I did a research study with the Mayo Clinic that was cool. We have copies of that if you're interested. I teach this amazing class, it's a one-year mentorship. It gets better every year. If you guys are thinking about starting this class, we're starting a group right now, so you should sign up because it is just a wonderful experience for the right person. We have a community, we have a curriculum, we have this amazing group of doctors that are here. I teach all the classes myself. We have a special offer for you all. If you do VIP June 2018, you get a grand off the 1-year class, and that's good through July the second. You can contact the office if you're interested. And again, it, it just keeps getting better. This year is we have some whole new sections of the course that I've developed. Months and months of new materials are out there, and it's, it's just a wonderful experience for doctors. It's really transformative. I'd say that's the one thing that I see now is we transfer practices and the right doctor gets into this class, it's really, it's quite an experience for people, and people just love it. And I love teaching, and it's a really good thing. And if you're a patient, I work with patients still. You can check out my patient website, Kalishwellness.com. We'll have to work with patients. I spend every Tuesday and Thursday with patients now.

Okay, so here's, here's the big picture concept. Is that we're, we're needing to reevaluate everything in terms of how we look at the GI tract. And we talked a lot of tonight about neighborhoods of the gut and different bacteria and how all this kind of goes down. But I think there's a central question or theme that's going to go throughout all these talks on the microbiome. I'm going to do a whole series of these talks throughout this year now because I think, you know, the, the central, central point in some ways of naturopathic medicine, which was how I was trained. I was a chiropractor by license, but my main teachers, all of them were natural paths or NDs. And this was, you know, early 1990s. And to me, the central concept in naturopathic medicine was the health of the gut. You know, how do we analyze and treat the health of the gut? And when I was coming up in this field of functional medicine, again, early 1990s, you know, the, what I learned from my teachers was that you find things in their gut that are bad and you kill them, and then people get better. And so the question that was being asked in those days, if I look at the bigger picture, was how can we get patients who are sick better quickly? That was the question. How can we get patients who are sick better quickly? And the answer was, we figure out how to do these stool tests accurately, we find infections, we treat them, and then miraculously, people get better. And, you know, I have 20 years invested in that model. And, and, you know, just a couple years ago, I think that whole model, in my mind, got upended. And I want to ask a different question now.

So in the original question again, is I have a sick patient, and it doesn't matter if they have autoimmune disease, thyroid problem, a gut problem, or a brain problem. They could be depressed, anxious, whatever it is. You know, we know a lot of these problems come from the gut. So the question again, in the early years of my career, the first 20 years of my career, was, I got the sick patient, how am I gonna get him better? I'm gonna run a stool test, I see they have a pathogen, I get rid of the pathogen, they're better. But I just want to pose a different question now. I want to pose the question of, you know, why, why this is happening? And why do we have colleagues out there that specialize in chronic gut problems? And why does it seem like every year everyone's gut is getting worse? And everyone's getting more gluten-sensitive and more food allergies and more everything bad is happening in the gut? Like, why is that happening? You know, did you already, I get more, you know, very late in the last 10 years, you know, did the Cryptosporidium become more prevalent? I don't know, maybe. But I don't think so. I think it's a host-specific problem. I think it's the immune system in the host. Our immune systems, our gut health is deteriorating. And so we're having to do more and more and more killing. And I think you talk to the more experienced doctors that I hang out with, you know, they'll all say, you know, back in the day, you can just throw some herbs at someone and their gut would get better. But now we have, again, whole clinics that specialize in people who are non-responsive to these kinds of, you know, kind of find it and kill it kind of protocols. And so I think because people are getting sicker, we have to start to ask a different question, which is, what is health in the gut? And how do we define that? And why are these pathogen-related problems so prevalent now? And is there another approach we can take that's going to complement the test it, find it, and kill it approach? I still love killing things in the gut. I am never happier than if I see a Giardia finding on a lab. I'm really, it makes me sort of sick, but I get excited. I'm like, wow, this is great. We're gonna get rid of this Giardia and this person's going to get better. Not against killing things, but I think we need to play a longer game here and start to think about this in a more complex way. And that's what this series of talks is about.

Okay, so we're going to look at the gut in an introductory way today. And then there's, you know, we're going to just keep going until this is all sort of out on the table. All right. So as I overview, there are different neighborhoods. There are different neighborhoods in the GI tract where different bacteria flourish for different reasons. And this becomes really important to understand what's growing where and why. Because if we can define the healthy gut, if we can define what the healthy microbiome is, then we're answering that question, right? Instead of like, I got a sick patient, I want to get them better fast, we're asking this question, well, what is the reason why this is happening? And it's because of the disruption of the microbiome. So then we have to ask the question, well, what is the healthy microbiome? What does that even mean? And so we have to study all this kind of complicated and I think fascinating stuff. There are some known pathogens that are actually harmless in the presence of a robust community. So in other words, in presence, the spills run there, sorry. So in other words, there are bugs you can have, like the classic one is H pylori, right? You can have H pylori at a really high level, and if everything else in your digestive tract is working okay, it may not cause any kind of problem. And these communities are going to work together. We're gonna talk a lot about bacterial communities that produce hydrogen gas, hydrogenogenic, and we're going to talk about communities of bacteria that consume hydrogen gas. They use that same hydrogen gas as a fuel supply, hydrogenotrophic. Okay, ones that make it and ones that consume it. And, you know, you can also fall back on things that are classic that we understand, which is things like prebiotics and probiotics used to, you know, get all these bacteria back on track. So some of the treatment options are relatively straightforward. But I think understanding the old picture here is really sort of an enlighten me as to a lot of the, the kind of chronic illness problems as I see.

So there are a lot of microbes, right? And when you look at the lab tests that we often run, there's, I think, you know, in a gram of stool, you can have somewhere around 10 to the 12th bacteria growing or present, I should say. So 10 to the 12th is 10 with 12 zeros after it. That's a really big number, right? We have like gazillions and gazillions of these things. And they have their own wishes. These bacteria have their own dreams, to have their own life. They're not in your gut, you know, to make your immune system work better and to make you happier. They're just in your gut doing their own thing. This is nature, you know. It's not like there's some altruistic bacterial, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, uh, you know, 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different, okay. It has to do with how much oxygen is there, how long it's been in your gut, and where these bacteria like to hang out. Remember, some of them hang out in certain areas like the cecum, and some of them hang out in other areas. And so their populations are going to differ just based on location as well.

And all of this matters because everything that we're talking about is just a description of sort of the logistics of the situation. When you get into how these organisms actually impact our health, you'll be like, "Oh man, I can't believe that that organism is living there and it's doing that for my immune system." Right? This is going to matter a lot as we get into the specific organisms.

So, the here, this is a note here that we should mention here. Anaerobic conditions, right, the lack of oxygen, are going to intensify. And we're going to look more and more at these villus structures, the crypts that we looked at earlier, and the mucosal layers that we talked about. Okay? So all these things are variables in these organisms because some of the organisms live down in the crypts, some of these organisms live on the mucosal layer. Their food supply is the actual mucus in your gut. They're eating that. That's what they're eating. That's how they're living. Okay? And some of them live on sulfur. They have their whole own little thing going on in terms of life cycle.

And then as the food then goes a little further, right, the ascending and transcending. It leaves the cecum and things start to slow down. You start to absorb water. The water leads to dehydration. You start to actually form fecal matter. Right? Now it's not just as kind of slimy thing, we're just going to liquidy now, starting into more what we've seen on the toilet bowl. Right? And then the effects of the bacteria are gonna get more and more profound as more and more of them accumulate and go through this whole process.

And then this is a really important point. We're going to need for later on for later lecture here. This is so important. This is one of the real make-it-or-break-it Italian things along with these changes. Oxygen concentration drops on arrival in the cecum. Okay? Let's say that again. Oxygen concentration drops when the food hits your cecum. Okay? It passed through the ileocecal valve, assuming the ileocecal valve is working okay. And that, and here this is where it gets super cool. Like I can't even believe this is true, but it makes so much sense when you think about when you took microbiology. Oxygen concentration drops on arrival in the cecum. So that those organisms with full capacity for anaerobic growth, that's growth without oxygen, start to dominate. As facultative anaerobic members such as Bifidobacteria, Lactobacilli, E. coli, etc. Now, I'm sorry, and and and sorry, facultative. I said this backwards. And facultative anaerobic members such as Bifidobacteria, Silla, and E. coli start to die off.

So what we're trying to say here is that as the oxygen concentration drops, the ones, the organisms that can grow without the presence of oxygen begin to dominate. And the ones that need oxygen, they don't have to have oxygen, but they do better with oxygen, start to die off. And this makes a really big difference because if you get kind of tech nerdy on this later, you'll see the various bacterial organisms and their concentrations on the stool test. It'll tell you what part of the person's gut potentially is messed up. So in other words, you can reverse engineer this whole thing from a clinical perspective if you understand what's an anaerobe and what's an aerobe, whether the organisms that can live easily in the presence without the presence of oxygen versus the ones that do better with oxygen. And you know how this changes in different parts of the gut. When you see the lab, you can get a sense of where the problems are happening and what that means in terms of patient care.

I'm a really simple example of that is if you see E. coli levels that are extremely high because E. coli proliferates in the earlier part of the gut, right, and right around the cecum, it's kind of peaking. So if you have really high E. coli levels showing up in stool samples, it shows that there's a really rapid transit time. Why? Because if there was the normal transit time, that E. coli population would have dropped and dropped and dropped and dropped as it went through the portions of the large intestine that don't have enough oxygen to support it. Right? So in other words, you can reverse-engineer this and start to the bacterial levels can start to tell you about the functioning of different parts of the intestinal tract and where things are going awry and even tell you about things like transit times. So you know that there's a problem right off the bat with a patient if you see these super high E. coli levels. They probably have rapid transit. Right? And you're going to want to obviously, you know, treat that and slow that down.

All right, competition strategies and dead bacteria. So competitive factors as you move through the gut, and we've talked about some of these already. So number one, oxygen concentration, right? If it's an organism that does well in an anaerobic environment, then you're going to see lower and lower, lower in the intestinal tract, it's growing more and more and more. If it's a facultative anaerobe, right, if it can deal with higher oxygen situations and doesn't do quite as well in lower oxygen situations, then you're going to see those numbers shift as well. Like we're saying here with the Bifidobacterium, bacilli, E. coli, they're going to start to die off as there's less and less oxygen available. Okay? And then this just keeps getting more interesting when you get into it.

All right, this mark is a bullet point here. Depletion of growth substrate as residual levels of dietary and host-derived carbohydrate, fat, and proteins dwindle under conditions in the cecum. So what Dr. Lord's saying here is that as the growth, as the stuff that these organisms to grow becomes depleted more and more and more, right, it's going to change the populations. And this is also another thing you can go right back to the way that the person eats. You know, if so, if the person has a really high carbohydrate meal, it's going to have a really big impact on their microbiome. If they have a super high fat and protein meal, it's going to have a really big impact on it as well.

And then the last thing here, the formation of metabolic products from ingested polyphenols. So we eat polyphenols, right? These are the antioxidant compounds that we have. You eat your blueberries, you get your polyphenols. And the bacteria, certain bacteria use the polyphenols as a food supply. This is one of the reasons why eating foods that are high in polyphenols is so good for you. So if you're eating a diet that is low in polyphenols, you're gonna have a low level of these various metabolic products that are really, really important. If you have the high level of polyphenols in your diet, you're going to have robust but good bacterial growth. So you literally are feeding your bacteria the good ones when you're eating polyphenols. It's very important. And that's basically eat your fruits and vegetables. Why? Well, your bacteria are relying upon them to survive.

And I'm gonna end on this slide for real. I'm gonna end up because we're coming up on the hour. Okay? So and this is like the holy moly, are you serious? Can we really do this? And I'm like, yeah, yeah, you could do this. This is like the, I didn't even know this was possible slide. Yeah, it is. Okay. And it's just an, no, I'm like the spokesperson. This is what Dr. Richard Lord sitting down and thinking about this obsessively for 15 years. Well, and I'm gonna take some credit for this because when when I first started to study with Richard a couple years ago, you know, he, the whole first class that I, he put me through, I'm a student. I'm like a student for hours and hours every Monday. He's like drilling me. It's like, what's the tax up for this? What's the phylum for this? What's the whatever? I'm like, I don't know, Richard. I don't remember that stuff. I'm old and I took microbiology like a hundred years ago. We didn't even have books, we just were using tablets. So so long. And so finally, he just looks at me to start in the analysis. And this kid is messed up. He's not, he doesn't remember any of his microbiology. And then he realized, well, maybe maybe that's okay. He's a clinician. Does it really matter what phyla or tax on or this sort of classify? And he's like, and then I think I taunted him. You know what? Clinicians don't really give a hoot about the taxonomy of these bacteria. And then I put out a demand and I said, you know what? I care about, Richard, is function. Like I just want to understand these things by function. And so he was like, all right, and game on, kid. You know, and he created this chart, which is breaking these organisms down. That we look at on all these different labs. Whatever lab come to you using for looking at commensal bacteria, you'll recognize some of these names. And we broke them down by function. It's functional medicine. Right? We broke them down by function instead of by phylum, instead of like instead of categorizing them the way that the microbiology community does. And instead of categorizing them the way that they are categorized on every scientific study because it's done in the scientific community. That's how you classify things. I kind of forced Richard's hand and he classified them for us by function. It's functional medicine.

Now you can see the bacterial groups. The Bifidobacterium, Bacteroides, Prevotella, right? The Lactobacillus. Their function is united. They do the same thing. When you talk about this more in the next class, you can see Clostridium, Ruminococcus, Bacteroides, Oscillospira, Prevotella grouped together by function because they all do some really similar stuff. And then you see some of these super important ones again, grouped together by function. This one produces methane gas. This one produces hydrogen sulfide. But their function is the removal of hydrogen. The function of these guys is to break down the fiber and produce short-chain fatty acids. The function of the green guys is to make the hydrogen gas. So just think about how beautiful this is. These guys make the hydrogen gas that these guys can. These guys make, take the short, take the fiber and break it down into short-chain fatty acids that these guys need to make the hydrogen gas. It's this intricate system. And when you look at it this way, it takes a really confusing taxonomy, phylum generated, overwhelming, understandable conceptual framework and turns it into something that we can use actionably as clinicians because we're looking at it now by function. And that is like kind of heart and soul of what I want to talk about in this whole series. Okay?

So we've done the warm-up. You guys can kind of see the punch line here now and where we're heading with this. And we're going to get into this in much more detail later. I'm going to do a wrap-up. We have another minute. I'm starting a class. If you want to like have a year of this stuff day in and day out with hundreds and hundreds of hours of lectures and clinical topics and live calls and reviewing of labs and the coolest group of doctors you could ever imagine, then you should join the class. We have a special offer that I mentioned at the beginning. You save a thousand bucks off the one-year mentorship if you sign up by July the second. I'm kind of peaking right now in terms of my teaching ability. I think I'm really kind of hitting a good groove. We have Richard Lord and all his content coming out now, like I'm talking about tonight. And we're really in a good space. The Cancer Institute, if you're a patient, you're interested in becoming, you know, getting in touch with me, you can check out the Kalish Wellness website, you know, for patients. And then we're going to continue this. I don't know the date. I'm sorry, actually, but my staff will send out the date because we're just getting warmed up, right? This is the intro to kind of lay the groundwork. Remember, we're talking about all the commensal bacteria. We're asking this really important question, which is, are we just going to spend the rest of our careers collectively killing pathogens? Or is there a bigger game here? Is there a way to analyze and correct the Gestalt of this, right, the totality of this by looking at the microbiome, understanding these organisms, where they live, what they do, grouping them functionally so that we can start, you know, basically treat them effectively. Effective clinical treatments for the microbiome that are really going to move the needle using food and supplements. That's what I'm after. And that's kind of my goal over the next few years as a community that we can come together and figure out how to do all this stuff, right?

So have a great rest of your evening. I hope you join me for the second part of this. And we're going to get more and more into the clinical application. All right, take care, gang. We'll catch up soon.

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Introducing the Microbiome : Its Function and Dysfunction in the Human Body

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