GI Health: The Microbiome Revealed

Hello everybody and welcome to our next mini-series class. Dan Kayla's here. Introduce myself. We're going to do a real practical round today, practical application stuff. Um, and I'm gonna invite to divide it into two parts. So if you need a mental break, you can go take a mental break, come back, and listen to the recording later.

So, who am I? This is me. I just turned 56 a couple days ago, getting kind of old. Uh, I have done a lot of really strange things in my career. I developed and now I teach IFM's My Practice Plan course. It's a collaborative class between IFM and the Chaos Institute. It's pretty cool. And I've done a research study with the Mayo Clinic, actually. I'll show you a copy of it in a few minutes about all this GI stuff that we're talking about today, and it showed that, hey, this stuff actually works, which is kind of cool.

And then, um, right now, it's probably the most exciting part of my career. I'm working with Dr. Richard Lord, who's, um, really the grandfather of functional medicine testing. He's a scientist that developed much of the work that we all do every day. And we spent five hours yesterday recording lectures. I'll be releasing these Dr. Lord's series of lectures in the fall, which I think is going to be the best content our industry has ever seen. He's just a brilliant man and a wonderful person and was at the bench at the lab, you know, developing organic acids, fatty acids. He's a guy that did all the original work behind a lot of what we look at today. Neutral valves, we call them neutral valves, or ion panels, or organic acids testing. So Richard's a national treasure, as my good friend Cara Fitzgerald describes him. And he's back and better than ever, and funnier than ever, and smarter than ever. He's in his late 70s and he's having a renaissance right now. So we'll be releasing that curriculum later this year. Pretty probably the most exciting professional thing I've ever worked on.

And I also work with patients. I spend all day today with patients, you guys. I just had to take a few minute break and now I'm back at it. So I'm actually doing this work on a, you know, day-to-day basis for real. And a matter of fact, my last patient that happened about an hour ago, it's a great story. It's an 18-year-old kid. She's going off to college. She had horrible bloating, constipation, deep fatigue, my, I would call mild depression, pretty lightweight depression, and really bad female hormone problems. I just talked to her and her mother. I have a, you know, full-time telemedicine practice that I run. Talking to her over the phone. This was just like an hour, hour and a half ago. And this kid, she lost 20 pounds, which wasn't even the point of this, but she feels great. All her energy levels are back to normal. She can sleep normally. Her mom is like, "You've given me my daughter back." Okay? That, that whole scenario revolved around a GI test and a couple of GI herbs. And this kid's gonna go after college, you know, in a happy, great way. She can sleep again, she has energy back, she lost a bunch of weight, she feels great. So this stuff really does work.

And, you know, um, if you know how to interpret the labs, it makes a huge difference. And I'm, I'm finding that, um, I think that's sort of the key point in my career trajectory now is to just to try to explain to doctors how to interpret labs as best as I can understand them. We also have a GI Master Class. If you really get into this stuff, we'll send out this link later on, um, for those of you that are interested in doing more work. You like this little short class, the GI Master Class goes into a lot more detail about these different stages of GI dysfunction, how you can start to wrap your mind around the labs. And whenever you see the word "stages" and Kayla's anywhere near each other, this basically patient education stuff, right? This is not, and it's a way for us to be able to understand it so we can explain it to our patients. So we have all that coming up too with the GI Master Class. You guys are interested, you can check that out.

All right, so where this gets confusing is nobody can understand the microbiome. That's not possible. That would be like understanding God. You know, if someone came up to you and said, "Yeah, I pretty much understand God," you'd be like, "Yeah, you're a little crazy. You probably don't." You know? So you cannot understand a microbiome any more than you can understand the universe because it's so complicated. And we probably unders, you know, scientifically have looked at a fraction of a percent of a percent of what's really going on in the gut. We have no idea. I mean, just the fact that there's all these gut bacteria was like a revelation, right? I mean, we've only known, only been able to even see bacteria for a certain number, 100 years, a couple hundred years. And the PCR testing, all this stuff is brand new. Nobody really knows what's going on.

So, um, but we still have to treat patients, right? So that's kind of what today's about is how you can do some GI testing. I'll show you some sample labs in part two of this class. And, um, how you can actually get people better without fully knowing what you're doing. And you have to embrace that uncertainty, as Dr. Lord says, because nobody understands every detail about the microbiome. If they say that they do, then they're just really BS-ing you. It's just not possible to. But what we can do is run these tests and differentiate: are there microbiome treatments that might help? Are there GI organ treatments that might help? Are there pathogen treatments that might help? What do you want to do? Do you want to improve the microbiome of that patient? Do you want to try to eliminate a GI pathogen? Or do you just want to work on their gallbladder for a little while and see if that clears up their SIBO or FIFO or whatever they may have, right? Um, or SIFO, SIFO, small intestinal fungal overgrowth, SIFO. Yeah.

So, you know, there's so many different variables here. But, you know, the treatment side of this is not too complicated, at least at the beginning level. And I'm at the beginning level after 28 years. I'm sick, you know, not saying that, you know, just so your first years of practice, but just as the basic level of treating your basic patients. So I want to talk a little bit in the beginning of this class. You can't get very far if you don't get people to do the tests, right? And so from a practical implementation standpoint, you've got to be able to sell people stool test kits easily, or you're not going to have a successful practice. So it's not an easy thing to do, right? It took me years to figure this out. So I just want to bring it up because nobody ever told me this. I just tried it and failed, you know, for five or ten years until I figured out how to actually convince people to do a stool test. And as silly as that sounds, that's the first step of the job. And unless you got some salesperson in your office who's going to do it, you know, you're going to be the one that is the one that's going to make this sale happen.

So, what, what's relatively easy is to tell people that have GI problems that they should do a GI test. That one is not too hard for people to wrap their minds around. Like, you have constipation and bloating like this teenage girl. Are you talking about you have constipation and bloating, or your daughter has constipation and bloating? I think she should run a GI test so we can figure out if there's something going on that I could treat with natural solutions that might help. Not too hard for the mom to sign up for that test, right?

However, where this gets really difficult, and where you have to master this, or you're not going to be successful, is how are you going to get people without GI symptoms to do a GI test? Because that just sounds so crazy. If I went in to see my regular doctor and I told her, you know, "I don't know what's happening, doc, but my left knee, it just buckles every time I go hiking, and it's incredibly painful, and I can barely walk, and I have that left knee problem." And then she looked at me and said, "Oh, well, that's interesting. You have a left knee problem. Hmm. I think I'm going to give you this, uh, blood pressure medication." You know, I'd be, "Well, that doesn't make any sense." You know? Well, then let's do a cardiovascular exam. Like, you know, we're used to, like, if you have a left knee problem, you want a left knee MRI, right? We're not used to people with left knee problems thinking, "Oh, maybe you need this random medication or you need some cardiovascular workout." It just sounds so crazy.

So when patients come in and they have fatigue, depression, weight gain, and you say, "I don't know, you don't have any digestive problems, do you? We should really do this digestive test." It doesn't make any sense to patients any more than if I went in with a left knee problem, the doctor gave me this whole unrelated treatment regimen. So you have to learn how to explain why GI testing is required in people without GI symptoms, or you can't really progress in our profession very far. If you're only testing people with GI problems with GI testing, then you're missing out on the whole point of functional medicine. Because the whole point of functional medicine is that we're not symptomatically oriented, right? And that the gut is the basis for many health problems. And so you just need to learn how to be able to explain this well to patients in order to be super successful. So I'm going to talk about that for a few minutes. So, um, and then we can talk about some of these other things too, like follow-up testing and whatnot, right?

So first step is to get the test done. If they don't do the test, then you're not going to interpret it, and they're not going to get better. And this is a problem. So if patients have GI symptoms, again, we're just saying that's relatively easy. If they don't have GI symptoms, then I suggest you do what I call the condition description technique. And I made up this name because I couldn't think of anything more creative. It's, if they have this condition, then you use this description to get them to do the stool test. So the most common symptoms that I see in my practice, I call the big five: weight gain, fatigue, depression, and hormone imbalances are the first four of those. Digestive issues are already said are easy. But what if someone has a weight problem, fatigue, depression, or hormone imbalances? And then you, you want to do a GI test, and they're looking at you like, "I don't have any GI symptoms. Why are you doing this? It doesn't make any sense."

So you have to be able to under, you know, explain to this patient exactly why you want to do this test in a way that makes them so excited and so convinced that you're right that they run out and they do the test. And I'm not saying this is an easy thing, or that this is going to happen overnight, because it's not an easy thing. And it's probably going to take a while for you to figure this out. But once you figure this out, then you got it made.

So, as a couple of simple examples, um, I'm gonna give a couple of simple examples. Let's see, uh, let's use depression, okay? So patient's main complaint is depression, and they're wondering, "Why do you want, are you insisting they do this microbiome test?" You would say, "Well, there is all kinds of research out now that talks about the gut-brain connection. And we know that there are these pathways, like this kynurenine pathway in your brain, that gets activated when your gut, when you're inflamed. And this inflammation often comes from the gut. And that kynurenine pathway can lead to a depletion of this nutrient called tryptophan, which lowers your serotonin. So we see commonly that people have low serotonin that can cause depression because they have gut infection and brain inflammation. So even though your complaint is primarily depression, I think we should rule out the microbiome issue as a potential, you know, problem here." Okay? So that's a simple example.

If the person is, um, tired all the time, or they say they have a, let's say they have a, uh, something like a thyroid problem. So if they have the thyroid problem and they're tired and their hair is falling out, something like that, and they don't have any gut symptoms at all, you could say, "Hey, I know that this is primarily a thyroid issue here. We're going to test and correct your thyroid. But I also think we should look at your microbiome because thyroid hormones don't convert properly. This hormone called T4 doesn't convert into T3 very well if you're chronically inflamed. And in functional medicine, we find the major source for inflammation is coming from your gut, from the foods that you're eating that may be inflammatory, and from gut infections or imbalances in the microbiome. So I think we should test and correct your gut in order to do a complete evaluation of your, uh, thyroid problem." Okay?

So whatever it is, I'm not gonna, we're gonna keep going here because it's a short webinar, but whatever the condition is, you need to learn how to describe that condition in a way that makes the patient want to do, um, a GI testing. A GI test. Another way to look at this too is that we're dealing with, I'm going to skip through some slides because this is a longer presentation and I want to have time for us to look at cases, okay? Um, that we're, we're always, you know, wanting to consider the patient symptoms. And again, here we go: weight gain, fatigue, depression, anxiety. Any of those can come from a gluten sensitivity or a GI infection as easily as they could come from a genetic issue or a toxin-related issue. So you can't tell based on symptoms exactly what's driving the problem. Hence the need to do a GI test on every new patient.

And in fact, my teacher, original teacher in functional medicine, a man named Dr. Bill Timmons, who some of you may know if you've been around for a while or have no new. He's dead. Been dead for, I don't know, a good 10 years, probably. Although I swear I communicate with him just as much now that he's dead as when he's alive. I think about Bill every day because I do his work every day. And I, I'm living representation of Dr. Bill Timmons here. But, um, one of the things that Bill did in his practice is that you could not talk to Dr. Timmons until he had done a stool test. That was his requirement. He wouldn't even do a new patient consult until your stool test had been completed. And I have followed that pretty closely most of my career, and it's made a big difference.

I put this header upside down because we're really wanting to think outside the box. But what that says, you can turn your head upside down and read it: "GI problems cause inflammation, catabolic physiology, breaking down of the gut lining, right? Insulin resistance, oxidative stress." And you can imagine if someone's pre-diabetic or has, you know, fluctuations in their blood sugars, you got to check their gut. If someone's at risk for cancer or has a lot of oxidative stress or has high risk for cardiovascular disease, you got to check their gut. If someone's just joint, has joint pain all over, no GI symptoms, you got to check their gut because gut problems cause inflammation, catabolic physiology, insulin resistance, and oxidative stress. This is like the premise of functional medicine. So we just need to act in the way that we think, or act in the in accordance with what we're sort of promoting functional medicine to be.

And when I go to conferences and I do a talk, you know, live audience, and I say, "How many of you believe, you know, your health begins in your gut?" Everyone always puts their hand up. Because I was like, "You don't want to be the one person that doesn't raise your hand with a microbiome question, right?" But then when I say, and this happened a few years ago in Arizona, most famously, not that I have any problem with Arizona, I'm sure the people in Arizona are fine, but I was at a conference in Arizona teaching a group of about 50 doctors, and I said, "Okay, well, then how many of you require every new patient do a GI test?" And like four people put their hands up. And they were all in the back row, and they were all people that had taken my program. And I was like, "Go Kayla's team!" But no one else put their hand up because no one else is doing it.

So if you really do believe that health begins in the gut, you've got to test everyone's gut as the baseline test. Just like if you went to see your regular internal medicine doctor, they would just order a blood chemistry, CBC thing. And why do they do that? They just do that on everybody. They don't, you don't have to say anything. They just run these basic labs on everybody when you go for your annual checkup, right? There's no question about it. We need to be like that, but about the microbiome, right? And then I also want to think about, you know, from a marketing standpoint, from how you promote yourself standpoint, you know, if you really want to get people all the way on this journey towards optimum health, you have to make sure that their gut is working properly, okay?

So let's take a look at, um, we've already talked about all these things. I'm going to slip through it here. I want to talk a little bit about treatments. And, um, let's go. That was the end of part one, just kind of like an introduction to why to test. Now I want to talk, show you some actual labs, and we can talk about treatments too, okay? So I got a whole bunch of labs that I pulled up and show you these. Pull them over, and I'll show you why you have to have a system for this because when you actually look at the tests, and they're so complicated, unless you have a PhD in this subject, you're not going to really be able to understand what's happening.

So here's a Doctor's Data GI 360 test, one of the newer tests on the market with state-of-the-art microbiome analyses. And let's just look at the test. Well, they have these key findings on the front page. So they give you some summary stuff. And thankfully, they give you this dysbiotic score. So you have a general sense, just from looking at these graphics and summary items, what you should do, right? So we love the lab, and all the companies tend to do this. They give you like a summary page. But when you actually look at the microbiome markers themselves, here they are. And I, I don't think I know anybody that's a regular practicing integrative or functional medicine doctor that could pronounce each one of these organisms, let alone tell you exactly what each one of these does. Okay? Like Bacteroides zu glio forminus. I mean, you have to have a degree in microbiology to really understand this from the level of, you know, reading the raw data off the lab. It's just too complex.

So, and I'm just going to keep scrolling through this. You can see there's so many organisms. The more comprehensive these labs get at doing the testing, the more inundated with information that we can't handle, the clinicians become. And so what all the companies have done, thankfully, is set up, you know, a summary page. You can see, oh, is this a good microbiome or a bad one? So you need to be able to read that, and then you need to be able to differentiate into these three different stages so you can have a sense of how you're going to explain this to a patient and how you're going to do your treatment. Okay?

So, a similar test from a different company. This is a GI-MAP. Sorry, hang on. So let me get this so it's a little clearer. There we go. And, uh, these guys also have, you know, a whole variety of PCR-based tests. They have, uh, see, in this particular example, a C. diff was positive. They have the H. pylori markers. And here's their normal bacterial flora. Not as many, not as overwhelming. I think the other one is like 50-some. This may be like a dozen or so. But, you know, again, honestly, like this particular pattern that we're looking at here, I don't think it definitively means that anyone needs an exact treatment, right? It's not like when you see something like, um, H. pylori that's high, and you know, "Okay, this is H. pylori. I know exactly what I need to do." Or you see C. diff high, it's a, you know, targeted pathogen-oriented treatment, and you know exactly what to do. It's just not like that, right? The micro-biomarkers, the normal bacteria markers, you have to look at in some kind of collective sense so you can explain to patients what kind of treatment you want to do.

And I'll just show it while it's up, while we're talking about all this stuff here. And this is the study that I did with Mayo. We published this in 2016. Sue Cutshawls at the Mayo Clinic in Rochester. Larry Birdstrom's the head of the founder, really started the integrative medicine department at Mayo Clinic at their Scottsdale campus. And we took 25 people from my practice and we ran them through the adrenal programs and the gut programs that I do in my practice, which is what I teach in the mentorship class. And it turned out that it worked really well. And we got sort of this wonderful documentation on the success of all this. So if you guys are interested, I can upload this here into the handout section, and you can take a look at this later. If you look at the handout section, that should pop up there. You can download the study. If you can't figure out the technology behind downloading that, which is probably harder than it sounds, um, but we can just email it to you too if you're in, if you want. Okay? So this stuff is real. It really works. You know, you can get a stamp of approval from a group like Mayo to prove that this stuff works, which is great.

So now let's talk a little bit about these different models and treatments. So I divide this into stages. When you see a complex lab like I just showed you, you want to just answer three questions, which you're going to explain to your patient: Is there a microbiome balance disruption problem? Right? You're going to try to work on the microbiome or not. Is there a GI organ imbalance? Do you need to work on the pancreas with enzymes? The gallbladder with bile? Do you need to work on the stomach with HCl or betaine HCl with pepsin? Do you need to work on the gut that's damaged or inflamed with the leaky gut repair program? Is there organ dysfunction in the GI organs themselves? Or is there a pathogen that you need to kill? These are the three primary questions. You can, if you can say yes or no to each one of these, you can set up a treatment program and you'll be super successful and be able to explain to patients exactly what's going on, and you'll look like a genius, even though you can't pronounce every one of those lab markers on the, on the microbiome test. I mean, there's some that we kind of learn how to memorize, like Akkermansia. Everyone pretty much says that. But most of these organisms, you don't have to know the exact detail about every little detail of that particular bacteria and what phylum it's in and all that kind of stuff. You just need to be able to make these broad assessments because the treatments themselves are pretty broad.

Okay? And then what are the treatments? Prebiotics, polyphenols, probiotics, and fiber. That's right out of round one, right? So prebiotics, obviously, to help the microbiome grow better. Polyphenols, you can, like, I guess you could probably argue those are kind of prebiotics, but polyphenols specifically, you think about these all the times, like this is why you tell patients to drink green tea or eat blueberries because the polyphenols, it turns out the polyphenols are rather large molecular structures and they don't get absorbed real well into our bloodstream, but they're really great for the bacteria to grow on. Same with prebiotics, like the fiber that you would find, for example, in beans or some other foods that are wonderful substrate for these bacteria to grow on. Then, of course, also with the microbiome, you can use probiotics. So prebiotics, polyphenols, probiotics, fiber. All the supplement companies we work with will have these products that you could use for treating the microbiome.

Okay? Now, if you're into a patient that has an organ problem, a GI organ problem, then you might use enzymes for the pancreas, gallbladder support, their gallbladder markers show up like steatorrhea, stuff like that. Leaky gut repair, or a GI immune boosting repair if the small or large intestine is involved. So here we have your microbiome-related treatments. Here we have the organ-related treatment options. And of course, for pathogens, you'd be doing an antiparasitic or an antibacterial or an anti-yeast treatment, either with herbs or with medications. We just had this big discussion this morning, and this morning's mentorship call, um, it was really good. There was this patient that had super, super bad yeast or Candida overgrowth. And then all the doctors were talking in class, and I'm like, "I use the herbs because I'm a chiropractor. That's like my only choice. I don't usually want to refer out." And this one medical doctor, Jeff, who's been in the class for a while, he's like, "Yeah, Dan, you know, I use Diflucan for two weeks because it works really well." And so, you know, we're open to any of these potential solutions. It doesn't have to be all herbal. In fact, there's general consensus by most of the docs in class this morning that Diflucan for two weeks is safe, totally effective. Can give the person, it's not gonna solve their whole yeast problem, but, you know, it'll advance them to the point where they're gonna be able to, you know, get over, you know, with the follow-up.

Okay? And then see here. Yeah, we're good on time. Okay. So three stages, remember: microbiome, GI organ, GI organ issues, or GI pathogen problems. And these, in my mind, are progressive. This is patient education stuff. When we're stressed and we don't eat well, and that goes on for a long time, your immune system starts to weaken, your microbiome diversity starts to fall apart. And this is why people start to get sick because we're not taking care of ourselves and we're stressing our minds. Eventually, if that disruption goes on for long enough, then the organs start to get involved. Now you're not making enough hydrochloric acid. Now you're not making enough enzymes or bile. And then really bad things start to happen. Now the organs aren't working well. And if that goes on for long enough, you can have a leaky gut, you can start to have damage to the gut lining, a rise or drop of secretory IgA, and things start to get, you know, wonky or wonkier. Okay? And so we really want to start to think about this progression. The end of this is that you've got a pathogen that needs to be killed. In a perfect world, we would get everybody in their first stage of dysfunction, when their diet's not that great and they're stressed, but their organs are still okay and they don't have any pathogens. And in fact, if you can just do a microbiome treatment with prebiotics, polyphenols, probiotics, and fiber, you can correct these people who are in this early stage with just that prebiotics, probiotics, polyphenols, and fiber, and that will rebalance their microbiome and get them back on track. And hallelujah, if that can happen, that's a really great thing.

If the problem has progressed and that's not enough, then you can think about betaine HCl for the stomach, digestive enzymes, or bile support for the gallbladder or pancreas, and a leaky gut repair program, or a program to help strengthen their gut immunity if the GI organs are now, you know, involved. And then if it's gone even further, and there's this third stage, and there's pathogens that are required, pathogens that are expressing is a problem, then you're going to need to kill something, whether it's Diflucan or an antibiotic, or it's a herbal program, you're going to need to go after the bugs. Okay? So this, I think of as progressive, and it's a really convenient way to describe to patients how all this stuff works. Okay? All right.

Um, now, and we'll do some questions at the end too, for sure. So let's look at, oh, I want to show you a couple things about the class. Uh, first of all, yeah, so we have, again, I'll mention for those of you that joined late, we have a GI Master Class that's available. If you want to sign up, I think it's $49 bucks. It's a ton of information in there, protocols, and more examples and detail that I'm getting into today. And then I just also want to show you a little bit about, because this is just on my desk, literally from earlier, what, you know, my main job now, I mean, I do a lot of these free things like today, but my main job is training doctors in my mentorship program. And we are having a phenomenal year so far in terms of educating doctors and enthusiastic doctors coming in, acupuncturists, chiropractors, medical doctors, you know, and it's been, uh, really heartening because I thought when, when the outbreak first started and COVID first started, I was worried that all of our practices would fall apart. But we're not seeing that at all. In fact, we're seeing a lot of practitioners now going to a telemedicine model or telehealth model. You can order these labs, the lab company will drop ship it to the patient's home. You can get on the phone and talk to the patient about the lab results. You can put them on a program. You can contact Fullscript. If you don't know who Fullscript is, they're a supplement dispensary, an online dispensary. Fullscript will fulfill all the supplement orders that you want and immediately drop ship it. All can run this whole operation from your home really easily if you're also on lockdown. Okay? And it's a really great way for us to be able to help people even during, you know, and keep our businesses going even even though we're having a pandemic. Okay? So anyways, the teacher's mentorship class, I want to encourage you guys to take a look at it.

And we also have, you know, from simple things like, I'm not talking about today, we also have some really complicated stuff. I like the complicated stuff. And like, you guys should know this too. You should know all of this. Like this is Richard Lord's thing. So like, you should know what it means when Richard says, "Patterns of low organic acids revealing mitochondrial retracted hypometabolic states calling for free-form amino acid daily therapy as mTOR stimulation of tissue restoration." Like that should make total sense to you. You should go, like, "Patterns of low organic acids revealing mitochondrial retracted. What does that mean?" They're not really sure. But hypometabolic states, never even heard the term. Hypometabolic, calling for free-form amino acids, I know what free-form amino acids are. As an mTOR stimulation, I thought we were supposed to not stimulate mTOR of tissue restoration. Like you should really know inside and out what that means. And so the training program, the mentorship, by your third month, you would understand that sentence and not only understand it, but be able to fix people who have mitochondrial retracted states using free-form amino acids to stimulate their mTOR. Not only know what that means, but be able to actually make it happen. So we go from like the simple, which is obviously today, which is patient explanations, to the complex, which is things like Richard Lord's work. Um, and that's basically what I do, try to get doctors up to speed so you guys can use have the simple explanations like we're doing today so you can educate patients and run your business, but that you can understand what mTOR stimulation with free-form amino acid means as a hypometabolic or mitochondrial retracted state so you get the science behind this as well. And that's kind of what, uh, the Chaos mentorship is all about. Okay? All right.

So let's go take a look. Now we're gonna try to look at a few labs and then identify: Is there stage one, that's a disturbed microbiome? Remember the treatment: fiber, prebiotics, polyphenols, probiotics, etc. Is there stage two, that's an organ involvement? You're going to give them the organ support. Or is there a state? And here's the organ support again: steatocrit, gallbladder support, elastase, pancreatic enzyme, secretory IgA, or calprotectin or zonulin, leaky gut repair. So the organ ones are pretty easy to differentiate. And then are you going to do a GI pathogen treatment? Those are the three biggies that we're trying to figure out. And then a lot of people have all three. So which one are you gonna do first? Gonna start with one? We're gonna start with three? I'm gonna start with two? You have to think through all that in terms of sequencing things. Okay?

So let's look at a few example labs first. All right, let's check this one out here. 78-year-old male. Well, right off the bat, you don't have to be super up on these tests to realize the dysbiosis. The dysbiosis index, when it's all pegged to the right, right, with the red, red is bad, green is good. So now, right off the bat, we know, okay, this person has some dysbiosis. And then we look at the key finding section, and we see, oh, they have Blasto and Candida, a couple of potential things to kill. They have a problem with their microbiome. And you can see these commensal bacterial markers up and down and all over the map. And they have, uh oh, a problem with secretory IgA. So again, you know from that, that's would be an organ involvement, right? That's to do with the immune response in the gut lining itself. And then their butyrate is low, which means that they need more short-chain fatty acids, which means they need more fiber. So you've got all three present here. The low butyrate indicating that there's a microbiome imbalance. You can explain to the patient, "You need more fiber. We can give you supplements for this. You can do this with food. Let's figure that out." That's the microbiome portion of the problem. Your secretory IgA is low. That means your immune response in your gut isn't working well. That immune beautiful mucus that lines the intestinal tract isn't functioning properly. That's a organ-related problem. We want to fix that by improving your the health of your digestive tract itself, the organ itself. And then we've got this Blasto and Candida here that we're going to want to kill. So there's our stage three, there's our stage two, and there's our stage one. And again, this gives you a way to explain this to a patient. And you can say, "Because they're going to want to know, like, why this all started?" Well, it starts when your microbiome is out of bounds, and then it can progress, and then it can get even worse. So then what are we going to do? Well, should we treat where it started, or should we treat where you are right now? And that's a judgment call. That's different for every patient. I personally really like killing things. I don't know why. I find it satisfying. So if I can get away with it, I'll start with parasite treatment, and then I'll work down, and then I'll get, you know, these other things done. It is totally legitimate to do it the opposite way and say, "Well, Dan, why would you start with the parasite treatment when you're telling us the origin of this is with a microbiome?" And in fact, that's what Dr. Lord would say. He would say, "Oh yeah, Dan's still got a lot to learn." He would say this. He wouldn't say this because he's too polite, but he would think this. He'll think, "Okay, Dan's still got a lot to learn. He's in his 50s. Let's give him some time. But I'm the man, the senior guy here. Like, I've been thinking about this for decades. I'm in my late 70s. I'm just like, go for the actual problem. Let's treat the microbiome first and see if that's enough to fix everything." Okay? So that might be a more enlightened view, and somebody who's, you know, more of a sage than I am. But I like to really kill stuff. Point is, you can't really do this wrong. You can start with the third stage, you can start with the first stage. It doesn't really matter. Okay? Well, it does matter, but you can do, you shouldn't feel bad about doing it in one way or the other.

Again, here we're just going to scroll through these markers because I don't know, you should study them. I study these a lot. You know, I still don't understand them. The more that you study these commensal markers, the less you're going to understand them because it's so complicated. I'm not saying you should avoid studying these, but I'm saying that if you wait until you understand what *Fecalibacterium prausnitzii* does before you treat anybody, and how it relates to, uh, *Lactobacillus* or whatever, you're, you're just not going to be effective as a, you know, as a clinician. So as we study these things and we learn more about the microbiome, you should still have some treatment strategy or treatment model that you can use. And that's okay because no one understands this. Remember, even the scientists are barely scratching the surface of this information. It's all new. Even the technology has only been around for a short period of time. This PCR testing that's done now. Okay? Because back in the day, you think about it, the, uh, we used to use microscopes, right? And people used to grow things out in culture and petri dishes and stuff. We've come a long way. This is all DNA-based testing now for these microbiome things.

So I just also want to show you on a report like this, again, this is a GI 360 from Doctor's Data, one of the premier labs. And I use several different GI testing companies in my own practice. I found it's, it's helpful to have more than one company that you're familiar with. But I want to show you their their section here. They're going to have, uh, markers that relate to the organs. If elastase is out of balance, then you know there's a pancreatic involvement. If the fat stain is out of balance, you can start to suspect fat-related issues in gallbladder, obviously. Here with inflammation, we're talking about inflammation in the intestinal tract. And immunology, we're talking about the immune response in the intestinal tract. So here's where you see a lot of information about the organs themselves. And do you need to work on a digestive tract tissue, digestive tract organ, or not?

Okay, let me show you one more example. This is again a GI-MAP, also PCR-based testing from Diagnostic Solutions, a very popular lab company. And we see these every day in classes that I teach. This patient, C. diff toxin A and B are both positive. Now there's a problem there. H. pylori also positive. Yeah, that's not good, is it? And then these normal bacterial markers, a couple are low, one is high. Okay, understanding that there's a microbiome imbalance as well as some pathogens, some opportunistic bacteria. So dysbiosis, like we saw on the GI 360, dysbiosis, but just kind of diagnosed a little differently based on different, slightly different markers. And then this particular lab, at the last page, they also have the markers for, um, the organs. So if steatocrit is out of balance, there's a gallbladder problem. Elastase, there's a pancreas, pancreatic problem. Uh, secretory IgA means that there's an immune response issue in the intestinal tract. Calprotectin, zonulin means that there's inflammation, and you may want to work on the intestines and do a leaky gut or anti-inflammatory program.

So again, stage one, stage two, stage three. Stage one is the microbiome being out of balance. That you would see on this test under the commensal bacterial markers. Is it out of balance? Well, let's look at the normal bacteria. Yes, it is. You're going to treat them individually, kind of. You could, low *Lactobacillus*, you could give a *Lactobacillus* probiotic. Low *Bifidobacterium*, you can give a *Bifidobacter* probiotic. Sometimes people do that. There's nothing wrong with that. But usually, this is looked at as a system, the microbiome itself. So prebiotics, probiotics, polyphenols, fiber, right? And then, so this is the stage one thing. Talk about stage two would be found down here at the bottom of the test that I just showed you. Again, these are the GI, they call intestinal health markers. And then stage three is the rest of the test, right? We're looking for pathogens. So breaking it out in your mind that way, I think can be really helpful in terms of being able to explain this to patients.

All right, I'm going to show you one more thing and then we can entertain some questions and then I, I've got to run. Where's my other thing I want to show you? I thought I pulled it up. Why is it not here? Hang on. Let me just show you this is really important and no one knows this and this just got lost in the haze of time somehow. And if you're looking at these tests, you know, you appreciate knowing this. So let me show you here. This is an organic acids profile, or Organix with an X at the end, from Genova Lab. I just want to show you here these markers at the end. So they're called, it's under the subcategory of compounds of bacterial yeast fungal origin. This is the gut portion of the test. And so when you're looking at, when I keep saying this word polyphenols, so benzoate, hippurate, phenol acetate, is the phenyl, phenopropionate, hydroxy phenyl acetate, right? So these are the polyphenol markers of the test. And so if these markers are quite low, it indicates a lack of polyphenols, and that would mean that the person needs to eat or fruits and vegetables and drink some green tea and the things that will get their polyphenol markers up. So low, and again, it's benzoate, hippurate, phenol acetate, these markers here, the section I'm circling here, if they're low as a pattern, which this one is low, low, low, DL means undetected, right? These are quite low. That means this person needs more fruits and vegetables to get the levels of polyphenols back up. Now, if you see these polyphenol markers extraordinarily high, that could indicate that there's some dysbiosis and overgrowth of gut bacteria. And where you want to see them on these tests is in the third or fourth quintile. That shows a good consumption of fruits and vegetables, but not any kind of harmful overgrowth. Okay? That's the goal. So low polyphenol markers, not enough fruits and vegetables. High, potentially dysbiosis, right? In the middle, high range, middle to high range of normal is where you want to see them. That shows a good bacterial growth, commensal bacterial growth in response to a healthy diet.

All right, so I'm going to take a pause here. I'm taking a glass of water here. All right. Now we're in part three. Part three is now questions. So let me go through the questions and see what we have time for. I hope this is helpful. I think that we are inundated with so much information on these labs that if you can, like, do a great patient explanation of this, you're going to really be able to be successful. We have this GI Master Class. You want to learn more. And let me pull up the questions and see which ones I can answer here.

So this is from Chris. "Do you consider an overgrowth of additional dysbiotic bacteria pathogens?" Yeah, technically it's not. So that's not, that's a semantic kind of thing. But with a dysbio, dysbiosis overgrowth that's severe, you want to kill it. So it's not a pathogen, it's probably not officially disease-causing, but it's something that you want to kill. Okay? So we could say stage three is pathogens and dysbiosis, if you want to not get confused about names.

"Won't Diflucan kill other beneficial yeast?" Yeah, I've, I, I've been in practice 28 years and I've never had a patient take Diflucan ever. So I always go after the yeast with, um, herbs. But, you know, Jeff this morning is like, he didn't say that's kind of dumb, Dan, but he he's just like, "You know, I don't do that. You know, I give him Diflucan for two weeks. It's just so much faster." I'm like, "Okay, that's fine." And a bunch of other doctors chimed in and they're like, "Yeah, I do that too. They're getting away with it. It's working well for them." So I think that's another option. You know, um, and a lot of times, you know, we do things.

because we can. like, I'm a chiropractor, so I can't prescribe Diflucan. Jeff's a medical doc, he can, so he just does it. It's easier for him and it works for him.

Let's see, Lindsay has a question. I have a client who's self-treating for yeast and bacterial overgrowth by taking tons of different herbs but high dosages and tons of probiotics mixed together at high dosages. Yeah, that's a bad idea. People can't self-treat. You can't self-treat. That's not like a good thing to do. That's just a bad thing to do. That would be like if you were parachuting for your first time and you're like, "No, I'm going to pack the parachute myself." And then the parachute instructor is like, "You know, you've never pat, you've never even been parachuting. You think I should pack it for you?" Like, "No, I'll figure this out. I'll pack my own parachute. I'm going to self-pack my own parachute. I'm going to jump out of a plane." And that's probably going to work. That's just dumb. You can't self-treat. You have to have labs and you have to have a clinician that's objective that's telling you what to do, and then you have to have follow-up testing to make sure it's working, right? So self-treating is just, I, I'm really against it. I think it's dangerous.

Um, what are the most common anti-parasitic, antibacterial e-cerebrals use in your practice? Uh, berberine, caprylic acid, undecenoic acid, artemisia. But you got to know how to use artemisia. You can screw people up, so be careful with artemisia. It's one of the better anti-parasitics, but it can cause liver problems, so you got to be on the lookout for that one. Grapefruit seed extract, you know, it's all the basics. You look at any company catalog. Um, companies I use the most: Pure Encapsulations, uh, their GI platform is kind of like, I'm teaching their GI platform. I use their stuff a lot. And then Designs for Health, I use a lot also.

Let's see, how do you treat low CGA? Oh, there's protocols for low CGA. I probably don't have time to lay them out, but you can just Google that or talk to any of the company reps. Every company don't have low CGA stuff, uh, that they use. Um, yeah, I still do neuroendocrine. Je is asking, I still do neuroendocrine before we do the killing. It still seems to make a difference.

Uh, see, we're not gonna have time for all the questions because I've only got another mini here, but I'm trying to skim through these. Um, anything you recommend with antimicrobials for H. pylori? Um, well, I always use mastic for H. pylori. I don't know why. I just, well, I do know why, because that's what Dr. Timmons said to do like 30 years ago. I've just stuck with that. So I'm like a one-trick pony on H. pylori. I just use mastic, but in a really high dose. And if you look at this Mayo Clinic study that I was referencing earlier, uh, eight, the nine of the nine of the patients in the Mayo Clinic study had H. pylori. Put them all on mastic, just like I have for gazillion years, just like Dr. Timmons did his whole career, and eight out of the nine H. pylori infections were cleared up according to this research study that then, you know, um, we did the pre-post testing. And so anyways, that seems to work pretty well.

And then if you, if they're, if you're having side effects or problems of killing something, like you're killing H. pylori, you're killing Blasto, and they're not doing well, then go back and do the microbiome support, right? Either at the same time or first, and then come back and do the killing later. So they're not doing well with the killing stage three, go back and work on the microbiome or work on the organs either with the killing program or instead of the killing program. Get that gallbladder working, then do the killing. Get the microbiome in better shape, then do the killing. So if stage three is too aggressive, it's not working, that's why I divide these up, right? Do stage one for a while, and then come back to three, or do stage two for a while, then come back to three. Sometimes the patient can't handle just jumping into the stage three thing right off the bat.

Yeah, and I love treating H. pylori. Don't get me started on H. pylori. I treat H. pylori any chance I get. I know it can be commensal, I know it can be good for you. I'm just telling you my own personal problems here. I like killing stuff. If I see H. pylori and I see a sick person, I kill H. pylori any chance I get. Um, Dr. uh, Lord would be cringing if he was listening to this. Hopefully, I'll never listen to this. He's really against treating H. pylori because he's older and he's smarter. I just like killing stuff. It's also, you know, I'm also running a business and like getting rid of H. pylori is good for business. Why? Because people get better really fast, and then they tell their friends and family and they refer people. So there's, you know, it's, you know, clinical consideration there too, that it just works really well.

Um, gallbladder support. If there's a, if the person is a vegan or a vegetarian, then you, the all the companies will have, well, not all of them, but most of the companies will have a non, you know, bile, non, you know, animal product-oriented gallbladder support product, and it's going to have silymarin or turmeric or artichoke or beetly extract. So that's easy to do. Taurine is really kind of famous for helping with the gallbladder as well.

Um, yeah, and I'm all, I like the PCR testing a lot. You know, can you treat yeast with Espelardi? Absolutely. Yeah, you can definitely do that.

Right, see, I'm going to wrap up because I've got another class, but thank you guys for participating. I'm sorry I couldn't get to all the questions. We have a whole summer series going on, so there'll be more of these coming up. If you're interested, you should be getting emails about them. And then if you're curious about the GI Masterclass, it's $49 bucks. You can sign up with this link, and we'll be sending this link out to you guys in the very near future, so you can sign up for that if you want. And look forward to hearing from you on the next one of these classes. Okay, talk to you all soon.