H. Pylori - Diagnosis and Treatments

Hey everybody, and welcome to our H pylori diagnosis and treatment class. If you can hear me, hit your uh, raise your hand button, just so I can make sure my sound is working. Oh, thank you very much, because I have done up to 30 minutes of a lecture without having the sound working. I did it only one time ago, obviously.

Anyway, so I am Dan Kalish. I'm super excited to be doing this class. This is, I probably say this a lot, but this is like, really my favorite subject, H pylori. I'm in my top 10, anyways. After 30 years of working with patients, I put this in the top 10 most exciting things to learn about. So anyone who's listening to this, I'm super glad you're here, and I hope you get as excited about H pylori as I have been all these years.

So I'm going to introduce myself, a little bit about Kalish, since, what we're doing here, and then we're gonna get into talking about H pylori. I'm going to show you a sample lab, and then we'll show you the solutions for treating this bug. Genova Diagnostics has put this on for us. So I also want to thank Genova for all their support in getting you guys to come and listen to this incredibly important topic. And of course, what we're talking about is the Genova Diagnostics GI Effects test. And one of the great privileges of my life has been for the last nine years to work with Dr. Richard Lord, who is long retired, but worked for Genova way back in the day and was the developer and the scientist that created the GI Effects. It's morphed and changed a lot since Richard's day, but anyways, I'm going to give him a little shout out for all the work that he's done in training me over the years.

Okay, so who am I? If you're brand new to this stuff, um, Dan Kalish, founder of The Kalish Institute. I've worked in a lot of different aspects of our field. I've done research with the Mayo Clinic. I've trained Mayo Clinic physicians in my training programs. Um, I've been in practice since 1992, '93, around then, about 30 years now. Have taught a lot with IFM, doing their practice implementation workshops, and have been an attendee of more IFM modules than I can count. Have been certified for a while. And, and, um, I guess since the very, very beginning, have been focused on GI because my first teachers, that's kind of what they trained us in, in the early '90s.

We have some special things coming up with Genova, and you can get a 20% discount on this class. It is starting soon. It is March is soon. It is a lab interpretation boot camp. It's the first one of these we've done on the GI Effects ever. So this is pretty exciting. I put a lot of work into this, nine years of working with Richard, to bring this to you. So anyways, it's a short class. Boot camp means short, you know, it's like a month. It's intense. You learn a lot. You cry, you laugh. You learn how to interpret labs. And it is hands down, just like workshop format. It's not learning about, you know, how short-chain fatty acids are made or anything like that. It's just interpreting labs. Here's another one, interpreting labs, designing programs, very practically oriented, work.

Okay, so that's what this class is. And you get 20% off if you use that code, GENOVA23. You can register now. And this class has just been posted. And if you want to invest a month of your time and learning how to interpret this test, I think it'd be great. And you'll be learning from, you know, the scientists that developed the work, basically, because I'm Richard's translator for how he looks at the GI. And so that's kind of the role that I've taken on, uh, which is a wonderful thing.

So, you know, if you back up a little bit, what we're trying to do here. All right, let me make sure I get all my sound working. There we go. Um, and I'm going to go through some slides. I'm going to show a sample lab, design a program, and at the end, we'll have some time for questions. Okay, so if you type your questions in now, I'll try to get to them towards the end. I might not be able to answer them all.

So the point of this is to understand the types of patients that are going to benefit from H pylori treatment. It could be fatigue, that's their main problem. It could be a sleep issue, a mood issue. Most of the time, when you treat H pylori, and there's a miraculous thing that happens, and the patient's life changes, it's not related to their GI tract. That's the hardest concept to get. Functional medicine, for real, is not symptomatically oriented. So we're not saying you have to have an upper GI problem, and then we get rid of H pylori, and then the upper GI problem goes away. It is way beyond that, way beyond that.

We had a case in my mentorship class last week, brand new practitioner, doing one of her first GI tests. Two-year-old kid. This is a true story. This just happened, like, less than a week ago. Two-year-old child, in and out of emergency rooms with abdominal pain. Every GI workup you can imagine on the planet, seeing all the best doctors, all that kind of stuff, has been done, right? Couldn't figure out what was wrong with this kid. Starting to think about, who knows what they're going to do next, kind of exploratory testing. One lab test, one GI Effects test. H pylori and Giardia on this two-year-old kid. And we talked about it in class last Tuesday. The doctor had the child on probiotics and prebiotics, had not even started to treat the H pylori yet, and most of the pain was gone.

Okay, so H pylori causes all kinds of problems. It can put two-year-old kids in the emergency room. It can make 42-year-old professional poker players not be able to play poker. I mean, the range of problems that this bug can manifest is truly incalculable. And the only way that you will ever really get to appreciate it is if you test every single patient. You just have to test every patient with a GI Effects test. It doesn't matter if they have a GI problem or not. That's the hardest thing to overcome. It's a general screening panel, like when you go to see your regular doctor for a checkup. They don't ask you, "Oh, you know, should I do like a basic blood workup?" No, they just do that automatically, and you go in, and they tell you what it said. If I go see my acupuncturist, um, he doesn't like decide whether he's going to check my pulses that day or not. He just checks my pulses and sees what's going on, and then I get a treatment. This should just be like, boom, boom, boom. You get a patient, you do the GI Effects test, you see what's going on. If H pylori is present, nine times out of ten, you're going to want to treat it, and then just sit back and watch the different kinds of things that get better when this bug is gone. Most of the time, it's not going to be GI related. I'm just going to say that one more time because that's the hardest thing to understand. So let's get that out of the way.

Right, so now, obviously, you can have an infection like H pylori that's going to trigger something like malabsorption. If your stomach is infected, it makes sense that you wouldn't be able to absorb nutrients very well because your stomach's not working very well. And one of the key things that the stomach's responsible for is the initiation of protein digestion. So a lot of people with H pylori end up with all kinds of amino acid problems, and that then can translate into fatigue, mood issues, right? So that's why H pylori can manifest in a lot of different ways because it may not cause GI symptoms, but it will cause malabsorption of nutrients. All right. And so just keep that in the back of your mind.

So it's not that hard to treat. It's just, you just gotta find it, you know, that's the hard part. You just got to do the test. And how are you going to address that? You're just going to test every single patient. That's the only way to really cope with the problem. In fact, my teacher, Dr. Timmons, you couldn't schedule a consultation with Dr. Timmons until you had completed a GI panel. He wouldn't even let you schedule to talk to him. He didn't even want to talk to you about anything until you had your GI testing done. He would also do an adrenal test. He did adrenal and GI testing prior to the first new patient consultation. That was his sort of, "Let's at least have something to talk about during this first hour" kind of screening. And at the time, 30 years ago, I thought that was crazy. I thought, "That's so, I could never do that." I thought, "Why, why does he do that?" Like, you know, because I was worried about patients not wanting to be patients, you know, and you're just concerned about money or whatever I was concerned about. And now, of course, I do the exact same thing. Test everybody.

Okay, so as we're going to, once you get over that hump and you're testing people, now you're rolling. You got your first five or ten labs in, now you're starting to interpret these. Then you want to start to think about treatment options. So you got inflammation that you need to get under control, okay? And we use a lot of adrenal programs and adrenal hormone testing. You can run salivary cortisol testing with a cortisol awakening response. You look and you'll see from that what's going on with cortisol and DHEA, and you can start to strengthen the secretory IgA levels by working with improvements in cortisol, right? So you improve cortisol based on the cortisol testing, that strengthens secretory IgA, and that allows you to get the edge on being able to kill the bugs. If you skip that step and you don't do the lifestyle stuff first, and you don't test the adrenals and get the stress under control, and you don't change the diet, and you don't reduce their inflammation first, and you go right to treating the GI, then the odds that it's going to work have just diminished with every step that you skip. Don't test the adrenals, your results won't be as good. Don't change the diet, your results won't be as good. Don't deal with all the inflammation in their gut ahead of time, the results won't be as good. You don't strengthen their immune response, you know? So it's not a battle against H pylori at all. It's a battle against the fact that this person's body has weakened to the point where this bacteria has taken over and is controlling things, okay? So you have to win the setup to the battle. You can't just, you know, find H pylori and kill it automatically. That's not how functional medicine works.

And then the other kind of failure, I already talked about a lot, is that only testing people with GI symptoms. That doesn't make any sense. Now, you can have gas, bloating, constipation, diarrhea, acid reflux. Those are kind of obvious reasons that you would want to test somebody. But again, even if someone has low sex drive or a neurocognitive kind of problem, you want to, you know, test all these folks. And then from the patient perspective, patients aren't seeing or caring, usually, about the underlying cause of the problem. If they have immediate symptoms, they're relating to clusters of symptoms that they're struggling with at any one moment. And the problem is that they might have had heartburn 15 years ago, and then it went away, and the H pylori is still there, but now they have extreme fatigue and insomnia, and they don't realize that the H pylori triggered that. And because the gut symptoms are gone, they're not thinking that it's a gut-related problem. That's why we do the testing. And again, you will see over the course of treating thousands of patients for H pylori that they have all kinds of different symptoms unrelated to the gut. That's sort of the central point of what you have to understand with H pylori. But you want to get to the origin of the health problem, and many times the origin is going to be in the digestive tract.

So then we think about, well, you know, from a larger perspective. So we're kind of honing in on H pylori and how to treat it, but I just want to mention that before you do the killing part for H pylori, you want to make sure that your, you know, healing diet is in place, exercise, sleep, meditation, spiritual practices are in place. You're working with the cortisol hormones. Are you working with the thyroid or the brain? You're doing all these other things. And then in that overall context, H pylori is treated. In general, the more specific you get to kill H pylori too early in the process, the more you're just like, "I just want to do that one thing," the less likely it is going to work, okay?

Now, from a symptomatic standpoint, if you're just getting started and you're like, "I, you know," well, Dr. Timmons told me that he tested everybody, I thought he was crazy. So I have to consider that a large percentage of you were probably thinking, "Dan's a little nutty that he does that. I'm not going to do that." So then, at least you can do the least you can do is screen everybody that has H pylori symptoms. And that would be this list here, right? Anything from constipation to nausea, to stomach pain, reflux, indigestion, ongoing need for probiotics, you know, upper abdominal pain. And it's suspicious, especially, um, significant. We see H pylori in kids, like I was saying. We had a two-year-old in a mentorship class last week. Teenagers. We often see 13, 14, 15-year-old kids really being taken down by this infection in a much more significant way than you would imagine. It's very damaging to children. Not all children, obviously, but some children can be quite severe. And so if you find one person in a family, like the two-year-old that has it, of course, you want to test the parents. Where did they get this from in the first place? Was it from food? Was it from another person? You have to figure that out.

So whenever you get one family member, and I just was talking to a couple yesterday in my own practice, actually. The wife, let's call her Mickey or Nikki or, you know, let's call her Lisa. The wife, Lisa, um, had H pylori. And about a month later, the husband came in because I suggested to her that she have her husband tested. And we just reviewed his H pylori test yesterday, and he has it too. And now they're both kind of happily treating their H pylori together. And then, in fact, it was kind of funny because I said, "Well, I," one of them asked, I can't remember which one, like, "How do you get this in the first place?" "Oh, you could get it from undercooked chicken. You could get it from undercooked eggs. So you can get it from food. You get it from bad mayonnaise or something like that. Or you can get it from, you know, another person, from kissing another person." And then she totally fessed up. She's like, "I'm sure that I gave it to him." Dr. Kalish, because I had these stomach problems for like 20 years. His stomach was fine when we met. He started to have stomach problems. It's kind of cute, kind of a cute couple moment there. But anyways, they're in it together, testing together, treating together, they're going to get better together. Super good to do this for families.

The reason why this bug is so nasty is because it just rips apart the stomach lining and it damages our ability to produce stomach acid. Food then will sit in the stomach partially digested, releasing organic acids, which can cause a lot of burning and heartburn type symptoms. So undigested food is kind of coupled with H pylori, and oftentimes you can't give stomach acid support like betaine HCL because that'll burn and hurt the stomach even more. It causes more damage to the stomach lining than you could imagine in certain people. And yet, it, in some people, the effect of that is not noticed for a long period of time. Okay, if you don't have stomach function that's optimal because you have this H pylori problem from 15 years ago, but you don't have any, maybe your digestion is a little off, but you don't really think about it, you're going to start to have a malabsorption syndrome. You're not going to absorb amino acids very well. And what do you make out of amino acids? Well, here's a little list: antibodies, that's important. Enzymes, thyroid hormones, FSH, insulin, hemoglobin is made from amino acids, neurotransmitters are made from amino acids. So you could have a problem with your immune system because you can't make enough antibodies because you have H pylori and you're not doing that great with your amino acid levels. You could have depression or anxiety or ADD because you don't have enough dopamine because you don't have enough tyrosine, which is an amino acid that you need to absorb, right? So you can see, if you have malabsorption in the stomach with H pylori, it can trickle down to all these other body systems. And that's why it's such an interesting infection to treat because it manifests in all kinds of different ways.

So amino acids are required for making hemoglobin. Amino acids are required for making hormones like insulin, it's another protein. Amino acids are required for making enzymes, like this is one of my, I don't know if it's my favorite enzyme, yeah, maybe it's like in my top three, pyruvate dehydrogenase. This is the one that's, you know, when you're breaking glucose down to make energy, to make fuel, you go glucose, pyruvate, then it goes into the mitochondria, and you make energy. So this whole thing can get screwed up if you have H pylori because you don't have all the amino acids you need to assemble this relatively complex protein.

Another thing that happens on the immune system side is not only are you making immunoglobulins from amino acids, which will be interfered with with an H pylori infection, but the other thing that happens is something that some of you probably heard of, Dr. Robert Naviaux. Naviaux has described in his research the cell danger response, such that when we get an infection, when we get an infection like H pylori, the cell responds in a very specific, and I would say, almost like catastrophic way. So when we get an infection, your body immediately, this is crazy that this happens, right? Your body immediately stops using oxygen in the mitochondria. When that, when it's a cell, we're talking about a cell, not your whole body, obviously, it's happening in your whole body, you'd be dead. But you have a cell that gets infected, right? It could be anything. It could be, we're talking about H pylori, it could be COVID, same thing happens, right? So you get a cell and it gets infected. Immediately that cell goes, "Oh, this is not good." And your mitochondria are like, "Don't worry, guys, we got this." And the mitochondria stop directing that oxygen that's coming in and out of the cell, that's coming into the cell, you know, to make energy. They stop directing that oxygen towards making ATP, and they turn that oxygen into reactive oxygen species. They create oxidative stress on purpose, okay? And at the same time, those same mitochondria, they're like, "Hey, this is not looking good." They generate inflammatory fatty acids and they cram them into the cell membrane, okay? So you get an infected cell. Now the oxygen is being used to make free radicals. The cell membranes are completely screwed up on purpose. Your body's trying to kill that virus, bacteria, bug, whatever it is, and keep it from getting out of the cell, okay? So you're going to end up with cellular membrane problems. You're going to end up with major mitochondrial problems as soon as you get an infection like this. And that's why one of the reasons why so many people get so tired when they get sick, right?

Okay, you can get it from undercooked foods, eggs, chicken, stuff like that. Sometimes you'll have a patient that, you know, that's not so common anymore, but used to be people that do, you know, consume raw eggs in the morning in like a shake, like that was a healthy thing. You can get it from kissing somebody that has it. So you'll see it with a lot of couples. You can get it from the kissy, snuggly thing you do with the little two-year-old baby, right? So it doesn't have to be sexual kind of kissing. It can be just like, "I'm snuggling with my little kid," kind of kissing. So obviously, that's in the case with a two-year-old, that's where that two-year-old got it. Um, and the likely, now, the likelihood of the infection is equal to the person's age. So, in other words, like, if you're 50 years old, there's a 50% chance you have H pylori.

The problem here is that, and I've read all this research myself, is that H pylori can be protective. H pylori can be a good thing for your immune system. H pylori can be neutral. It can be a whatever kind of bug. Or H pylori can be a pathogen and cause a lot of problems. And so in my practice, the types of patients I attract in general, when we find H pylori, are greatly relieved when we clear it out. I don't get a lot of patients who have like the, um, you know, H pylori supporting me kind of version of it. You know, I'm sure that exists because you can see that if you look at larger patient population, larger populations of people. But the types of patients that are attracted to a functional medicine practice seem to do well in general if you kill the H pylori. Um, I, I'm a student of the Nobel Prize. I don't know why, I just kind of think it's cool. And one thing you could Google sometime, if you just really are, you know, if you're on YouTube and you don't have anything else to do and you're tired of watching news or something, is Google Nobel Prizes since like 1900 in nutrition. And you see how many Nobel Prizes in medicine were given out for scientists that discovered all these different nutrients. It's pretty cool. So there's a really strong history going back 100 plus years of the Nobel Prize and clinical nutrition. Interesting, right?

The Nobel Prize was given out, I don't know, was must have been 20 years ago now, a while ago, to a scientific group in Australia that discovered that H pylori is one of the major reasons why people get ulcers. Anyways, it's worth reading that if you just Google later on, Nobel Prize H pylori. It's worth reading the paper that they put out, um, because it says in there very specifically that H pylori always causes inflammation. And in some people, if they're predisposed to a problem, you know, it can develop into an ulcer or even something like stomach cancer. Okay. And so, anyways, these are diagrams from that, uh, Nobel Prize committee paper that they put out years ago.

So the general guidelines for H pylori, let's think about that. Let me take a sip of water here. You got to test for it. I have never treated H pylori on a guess. I mean, I guess you could, you could just say, "I think you have H pylori," but that doesn't make any sense. You got to do the lab first. And we'll look at a sample lab in one minute, okay? Then you eliminate the pathogen. Step number two. Do you always eliminate the pathogen if you have H pylori? I would say yes, I do. And it's worked out really well for me. I have never had a patient who said, "I'm sorry that I took the time and money to get rid of my H pylori." Like, that's never happened in my practice, ever. So I would suggest, for the time being, yeah, treat pretty much every H pylori that you find. You don't have to treat it with antibiotics. You know, obviously, you can treat it with antimicrobial herbs. So it's a gentle treatment. It's not going to get people in trouble in any way. Um, if the person is quite sick, you might want to recommend antibiotics, but you certainly don't have to. Can be very effectively eliminated with a mastic gum product. And in fact, the research study I did with the Mayo Clinic, we had 25 patients in there. They all did GI testing. Nine of them had H pylori. And at the end of the six-month program, we eliminated H pylori in eight out of the nine using a non-prescription, non-antibiotic, you know, using mastic gum, basically. The exact same protocol I'm going to show you tonight is the one that we used in the Mayo Clinic study. You're welcome to read that too. We can send you a copy of that if you're interested. You can ask my staff. It's got, um, it's not a huge write-up on the, on the, there's not a huge write-up on the, um, H pylori part of it because it was a wider study about the adrenals and the gut, but anyways, it's mentioned in there.

Okay, you then need to retest. That's a pretty important step because what if you missed it? What if the person is feeling better, but you didn't really get it? So you retest. When do you retest? Usually, the treatments take two or three months to eradicate it. Usually, you have to wait a month or two to do the preparatory work before you try to eradicate it. So you're usually looking at a retest a month or two months after your killing treatment is done. So that's typically around six months into this. So the first month or two are the preparatory phase, the lifestyle and adrenal programs. Then you have a month or two of either antibiotics or antimicrobials, depending on what's more important or appropriate for that patient. And then you want to wait one or two months after all the killing is done, retest, and make sure it's gone. And then, of course, you want to repair the GI tissue. That could happen in the beginning, middle, or end of this whole process, depending on how you want to structure it.

Protocols. H pylori treatment. But remember, if you just do the killing treatment by itself in isolation, your success rate is going to be pretty poor. And the last thing you want to do, I'll tell you the biggest mistake that you could make that I've made is suggesting somebody take antibiotics for H pylori without sufficient preparatory work. Because then the bug can become treatment-resistant, and then it's even harder to kill. So that's a, just right there, is a good argument for doing all the preparatory work so that if you are going to use antibiotics, you're sure they're going to work. We're more sure they're going to work. You can also mix and match things. You can do antibiotics combined with micro, micro antimicrobials. So you can do antimicrobials for a month or two, and then hit it at the end with antibiotics. You can do antibiotics upfront and do antimicrobials for a month or two afterwards to make sure you got it. So most of the time, people don't do both, but you can. Most of the time, people pick a lane and decide which way they want to go.

And then you have to treat other pathogens. Like I was telling you, that two-year-old, um, also had Giardia. So H pylori was causing the stomach pain, but, you know, still had Giardia to get rid of too. So there's oftentimes other bugs that are associated with H pylori for reasons that are beyond me. The most common pattern that you see in the H pylori cases is that they also have a parasite called Blastocystis hominis. That combination, or that pairing of H pylori with Blasto, is the most common pairing of any two bugs that I've seen. And, you know, I have, I don't know, I stopped counting. We, at around 10,000. I've had more than 10,000 patients. And that 10,000 was like 20 years ago, so a lot more than 10,000 patients. I've seen this pattern with. And then I worked at one of these labs years ago, and I saw thousands and thousands of these GI tests. It's really common to see H pylori and Blasto together, okay? So just be on the lookout for that.

There's a bunch of different ways you can treat it, right? So you can use a PReP-Pack. That's the most commonly used thing, I think, in the U.S. Um, some people use other drugs. There's different opinions about what might work best if you're using a prescription. And then when you're treating with herbs, mastic gum combined with things like slippery elm, DGL, zinc carnosine, work really well, okay? And I'll do some protocols at the very end so you can see like how you'd actually lay that out. And then probiotics, super high potency probiotics can make a huge difference. And of course, you want to repair all the damage. So glutamine-related powders plus herbal support to repair the damage. The most important ingredient in all this is the mastic gum. But you want to give the mastic gum after a month or two of preparatory work. And you want to give the mastic gum along with some anti-inflammatory, kind of calming things down, type herbs like slippery elm or DGL. Um, and sometimes you can run all these things together. So the mastic gum plus the anti-inflammatory stuff, plus the probiotics, plus the GI repair powder. Sometimes, depending on how complex the other components of your program may be, you may want to do just the killing part, you know, and then just the probiotic part after that, and then just a GI repair part after that. So sometimes they're stacked: two months of mastic gum plus the slippery elm and DGL, two months of probiotics, two months of GI repair. So doing like that, one after the other, after the other. And then in other cases, you can have the luxury of running maybe two or three of these programs simultaneously. It varies depending on on how you want to approach it, okay? You have a lot of different options there.

So you had children. So I had this summer in my life. It was like 2007, 2008, somewhere around there. It was right around the financial crisis. Anyways, I had this summer that started off in June with like a couple of H pylori kids. And I'm thinking, "Okay, whatever." And then there was another one, and another one, and another one. And it was like, you know, over maybe an eight-week period, I had like H pylori children, every, just over and over and over, more than I could count. I didn't know what that was about. Um, it wasn't like there was one, and then there was some H pylori support group, and they sent in all their friends. It was like different families and different. Anyways, at the end of that summer, I was kind of emotionally traumatized because the amount of damage that happens to kids when they get H pylori, it's horrible. High school football player can't play football, can't even go to workouts. 15-year-old girls with horrible female hormone-related problems, right at that young, young age. Young girls also, 14, 15 years old, diagnosing with diagnosed with eating disorders. I've seen that over and over. What's happening? She's waking up and throwing up all the time. She doesn't want to eat because when she eats, her stomach hurts and she throws up. And then people like, "Oh, she's bulimic." Or she's gonna, no, not an eating disorder. If you have an infection and your stomach hurts and you're not eating because your stomach hurts, but you're a kid and you're 12 or 13 and you're not articulate enough to explain all that. Seen that so many times with children.

Okay, we had a 12-year-old boy last year, at the same exact problem. Wouldn't eat dinner because it hurt. As soon as the H pylori was done, poof, he's eating like bucket loads of food. Okay, so children get devastated by this. You gotta test every kid for this problem. You're gonna, you, once you've treated like 10 of them, you'll see what I mean. It's a really easy, straightforward treatment. You can choose between antibiotics or antimicrobial herbs, depending on what you and the parents think is the best option. And when it's gone, it's gone. Like the football player kid is back playing football. You know, people are eating normally again. This is not a complicated thing to fix in a child. Kids respond really quickly, but they're devastated by it. So I have a slide on that. And they talk a lot about this. And now it's great because it's working. It's bleeding over into the mentorship. We have people testing kids all the time. I mean, that one doctor tested a two-year-old. You know, what a great, what a great thing. You want to really be able to help these children. It's horrible.

So this is one of my old, old patients named Jesse. And he was a great case. His complaints, he had a lot of different complaints, but at the time we were working on insomnia. He couldn't sleep through the night. And I hate treating insomnia. It's such a hard thing to treat, right? So it's true, after magnesium, and we're testing his adrenals, as we're doing this, and all these neurotransmitters, and I'm giving him everything I can possibly imagine, and nothing's working, even a little bit. And at the time, he was a young man, he was like, maybe 19 or 20 or something like that. And he was, you know, basketball player. He's playing like at a Division I college basketball level, which is hard, right? It's a lot of work for these kids. They're working really hard. And so I just randomly treated, not randomly, but I did the GI testing. But I'm not thinking much of it. He's got H pylori. I give him the treatment for it. As soon as we're treating the H pylori, he comes back after me trying all these other things and not that didn't work at all. He comes back and says, "I'm sleeping through the night now." I'm like, "Why? Why is that really into your stomach?" And he said, "Well, I didn't really realize this until a few nights ago, but I don't wake up anymore at night. And I now I realize that I was waking up at night because my stomach hurt." But I never really thought about it. I would just wake up, you know, every night and go get something to eat and then go back to sleep. He was awakening at night with stomach pain. Didn't really register as that was. He was just so used to it. He would go get something to eat, go back to sleep, but he could never sleep through the night. As soon as we got rid of the H pylori, insomnia problem solved.

Okay. And what am I just looking at? You know, there's neurotransmitter thing that's not working, and all this other stuff that's not working. Um, and so this is why you have to test the gut and do the microbiome testing. All the sort of veteran functional medicine docs will tell you that you test the gut, check the microbiome. Don't blow that off, no matter what the complaints are, even if it's something like insomnia.

And then here's like the overall treatment program. Then the steps: adrenal support. That's for another day. We can talk about how to test and correct the adrenals with Genova lab. You can use their cortisol awakening response test plus the salivary cortisol and DHEA, right? That you can order that as a single test kit. So that's a test that you would do. Put the person on adrenal protocols. Then treat the H pylori after a few months of the anti-inflammatory, sort of adrenal support part of the process, because you're, during that time, you're strengthening secretory IgA, strengthening the immune response, and you're reducing inflammation. So when you get to the killing part, it goes really well. Step two is the killing part. And then step three is, you know, making everything better. And once the killing part is done, right? And so I can show you a few of these. Step one is the adrenals. Step two is a killing. Step three is a recolonization, right? And then strengthening the secretory IgA through the adrenal protocols and stress management. All right.

So I'm going to, and here's a timeline. This seems to help people a lot. This is sort of a typical timeline for a typical patient of mine. So they do an adrenal test and a stool test and organic acids. We get them on the diet. You know, a month or two into that, we start to treat the H pylori. They're already on the adrenal program. We knock out the H pylori in months like three, four, five, somewhere in there. We do a second round of adrenals. Usually, that means you test again after six months. You put them on another, maybe they're done. If they're done, they're done. You don't need that second round. And then we eventually end up doing, you know, detoxification programs if they need it. And almost all of these H pylori patients are going to need the nutrient replacement that you see in the lower right-hand corner there. The nutrient replacement, right? Because what's happened is malabsorption because the stomach wasn't working for very long for so long. Okay. So the treatment for the H pylori happens here. After that's done, you do all the nutrient replacement. Doing the nutrient replacement while I still have the infection in their stomach, that doesn't make so much sense. And the only reason why the adrenal program comes in the beginning is because you're strengthening their SigA to make their immune response better, and you're reducing inflammation with the diet and lifestyle stuff in the adrenal program. So that when you get to that treatment for H pylori around the middle of month two or three, you're much more likely to get it, okay? So you got to be patient with this. The earlier you jump in to treat H pylori, the less likely it is that it's going to work.

If you came late, I'm just going to mention again, and before we look at labs, that Genova is helping us with, uh, producing this class, which is wonderful. And, um, you get a 20% discount, thanks to Genova, if you enter this code GENOVA23. Pretty easy to remember for our interpreting the Genova GI Effects boot camp, which is starting in March, okay? This will be a one-month class where we just review labs, review labs to really get you over that hump so you feel comfortable with, uh, the whole process of designing programs. Does it teach you everything you need to know? Well, of course not. You know, I mean, how long does it really take? Timmons told me, "Give it 10 years." You know, that's not the best answer, probably. But at least a couple of years. When I see people in our mentorship class, it takes a year or two to really start to understand what the heck you're doing. But the first thing is to be able to order tests confidently. You can get that started in a couple of months, okay? And that's what this class is really about. It's not to make you, like, we can't give you 10 years of clinical experience in a month. But we can get you to the point where you're like, "Yeah, I'm going to order these tests. I'm totally confident in ordering the test because I know how to interpret the basics, and I'm seeing some results already." And getting you to that point where you're kind of excited about this, okay?

All right, so let's look at a lab, and then we can get the questions. So here is a GI Effects test. And on the first page, you will see a, uh, overview, which I really like the way they broke this out, to be honest. It's kind of a quick summary of everything. So categories: maldigestion, inflammation, dysbiosis, metabolic imbalance, and infection. And that's just an orientation dashboard. This is not to tell you what to do. This is just so you look at this first and you're thinking, "Okay, I'm getting oriented." So in this particular case, you would, the things that stand out are that there's an infection present. You're thinking, "Oh gosh, that's not good. I've got to go figure that out. What's going on there?" And there's a problem with maldigestion to an extreme, right? And those are probably connected. Remember, I just said H pylori causes maldigestion, malabsorption. So we're going to just scan through whole swaths of this test as if they don't matter, but they do, because we can't really talk about the whole thing right now. This page is particularly intriguing. These are all the commensal bacteria. That's the interesting part of the test. But we're going to get scoot down. We're just kind of showing you this is the culture, bacterial culture, um, to the bottom here where we see, oh, we're looking for things in red. Okay, under parasitology on page seven, you see, gosh, well, clearly that doesn't look very good. Blastocystis hominis present. And then we see labs exactly like this in my mentorship class every week. This is not unusual. We had one last night that had three parasites. She had Dientamoeba fragilis, Endolimax nana, and Pentatrichomonas hominis. There's three. So we see that a lot. And the more infections you have, the sicker you're going to be. And then you scoot down to this page eight, and you can see again, Blasto and Dientamoeba fragilis that was picked up on PCR. And then on the last page, add-on testing. So for the GI Effects test, you need to add on the H pylori. I would highly recommend that you do that with every patient. Do the GI Effects and check the little box to add on H pylori. In this case, they found it to be positive. So now we're in quite a quandary here because we've got a couple of parasites, okay, a couple of parasites and H pylori. So this is like the point in the game show where it's like, you know, you're kind of thinking, "What's going to happen next?"

All right, suspense is over. You ready? Let's solve the problem. So I'm just going to lay out the program. So it's going to be adrenal support. You're going to test the cortisol awakening response. Are you going to test the adrenal hormones plus cortisol awakening response and figure out how to treat all that stuff? That's a whole other subject, right? But don't forget about it. You're going to do the lifestyle changes, you know, diet, stress management, all that. That's the whole point of the Nobel Prize in H pylori, right? Is that for decades worldwide, every practitioner thought that ulcers were a stress condition. And then this crazy, you cray-cray guy, Marshall, I think is his name, in Australia, was like, "I think H pylori's from, I think ulcers are from an infection." And he took photographs of his stomach, he gave himself H pylori on purpose, took pictures of the ulcer, and then treated himself with antibiotics and took pictures of his ulcer getting better, going away. And I think that that was just such a crazy scientific stunt that the whole world was just like, "Wow, that guy is crazy. He should get the Nobel Prize." But he just showed that 80 to 90% of ulcers are caused by H pylori. But the point of the story is that when you're stressed, H pylori gets worse. When you're stressed, H pylori can go from just hanging out in your stomach to causing an ulcer, to causing bleeding, right? And damage to the stomach lining. So that if you're going to try to eradicate this thing and the person's stressed out of their mind, it's just not going to work. It's just going upstream, hard paddling upstream. If you've ever done that, it's not a good thing. You just don't get anywhere.

I was on a bike ride a long time ago in my 20s. It was a hundred-mile bike ride. It was like an event. And it was in Northern California. And there was a long stretch of this bike ride where you were riding directly into the wind. The wind was blowing at you. And if you've ever done a long bike ride, that is so taxing. It makes it twice as hard. It's easier just to climb a hill than to ride directly into a really strong headwind. So get, it's like getting rid of H pylori. If the person's got all this stress that's going the other way, it just doesn't work very well, okay? You're making your job twice as hard. So this is not just like a box to check and go, "Oh yeah, yeah." You got to actually do this part. Adrenal support, lifestyle changes, and then we're going to go for the H pylori. I don't know, it's called elimination program now. If you're using antibiotics, I'm totally open to that. I think that's a great thing. But I'm going to write out the antimicrobial herbal programs here. Mastic gum. And you want to get as many different brands that have, uh, I would suggest using one of the professional brands, but there's many different brands that have mastic gum. You want to get it, well, let's say for the purpose of this class, let's say a 500 milligram range, three times a day, okay? You can go higher than that, but that's a good one if you're just starting. And then you can use DGL. A lot of companies also have zinc carnosine type products or something with slippery elm. Again, this is like the supportive stuff. Now, some companies will have the mastic gum and all this other stuff together in one pill, okay? So

That's another option too. And usually, if you're doing those kinds of capsules, usually it'll be something like round two times a day. So that would be the killing program. You do this for two months. Then remember, there's other components here. So life, the H. pylori elimination is the first part. Then you also want to do the prebiotics and probiotics to get the gut microbiome back on track. And then you also want to do a GI lining repair. And again, you can do these things together, or you can chunk them out into separate programs.

So the first two products there are the elimination of H. pylori. If you feel like you, you can, if you want to, you can do prebiotics here. And those are usually in powders with fiber and polyphenols, all that good stuff. And then you can do probiotics, of which there are many types. There's the saccharolytic types, which are my favorite. There are the spore-based types, which are really good too. In fact, I'm taking a spore-based one now. I feel great. And then there's what I call regular probiotics. That's not to put them down. It's like regular gasoline. Hey, it's still good gasoline. Regular probiotics, those are like the lactobacillus type. I use a lactobacillus rhamnosus, but you're open. I'm open to any other kinds of normal, you know, probiotics. But there's three different choices there. I mean, the probiotics: saccharolytic type, spore-based, or the regular kind.

And then, oh, GI lining repair. Every company has a GI lining repair powder. Some of them will feature glutamine because glutamine is kind of famous as an amino acid that helps repair the gut lining and provides a lot of fuel supply and anti-inflammatory support. So some of them are glutamine-based, and some of them go more the IGG route, right, where they're more like a colostrum. How do you spell colostrum? Colostrum-based type thing, meaning that it's more for immune boosting. So sometimes they're more anti-inflammatory oriented, sometimes they're more immune boosting oriented. Everybody has their favorite. That would be the repair.

So these are the three phases. The killing part is right here. The prebiotics and probiotics. And then the GI repair stuff. And either anti-inflammatory powders like with glutamine, or ones for the immune system that have the IGG colostrum type stuff. Okay, you can do all of this at the same time. That's a lot for most people, especially if you're running an adrenal program. You can do the first part, wait, and then do the second part, and wait, and then the third part, you know, one at a time. So you have a lot of different options here.

And let me just show you the lab one more time. So it's an add-on to do H. pylori to a GI Effects. But I strongly encourage you to always do the add-on. The GI Effects is also going to cover PCR for parasites, Blasto, Crypto, Cyclospora, D. fragilis, Entamoeba histolytica, Giardia. These are super important to find. And of course, PCR is kind of the top of the food chain type technology for finding parasites. And just to complete this, in case you don't know all this already, they also do an O&P macroscopic OMP, which means that there's a human being looking under a microscope to try to find bugs, which is handy-dandy. Sometimes they'll find things. They do culture for bacteria and yeast, so growing things out in a petri dish.

The GI Effects includes this whole page on commensal bacteria. You see that? These are the good guys. They measure the good guys in excruciating detail. Very important part of the test. I was just reading about this one a few minutes ago. Uh, where'd it go? Fecalibacterium prausnitzii. Here, this guy right here. Fecalibacterium prausnitzii. That's the one that's strongly associated with long-haul COVID. People, that's an important commensal. It's a good guy. And it's strongly associated with butyrate production. Interesting. That one's kind of special. You should remember that one. Fecalibacterium prausnitzii. Okay, that one's extra special. The other special ones you've got to kind of know. You don't have to memorize all these, but you've got to learn about Akkermansia. If you don't know about Akkermansia, you should read about that like tonight. And, uh, Google, um, Fecalibacterium prausnitzii. Okay? And whatever COVID, butyrate production, whatever you read about that one. Those two kind of stand out as ones you should know about.

And then they have the section on metabolites, inflammatory markers, and digestion and absorption markers. Okay, I'm just going to write one more thing out here real quick because it's a beast of a test. And today's class is really about H. pylori. But I just want to show you the way that I try to approach these GI Effects tests in general. And it's simple. So, and this works really well. I can't tell you how well this works. Simple is better. Simple is always better. Complicated, not good. So, um, three stages. So simple, you ready for this? Microbiome. Three stages of what? Three stages of GI dysfunction. This is so great for explaining to patients. I can't tell you. Microbiome, good or bad. GI organs involved or not. And then GI bugs or pathogens. So when you're looking at these GI Effects tests, if you're looking to see, is the microbiome in good shape? Are there problems with organs? Are there problems with bugs? Those three things. Boom, boom, boom. That'll just help orient you. And then when you're explaining the test to patients, you can say, "Hey, let's talk about your microbiome. I'm going to go through a few of the organs that seem to have a problem here. And then we're going to talk about your pathogens." So if you're going to this test to represent that. Okay, let me show you.

So let's start with the microbiome. You know what I call stage one? So stage one, the microbiome. We're looking for, uh oh, here, right here. Microbiome support. Okay, so do you need to, oh, you got a problem there. Your microbiome is not doing that great. So we're going to have to address that. Second item, GI organs. Well, maldigestion. Pancreatic elastase has got pancreas in it, right? That's your pancreas not making enough enzymes. So right off the bat, you have a stage one with the microbiome not doing well. You've got a stage two problem. What's the problem with the organ? That's called the pancreas. Okay, you need some pancreatic enzyme support. So you got a microbiome problem. You've got a pancreatic problem in digestive enzymes. And of course, parasitic infection and, uh, H. pylori. So then we go back to our program. We're going to incorporate that stuff. I already wrote out the killing part here separately. You want to kill the parasites. And then separately, we'd also saw that this person needs enzymes, digestive enzymes, based on the pancreatic marker, right? A couple of those with each meal. And then, um, oh, and the microbiome was in disarray. And what do you do for the microbiome? Prebiotics, prebiotics, probiotics, and butyrate. That's the microbiome treatments. I should put fiber in there. So as you're looking for these at these labs, you're looking, is there a microbiome problem? Yes. What do you do? Prebiotics, probiotics, butyrate, fiber. Is there an organ problem? Yes. Which one? The pancreas. Pancreatic enzymes. Easy peasy. And then what we're talking about tonight, are there gut bugs? Yeah. Well, let's treat the H. pylori first. Later, you could do the parasites when H. pylori is eradicated, right?

Okay, so we've got a few minutes for questions here. And if you have a lot of questions, then you should take the class. Which class? This class, the class on the interpreting of the Genova GI Effects test. That Genova GI Effects test, which is coming up in like a month and a half, two months. All right, so let me go back and try to find some questions here. Uh, can health coaches order from Genova? You can order from Genova Connects. Genova Connects allows you to order testing if you're not a doctor. Let's see. Is mastic more effective with or without food? I always give it with food because a lot of H. pylori people have a sensitive stomach, but it's stronger on an empty stomach. But be careful because people are going to have more side effects if you do it that way. Okay. Um, H. pylori treatments are for two months. The length of time. That was a question there from Cindy. Britney wants to take our classes but has to save up. Well, look at the price of this boot camp. It's not that expensive. And you get 20% off. We're offering not that expensive classes now. That's the whole point of this because the mentorship costs a lot of money. And some people just don't feel like they want to spend that much money. Um, and if I'm looking at this now to try to find this, yeah, I would, I would say it's affordable. How about that? So look at the website and, um, you can see it's, it's not that expensive for that class. Let's see. More questions here. So can rather than using supplements, can patients reduce processed foods and add more plant-based foods? So we're assuming that anyone is doing that. The first couple months of treatments are reducing processed food and adding plant-based foods. That may be enough. I don't think so. Usually, if they actually have H. pylori and they're sick, then they have to do the diet changes, but then you should kill it as well. Um, yeah, we do have a sign-up thing here. I can show you. Oh, yeah, just go to KalishInstitute.com. Claude is asking. So go to KalishInstitute.com and then scroll down to the lab ordering. Not that one, sorry. Here. Lab interpretation boot camp. Getting started. Interpreting. Yeah. So just go to the KalishInstitute.com and then click on this thing. Lab interpretation boot camp. Is it really $5.99? Well, that's even cheaper than I thought. Clearly, I'm not the one that prices these things. I put so much work into this. You guys, like, this has been nine years of my life. If you can't afford $500, then you just, you've got to like, support me in some way here. Yeah, it's $500. And you get a discount with the Genova code. Okay, so it's 20% off of that. Yeah, that's what it is. So you go to The Kalish Institute and click on that, and you can get right into it. Okay. Thanks, Clive, for asking.

Let's see. We have one more minute. Yeah, we got another minute or so. Is it okay to use the same prebiotics and probiotics from the first program? Yeah, yeah, yeah. Generally, yes. You don't want to keep people on the same probiotics forever, but a couple months at the same, the same one is fine. Um, if you have patients that respond badly to probiotics, they've got a major problem with their gut. Okay. And so you need to, that's Wendy's asking that question. If they, if you have patients responding poorly to probiotics, stop everything. Do a GI Effects test and start to go with my three-system thing, right? The microbiome, the GI organs, and the pathogens. So if you can't do stage one with the microbiome treatment, then go on and try to treat the organs or the pathogens. Um, yeah, I don't. I do things one step at a time. So I would always kill the H. pylori first. This is Kelly's question. I would never overlap them. I would kill the H. pylori, just see what the heck that does, then do the prebiotics and probiotics, give that a couple months, and then do the repair. I like to do things one at a time, but you can do multiple things, but then it gets confusing as to what's causing what, and it's really confusing. Let's see.

Um, so the adrenal programs are a whole another can of worms. I can't really get into that now. You still have time in a minute or two here, but I teach these classes on how to interpret adrenal labs. Those are going to come out this year as well. And you can just look at our website thing here to find that. Uh, Lab Ordering Essentials, Adrenal Hormone Labs. That's, that's going on right now. But then we're going to have a lab interpretation boot camp on the adrenals. I don't think it's posted yet, but it'll be posted soon. So you can decide for that if you're interested. Let's see. Um, we got one more minute. Uh, are you more likely to be infected with someone who has never had? I don't know the answer to that one. Yeah, absolutely. FIFA is asking, can H. pylori infections simply look like acid reflux? Yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, 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