Your Microbiome and Why it Matters: Understanding Your Stomach, Pancreas and Gallbladder

Hi everyone, Dan Kalish here. We are in our summer series of health chats, and we are talking about your microbiome and why it matters. And understanding your stomach, pancreas, and gallbladder. We're going to explore how your stomach and pancreas and gallbladder work, and why they are so important to maintaining the health of your microbiome. And we're going to look at ways to test your microbiome to see how healthy it is.

So, this is all the stuff that it takes you 30 years to learn. And I can tell you that because I've been doing this for 30 years, and I'm just figuring all this out. So, I think a couple things, you know, about why are we even doing these talks? That's a good question. Well, number one, um, you should know how your body works. It's pretty important to figure all this stuff out. Number two, if you're not feeling great, it's even more important that you know how your body works. I don't know if you've ever had that feeling when you go to see a car mechanic and you have no idea what's wrong with your car? It's you just have to totally trust what they're saying. If you know a little bit about cars, it kind of helps you to understand that this person is on the right track and whatnot. So, you hopefully will never know as much as the doctors that you work with. No, but you should know a little bit, not a lot, but a little bit about what's going on with your body so you can understand the dynamics and at least make, you know, proper assessments about people who want to work with you.

So, the, um, and, you know, everyone just kind of forgets about the stomach, pancreas, and gallbladder. I don't know why. You just forget about how important it is. So, let's talk about stomach, pancreas, and gallbladder. And then we can look at some examples of really cool tests.

So, number one, your stomach is sitting here, and it's just a sack, really. But it does some pretty important and pretty strange things. It makes stomach acid, which is incredibly corrosive. It's like battery acid. And your stomach's really thick and tough so it can handle it. But if that stomach acid gets anywhere outside the stomach, no, not really good things happen. So, if you have esophageal reflux or GERD, you can have stomach acid that's coming into the esophagus, right? And that doesn't feel very good. That burns a lot if you've ever experienced that. If you're not making enough stomach acid, then you cannot break down dietary proteins, and you cannot absorb amino acids fully, and that causes a lot of problems. So, it turns out that if your stomach's not working well, everything downstream from your stomach, digestive organ-wise, is going to be suffering. And so, your stomach acid production relies upon zinc and vitamin B6. Those are very common deficiencies that we see when we test people. So, if you're low in zinc or low in B6, you're going to have problems with making enough stomach acid. Dehydration, the number one cause of not enough stomach acid. People just don't drink enough water. So, we can all pause here for a moment. I'll take a sip of water because you make huge amounts of stomach acid every day. If you're not hydrated, you can't make it. That's another common thing we see all the time. And if you're not making enough stomach acid, you can take this stuff called betaine HCl with pepsin. And that as a supplement, and it really helps your stomach work better. But it's not a solution long-term because if that stuff helps, it means your stomach isn't making enough stomach acid. It means something's wrong with your stomach, and that you should do some of the testing and figure it out. There's also an infection that often happens in the stomach for people that have stomach problems called Helicobacter pylori. And if you have that infection, it shows up on the test. You know, you're having stomach problems, you want to get rid of the H. pylori, and then you'll feel better. I've treated a couple thousand cases of H. pylori. It's a really common infection. It causes a lot of problems. So, again, if your stomach is not making enough stomach acid, or if it's making too much stomach acid, then bad things can happen. And it's pretty amazing that your stomach works at all if you think about it. You chew on a piece of food, and it hits your stomach. And if these things don't happen properly in terms of the stomach being able to break everything down, then, um, you're never going to absorb nutrients. So, stomach is super important.

Now, the proper acidity of the stomach, the stomach being very, very acidic, then the food contents go down, and they hit the small intestine. And that very acid food chyme, they call it, coming out of the stomach, hitting your very delicate small intestine, causes your pancreas to freak out. And it goes, "Oh my gosh, there's this horrible acidic environment happening." So, your pancreas cranks out tons of buffering anti-acid stuff, right? Which we call pancreatic enzymes. And so, if you don't have the right amount of stomach acid, the pancreas won't react properly either, and you have even more problems. What's the pancreas too? It makes insulin and it helps with blood sugar. That's a whole different topic before we're talking about today. The pancreas, part of the pancreas, makes these enzymes that further help you break down your food in the small intestine. Another common problem we see in integrative and functional medicine is people that don't make enough digestive enzymes because their pancreas is messed up. Okay?

And then a third problem, which is the, I don't know, it's not the worst of all these, but it's a really bad problem, and it's really common, and it gets misinterpreted a lot as being this thing called SIBO, is if there's a major problem with your gallbladder. Okay? And your gallbladder turns out to be pretty important. Let me just show you a picture here real quick so I can blow this up a little bit. So, your gallbladder sitting right underneath your liver, that's what they're trying to show here, okay? Oops. And it's highly susceptible to not working well. There we go. And when your gallbladder is not working well, extremely bad things happen. So, one of the things that happens is the gallbladder, again, it's like a sac sitting right underneath your liver, and it squirts out bile into your intestinal tract. And so, if your gallbladder is not working right and it's not squirting out enough bile, then you're going to have a massive proliferation of bacteria in the small intestine that cause can cause a huge amount of bloating. It can even lead to something that we call sometimes, well, sort of, and we'll get into details, but sometimes people with small intestinal bacterial overgrowth or SIBO can be triggered by a gallbladder problem by simply not having enough bile, not producing enough bile. And so, if that's going on, there's a really simple solution. You give people supplements that help restore normal bile production, you help thin the bile, help the gallbladder get cleaned up and work properly. It's like changing the oil in your car. It's more like changing, it's more like the lint filter in your dryer. It gets all messed up if you don't change, you know, pull all the linty stuff out once in a while. Your gallbladder can kind of get gunked up, and sometimes it needs a little bit of a tune-up.

So, stomach problems can trigger problems in the small intestine. Pancreas problems can trigger problems in the small intestine. And gallbladder problems always trigger problems in the small intestine. So, a lot of what we diagnose these days is SIBO can be coming from basic organ dysfunctions, which are easy to identify on the various labs that we do. And that's super important because you don't want to go off taking a bunch of antibiotics for your SIBO when, in fact, really what's going on is that you have a little bit of a gallbladder problem. Okay? That happens a lot. People just get, I don't know if you say misdiagnosed, or almost like they get over diagnosed, it's probably a more accurate way of saying it. And it's sad, and that's not a good thing, and we don't want that to happen to you guys.

So, there are really simple tests to figure all this out. And I'll show you a couple of simple, simple examples if you are interested. I got some pulled up here, some sample labs. And you just have to find a doctor that knows how to interpret these. And, uh, they're not as bad as they look once you've done a bunch of them. And most, there's many different lab companies that do specialized stool testing that are available. And let me just find one for you guys here. And they all have slightly different ways of looking at organ function. And, um, let me, sorry, I have to pull up the right one here. There we go. They have slightly different ways of looking at GI function. You can see this particular example here. They look for infections, inflammation, insufficiency, imbalances in the microbiome. And they'll list out, for example, if your fecal fats are high, it means your gallbladder is not working. If your protein products are high, it means your stomach's not working. There's another marker that's not on this particular one. If your elastase is high, it means that your pancreas isn't working. So, it's really straightforward and easy to do tests that can tell you all this kind of stuff. Okay? And, um, it's not even that complicated. You just have to do a stool test, which kind of grosses people out, but it's worth it. And I'll show you another example, different kind of test here. You get kind of a little familiar with these. And we're just looking at the organ parts on this particular test. You can see elastase, that's a pancreatic enzyme marker. If that's high, you have a problem with pancreatic enzymes. I'm sorry, if that's low, you have a problem with pancreatic enzyme. Statocrate, it's another way to measure gallbladder, that's pretty cool. And then these are inflammatory markers to see if the intestinal tract is inflamed. So, it's pretty easy to see this on labs if you can get the right test done. Okay? It's not like an overly complicated kind of thing to do.

All right. So, that's number one. You get your organs figured out. Stomach, is it working? Gallbladder, is it working? Pancreas, is it working? The main way that these organs get messed up in the first place is because we're all so stressed out when we eat, and we're all dehydrated and nutrient deficient, that our bodies aren't making these particular products. So, the keys to getting this all to work, if you don't want to take a ton of supplements, is to sit down when you're going to eat. It always reminds me of Paris when I used to go to Paris for work a lot, which sounds kind of fun, and it was kind of fun. You know, I used to go to Paris every, every four months for work because I, I owned an organic yoga apparel business, of all the crazy things I've ever done. But anyways, you had to go to Paris every, you know, two, three times a year to see all these fashion shows and stuff. And so, when you, when you're in Paris and you're shopping around, you go to these flea markets like right around, I don't know, 12 or 1 o'clock. Everybody just decides to forget about money. They forget about commerce. They don't give a hoot if you're going to buy something from them or not. They all pull out these card tables, a bottle of wine, and a really nice meal. And they sit down and they eat a meal, and they take a while, you know, half an hour, an hour, an hour and a half to just enjoy a leisurely lunch in the middle of a work day. Of course, the Americans are all walking around going, "Get off your asses, you French people, and work!" You know, "We're here to work. Why aren't you working?" But anyways, that is a way to improve your stomach, gallbladder, and pancreatic secretions. You sit down, you get out a tablecloth, you take a deep breath, maybe three deep breaths, you chew your food well. You don't have to chew it obsessively, but you just relax and chew your food well. And then a very important part is when you're done eating, you take, okay? You don't have to be like the French. You don't have to take an hour and a half to do this. If you're an American and you like to work hard like I do, take three or four minutes after your meal to just sit there and enjoy the fact that you just had a meal. And those few minutes after you eat, and that chewing, and that semi-relaxed eating will allow all these secretions to come out. If you cram the food down, you don't chew well enough, and you rush off to do your next thing, your gallbladder, pancreas, and stomach aren't, people are going to do what they're supposed to do. Okay? So, that's the lifestyle change you can make. And that's shockingly effective. We have patients all the time that, but they just learn how to eat properly, and then all of a sudden, all these chronic digestive problems are gone. I really like to use supplements because I have, I think it's kind of fun to prescribe supplements, and I enjoy it. But, um, if you're willing to make lifestyle changes, you know, that can be equally or more effective.

All right. Oh, and I'm going to show you a couple other things here. One is that we have, uh, obviously not, oh, there you go. We have Jennifer, who is our certified health coach, who is great, and you will love. If you're interested in becoming a patient, you can do a free 15-minute session with her. And, um, just go to the website, KalishWellness.com, and click on the schedule free consult button. And you can see if, um, you know, whatever's ailing you or whatever you're curious about would be a good fit for what we're doing here. Okay?

And in case those you don't know me, I forgot to do the intro slide, but I'm Dan Kalish. A little late for this one. But, um, I've been practicing for a long time. I'm teaching a lot now through the Institute for Functional Medicine. I've done research with Mayo Clinic. I'm doing all kinds of crazy projects with all these scientists. And very, very interested in the microbiome and how all this works. So, if your stomach, pancreas, or gallbladder are not working well because you're rushing through your meals, or because there's just something wrong and you have an infection like H. pylori, where your gallbladder is all gunked up because you ate a lot of fatty food, or something's going on, then you're going to have a microbiome imbalance because those organs aren't working well. You could call it SIBO, you could call it whatever you want. It's going to be an unpleasant digestive situation. If you can get those organs working well, and the problem goes away, then problem solved. If not, then you can do more investigative work and look in more detail at the microbiome itself. Okay? And that can get pretty interesting too. But don't forget that these most basic things like chewing your food, or taking some betaine HCl with pepsin for your stomach, or chewing your food and taking some pancreatic enzymes if you need them, or chewing your food and relaxing and not being angry all the time and taking a little gallbladder support. Those things can be really powerful. And a certain percentage of people will get better just from that. It's shocking, you know, just from the lifestyle changes and a couple of little supplements. And again, you can measure all of this on these labs, which is a beautiful gift that we can actually see that, you know, I mean, that's a really, really cool thing.

Let me show you one more example here. Here's another lab, a company called Doctors Data. And they put up right, right up front, you know, key findings here. They'll talk about the microbiome. And there's some code words here you need to know, you know. But if you have, for example, short-chain fatty acids that are out of balance, then you're going to have to deal with fiber. If you have some of these bacteria that are out of balance, you're going to have to deal with getting the microbiome organized. And you'll see on these tests, like the one from Doctors Data, there's Genova Labs, there's the GI-MAP lab. They have these really complicated reports with tons and tons of these bacteria, right? They're pretty impenetrable and difficult to understand. Okay? But then the companies all also have, in addition to this complicated stuff, they really, it doesn't take much to determine what it means, stuff here. Here we go. And it's pages and pages of information. This kind of trips up doctors. It's almost too much for some doctors. But here's the page that we want. So, remember we said if elastase is out of balance, you need pancreatic support. If fat is a problem, gallbladder support. Okay? Some of these markers will tell you if you're inflamed or not. Some will tell you if you need more fiber or not. So, you can also through these tests, not only see bugs like parasites, bacteria, and yeast, but you can also see if you're eating the right foods or not. So, I can tell by looking at someone's labs if they're eating enough vegetables. I can tell by looking at labs if they're eating enough polyphenol-containing foods or enough foods that have fiber in them. Okay? Because if you're under-eating fiber, your short-chain fatty acid levels are going to be off. If you're under-eating fruits and vegetables, these polyphenol markers are going to be off. So, it's really important that we get the lifestyle stuff dialed in, and that we're not really just relying on doctors and supplements and all this kind of stuff over and over. Okay?

So, I want to show you a few more things about the microbiome, and then I can open it up for some questions if people have questions. And we'll talk a lot more about the microbiome in future classes too. Okay? So, assuming your stomach, gallbladder, and pancreas are all working really well, and your small intestine is happy because you're getting all these secretions because you're eating like the French do, and you're just relaxed and having a healthy meal, and you're not eating on the run, right? You got all that figured out. You're chewing your food, you're hydrated, the lifestyle stuff is all dialed in. Again, that's the most important first thing you can try. If you're doing that for months and you're not getting any better, then we kind of start to think about, okay, is there something that's actually broken here? And what's going on with the gut bacteria that we may be able to, you know, adjust or fix? And so, there's a couple super important things about the microbiome that are, I think, fascinating. One is that your good gut bacteria direct T cells. T cells are news a lot now, right? Because they're very important aspects of your immune system. So, you have these things called regulatory T cells that are on the inside of your body. And out here is the tube of your intestine, right? This is your gut here, the inside of the tube of the gut. And these gut bacteria sneak through your intestinal tract lining. This is amazing. This happens. And they direct and control these immune regulatory cells. The gut bacteria in your intestinal tract reach into your physical body and tell your T cells what to do. And if these gut bacteria are not present, your immune system gets lost and doesn't know what to do. So, this is, this article I was reading earlier today, it's like, who, you know, is this idea of symbiosis where you have an organism like a bacteria, and it's getting a free ride in your intestine? I don't think so. It's arguable who's benefiting more from this. Our immune systems inside our bodies, not inside the gut. Our immune system physically inside our body is directed and controlled by bacteria that are outside in your intestinal tract lining. That's insane when you think about it. Our immune systems are dependent on these gut bacteria in order for our immune systems to know what to do. That's a high level of symbiosis, right? It's a dependence, total, total dependence.

If that wasn't enough, these healthy organisms maintain the lining of the gut. And some of you may have heard this term leaky gut, right? So, that, this is, or, you know, the inflamed gut. Let me just blow this up a little bit. You can see this. This is so crazy, you guys, that this even happens. I can't believe this. When I first learned this, I was like, "No way, this could really happen." And this is all just straight science. So, in a fiber-rich diet, what they're trying to show here is you're eating a lot of fiber, fiber from beans, fiber from vegetables, fiber from grains, wherever you're getting your fiber. And what do these bacteria do with the fiber? They take that fiber and they turn it into fat. That's the, this is true. They treat it. The bacteria take the fiber and they break the fiber down in their own little bacterial space, right? They're doing this for themselves. They're feeding on the fiber. The fiber is a fuel supply for them. And what they spit out from their bacterial bodies, what they don't need, is this stuff called short-chain fatty acids, which is fat. So, they can take fiber, convert it into fat. But this is a very special, very good kind of fat. I showed it a minute ago on the lab examples. It's this thing called butyrate. Some call, some of these fats are propionate or acetate, but they're short-chain fatty acids. But they're basically fats that have this massive anti-inflammatory and immune-enhancing impact. They're really, really, really important for us. And they're the main energy supply for the entire intestinal tract lining. So, again, you eat fiber, like some beans. Your bacteria, the good bacteria in your gut, grab that fiber. They pull it inside their little bacterial cells, and they convert it for their own purposes into energy. And then they spit out the waste product are these short-chain fatty acids or short-chain fats. Your body just sucks those up, uses those for energy, uses those to regulate the immune system and whatnot. And we can measure all this on these labs. That's how crazy this stuff gets. That's, let me just show you again, it's right here. Um, you can see on this one, butyrate, acetate, propionate, short-chain fatty acids. And if these are low, it means the person is not getting enough dietary fiber. So, these bacteria can't turn that fiber into these fats. It's wild that your body can do this, or that these bacteria can do this.

So, in addition to that, if that wasn't enough, there's this thing called mucin. And mucin is this thin layer, right here, they're trying to show it. It's the red stuff here, okay? And one of the jobs of some of these bacteria is to maintain the health of this mucin layer. They actually make this mucin layer healthy. And if you don't have enough fiber and you don't have the right kind of bacteria, then you can see that mucin layer starts to degrade. And when it gets really, really thin and messed up, then bad things happen. And we get something called leaky gut, which means the cells become overly permeable, they get spaces between them, and all kinds of negative, horrible toxins and food antigens and stuff leak into your body and bloodstream. So, this thin mucin layer here is protective. And that is maintained and controlled by the gut bacteria. They're doing that for us. And if you don't eat enough fiber, then the gut bacteria are like, "No, I don't think this is working for me anymore." You know, "You should have had the beans and spinach instead of the potato chips and french fries." If you don't have the fiber, right? Then the mucin layer gets super thin, you get leaky gut because the bacteria aren't happy. So, again, it makes you wonder, like, who's benefiting more from this? Okay? Yeah, we're feeding them fiber, but they're giving us back in return mucin to control and prevent gut damage and prevent inflammation and all kinds of health, health problems like Crohn's disease, irritable bowel syndrome, irritable bowel disease. All these things can be prevented if the microbiome is balanced, just by you eating fiber, right? And then, um, they're also making all these short-chain fatty acids, which is a major fuel supply for our gut lining cells. So, it's pretty profound how these things work and how this all ties together. Okay?

One or two more thoughts. I'm going to wrap it up. So, and this is some, this is kind of like something I talk about with the doctors, but something I realized this morning, which talked about with you guys, maybe even more, more important for you all, which is that when I go to conferences and I teach, and I did this a couple, I've done this, you know, 10 or 20 times at least, and I'll have like a group of 50 doctors in the room, and I'll say, "Okay, how many of you accept the central tenant of integrative functional medicine that GI issues are a really big part of every person's health? And that the microbiome is responsible for people getting overweight? If the microbiome is messed up, people can get diabetes, they can have neurological problems, they can be depressed, right? You can Google microbiome and cancer, and you can Google microbiome and cardiovascular disease. And there, the microbiome plays a central role in all these different health conditions." And everyone sticks their hand up and says, "Yeah, I believe that." And then I'll say, "Okay, well, then how many of you, you know, test all of the your new patients with the GI test?" And last time I did this was in Arizona, and there's like three people that put their hands up out of this huge room of like 100 doctors. And they're all three in the back row. I was like, "Oh, I know those guys. Those are guys that took my class." So, basically, out of like 100 people, 97 of them didn't do this. Three of them did. And it's because they took my training program, and I kind of wail on people and yell at people to do this all the time. So, if you believe that the GI is the center of central importance, then you have to run a GI test as a screening test on every new patient. It doesn't matter if you have toenail fungus as your main complaint, or if you're depressed, if you have an autoimmune problem. If you're seeing a good functional medicine doctor, they should just write out a GI, say, "You have toenail fungus? I think we should check your microbiome because maybe something's going on there." Or, "You have depression? I think we should check your microbiome." This is a core central test. This isn't something that it's kind of like an optional, "when you feel like it" type of test, right? It is really, really important that you do this as a basic screening tool. Okay? So, you can use that as a litmus test to see if the functional medicine doc that you're working with has their act together or not. And I'll tell you, the 95% of us don't. You know, it's very difficult. One thing about from the doctor's perspective, they're trying to sell you, the patient, on a test which you probably don't think that you need because you don't have tummy problems. Now, if you have a digestive problem, it's pretty easy for you to understand that you need a digestive test. But if you believe that the microbiome is really important, you can maybe let your doctor off the hook and say, "Hey, I know this is a little strange because I don't have digestive problems, but could we do a microbiome test?" And the doctor will be like, "Yes, thanks." Because it's awkward and hard in the doctor position to convince people to do things that don't make a lot of direct sense, right?

Okay, a couple more thoughts here. I like this thing called Labs, the Lifestyle. You know, which is basically like, we're taking these lab reports. If you want to test yourself, and then we're explaining how, for example, like I just showed, short-chain fatty acids being low means you don't have enough of those bacteria. That means that you're not eating enough dietary fiber, and you need to have a cup and a half of beans every day. It'll fix that problem really quickly. Or on some of these fancy labs, we see these low polyphenol markers. That means you need more polyphenols. Polyphenols are found in a lot of fruits, vegetables, right? Green tea. The poly, the really rich polyphenol foods would be cranberries, blueberries, um, the really dark, rich thing. Oh, green tea has a lot of polyphenols. They're everywhere, really. But there's certain foods. You can Google like high polyphenol content foods. And those polyphenols are molecularly large structures. So, when you're chomping on that blueberry, the polyphenols in there are physically large. So large that's hard for them to get across the intestinal tract lining into your body. Your body doesn't absorb them very well. But guess what? These gut bacteria love polyphenols. And so, they proliferate when you eat a blueberry. They proliferate when you eat a cranberry. And it's a beautiful system, right? You eat these fruits and vegetables, not even really for yourself. You're eating the blueberries, cranberries, and stuff like beans, etc., so that the bacteria in your gut can have a happy time because they're in charge of your nervous system, your cardiovascular system, and all these other things. Okay?

So, these are the two, two sort of big issues, right? Number one, how you eat. Not just what you eat, but you know, eat like a relaxed person who, even if you're not, and just fake it, you know, chew your food well, make sure you have plenty of water before your meals, not with your meals, and make sure that you spend two, three, four minutes after a meal letting all these secretions start to do their thing. Figure out the lifestyle part. If that's not enough after a few months, you still feel pretty bad, then find a doc that can order some of the stool testing, and you can start to look a little deeper into some of those examples. Do you have a gallbladder, stomach, or pancreatic problem? Do you have a problem with not enough fiber or polyphenols in the diet? You know, where is this all coming from? And from a lifestyle standpoint. And again, just to give you a little perspective on, um, you know, where we're at in our industry in general, is that as practitioners are coming into functional medicine, and I train a lot of them in my classes, right? There's, um, a really sincere, passionate desire to get to what we call root cause medicine. So that instead of just prescribing drugs all the time, doctors can someday, in our, you know, dream world here, really understand the underlying root cause of health problems, many of which come right back to the diet and the microbiome that we're talking about today. And that they, you know, the practitioner in the future can can see this as the central issue. But it's really difficult in the beginning years of practice to figure this out. And so, you can make it easier on your practitioner, just not by demanding, but by just, you know, saying that you're open to doing this kind of stuff and saying that you're open to to making this commitment to your health by doing a GI test. Okay? There's at least three great companies that I work with regularly. I order labs from all these companies. One's called Doctors Data. They have a very advanced microbiome test. There's a GI Effects from Genova, equally advanced. And then the GI-MAP, which is this DNA PCR test. So, you have a lot of different options out there when it comes to the potential treatments and assessments. Okay?

So, quick reminders here. You want to go to KalishWellness.com. You can sign up with our certified health coach, Jennifer, for a free consult for 15 minutes. Talk to her about your microbiome and the kind of testing that we do, and if you'd be a good candidate for coming to our practice. And I work with patients exclusively on the phone. People all over the world. So, you can do this from wherever you are. Okay?

So, I'm going to wrap it up for now, and then I'll pause for a moment here, and then open up for questions if you have questions. You can raise your hand or type in a question.