How to Correct Microbiome Imbalances: Three Stages of GI Dysfunction

Hello everybody, and welcome, welcome, welcome to our winter mini-series. I'm Dr. Dan Kish, and I'm here today to talk with you about the microbiome and how to correct microbiome imbalances, looking at these three different stages of GI dysfunction. And I want to thank Vibrant Labs, Vibrant Wellness Lab, for helping us put this on.

So, I went to visit Vibrant a couple of months ago. It's an amazing company, it's an amazing place, and an amazing group of people. And I just want to call them out as a, um, a group that we should be supporting. You may not think about it this way, but the lab companies in our industry need our support by us ordering their labs. And, you know, once you get to know these lab company folks really well, as I have over the last decades, you realize, hey, they're running a business, and so are we. But, you know, they really need our help, they need our support, and we should be ordering as many tests as we can, all the time, because you're going to get better patient outcomes the more that you test. And we'll have a more sort of vibrant, to use the expression, a vibrant community, right, of of of companies that support us and, um, and our patients. So, we take these companies for granted, but I'm just saying we shouldn't. You know, and we want to be, uh, on good terms with them and support them with our patient work.

So, a little bit about me. I've been around for a long time, and I want to welcome all of those of you that are new. Uh, this is your first Kish Institute webinar, welcome. I've been training, uh, functional medicine doctors, uh, since 2006 in my own training program. We've got about 7,000 practitioners that have taken our various courses, and I've done all kinds of work, uh, you know, outside of the training programs that I've developed. Had worked with the Mayo Clinic very carefully, uh, did a research study with them that took a couple of years. I've worked with some of the really top SST in our field. Have been very fortunate. Richard Lord, we're going to talk a lot about his work today on the microbiome. He was, uh, the scientist really that first envisioned doing a, this, a long time ago, it's like 20, 30 years ago, envisioned doing a DNA-based test for the microbiome for integrative medicine. And so, he and I have worked together for the last 12 years very closely, and I've learned a lot of what I know about the microbiome from him. I've also been in practice forever, it's like 31 years now. I'm IFM certified in all that good stuff. Have been, you know, sort of a veteran of the industry.

And we put together with Vibrant a super special offer. So, if you like what you're going to hear in this next hour, you should check out this class that we developed together, okay? And so, the Gut Zoomer test, which we're featuring today, uh, you get a free test if you sign up for this class. We're also, that's Vibrant's contribution, and thank you Vibrant for doing that. And then the Kor Institute is offering you guys 30% off of our normal fee. So, this is like a $1,199 class. And if you take off the $500 for the free Gut Zoomer test, thank you Vibrant, you take off the 30% discount that we're giving you, you end up paying like $300 bucks or something for this class. That's really something. We normally sell for $1,200. So, a holiday special. Think about it this way, um, you save $800 bucks on a $1,200 course, and we can't really get much better discounting than that. So, if you're at all interested in learning how to interpret microbiome testing, scan that QR code, sign up for the class, use that discount code there as well. If you lose it later and you want to sign up tonight, we'll be emailing you this information as well.

And this is all new material. I spent 12 years working with Richard Lord to understand the microbiome. I've taken it all in the last year or so and dumped it into this class. It's a short class. You're going to think, wow, Kish, really, it took you 12 years to figure this out? Yeah, it did, because it's a complicated subject area. And what I try to do in this course is simplify it so you can apply it clinically. You can explain the microbiome to your patients, you can explain the lab results and what they mean to your patients. And so, at the end of this class, this boot camp, you know, you have a real structure for interpreting the lab, designing programs, and explaining it to your patients. That's the goal. And we get deep, deep how the microbiome affects various nutrients and how you can analyze those nutrients on other kinds of tests as well, like the Vibrant Organic Acids Profile. So, there's a lot of tie-in here. It's not just about, you know, gut testing only, but really shows you how metabolic issues that you're seeing in a lot of your patients directly relate to these microbiome results. And it'll open your eyes to how you can also start to do organic acids testing as, as part of an overall solution. So, anyways, I put a dozen years of work into this. It's a couple of month class. You get a ton of information and, um, uplevel your, your skill set so that you understand the same way that I understand, based on being taught by Richard Lord. So, I'm condensing my 12 years of experience into a couple of months. So, it's a boot camp. Like, it's not like an easy class. You gotta, like, listen to the lectures. You gotta come to the live calls. We'll have a series of live calls where we're going to be reviewing your labs. You submit your lab test, we're going to look at the Gut Zoomers and show you how to work with, uh, the patients that and cases that you have in your own practice. And we also very much encourage you, if you haven't done a Gut Zoomer test on yourself yet, grab that free test, run it on yourself, run it on a family member, and then come to this boot camp, and we'll interpret it together, okay? That's the whole point, get you sort of engaged and, uh, involved in the work that we're doing here.

All right. So, now we're going to have, um, I'm just trying to keep this simple because it's a complicated subject, and everything that I'm about to say is hopefully in the same general language that you could explain this work to your patients in, okay? Because if you really read enough scientific papers on the microbiome, you start speaking Gobbledegook, you know, and then your patients kind of glaze over and don't understand. So, we want to kind of dumb this down to the point where you can be articulate and, uh, accurate in your explanation, but also understandable. So, we're going to zip through these slides. I've got a bunch of slides at the end. We're probably not going to get to all of them because I tried to pack a little bit too much in here. But, um, let's just jump in. And some of this is sort of self-evident, so I'm going to go through the basics kind of quickly, assuming you guys have, uh, you know, some pre-knowledge about this.

So, 40% of people worldwide are affected by GI disorders. That's not a good thing, and there's a citation for that. Meaning that, you know, in your practice, probably more than half of the people you're working with have a GI, a functional GI disorder. That's, call it anything from heartburn to constipation to diarrhea and all that good stuff, okay? And so, what's going on with there with that problem is that there's an issue that starts to, a large extent, with the microbiome, with a good gut bacteria, that couple of pounds of good gut bacteria not performing properly, not being in the right balance. And how do we know this? Because we test people. I've tested thousands and tens of thousands of patients, and it is rare and remarkable when, in my mentorship class that I lead, we get a normal microbiome test. And it happens. And it happened, in fact, this week, and it was one of the doctors testing herself, and her test came back perfectly clean on the microbiome part of her lab. And I described to her her diet. In other words, I reverse-engineered it. I saw what her microbiome looked like, and I told her what she ate, and she said, "Yeah, you're right." I was like, "Okay, well, good on you." So, in other words, if you eat the right foods for like 20 or 30 years, your gut microbiome is going to respond to that, and you're going to see that on the test. You can literally see what people are chewing on based on what bacteria are in their gut. I mean, that's kind of cool. You can even, you can do that.

But how does it actually work structurally, you know? So, it's a lot of, I'm going to just summarize this for a minute in case you space out later. Just a quick summary is that there's a gazillion of these organisms, organisms in there, and they all have their different functions that they contribute. And guess what? They interact with one another also. And not really for our good, necessarily, for their own good, right? They're doing their own little bacterial things. They may be producing short-chain fatty acids, they may be producing pantothenic acid or vitamin B5, they may be producing B12, they may be, um, you know, chewing up the mucosal layer of your gut to keep the inflammation down and keep everything kind of healthy there. They may be sending little tendrils into your body and telling your immune cells what to do. There's a lot of command and control of these bacteria over our tissues. And when you start to study how the microbiome actually works, you realize that we're kind of along for the ride here, right? These bacteria are, to a large extent, directing a lot of immune functions, metabolic functions. They have a fair amount of control over your brain, okay? For you, think that's good or bad, I don't know. It just depends on what you eat. And if you're eating well, it works out. And if you're not, then really bad things happen.

And so, just want to start with a central premise that 98% of the people that we test are not eating in a way that supports what the microbiome really should be doing on its best day. And that primarily, you want to work with diet. I'm not going to talk about diet that much anymore after this. We're going to kind of gloss through that, but because I want to get to the portions that look that show you a clinical model for treatment. But we're assuming you're doing a lot of good things with diet. I have three stages of GI dysfunction. It's easy to remember. It's microbiome, GI organs, and GI pathogens. Stage one, microbiome. Stage two, GI organs. And stage three, pathogens. So, microbiome, there's only one microbiome, that's easy to remember. And there's a few treatments for the microbiome that you can do. We already mentioned diet's the most important one, but we're going to get into, like, supplement treatments. So, for microbiome supplement treatments, we're thinking about prebiotics, probiotics, and butyrate. Prebiotics, probiotics, and butyrate. Polyphenols and fiber are the prebiotics, right? So, prebiotics, i.e., polyphenols and fiber, probiotics, and butyrate.

For the second stage, where there's a GI organ involvement, there's not that many organs. It's your stomach, your pancreas, your gallbladder, your intestinal tract, your immune system in the gut. So, there's separate treatments for each of those, but there's only like four or five. And then on the pathogen side, which is a stage three, it depends on the pathogen, right? There's antibiotic treatments, there's, um, other kinds of medications for some of the worms. You've got all kinds of natural herbal treatments, you know. So, you have a whole bunch of treatments on the pathogen side, but those are the three biggies.

So, stage one again is microbiome disrupted by our lifestyle. And it could be that the person's an alcoholic and in a bad relationship. Every single alcoholic has just an absolutely destroyed microbiome. And I know that because I've tested hundreds and hundreds of alcoholics and recovering alcoholics. It could be as, um, over exercise or under exercise, of course. It could be related to food. Food. And once that microbiome is disrupted, you run the risk of other problems starting to happen. Stage one leads to stage two, which is now where the immune system and the GI organs aren't working that great. Your stomach isn't making the right amount of hydrochloric acid. Your pancreas isn't making the right amount of digestive enzymes. Your gallbladder, it's just like, whatever on the bile production. We had a couple cases like that this week in class where the main patient problem with their microbiome being screwed up was that they didn't make enough bile. The lack of bile produced by the gallbladder will cause bacteria in the small intestine to overgrow because one of bile's main roles is to keep those bacteria in the small intestine out of, you know, under control. That can then lead to problems either with SIBO or problems downstream with other parts of the gut. If you're in a stage two for a long time and your immune system is disregulated, what's going to happen? You're going to get an infection. It's kind of obvious, right? If your immune system is not working really well, then you're going to get an infection. And nothing else can really happen. I mean, this is like a trajectory upon which our patients are on. Microbiome disrupted, immune system disregulated, get an infection. And so, those are the three different stages. You can treat the microbiome, treat the GI organs, or treat the infection, or perhaps treat all three.

And today is kind of really designed to just sort of present the model to you. The boot camp is to show you how to make it work. If you've ever driven a car that has a stick shift, I hope all of you have. Some of you may be young enough that you don't know how to drive a stick, but remember the first time you drove a stick and you look down on a stick and it has that little diagram and it shows first gear's here, second gear's, that's kind of what today's class is about. It's just to show you the diagram, okay? But what I want to do in the boot camp is like shift into first gear and shift into second and learn how to use the clutch. I want you to see how to use all these component parts that we're talking about in real time with your patients so you can apply this in your practice. Today is more theoretical, but I just want you to know the boot camp is very practical. It's like, here's the lab, here's what you do. Here's another lab, here's what you do. And you guys are going to be getting free labs. So, there's no reason why you're not going to have a lab to submit because it's, you don't have to pay for it. All right, thank you Vibrant again for doing that. The goal here is to get you to see how important these things are so that you can start to do this work with all your patients.

So, again, stage one, the microbiome is disrupted, usually from diet. We talked about that a lot. And it can also be related to lack of sleep. It can also be related to lots of stress. And overall, it's the lifestyle stuff that triggers all this. So, then obviously, we want the healthy lifestyle to be restored. And a lot of what we do in functional medicine, as you guys know, is to do lifestyle coaching. Now, a stage two is where the microbiome's been a problem for a while due to what? Lifestyle. And now the organs are actually involved. So, you're not making enough stomach acid, your pancreatic enzyme levels are dropping, you can see all this on the lab testing, we test for this. You have some what we call leaky gut, or the immune markers are off. Now, you know, okay, this is a little more serious. The organs are getting involved. And of course, you have to then not only do the labs for the organs, but then correct the, or organs separately. Pancreas, gallbladder, immune system. They're different supplement protocols for each. And there's so much research on this now, like you couldn't, you know, there's more studies than any of us could ever read on each of these subject areas related to the microbiome.

Now, if the immune system is down for a long time, if you're not making enough bile, just think about it. If you're not making enough hydrochloric acid, what, when one of the roles of the hydrochloric acid is to keep bad bugs from getting in from the food that you just ate or the water that you just drank? So, right away, low hydrochloric acid, you're more susceptible to infection. I mentioned already, if you don't make enough bile, and this one is missed more often than not, people always just miss the gallbladder problems. But if you don't make enough bile, the small intestine bacteria can overgrow because one of the roles of bile is to keep that under control. If your immune response in your gut is busted up and not working well, then clearly it's easier for a pathogen to get a foothold. There's a study that was done that I learned about like 30 years ago, and it was old then, was like in the '50s or '60s, and it was done in a prison. And they, I don't think they could do studies like this anymore, but they did it back in the day. And they gave a group of like 20 or 30 prisoners, prisoners, yeah, kind of not a great study, but anyways, they gave them all a glass of water full of Giardia. And of course, everybody got sick. And then they tracked what happened to them over time. And the ones that had good secretory IgA, good immune response, a good immune response, were able to get sick for a few days and then kick out the Giardia. And guess what? The ones with a poor immune response, I mean, everybody got Giardia, right? They had to. So, the ones with the poor immune response still had Giardia many, many, many weeks later. And for us in our practices, it can even be, yeah, months or years later, that patient walks in, 12 years ago they drank some bad water or ate some bad food, and now they still have an infection. That's going to happen. So, the weaker your immune response is, the more you're going to have problems with infection. And why do we have a weakened immune response? Because the organs aren't working very well, right? And why are the organs not working very well? Because the gut microbiome isn't in great shape. So, you can see how these three stages relate. And then you can think about how they each make the other worse. So, once you get a bunch of GI infections, the microbiome is even more disrupted. And so on.

But this also shows you what the potential treatment options are. Just intuitively, you can see that, oh, for those of you that joined us late, there's this boot camp. I keep mentioning it. It is a $1,200 class that you get for 30% off, plus you get a free Gut Zoomer test. Thank you, Vibrant Lab, which is worth $500 bucks. You scan that QR code there, you can sign yourself up. It's going to be limited in terms of the number of people because part of the class is going to be a series of live Q&A calls where you guys submit these tests and we review them and design protocols and programs for you. So, it's a sort of active participant-based workshop kind of learning. There's also going to be a very extensive online lecture series that I put together, which describes in detail how the gut bacteria are produced and what they live on and what they do and how they relate from a clinical perspective, especially to metabolic health, but also to immune health and the different inflammatory problems we see with patients. This is brand new material. It's a culmination of a dozen years of work or so of me working with Richard Lord to really, really put together, uh, a clinically actionable understanding of the microbiome. It took me a long time to wrap my own mind around it in a way that I think I can teach it. And, um, I know you guys are going to love this class because this stuff really works. How do I know it works? Because I do it in my own practice. We have hundreds of mentorship students that are doing this work as well. So, highly effective clinically. If you're interested, you can sign up. It's going to be starting in mid-January, okay? Uh, in fact, we talked about that.

And then the feedback loops, right? One makes the other worse. So, now this is the hardest part of functional medicine. When I watch practitioners learning how to do functional medicine over the years, which I have been doing, you know, for almost 30 years now. [Music] Um, oh, and please, I forget, please ask questions. Type them in. We'll do questions at the end, okay? So, you have a question, type it in. I'll get to it at the end. Um, and this hardest thing to understand is that the vast majority of people that you are working with right now that have really bad microbiome problems have no digestive symptoms that they're aware of at all. And I've said this thousands of times. We have a doctor in our mentorship program, I won't mention his name, but he has heard me say this hundreds of times. He's been in the class for a while, my more advanced group. And then he himself developed a pretty serious skin problem. You know, he's a medical doctor, he's not a bashful about going to, you know, med, regular medical treatments. And it was not looking good. I mean, you know, it's like staring down the barrel of hospitalization and some pretty serious procedures with his skin problem. Like, really, not like a rash, this is like a serious medical problem with his skin. He did a GI test, no GI symptoms, fixed his GI, and this very strange skin problem just completely disappeared. So, we had that in class, and it was really great for all the students to hear because it was like a testimonial of this doctor himself, just saying, "I had no idea I had this GI problem. I had no idea it was going to cause a skin issue."

Do most diabetics know they're diabetic? No. Do most people that have like an early stage of a tumor developing know that they have cancer developing? No. Do most people that have their arteries that are starting to get clogged, you know, 10 years before they have a heart attack, are they aware of it? Never. If they were, they wouldn't have a heart attack later in their life, right? So, it's very common in medicine, all of medicine, to not know that something is happening that's really horrific in your body, whether it's a tumor or diabetes or it's blood vessels that are getting all gunked up. It's no different with your gut. The vast majority of patients that you have right now that have a big microbiome problem have no GI symptoms. So, if that's true, which it is, and I promise you this is true, this is not my personal opinion, this is born out by centuries, literally, of naturopathic treatments and decades of functional medicine testing and tens of thousands of functional medicine doctors, all anyone who's senior in our field, has been doing this for 10 or 20 years, you know, would agree with me because you just see this all the time, okay?

So, if that's true, who should you be running a Gut Zoomer test on? Most, almost all practitioners just run these gut tests on patients who have gut symptoms. That is absolutely not the point of functional medicine. The whole point of functional medicine is that everybody has a microbiome, and you have to know the status of that microbiome. If they have a neurological issue, Parkinson's, Alzheimer's, you know, tremors, do a gut test. If they have an autoimmune condition, you have to do a Gut Zoomer test. Any kind of hormone imbalance, anything from insulin resistance to adrenal issues to a thyroid problem to low testosterone problems with estrogen, progesterone, you have to do a gut test for all these cases. And most of the ones that have a really messed up microbiome are not going to, at the present moment, have GI symptoms. Now, when you talk to them about the infection or the this or the that, you're going to figure out the history, and maybe in the past they had GI issues, okay? But a lot of, most of the people, people that need these tests are not aware that they need these tests. And that is kind of problematic, to say the least.

So, the lifestyle changes that we want to make. Elimination diet. You can do gluten-free. You can do a low-histamine diet. I mean, there's a million different versions of this, but you want to do something to shake up their food. You have to get exercise going. And I think that's one of the harder things to do with most of our patients is to figure out what's the best exercise program. You want to address sleep, obviously, for gut repair. Deal with stress. So, if people are going into each one of their meals stressed out of their mind, then they're not going to be making enough hydrochloric acid, they're not going to be, uh, making enough pancreatic enzymes, they're not going to be making enough bile. The production of those secretions, to a large extent, is blocked due to stress. The majority of the stimulus for us to make hydrochloric acid, to make bile, and to make pancreatic enzymes is coming from the brain thinking, "Oh, I'm sitting down to eat now." And if you're sitting down to check your email and you happen to also be eating, then it's not going to go very well. So, it's not complicated. You just have to take a deep breath before you eat, you know, or put the computer away, or don't eat while you're driving. I think one of the best traditions that humans have developed is sitting around the dinner table, holding hands for, you know, 30 seconds or a minute, and just acknowledging their gratefulness. And whether they do prayer, if they're a religious person, or they just connect with each other, just that momentary pause of 30 seconds or a minute out of your life gets your brain to acknowledge what's happening, decreases your stress hormones, and then you start to get prepared, your body starts to get prepared, um, for digesting your food. And of course, you have to make sure that people are chewing their food well. Believe it or not, that can be a huge problem. You know, every practice that we work with has at least one case every year where all they did was help the person learn how to relax a little bit before they eat and chew their food properly, and all of a sudden, you know, lo and behold, it's the microbiome that's better. It's not always the food that's the problem, sometimes it's the way that people are eating, okay?

And then this comes up in class every week too, which is, you know, people drinking so much alcohol, it's just insane, um, you're not gonna, alcohol is incredibly destructive for your microbiome. That for a whole variety of reasons we can go on for hours about, but suffice to say that you're never going to have a healthy microbiome if the person is drinking large amounts of alcohol on a regular basis, you know. And that most of the alcoholics that are in our practice may not have been yet identified as an alcoholic. And so, it's something you always want to bring up and see the person's drinking heavily, have them eliminate the alcohol. And if they can't do that, then you need to talk to them about getting into some kind of, uh, treatment program or therapy or a 12-step program so they can work towards their goals of getting healthy, including the elimination of alcohol.

So, I have this cereal bowl diet, that is actually a picture of the cereal bowl that I physically use, exactly. It's not a replica, it's the exact bowl. And this is kind of silly, but patients seem to like it. So, I've been using this for a long time. And, um, the cereal bowl diet has nothing to do with eating cereal. It's that I want every patient, I just tell them all this, I want you to have a cereal bowl full of vegetables with each meal, breakfast, lunch, and dinner. You know, you can have breakfast vegetables, the kind of things you might put into an omelet, you know, spinach and red pepper, whatever. You can have a salad at lunch. They can be cooked or raw, doesn't really matter. Usually want one raw meal a day, so in terms of vegetables. So, you know, maybe a big salad at lunch, throw in there whatever you want. And then a bowl of vegetables with dinner. And to eat that cereal bowl of vegetables first, get the fiber, WIP fiber, polyphenols. This is like the most friendly thing you could do to your microbiome on the planet. So, if we have them eat, eat their cereal bowl full of vegetables, breakfast, lunch, and dinner, and they do that before they eat any other foods, then it really reduces the overconsumption of carbohydrate and the overconsumption of fatty foods and, and that kind of thing, okay? So, that's a simple trick that patients seem to love.

And then do a lot of work around deep breathing and getting, just people to breathe properly. And of course, you're not going to, you know, be able to, the most common nutritional deficiency I always tell my patients is just simply dehydration. Amazing how many people just get hydrated and then they get better.

So, in terms of stage-specific recommendations, let's take a look here. So, stage one, microbiome problem. And you'll see this very clearly on the lab. Now, we're not going to review labs today. I'm going to spend the extra time after these next few slides are done to answer any questions you have. But in the boot camp, we're going to be reviewing, you know, lab after lab after lab during the live Q&A calls, right? So, if the microbiome is screwed up, and you can look at the Gut Zoomer, it's pretty easy to figure that out. They have all kinds of gauges and charts and, and, you know, the raw data and everything there, and it's all color-coded, it's pretty easy to understand, I think. If that's the main thing that's going on, the first thing that's going on, then you want to figure out how you're going to promote healthy commensal bacteria. Lifestyle and supplements. Lifestyle, pretty obvious, you can just Google that and figure that out. But on the supplement side, we want to get into prebiotics, probiotics, and berate. Prebiotics are fiber and polyphenols in a supplement form. Probiotics, as you well know, we, probiotics, I divide probiotics up into, let's say, three different categories. There's like the regular probiotics of the world, the Lactobacillus type things. There's the soil-based organisms, which are very popular right now and very effective. And then there's my all-time favorite, which is *Saccharomyces boulardii*. I don't know why I love *S. boulardii* so much, it's like an affection I have. It just works really well for so many people. So, three different types of probiotics: the regular kind that we're all used to, the soil-based organisms, and then *S. boulardii*. Don't forget about *S. boulardii*, it's one of the better ones to use. And then berate. Berate is the short-chain fatty acid that the good gut bacteria make. So, taking butyrate, in a sense, in the over the short term, is like, um, it's almost like replacing the gut bacteria that aren't there by providing one of the major substrates that they should be making. And then over time, as a person gets more fiber and polyphenols in their diet, they'll get their own bacteria up to speed to make butyrate. But the short-term butyrate can be extremely effective. Um, it's one of the more powerful supplements on the market now, I think, very powerful. Okay, so that would be for stage one.

Stage two, chewing your food, no fluids with meals, but we want you to be hydrated, you know, taking a deep breath before you eat, and all these kinds of things. And then on the lifestyle, then on the supplement side, if it's clearly a stomach-related issue, you can give Betaine HCL. If it's obviously to do with, uh, gallbladder and/or pancreas, you can either use digestive enzymes or gallbladder support. And remember that gallbladder problems are very often missed. Probably among the GI cases that we review in my various courses, that's the one that is missed the most. And it's very easy to fix. You can just give gallbladder support, and the person gets better right away, you know, that was a gallbladder problem. Plus, there's gallbladder markers, you know, for fat absorption, fat, the ability of the gut to deal with fat, are on the test, you're going to see those, um, so don't ignore them, you know. And then of course, there's leaky gut repair powders. And also in that, I divide those into two categories. So, there's ones that are just more anti-inflammatory, and there's ones that have all the IGG type stuff in them that are more for immune repair. Usually, we want to pick a lane and say, "Okay, we want to do the anti-inflammatory powders for the next couple of months," or "We want to do the, uh, immune stimulating powders for the next couple of months," depending on what you think you want to try to regulate. Obviously, there's a lot of overlap there, um, okay. So, that would be for stage two.

And then on the stage three, again, with diet, but then, um, you're either going to use antimicrobial herbs. In some cases, you may use antiparasitic medications. Variety of choices there in terms of knocking things out. And then if you want to summarize, you're going to test for the microbiome, we want to get people eating the right foods, we're going to test for the different digestive organs, and then test for these different infections.

And then this is a question I want to spend, spend a few minutes on this, and then we'll go to questions, okay? This is the most commonly asked and unasked question from practitioners in my more advanced trainings. Is, I mean, I see all this stuff, okay? It's not that hard. I can see there's a microbiome problem, they got a, they got a digestive enzyme issue, and they have, you know, some yeast overgrowth. But that, okay, so you figure that out in the first few months of learning how to do this work, and you can, you know, learn that in a bunch of different ways. You can just look at the lab report, you can read it, you can call the lab and do a consult, you'll get that information. But then, how are you going to know where to start? That's like the conundrum. And until you've done this thousands of times, it's hard to know where to start. When I first did my first functional medicine test, I completely panicked. I got incredibly lucky. My very first GI test had a Giardia on it, and this woman was very, very sick. She's 29 years old, her name is Nancy, I can still see her face, and she was in graduate school, she's getting her PhD, and she had just been diagnosed with ulcerative colitis. She was a patient of mine already. She got diagnosed with ulcerative colitis. I was like, "Oh, maybe this is my opportunity. I'm going to run a stool test." And she had Giardia. And it got bumped back to her GI doctor, who just didn't believe it, which was kind of not a good thing. And when she was diagnosed with the ulcerative colitis, she was put on some immunosuppressing drugs, so Giardia really flared up. So, she was pretty sick. Anyways, we treated it, and I really didn't know what to do, and I just panicked. Before, I just didn't even understand what my options were. And I called the lab at the time that I was using, and I talked to this, this guy, Dr. Timmons. And he picked up the phone, and we're talking, and he just steered me through everything that I should do. He spent a long time on the phone with me, way more than he should have. And then the next time I did a test, I called him again, and then I called him again. And then it turned out that he lived in the same area, down in San Diego. And then I started to stalk him, and I just went to his office and just spent, you know, the next six years working with him. So, every one of my GI tests I had in those early years was reviewed by just an absolute expert in the area, okay? And so, I didn't have to figure out what to do first or what order to do things. He was just telling me, I would just do exactly what he said. And that's part of why I teach these classes, is because in the beginning, it's scary to order the test if you're not sure how to interpret it, okay? That's one thing. But let's say you can interpret it, but then how do you know how to sequence everything?

And so, number one, doctor experience, your skill, and your confidence level. I know that seems like a strange reason to pick a stage of treatment, but it, you know, if you're nervous about this, you can always start with stage one. You can never go wrong treating the microbiome, never, because that's the origin of the whole problem anyways. And so, if you talk to, you know, how they say, like, what would it be like if you went back in time and talked to your 15-year-old self? You know, and like, uh, if your 15-year-old self was looking at me, it'd be like, "What are you wearing? Why is your haircut like that?" You know? But if you, if you go back to like when I was a brand new practitioner, what did I do? I just did exactly what Dr. Timmons told me to do. That was it. And so, I had the confidence because of what he said to do other treatments. But if you're just getting started, you can never go wrong with the microbiome treatment. And in fact, some of the most advanced practitioners that I know, people that are decades ahead of me, people in their 80s and 90s that have been doing this work for 50 or 60 years, believe it or not, there's doctors around in integrative and functional medicine that are in their 80s and 90s that are still practicing. I've been doing this for like over 50, 60 years. A lot of them start with the microbiome. A lot of them. So, that's not like a cop-out to start with the microbiome. It's just easier in a lot of ways. You're less likely to have side effects, your effects, you're really addressing the underlying root cause. And so, if you're nervous about it and you don't have a mentor yet, you're not in one of my classes where we're reviewing labs, then just start with the microbiome. You never go wrong with that. Once you get more experience, you can get into like, "Oh, this is the best gallbladder supplement. This is the best leaky gut repair product." You can start to treat more of the stage two GI organ-related stuff. And once you really have your stuff together, you know, once you really have the confidence, you're like, "Yeah, I got this. Nancy's in the office, she's got Giardia. I'm recommending this antibiotic, and then I'm recommending an anti-yeast follow-up because I know her yeast is going to get worse right after the antibiotics are done." Once you got that, and or you have a mentor or someone to step you through it, then you can go after the infections at any time. But if you're brand new, it's your first test, like with my Nancy example, if I had treated her Giardia, even if I had figured out which was the right antibiotic and got her to, you know, some internal medicine doctor to prescribe or something, I didn't know at the time that most Giardia patients, when the antibiotics are done, have a horrible yeast rebound, yeast overgrowth, and get even worse with Candida. I didn't know that. So, I probably would have made her worse, you know? But Tim and stepped me through it and said, "Look, you know, here's the antibiotics. Let's get this doctor friend of mine to prescribe them." I'm like, "Great, refer to that doctor." Got the antibiotics. And then he told me, "Hey, right after the antibiotics are done, most people with Giardia, not everybody, but most of them, have a rebound yeast or fungal overgrowth. So, the day that the antibiotics are done, I want you to put her on this anti-yeast program." I was like, "Really?" He's like, "Yeah, you better do it." All right. And of course, I didn't know, but he was able to give me the confidence.

So, that's one factor. Then, in terms of, you know, again, this, which stage you're going to treat, you can also base it on how sick the patient is, okay? So, if they're super uber sick and they have a really bad series of infections, you kind of have to go after the infections, okay? And the MSQ for those who don't know, that's a, it's a questionnaire, it's commonly used, right? So, if they have not too many, a low score on the MSQ, the symptoms aren't that bad, then you can always start with the microbiome and then see where things are at. But if they have like three different autoimmune illnesses and Lyme disease is variable and this and that with heavy, then you usually want to go after the infections in the earlier stage because it's going to really move the needle quite a bit. So, that's another way to look at it, either based on your skill, your, your skill level, or based on what's going on with the symptoms, okay?

And then once you get that figured out, and you're like, "Okay, where am I at on this? Where's my patient at on this? Like, what should I do?" Then you figure out what are, what are the goals of the patient, you know? And it's shocking, some people's main goal is they want to get pregnant. Some people's main goal is they just want to lose weight, you know? So, figuring out how, what the program that you're designing is going to interact with or overlap with what the patient's goals are. And then what are your goals? A lot of times, my personal goals for the patient are not what the patient's goals are. And I always defer to try to meet the patient's goals. But I didn't used to do that. I used to have the main goal of finding what the underlying cause of their problem was and then solving that underlying problem, even if it wasn't what they necessarily wanted. I thought I was an underlying cause doctor, and then I had to find the underlying cause and fix it. And I didn't realize in those years that sometimes I didn't meet the needs and goals of my patient. So, even though I fixed the underlying cause, they weren't happy. And really, my whole point of being in practice is not for some abstract theory of fixing underlying causes, but it's to relieve human suffering so that people feel better. And so, putting that all together, the little bit complicated, another way to think about it, and again, these are, this is different models for you to, you know, one of these, hopefully, it'll stick in your brain and it'll be like, "Yeah, I think I could do that." Well, one, another way of looking at this, another model is to think about, okay, what are the stages that are present? Is there microbiome problem, organ issues, or pathogens? And then I'm just going to treat whatever is the most severe first, and they go in the order of one, two, and three. So, that's definitely a way to do it. If you want like a shortcut, if you want to get results that are the most dramatic and the fastest, then if you have pathogens present and you treat them, that's where the needle moves really quickly for a lot of people, okay? And if you're brand new to this, and it's your first case, like it was with Nancy and me, and it's Giardia, I don't know if you really want to aggressively go after it, you know? You want to get someone, you know, that can coach you through that a little bit so that you predict and understand the consequences of each one of the steps that you're that you're going through, okay?

Um, another skill is that, and this one takes a little while, you know, probably takes people maybe six months to get this figured out, maybe a little longer, is that you, you get a list of, let's say, 40 or 50 supplements that are commonly used in most functional medicine clinics and practices, and you figure out how to explain each one of those products. And we go through this over and over and over again in all the Q&A sessions that I teach where I'll just pull up a list of, you know, 10 different GI supplements and go through each one and explain to the doctors what each one is for and how to use it, okay? So, that's another sort of general skill set that you want to have. And then again, in terms of GI program design, I think for a lot of people, the hardest part is

The patient education, like how you're explaining this to the patient. So let's say you get to this point where you've analyzed the lab, you determine what stage they're in, you're going to treat this and this and that. You've designed a program, you have the, you know, everything kind of laid out. Then you have to explain it.

So in the beginning with patient education, you have to convince the patient to do the test, which is challenging if they don't have any GI problems, right? I mean, it's easy if they have a GI problem, but if they don't, when you're saying, "Hey, I want you to do this Gut Zoomer test," and they're like, "But I have an autoimmune illness." You have to be able to explain to them how the gut is related to autoimmunity. Or if their main complaint is hot flashes, night sweats, and, um, low sex drive, and you say, "I want you to do this Gut Zoomer," you have to explain to them how the microbiome is directly related to female hormone balance, right? So you have to get that first stage figured out, that first, um, sort of problem really solved, which is getting the patient to do the test.

But then, once all this other stuff has been done, you have to explain the lab results. And then you have to do it in a way that makes it so that they want to make these lifestyle changes and that they're excited enough that they're going to go out and buy all these supplements and make all these lifestyle changes. And that takes a lot of, um, strategy on your part is to explain to the person what their actual direct benefits are going to be from doing these things. And it takes a little bit of time to figure that part out, but I think that's a, a key component in program design.

So again, four components: patient education, so they do the test; you analyzing the lab findings; determining what stage they're in; you then designing a program that's based on the lab findings. So you lay, you can't do everything all at the same time. You can't, three can't really, can you? I guess you could. Well, you, you can't really treat all three stages at the same time. So you have to figure out a sequence here. And then being able to explain that all to the patient and tying the lab back to the lifestyle changes. So I call that labs to lifestyle, meaning that I don't know, let's see, um, what's a good example? Let's say if they're, if their, um, gallbladder markers are really screwed up, that you talk to them about how bile is produced and how you want them to relax before they eat and take a minute or two after they eat to allow all their digestive juices to start to flow, right? Or if they have a yeast overgrowth, how you want them to really cut back on the sugar and alcohol. Whatever it is that the lab helps guide you so that you can instruct them on the lifestyle change.

And when you have a patient, let's say that the goal is that everyone should stop drinking alcohol, uh, for at least, maybe not the rest of their life, but say for at least 90 days when you're starting a treatment. If you just say that as a blanket statement, then people are like, "I don't know, this guy tells everybody to do that. That's kind of silly." But if you have a lab that shows a bad yeast overgrowth, you say, "Oh gosh, this yeast overgrowth is never going to clear up unless we have you stop alcohol for 90 days." So that's labs to lifestyle. You've got the lifestyle change that you want, which is cutting out alcohol, but it was based on a lab test. You can do the exact same for sugar. Obviously, if you say to all your patients, "I think everybody should stop eating sugar," nobody's going to do it. But if you have a yeast overgrowth on the lab, you let them know, "Oh my gosh, every time you eat a body sugar, you're feeding this yeast overgrowth. We're going to try to kill it. So for the next 90 days, can we try to get you sugar-free so that we can get rid of this infection?" So again, using the lab to get the person to make a lifestyle change gives you a ton of leverage that you wouldn't already have, right?

And then GI issues, figuring out what stage the person's in, what degree of other GI symptoms are involved. And, and we're going to talk a lot in the boot camp about metabolic function, especially B vitamins and how they relate to the gut and how they relate to metabolism. I'm kind of excited about that right now, kind of cool. And then make sure that you have a patient-centered view on all this. Some patients want to do, um, everything they can all at one time. Some patients are much more one step at a time kind of people. Some patients might say, "This is my most urgent priority," so you want to meet that need. Some people can't afford everything. Some people want to spend money. Um, you know, ironically, some patients, they just, the more they spend on supplements, the better they feel about the program. Other people just can't afford that. So really getting into that patient-centered view and understanding how they're looking at all this. What's the number of pills that they can take? I can't tell you the number of patients that I get in my own practice that I've seen other practitioners who are just overwhelmed. The reason why they left that other doctor and came to me is because they were overwhelmed with too many products and the whole program just fell apart. So hence, stage one, two, and three. You're not going to overwhelm people if you just do a stage one program. It's not enough stuff to overwhelm. But you try to do all three programs, you try to do leaky gut repair, you know, GI pathogen treatment, and a bunch of microbiome restoration at the same time, you're definitely going to overwhelm people.

So again, quick review, thinking about your skill level, the severity of the patient complaints, what stage does a patient have, and then what lifestyle factors are going to fit. You can't make all the lifestyle changes at the same time, but you want to hit the ones that are the most important, like no sugar, no alcohol, those kinds of things, just to meet the patient's needs. Okay?

And then a final step is understanding, you know, I don't, I design every program from scratch when I'm talking to the patient. In the old days, I would design programs the night before and then present it to the patient. And then I realized that it worked a lot better if I designed each program while I was talking to the patient. So we could negotiate how many you're okay with taking, do you want to deal with, deal with, you know, all these problems at the same time? What's your timeframe? What's your attitude towards, like, uh, taking the number of certain number of pills? What are your goals? How quickly do you want this to happen? And really kind of negotiating with them directly as to how the program is going to work. Okay?

So again, which protocols you want to use, it depends on symptoms, your experience, the severity of the problem, on the cost, on patient preference, on time. All these variables kind of put together to make a program that's going to work. So quick refresher: stage one, microbiome; stage two, GI organs; stage three, pathogens. Treating pathogens first, if they're present, is the fastest, but also the most prone to side effects and problems. You can never go wrong treating the microbiome or treating the GI organs. Never go wrong.

Okay, so before we get to questions, just a quick reminder. We have this boot camp I keep talking about. I'm extremely excited about it. I've been waiting for almost 12 years to present this information. About 12 years ago, Richard Lord started to describe to me how the microbiome works. I was excited but overwhelmed, and it took me this long, honestly, to apply it in my own practice and to teach it, you know, here and there before I felt confident enough to put it together into a program. So this is a brand new class. Those of you that already took my mentorship, this is brand new. Those of you that have done level one certification, this is brand new. This is a, a whole new structure and a whole new course that I've never presented before. So I hope a bunch of you guys sign up.

All right, so let's take a pause here for a moment and get to questions, and I'll answer as many as I can. Uh, we have about 10 minutes here. Uh, let's see here. What happened? Uh, yeah, okay. Um, when treating GI infections, parasites, can also give patients prebiotics and butyrate? Yeah, so that's a supplement overwhelm question. That's from Anna. So you can, yes, yes, yes, treat an infection along and also give, you know, butyrate and pre and pro, prebiotics and probiotics, as long as the patient is not overwhelmed by too many products. It's going to go faster that way, and the more GI support you give while you're doing the killing programs, the less, you know, side effects and problems people are going to have. Yeah, this is going to be recorded, and you guys will get copies of a link to the recording.

Um, so what's your possibility of too many supplemental? Catacol, but this is, say, too. So just the bigger picture. This is for Cheryl. This is a classic Richard quote. Any nutrient can be a toxicant. Any nutrient can be a toxicant. So vitamin B1, one of the most powerful nutrients we have. Once you learn how to use B1, you can save lives and reverse some of the sickest people. But if you give too much B1 to the wrong person, you could make them worse. So for every herb and every nutrient that we use, there's a dark side to it, and that's why you really have to study this stuff carefully.

Um, let's see here. Uh, CEs. So Bridget is asking about CEs. I don't offer CEs. You know why? Because in order to offer CEs, you can't talk about specific brands. And in the Gut Zoomer class, we're going to be talking a lot about Vibrant, and I'm going to be making recommendations in that class with exact products. I'm going to tell you the name of the company, the name of the product, and how to dose it. So we're not able to offer CEs because of the practical application there. And it looks like I'm supporting these other companies. I'm pretty company-neutral in terms of supplement companies. You guys can use whoever you want, but I will make specific recommendations about companies there. Okay.

Um, oh, yeah. So this is for Lynn. So you get $360 discount. That's 30% off. The $500 savings is because you're getting a free Gut Zoomer test. Okay? So you're going to pay, I don't know what the dollar amount is, but whatever, $1,200, you're going to, you get a 30% discount, cash discount upfront. And then for the money that you're paying us, you get a free test. Okay? So there's not a separate $500 discount.

See here. Um, everybody's asking about slides available. I don't give out free slides. I don't give out slides during the free webinars, but generally in the paid classes, you get copies of the slides.

See here. Yeah, so Ha was asking a good question, like, um, what about the ethnicity of patients? And so the microbiome is quite common, plag. You know, I have a couple, a married couple, Esther and Harald. They're Americans by birth, but they for a very long time have lived in a small village in Italy. And I knew them before they moved. They're in their late 80s now. I've known this, this couple forever, and it's the cutest thing. Every year they, they do a GI test, and she's always yelling at him. Anyways, they're a very cute couple. And, um, I've known them since before they went to Italy when they lived in the United States. And right now, as we do their yearly reassessment for their microbiome, their microbiomes are almost identical, the two of them, which I find incredibly endearing. And they're very different than they were when they lived in the United States. So apparently, if you move to a village in Italy and eat a lot of basil and tomatoes and drink maybe a little bit of red wine, and you know, you're living your best life on that kind of a diet, it really changes your microbiome. So not only ethnicity, you know, but where you live and what your native diet is. And of course, your microbiome is granted to you by your mother. So your mother's health and your mother's microbiome is going to have a massive impact on what yours is like. In fact, the impact, right? The biggest impact.

Let's see. If the gallbladder is removed, um, you still do the same testing, and if it's indicated, you would give gallbladder support. Some people give gallbladder support for people that have had gallbladder surgery as a matter of course. But I, I think it's worth testing and seeing.

Uh, bunch of you are asking about where the test is available. You have to check with the company on that. I'm not sure. Um, I believe anybody that signs up and pays for my class, remember, you got to pay for the class first, is going to get a free test. We're not going to get all judgy on you. So anyone who pays for the class gets a free test, I believe. Okay? And you can sign up. Just scan this code here. This QR code. You'll also be getting emails and the, you know, very soon, um, with a link. If the whole scan the code thing doesn't work, but it's not that hard. Here, I'll show you. You just grab your iPhone, you hold it up to the QR code there, hit the camera, and then click, and then click on the QR code, and it'll pop it up on your phone. If you can't figure that out, you don't have an iPhone or whatever, then, you know, we'll send you a link so you can just click on the link. And if you can't figure the link out, just email my office and we'll, we'll step you through it.

Uh, let's see. Oh, Alexis has a question here. Do we have time for this? Yeah, okay. If the microbiome regenerates every three days, how long does it take to recover the microbiome to heal tissues, or how long to balance bacteria? Well, I know from talking to Richard that they did these experiments back in the day where he would have people change their diet dramatically and then test their microbiome every day, and they were seeing changes in the microbiome like per meal. This is a long time ago. This is like 15 or 20 years ago. I don't know if anyone's done this research lately, but they were just doing this at the lab for fun. So he was taking people that worked at the lab and having them change their diet radically and then doing the testing on them. And so I've seen this in practice too. If you, we had this guy in my clinic like five or six years ago who hadn't eaten vegetables in like a decade, which is amazing. He was even still alive. Like he had not had a vegetable in like a decade or more. He was in his mid-20s, maybe some kind of entrepreneur guy, he was starting some company, he was kind of rich, but anyways, and he had this horrible GI problem. And so we all we did was get him to start eating vegetables. That was the only treatment that we started with. And then he had all these test kits, and we're waiting to get the test results, you know, getting him to actually do the kits. But it takes a little while to get the person the kits and for them to do them. And within like three or four days, it was the same week. It was like, I talked to him on Monday or Tuesday, and by Friday, all of his GI problems had cleared up because just because he had started to eat vegetables. We hadn't even done the testing yet. So your microbiome responds like to each meal, literally to every meal. It's almost like per bite. Okay.

And, uh, let's see what else. I'm not going to be able to answer all of these. Nutri, I know that brand. They're a good brand. I like them. I've worked with them in the past. I like those people a lot, and it's, it's a good company. Um, now you can use butyrate, obviously, if the patient tests low for butyrate, but you can also use butyrate if the microbiome is damaged, but butyrate levels are okay. It's a little complicated, but you will all get a, you all get a copy of the recording.

Uh, let's see if we have maybe chance for one more here. Let's see. Find a short one. Yeah, specific brands. I can't mention them on today's call, but in the boot camp, we get into specific brands and specific products in extreme detail. Give you a list of every product so you know exactly what to buy from whom. Okay? And then if you have other companies that you want to use, I can kind of translate that for you.

Uh, so when you say start with the microbiome, that's prebiotics, that's fiber and polyphenols, probiotics, and butyrate. Those are the treatments. Prebiotics, probiotics, and butyrate. And prebiotics are polyphenols and fiber. So in terms of detox pathways, anytime you're working with pathogens, you have to take into account detox pathways. That's a question from Kim. And if you want to be on the careful side, just give, you know, liver support for a week or two before you start to go after the pathogen and then continue it all throughout that time. Okay.

Uh, let's see here. Yeah, you can treat, uh, any of these GI infections with non-prescription items. Okay. Sometimes it's better and faster to do an antibiotic. It's better in the long run to not, you know. So it really varies. All right, let's see. There's a bunch of long questions. I'm sorry I'm not going to be able to get them all. If you just Google for Paul, if you just Google MSQ questionnaire, it'll pop up. You can download a PDF right off, off the internet somewhere. Okay.

Uh, let's see here. I think I'm out of time. Well, I am sorry I can't get to all the questions. I apologize, but I hope a bunch of you sign up for this class. Again, it's brand new material. I've never taught before. I'm about as excited of this about this class as anything I've done in the past, and really hope to shake up your understanding of the microbiome and through this boot camp, give you guys, you know, the information that you really need.

If you're not ready for that, we have a free master class also. If you're not ready to sign up and pay for anything, just click on this thing, do a QR code, and we have a free master class for those that just want to learn a little bit more but aren't ready yet to spend a bunch of money. All right, take care, everybody. And you'll be getting emails on all the details on this soon. Bye for now.