Transcription
Hello and welcome, welcome, welcome to our mini-series. We're starting off talking about H. pylori, one of our more popular topics, and we're going to try to keep it short and punchy and clinically relevant and leave some time for questions at the end.
Um, let me just make sure that all our technology is working. I think you guys can see everything okay. So, so much to talk about. Let's just jump in and look at these slides. I could go on for H. pylori for years.
Um, we have coming up in a month, uh, a start of our mentorship class. If you are interested in reviewing labs week after week after week, looking at hundreds of real cases, going through the year-long curriculum that I've developed over the last 20 years, it's a really great course. It's a full year kind of immersion in how to interpret labs and how to set up clinical models and how to learn all the protocols that you need to learn and how to deal with patient questions, how to sell labs, how to sell supplements. So there's business built into it, there's clinical models, there's the training. And then I think what I'm the most proud of with the mentorship is that by the middle of the year, people are interpreting labs at a level that's just not seen that often in our profession. You know, people are really getting it. And that is cool. And I could go on for days about what that means. But, you know, when you get your first case where there's this high lactic acid level and you see all these neurological symptoms and then you give them a bunch of B vitamins and it goes away, I mean, that's just some amazing stuff. So I love the course and I love the people in the course. You guys get a thousand dollars off if you want to join for the March group. Okay, so that's coming up soon. And we have some other courses too. We have some shorter format courses like some boot camps that are coming up as well.
Right, so let's see here. I'm going to get down to brass tacks here and start to think about this. So the way I wanted to do this is I want to talk about H. pylori for a while and talk about treatments, and then I want to show a few kind of off, off in the corner slides about why this really matters. But the setup here is that how can we understand how much digestion really matters? You know, and the naturopaths have been saying this for 2000 years, and now the scientific community is doing nothing but talking about the microbiome and how important it is. And in a way, you could say the microbiome starts in your stomach, right? I mean, I know there's not a ton of bacteria there, hopefully there's not a ton of bacteria there, but what happens in your stomach sets the stage for everything else that's going to happen in your digestive tract. If your stomach's not working properly because it's infected, you're going to have major problems throughout the entire digestive tract and in fact, throughout the entire body. One of the major things that the stomach helps with is the breaking down of our food, right? And one of the really important components of that is the ability to break down dietary protein. And because human beings are heavily reliant upon dietary protein, if your stomach can't do this very well, you're going to have some serious, serious problems. And I'll show you some slides in the middle of this talk, some different slides, um, that kind of emphasize why that, why that is such an issue. But we're going to talk about H. pylori first, and then we'll get to the kind of secret slides that I'm hiding off in the corner there.
Okay, so, um, what we're going to talk about specifically in the beginning here then is how stress affects all this, how H. pylori treatment protocols can fail, you may be frustrated by that, and then the things that you can do to increase your success rate. And realizing that more so than a lot of infections, H. pylori is really going to wax and wane and be easier, difficult to treat based on how stressed out the person is. So the way that we try to address this, reducing, and this is the most important step, the first and what is the most important, right? Reducing inflammation through diet and lifestyle. So if the person's in a bad marriage, you might not be able to get rid of their H. pylori. I'm not joking. It's like if they're, you know, going home every day to a spouse that they hate and they're that stressed, they may not ever get rid of their H. pylori unless you address the lifestyle and figure out how they can get into couples counseling and create a happy marriage. So emotional stress weakens our immune response and allows things like H. pylori to proliferate. And a lack of emotional stress and a strong spiritual and emotional connection, you know, provides our immune system with the boost that it needs to function properly. Secretory IgA levels need to be supported through adrenal programs. So the beginning of any H. pylori treatment protocol is diet and lifestyle changes. The middle part of any H. pylori protocol is strengthening the adrenal glands. And I do that through using DHEA and pregnenolone. We do these four-point cortisol tests and just fix the HPA axis and get that working. So that's step two. And then the third step is the actual elimination of the bug. If you do steps one and two really well, step number three is easy. And if you spend one or two months on steps one and two, and by the third or fourth month you're going after the H. pylori, your success rates will be high. You know, not 100 percent, but, you know, decent.
In fact, just because you asked, it's funny that someone brought it up. Is we actually did a study on this? What the heck? It's the only time I've actually done a study. So I will show you right now. And about 10 years ago, a group of doctors from the Mayo Clinic took my mentorship. It's true. Larry Birdstrom, Sue Cutshall, Brent. I mean, it was pretty incredible. And then the story behind that is that it was, it was a Wednesday. I totally remembered this. It was a Wednesday. It was around Christmas. I slipped, I fell, and I shattered my left arm, like shattered it, it was broken, okay? And I herniated two discs in my neck. This is a totally true story. And, and I just, I'm powering through it. It's like, Wednesday night, I call my buddy, Morgan Camps, medical doctor. He's like, "Dan, you gotta go to the ER." I'm like, "I can't, I can't, I can't. I gotta teach this class." Because it was the first night of the club of the mentorship with the Mayo Clinic doctors. This is true. So I taught that whole class with one hand, you know. And we got through it. I got through it. It's a 90-minute class. And then like at 11 that night or something, I was just in so much pain. I went to the emergency room and they're like, "God, you know," they did some X-rays, like, "Okay, this is not good. We're not sure if we're gonna have to pin your arm. It's shattered." And anyways, that's a true story.
So Larry and I became really good friends. We decided to do a research study. And one of the outcomes of this study, uh, was published in 2016. It was 25 of my patients that I worked with. And we put them on an adrenal and a GI program, just like I'm teaching you all now. And nine of the people in the study had H. pylori on the testing. Eight of them were able to clear it using exactly what we're talking about. Okay? And so that's cool. And the stuff really works. That was sort of my wake-up call to realizing, oh, okay, it's just not, you know, my amazing personality that we ask people better. Really, there's some truth to how well these labs work and how well these programs work.
Failures. Why would things not work? People can use the wrong sequence. Everybody seems to want to treat the GI tract first, and that is really going to limit your results. You probably have a 50 percent reduction in your potential success rate if you just try to do GI treatments initially. If you do chapter one, lifestyle, diet, stress reduction, right? Step number two, chapter number two, you do the adrenal program, DHEA, pregnenolone, you get the HPA axis working, and then you do the killing, you'll have a much higher success rate.
And then the other problem that, uh, that I see all the time, which is worth mentioning, is that people, um, only treat, uh, GI cases when there's GI symptoms. And the whole premise of functional medicine is that we're not symptomatically oriented. And so you can have an H. pylori case that has chronic fatigue. You can have an H. pylori case that's depressed. I've had more H. pylori cases that I can remember whose main complaint was they couldn't sleep. No any digestive problems? Nope. Just, I just can't sleep. Got insomnia. What lab should I do? I'm like, well, you're going to do an adrenal hab and a GI test and, uh, and, uh, organic acids. And they're like, "GI tests? I don't have any digestive problems." Like, "Yeah, I know, but we just gotta check and see." And I've had, again, more cases than I can remember who had insomnia that was cured if you can cure insomnia by getting rid of their H. pylori. So it's not just for GI problems. And that's the whole premise of functional medicine is that we're not symptomatically oriented.
Now, there are some obvious examples like acid reflux, gas and bloating, constipation, diarrhea, obvious digestive problems that you would tie right back to some kind of infection in your gut. But I think you'll find if you treat H. pylori well, that you'll find all kinds of symptoms from ADD to extreme fatigue clear up when the H. pylori is gone. And so I think in the patient world, you know, they have this sort of connection to their symptoms because that's what they're experiencing, right? And so they may just be tied back to their fatigue or their heartburn or their bloating, whatever it may be. But they're not going to be really necessarily tuned in to the fact that there could be a hidden infection that's driving this, right? And so it's very difficult sometimes to trace it back and, and have all of this make sense to a patient. So I always try to go back in time and talk to the person about how did this problem first occur? What was going on originally in your life around the time when you start to not feel very well? And most of the time, people will say that there was some major stressful event going on, a divorce in the family, a death in the family, a new job, a move, something like that, that weakened their immune system, threw off their neuroendocrine system, impacted their GI system, right? And when we're treating, we want to treat not just the GI problem, GI symptoms, GI system, however you want to put it, but we also want to go back and deal with the lifestyle factors so that we have a more, no, no, I don't like the word holistic, but a more comprehensive approach.
Now, with H. pylori specifically, it's a nasty little infection. And nothing good to say about it in my mind. It just causes human misery on an untold scale. And I have no sympathy for H. pylori. And I think if you give him a half a chance, you should just kill it quickly. Not a nice person, not a nice person, not a nice organism.
So now we're going to, now take it down a notch. Now I just said that most H. pylori cases don't have digestive symptoms. However, that's kind of advanced level thinking and it's hard to kind of get there. And I'm not saying that I'm even there yet because I still think symptomatically too. But if we're going to kind of take it down to the patient experience, H. pylori symptoms that are obvious: belching, nausea, constipation, constant need for digestive enzymes, having to do crazy diets like autoimmune diet, or having to do a GAPS diet, or SCD diet, or only being able to eat if you're eating in some really extreme way, often means there's a digestive tract infection, right? It could also be pain or reflux, gastritis, constant indigestion. So these are the no-brainer obvious signs that there's H. pylori, okay? But we also want to think about that and remember that it's not always going to cause digestive symptoms. And that's one of the harder things to really understand. But when it does do is cause damage to the stomach lining and reduce stomach acid production. Potentially, it's common in patients with with heartburn. It's pretty easy to get H. pylori and a lot of people have it and don't have a problem with it. It's when the immune system weakens that the H. pylori is problematic. So just having H. pylori doesn't mean that you're going to have a horrible health outcome. It's having H. pylori and then having a decrease in your immune surveillance that's going to lead to the problem, okay? And you can get it from other people. You can get it from food. Get it in a variety of different ways.
So one of the hallmarks of of H. pylori that makes it so complicated, oops, sorry, hit the wrong button there, that makes it so complicated is the very nature of what it does to amino acid absorption capacity, right? How it specifically damages the stomach. And if you can't digest your food well because you don't have enough hydrochloric acid, and you know, even though you're eating some protein, you're not able to break it down, there's going to be a whole host of problems in your body's ability to absorb amino acids into the bloodstream. And what is the ramifications of that? What do we do with these amino acids? Well, we use the amino acids from proteins all throughout the body to assemble proteins. And what are the different kinds of proteins that we have to assemble from amino acids? Antibodies, enzymes, hormones, hemoglobin, neurotransmitters, the list goes on and on and on and on. We actually have to take amino acids, slap them together into proteins, and to make stuff. You need to make enzymes so you can metabolize your food. You need to make antibodies so you can fight off other infections, right? And so this is really, really significant. When your stomach's not working well, it has body-wide impact, body-wide impact. And so when we say you don't absorb amino acids well, you can't assemble proteins, hemoglobin, ferritin, storage proteins, insulin, a protein that's the actual structure of insulin, all the beta sheets and alpha helices, all twisting around, everything. Pyruvate dehydrogenase complex or enzyme. This is one of my favorites. It's a beautiful structure that's all these amino acids crammed together into protein. But what does that thing do? It makes it so you can make energy, right? It makes it so you can take glucose and convert it into acetyl-CoA and make energy. So if you don't have the amino acids you need to make this, you could have whacked out blood sugar, just from that. Immunoglobulins also proteins, goes on and on and on and on. So if you can't absorb nutrients very well because your stomach's not working great, and you're not starting that initial process of the breaking down of your food in your stomach, and it's partially digested when it hits your small intestine, you could have amino acid absorption problems that lead to antibody issues, insulin issues, blood sugar control issues, hormone issues, et cetera, et cetera. And that's why H. pylori can manifest in so many different ways. And that's why it's fun to kill because when you get rid of it, all these things get better across the board. And in fact, you could never really tell what's going to get better with swimming with H. pylori in my experience until you treat them.
You can get the bacteria from uncooked foods. You can get the bacteria, H. pylori, from kissing someone who has it, which is a bummer. And a lot of people have it. And if you have some free time later tonight, you're just sitting around and you're kind of tired of watching Netflix, you can Google Nobel Prize H. pylori. And this is, um, off of the Nobel Prize team's write-up when they gave out the Nobel Prize for the doctors that connected the dots between H. pylori and ulcers. And one of the wonderful things in this article, this is from, you know, 20 years ago, was that, and I remember reading this 20 years ago, and there's one line in this, in this Nobel Prize committee sort of summary of why they gave out the prize that says, "H. pylori causes chronic inflammation in all patients that have it," or something like that. I was like, "Wow, yeah, Nobel Prize committee, go." So whether you have an ulcer or not is a whole other set of issues, but everybody that has H. pylori has chronic inflammation. And we know now what chronic inflammation can do. Not a good thing, not a good thing.
So there's different ways that you can sort of, uh, create a hierarchy, right? So you want to test for it. I've never treated H. pylori without testing for it. You wouldn't just randomly treat someone for it, right? You have to do a lab test. Then you have to figure out how you're going to get rid of it. After you do those other steps that I mentioned earlier, then you're going to replace the good bacteria, get the gut lining working really well, in the small intestine, large intestine, get all the probiotics you need down there and working well, right? And then re-test, typically, and make sure that everything's gone. And then you can do some repair.
So the different kinds of tests are numerous. You can, people do endoscopic exams. There's a breath test for acute H. pylori. There's blood tests, right, for the antibodies. And then there's stool PCR testing. There's stool antigen testing. It's a variety of different ways you can measure for it. And then again, the treatments are to make sure that you're not just isolating H. pylori, but you're also working with diet and other pathogens and whatnot.
Now, some of the medical docs that we work with really closely like to use a Prev-Pak. It's a prescription. I'd say in the last 20 years, in my experience, 25 years, all my MD friends seem to be less and less enthusiastic about killing H. pylori with antibiotics. Everyone's kind of moving away from that and much more towards doing it with the herbs if they can, you know. And I know when I first started my practice almost 30 years ago, we would refer out for H. pylori treatment all the time to the local medical docs, and they would prescribe the drugs. And people are just a little more hesitant to do that now, you know. I'd say there's a bigger emphasis on the natural treatments. They're just as effective. They're quite effective. Um, eight out of nine people in the Mayo Clinic study I did, we got rid of the H. pylori. So it's not that they don't work. It's just a gentler, kinder approach.
So what I've used all these years is mastic with some anti-inflammatories like slippery elm, DGL, zinc carnosine, always using some probiotics, very powerful probiotics, uh, Sac-B, some of the, you know, other strains that are out there, many good probiotics, right? And then some kind of repair at the end of the process. The treatments are pretty straightforward.
Now, in terms of just sort of random things, children with H. pylori seem to be particularly vulnerable to having some pretty bad problems like nausea and vomiting and stomach pain, difficulty eating regular food. And I've worked with a lot of kids with, you know, maybe they're diagnosed with with GERD, or diagnosed with, I don't know, you know, in the conventional medical world, maybe diagnosed with an ulcer, or diagnosed as, "We don't really know what's wrong with you" diagnosis. And, you know, I found H. pylori in a high percentage of these kids that are nauseated, throwing up, and, um, are just in pain every time they eat. So kids are really easy to fix. If you ever have a kid that has, you know, obvious tummy problems, just do, do a stool test on them and see if they have H. pylori or not, you know. Just, it's a relatively straight, straightforward thing. You can just get this kid back in school, you can get them out of pain. And I just highly encourage you to work with Trojan in this because, um, it's a, you know, important and satisfying kind of part of the job is to make sure that children are taken care of. And a lot of kids have H. pylori and are suffering from it.
Okay, so then, um, uh, this is an old, old patient of mine, Jesse. Um, he's who's the first, he was the first of my, I have insomnia and fatigue patients who ended up having insomnia and fatigue, not, not exclusively, but to a very large extent, because they had H. pylori. Now, it's a funny story because when he first came in, he didn't say anything about stomach pain. That wasn't like one of the things that we talked about in that first couple of hours. But once we found the H. pylori and I treated it, he came back and said, "I don't know what's in these pills, doc, but I just slept through the night for the first time since I can remember, and I'm like, well, really? Well, that's kind of strange." And he said, "Yeah, I didn't realize it, but I think I was waking up at night because my stomach hurt. Because I slept through the night and my stomach feels really good." And he wasn't, he was not aware enough that he was waking up at night with his stomach hurting. Takes to tell me that because it had been going on for so long. He just thought it was just kind of normal to wake up in the middle of the night with his stomach hurting. He didn't even really realize that that was a problem until it was gone. And then this was this whole big thing. And, you know, one of the other really important things about Jesse was that because of that chronic, long-term stomach problem, digestive issues, lack of absorption of amino acids, he had a huge amino acid problem. And we had to fix his neurotransmitters. Okay? So that's just like a cautionary tale about how this stuff can really roll out.
And let me, um, talk a little bit, maybe in a little bit more detail about the programs and how I try to actually implement these. And, and then let's see where we're at on time. Uh, oh, good. Yeah, we're right on time. And then we'll have some room for questions at the end. Okay.
So treatment programs. First of all, adrenal support, stress reduction, anti-inflammatory digestive programs, right? So in my world, again, the adrenal protocols, we do cortisol and DHEA testing, and then we recommend based on the labs, typically pregnenolone. Pregnenolone is the most amazing supplement ever made, and DHEA, and whatever else is indicated to move the cortisol either up or down, right? If cortisol is low, we can use things like licorice root. Cortisol is high, we can use things like phosphorene. We're trying to normalize that cortisol rhythm and get the inflammatory system under control, get the secretory IgA upregulated. That's what the adrenal programs do, right? They help reduce inflammation, they help regulate secretory IgA, which is really what you need to do in order to treat the H. pylori. So in my mind, the adrenal programs, testing and correcting the HPA axis, are the first step in the H. pylori treatment, probably the most important step. Because if the patient's inflamed, their HPA axis isn't regulated well, their secretory IgA is not regulated well, how are they going to ever fight off H. pylori? Even if you did miraculously get rid of it, they're just going to get it right back as soon as they kiss somebody or eat some food or something, right? So the idea is that the problem is not the infection, the problem is the host immunity isn't strong enough. And we want to upregulate that. And because H. pylori is so closely intertwined with stress, it makes sense to, you know, deal with the stress response. In fact, you go back and you look at that Nobel Prize, uh, article that I was ref, had some images on a minute ago, when prior to the Nobel Prize being being given out to Marshall for discover the discovery, quote unquote, that the majority of people with, uh, ulcers had H. pylori, there was this very strong association that everyone knew between stress and ulcers. When people got more stress, they got ulcers. But it really wasn't until, uh, these scientists did their own little study that they proved that the stress was triggering a weakening of the immune response, which triggered the H. pylori to flare up, which then caused the ulcer in, what is it, 80, 90 percent of cases? And that's a pretty high percent, right? So in other words, H. pylori at its worst comes to its worst when people are under stress. So we want to test and correct the adrenal glands as an important component to starting off this. And if you're not having really great success with H. pylori and you're frustrated, um, you know, that would be the most obvious thing to do.
Okay. And then, and then, uh, you know, the, the diet part is kind of obvious, right? You just get them to eat healthier food. What are the anti-inflammatory foods and fruits and vegetables and spices that are good for you and all that? The turmeric of the world, right? And the blueberries of the world, and broccoli, and all those things are anti-inflammatory and they'll make a huge difference in terms of improving function. In fact, we had, you know, you, the things that I hear in my practice like every day, like sometimes when I tell the stories, and these are all true stories, they just sound so crazy, it just almost sounds like you can't believe them, but this is a true story. So we had a guy in the last year, you know, maybe as, maybe as a year and a half, two years ago, before COVID hit, he had a guy, maybe he's 23, 24 years old. He had every digestive problem known to humankind. I mean, his whole intake packet was like an inch thick, right? And he had diagnoses that you just couldn't even believe, like whatever, I mean, nobody really knows what's going on with him. But let's just say he had stomach pain, he had constant diarrhea, and he had causing constipation alternating with the diarrhea, and everything he ate made him feel sick. And it was just this list after a list of what every digestive problem you can imagine. And when, this was kind of funny, when I talked to him on the second visit, okay, the second visit, all of his digestive problems were gone, like all of them. And it was only like maybe a week or two since he'd been starting to work with the clinic, you know, with my clinic. And so I'm like, "Well, well, what's going on?" He's like, "Oh, I don't know, Dr. Kalish, but I feel great." And we hadn't started any treatment yet, nothing. I'm like, "Well, what's going on?" He's like, "I don't know, everything, the last three or four days, all my pain is gone. I feel like I'm back in the gym, I'm working out, and I feel like everything's okay." I was almost a little disappointed because I was the one, I wanted to be me that was the one that made him better, right? And it was already happening. Kind of, I hadn't even told him what was on his labs yet. And I'm like, "What are you doing?" And he's like, "Well, I just listened to your health coach and started eating vegetables and fruit with every meal and everything just went." And it turned out this guy hadn't, this is true, had not eaten a piece of fruit or a vegetable in like over seven years. Seven or eight years since he was a kind of early teenager, and he's in his mid-20s. I'm going to say that again, he hadn't eaten a vegetable. I didn't know this was possible. He hadn't eaten a vegetable or a piece of fruit in like seven or eight years. And his microbiome was just completely trashed, strictly because he had a horrible diet. Just eating properly eliminated all his symptoms. Now, because I'm compulsive and because I like to kill things, I still put him on an H. pylori program and killed his infections and his gut and all that. But, you know, clearly it was diet-related. So that has to be part of the equation. Okay? And then you get into the killing, antibiotics or herbs, depending how you want to do it. And then all the repair stuff.
Okay. So adrenals, we've talked about this over and over. Stress is step one, right? Then getting rid of the bugs, and then all the recolonization and repair stuff. That's like the next step. Strengthening SIgA levels through adrenal protocols and stress management, that's the key. Some research study there, you can look at later if you want. But the big picture concept here is that as H. pylori causes damage to the stomach lining and reduces stomach acid production, the amino acids are not absorbed very well because your stomach breakdown of the food doesn't work. The food hits the small intestine, not really good things go on in the small intestine then. So H. pylori can cause symptoms. Remember, we showed what amino acids do. They help you make insulin. They help you make pyruvate dehydrogenase enzymes. So it could impact the H. pylori could impact someone's blood sugar. In fact, it usually does. H. pylori could impact your ability to make transport proteins like hemoglobin, the kind of important, right, to be able to, you know, shuttle oxygen around your body. Um, H. pylori infections that decrease amino acids are going to affect neurotransmitter and hormone production, all these things, okay, can be impacted by your gut. And that's why we don't want to think only about digestive symptoms. Like it's obvious, if, you know, a 10-year-old kid comes in and they're nauseous and throwing up every morning and their stomach hurts, they don't want to go to school, do a stool test and get rid of their H. pylori. But even in patients that don't have obvious digestive problems like that, you still want to go after the infections and get rid of them.
Okay. And then just in terms of bigger picture treatment. So I got another diagram. Let me show you here, and then I'll open it up for questions if you guys have questions. Let me, uh, let me pull this other thing up here though. Oh, and while I'm waiting on myself, let me remind you, in case you joined us late, that we have a mentorship course coming up, March 29th. It's the one-year mentorship with advanced testing and functional genomics. This is a great class. Been working on this class for over 20 years. We're kind of peaking right now. We got a really great group of doctors. You can come in and join. It's a full year program. You learn how to interpret labs. We talk, we talk a lot about lab analysis and use of supplements, a lot of communication skills, things around how to work with patients, how to get people to buy the labs, how to get people to buy supplement programs. We have a weekly live call, and I teach all the calls myself. So we review your labs together. Get a really active community that you join, and this massive curriculum that I've put together that you can study each week online to just really, just immerse yourself in in this the depth of the work that we have. And we focus on adrenal testing, female hormones, microbiome and GI testing, and then a big, big component on organic acids and really looking to, what do we call it? Get you proficient in lab interpretation and get you proficient in being able to be comfortable with the commerce part of this. How to explain the reasons to do labs so patients will buy them. How to explain the reasons why these supplements are so important so people will buy the programs. Because if you can't deal with the commerce part, if people are not buying labs and supplements from you, 100 percent of the time, you're just not going to get people better. So you have to like learn enough about how to communicate with people to make that work. And there's a thousand dollar discount if you guys sign up for this course using that code there. All right.
Okay, so let's start off with some questions here. Um, well, this is a complicated one. I'm going to skip the complicated one. Hang on a second. I'll come back to that. Oh, provide the names of labs that are gone over in the mentorship program. Yeah, so we do GI testing from a bunch of different companies, from GI-MAP, from Diagnostic Solutions, GI Effects from Genova, GI 360 from Doctor's Data is a great test as well. And then we go over salivary cortisol testing. A lot of people submit the DUTCH test, that one's really popular now. So we look at adrenal and female hormones either through saliva or through a DUTCH test. And then probably half of the course is oriented around organic acids. And, um, the organic acids, if you're not familiar with it, covers neurotransmitters, mitochondrial function, fat and carbohydrate burn metabolism, neurotransmitter, neuroinflammatory markers. There's a whole big section on oxidative stress and liver detoxification pathways. So it's a very comprehensive test and takes us about six months to a year to get through those. And then for people that are kind of overachievers, they get through all that kind of fast, we have some other more advanced stuff that we do as well. Okay. All right, let's see. Lori is asking, is it possible to have high and low cortisol? Uh, yeah, absolutely. Some people have high and low cortisol in the same day, not the same time obviously, but, you know, they start off in the morning really high and then they drop really low, and they go up and down. And they're for high cortisol levels, we use phosphorene to bring it down. For low cortisol levels, we use a special licorice root to bring it up. So there's different treatments depending on on where they and where they sit, you know.
And then which diagnostic test do I prefer? I use all of those. You know, I use all of them. The Doctor's Data 360, GI 360, the GI Effects from Genova, and the GI-MAP from Diagnostic Solutions. There's slightly different pros and cons to each test. And a certain, depending on the patient, depending on where they're at with their gut health, depending on how much you want to look at the microbiome versus look at pathogens, um, you know, you need to be kind of proficient in all three of those, I think, and, and use them interchangeably depending on where you're at. Okay. Um, let's see. If H. pylori is high but SIgA is normal, can we assume that the patient's handling stress? Absolutely not. No. You got to look at the, but if the cortisol is normal, yeah. So for Tony, you would want to test their cortisol levels. If their cortisol levels are normal and DHEA is normal, then for sure you don't have to worry about the stress component. I don't think you'd see that very often, but it's possible, you know.
So then, in terms of probiotics. So now I'm doing, I'm kind of getting old. It's like when you get older, let's like, screw it, this is like, do whatever. So now for probiotics, rather than trying to pick the best one, I'm just giving patients all of them. But this is at the very end of the program, not in the beginning, okay? At the very end of the program. So let me show you what I mean by that, because if you do this too early, then people are just going to rebel, um, meaning they're just not going to be happy. You know, let me just find this thing here. It is. So, uh, okay, I'm going to just show you like a mock program, right? Let's say we got the adrenal program going, they're getting better, that's really good. Now we're going to treat the H. pylori. Then at some point, you're going to want to repair the damage that it caused, and you're going to want to get the microbiome back on track. So typically, I'll wait until the adrenal programs are winding down, the pathogens are all gone, and then we can focus on probiotics, right? Because there's so many of the supplements that they were on, they're no longer on. So there's like room to do something else. And let me just show you here real quick. So there's three sort of groups, right? There's a spore-based, there's S. boulardii, this is my favorite, S. boulardii, and then there's like the regular kind, you know, Lactobacillus, Bifido, all that stuff, just regular probiotics. So when we get to that point, depend, if they're not fully recovered and they still need a lot of help, sometimes I'll give people all three of these, you know, one of each of these with each meal for a couple weeks, and then maybe up to 30 days, and then stop. Or you can try to guess and pick which of these they may do the best with. But sometimes it's not a bad thing to do more than one.
I'm keep going through questions here. See, uh, have you had any experience with combining traditional and alternative treatments? Yeah, so we've, you know, I've worked for last 30 years hand-in-hand with medical docs. I'm a chiropractor by training myself, so I can't prescribe anything drug-wise, right? And so I think with, with, with GI infections in general, that there's different circumstances, right? So like, if the patient's, um, bleeding in their stomach and they're in intense pain, and emergency room visits are happening every week, then clearly, you know, H. pylori should be treated as aggressively as possible, and many of those people are going to need to do some kind of an antibiotic program. Or if it's a, perhaps it's a woman and she's 39 years old and she really wants to get pregnant in like two months, she wants to start to get pregnant, maybe you don't have time to do the herbs. Or there was a couple years of my career where I worked with all these professional hockey players, and, um, turns out the best hockey players in the world feel a little embarrassed to be taking mastic in the locker room. I can remember Mike looking at me and going like, "Dude, like, I'm not going to be pulling out these herbs in the middle of a game and taking it." He's like, "No." So the hockey player guys, they all did antibiotics because they didn't want to walk around with their little purse full of herbs, you know, and be made fun of by their teammates and people on the opposite team. So there's some circumstances where the antibiotics make more sense. But for probably 80, 90 percent of people that I work with now, we start with and try the mastic, the zinc carnosine, the DGL, and those kinds of things first. And if it's going well, great. If it's not, then very open to doing the initial, initial takedown of H. pylori with the natural products and then upping the ante later on to antibiotics. And then there are other patients where the exact opposite makes more sense. They're in a lot of pain and they're vomiting every day and they're just done with it and they don't want to wait a couple months for the herbs to kick in. They start with the antibiotics, then some probiotics, and then we can use the herbs as a follow-up. For some patients, the killing window matters. And like a two-week antibiotic killing window for some patients isn't enough time. And what you want to avoid more than anything is creating bug, you know, drug-resistant bugs, right? So the worst case scenario here, the worst thing that can happen is that you try the antibiotics first and you do it too early and you don't get the H. pylori completely, and then you have to try to retreat with antibiotics, but now a lot of the organisms are drug-resistant, right? So you're kind of escalating the problem. So one of the ways that you can, if you do need to use an antibiotic treatment initially, one of the ways you can increase the killing time is use that two weeks of a Prev-Pak and then use some probiotics and get them a little bit better, and then go into the herbal treatments. You have a longer killing window with the antibiotics leading off and then the probiotics and herbals as the follow-up. Okay? And again, some patients are super sensitive and they're like, "Dr. Kalish, if I took an antibiotic, I would get really sick. I just can't handle those drugs." So we can also reverse it and say, "Okay, let's do the herbs for two or three months, knock this organism down, get you feeling better, and then we can introduce the antibiotics at the end of the program if, so, if necessary at that point, right?" So there's lots of different ways you can kind of integrate these treatments depending on what the overall goals are.
Let's see. Now, there's many different kinds of testing and they don't all catch the different bugs, right? The bug at different st, at the same stages. So for example, like there's a breath test that's more for an acute infection. The stool testing, antigen, stool antigen and PCR on stool is really great for chronic infections. If people do an endoscopic exam, they may miss it, right? And you may see it on a stool, you may see it on a stool test, but not on an antibody test. So that H. pylori is hard to find. And each different testing technique is going to yield you different results. In the old days, when I first started doing this job, we would do antibody testing, antigen testing side by side on every patient. I did that for years. And you see all kinds of results. Sometimes the antibodies are positive and the stool antigen is not. Sometimes the stool antigen is positive and the antibodies are not. Sometimes they're both positive. Sometimes neither are positive, right? There's all kinds of different things that are possible because of, you know, in one case you're looking for the actual organism in the stool sample, and the other you're looking for an immune response. And it's going to vary. So you're not going to have a direct exact correlation all the time between the tests.
The youngest I've ever seen this in, um, is a two-year-old. But that, I mean, I also don't think I've tested any infants for this problem. So it was a two-year-old that had a lot of stomach issues, and the mom had already been diagnosed with H. pylori, so she wanted to check her kid, and the kid had it too.
Um, is there ever a time when someone does not need HCL or digestive support? Yeah, I don't use it very often. I use HCL and digestive support sparingly. You know, don't always use it. Um, they don't always give people everything they need, you know, it's just not really how life works, is it? Um, I think I mentioned the labs. Let's see. I'm trying to get to all the questions here. Uh, oh, dosages for the herbal treatment. So that's a tricky one. So I mean, it's not that I don't know it because I've been doing it forever, but I have to like say it carefully or I get in trouble. So here's what I would say. If you want an aggressive treatment and you feel like you are an advanced doctor, I wouldn't do this the first time you treat H. pylori, okay? You're advanced, you want aggressive treatment, and you're like in regular contact with the patient every week, they're not going to just go off and do this on their own, right? Then all that thing, aggressive treatment, you're an advanced doctor, you're going to be in regular contact with the patient, all that, all those conditions are met, then I would do a thousand milligrams of mastic, three times a day, usually with meals because it's easier to remember. You can do it on an empty stomach, but sometimes it hurts people's stomachs. And then you want to use DGL or zinc carnosine or both, or slippery elm, or, you know, one of these kind of anti-inflammatory soothing gut treatments, either in a powder or in a pill, okay? So you get really good, you know, control over the inflammation with, uh, that one level of things, the DGL and the slippery elm type stuff, or glutamine powders, whatever you're using there. And then the mastic at a thousand milligrams, three times a day for the killing, okay? And so, um, so the more chronic the H. pylori is, the longer standing the infection is there, the longer that the infection has been there, the harder it is to test for, the harder it is to find. And so it can be extremely difficult for people to detect it when it's been there for 5, 10, 15, 20 years, okay? And a variety of testing is good. If you want to know what I actually do in my practice now, I just do the stool testing now, either stool antigen or PCR for stool, and look for it that way. I, I don't know, probably 15 years ago, I stopped doing the blood antibodies on everybody. I don't know why I did that. It was kind of compulsive that I did that for so long, but I just wanted to see the antibody tests and the stool tests together. And I'm kind of stubborn, so I just did that for a really long time. It was a hassle because patients had to get two labs. But after enough of those, hundreds of those, hundreds and hundreds of those combinations, I finally was like, which one am I going to do? And I let it go of the antibody test. And now I just do the stool. That's been my own, you know, personal process.
Okay. All right, I'm going to wrap it up for now, gang. Thank you very much for attending. We have more of the mini-series coming up. We have a mentorship coming up. If you like this kind of teaching and you want to review labs every week and really get into depth on this work, then sign up for the class. It's a really great group and we're kind of on a roll right now at Cash Institute. All right, take care of you all and I hope to see you at the next mini-series coming up in a little while. Bye now.