PART 2 - Introducing the Microbiome : Its Function and Dysfunction in the Human Body

Good afternoon, or evening, or morning, depending on where you are. Welcome to the Kayla show. Here, we're gonna talk about the microbiome, just because we can. And we're gonna wait another minute. People are streaming in as we're talking here. And well, it's sort of midsummer. I don't know about you, but I'm taking vacations this year. I've historically not taken a lot of vacations, but, uh, my office manager kind of required it, so I did a week-long bike ride. Now I'm gonna go to, you know, a juice fast place, trying to take care of myself here in my old age. And, um, you know, one of my personal obsessions for the last two years has been looking at the microbiome and trying to figure out how this testing works. And so I wanted to talk tonight about a couple of things. A conceptual thing about how we can view the microbiome and why it's important. And then I want to talk about a practical thing, which is how you can interpret commensal bacteria markers on a couple of different tests. So we'll combine the talking with the practical. And then what we really want is for you to sign up for my mentorship program. There are still spots available in the group that's getting going right now. It's a great class, and any of you are on the fence about it, you should sign up because it's a really good class, and we have a good group that's about to start. And let's see. So let me show you, like, let's do a little preview work around here. So let me show you when, when we do organic acids testing, which we all do, hopefully. Well, that's a little fuzzy, isn't it? Let me get you a more clear copy here. Sorry about that. Right here. Yeah, let's go back up here. Sorry. This is just like being in a regular class. Network. I'm just like scooting around on a on a bunch of labs. But here you go. Here's a clear one. So when we do organic acid testing, there is a section at the last page that talks about gut bacteria. And I find, in general, most people don't understand what the heck is going on with this section. So I want to talk about this because the point of this whole section is to look at the commensal bacteria. Who would have thought? We didn't know that, did we? No, we didn't. But now we know. So we're excited that we're in this class. So we're gonna talk about commensal bacteria, visa v organic acids testing. And then there's another more obvious thing. And a lot of labs do this. I'm just happening to show you what, you know, of a test. But many other lab companies do commensal bacteria markers. You know, if it has the most, I think, of all the different companies. In fact, they have a whole page of them, and they title it strangely, commensal bacteria by PCR. So this is all the commensal bacteria here. And because there's 24 of them, and we only have an hour, I want to focus on three that are ultra, ultra important that we should just immediately go to when we're interpreting these labs. And the first one is two soulful Vibrio pider. Deep hider. That's the one that's implicated in cardiovascular disease. We should look at that real quick as soon as you get these labs. A cure man, see, I'm in Santa Fe Leah. That's the one that has a really strong role to play in reducing inflammation, keeping the gut lining healthy, immune strength, and whatnot. And then methane over ever dr. Smith. I okay, which is methane oh, it's a methane related bacterial. Okay. So these, these are all three really super important and or the health of the gut. And if you see deep hogr, Nathanael brevibacterium, if I, and Ackerman, see I miss Anna philia, all three of those in the normal ranges, you've got a pretty decent lab test on your hands with a pretty good microbiome. Okay. So again, deep hide your, m smith i, acronym is sinha philia. These are three of the bellwether markers on this test. All three of these are normal, you got a pretty good lab on your hands. Some person is going to be pretty healthy. Now, as you can see from this simple example here, this person has a high level of m smith i. They have, let's see, a normal level of Akram and Xia. So you very rarely see all three of these lined up properly. Okay. But anyway, so those are things to screen for. And then again, as we're looking at these commensal bacteria in the lecture portion, let me just show you again with the organic acids test. There is a whole section of the test. By the way, this is what it's like in class, right? Doctors submit a lab, and then we go over the lab in class and talk about it. So making tonight a little bit more like a class. So here is the, it's an organic acids profile from Genova, zero-zero nine-one, that's the test number. And on this particular test, right in front of us, are these sections, right? And this whole section here is tracking commensal bacteria. Who would have known? It doesn't really tell you that. I've never heard this in a ton of different classes until a few years ago. So, you know, you can really misread this. Benzoate, hipper a, phenyl lactate, if you know, propionate, para hydroxybenzoic. All these markers here are looking at the commensal bacteria. Okay. So if these markers here are high, that's not necessarily a bad thing because they're tracking commensal bacteria. Indican is a marker for protein digestion. It also implies that there's tryptophan related problems. Try Karbala is a marker, magnesium related issues. D lactate is a marker for a neurotoxin. The Clostridium marker here, the marker for clostridial overgrowth, but that's not C difficile. There's like, I think 600 plus species of Clostridia. This is just one of them. So this is not the bad one. And then the last marker down here is a yeast or fungal marker. So anyways, we're going to go through this section because I find it's generally misunderstood and most people don't realize that the bulk of this section is actually testing for commensal bacteria. These are the good guys. And I'll show you some examples of that in a minute. Okay. So again, we're talking about the good guys tonight. Let's go back, look at the lecture material, kind of set the stage, and then we can interpret some labs. And then you guys can rush at the end of this talk to sign up for the mentorship. And you can do this every week. Oh, and I'll show you in a few minutes what the mentorship looks like in case you haven't seen it. So I'm microbiome function and dysfunction. And then, you know, I think there's there's a central question here, which is an eternal question. I'm not saying that I know the answer. I don't think anyone does. But, you know, are pathogens destructive when the microbiome is robust and balanced? Okay. So in other words, even a GI pathogen is contextual. In other words, in a really healthy microbiome environment, a GI pathogen may just be there and maybe just sitting there doing nothing. If you're well protected, right? You got a pack of wolves, you know, that's protecting you, then not that much bad stuff can happen. Okay. So if your microbiome is balanced, then you're really going to see a lot of these chronic GI problems disappear. So I think we need to have two skill sets. We need to be able to develop the skill set to identify and eliminate GI pathogens as needed. And we need to be able to have a skill set to rebuild the microbiome. In all honesty, up until quite recently, my idea of rebuilding the microbiome was killing the Giardia, killing the h pylori, and then saying, here, take these probiotics for a few months. And really, you know, don't come back. You can't just hand somebody a bottle of probiotics and say, you know, good luck with your microbiome. We have to actually get in there. It's a treatment. You know, we have to get in there, analyze it, treat it, you know, to make it better. And all these years, you know, in my practice, myself, of just treating pathogens and GI bugs and then kind of, to be honest, feeling like my job was done. And then blowing off the GI microbiome restoration part of the program, you know, I think is really not a good thing that I've been doing that. So I want to make sure that, kind of, get the word out that you don't need to do that. And that in some cases, you may even work on the microbiome first and then come back and realize, maybe I don't even need to treat the pathogens because now the microbiome is working well. Okay. So pathogenicity of microbes in the human gut being redefined based on our growing understanding of the nature of commensal interactions. Turns out this stuff is really, really, really, really, really important. So the idea of it just being good guys and bad guys, and that they're in fixed positions, is not necessarily true. Okay. So one of the things you can do is obviously assess the pathogens. And there's lots of great lab companies out there that do that. But as part of that assessment, you should also have a general understanding of the status of the commensal bacteria. Because ultimately, at the end of the treatment program, you're going to want to have the commensal bacteria of the microbiome in great shape. Or if you want to take this to a more radical extent, you could say, you might even want to fix the microbiome first before you even go after the pathogens. I'm leaving that as an open question. And remembering that the pathogen-commensal relationship can shift. So you can have an organism like, like Bacteroides fragilis, right? That can be not only a pathogen in some situations, but in the colon can be a super-important key component of your immune system. How crazy is that, right? You can have an organism like Bacteroides fragilis that's actually directing and controlling the immune system. Without this organism, your gut, your immune system starts to fall apart. Bacteroides fragilis penetrates into the mucosal lining of the gut, and it lives deep down in the crypts, and it has all these different things. It's a fascinating book if you want to read about this more. It has all these different things that it releases and controls so that it can regulate your own immune system. So we've got all kinds of organisms like this, right? This is a quote from back in the 60s. The state of health or disease are the expressions of the success or failure experienced by the organism in its efforts to respond adaptively to environmental challenges. So in other words, you know, if your microbiome is in beautiful shape, you may not have any problems even though you have Giardia or h pylori that are quote-unquote infecting your gut. And as the microbiome robustness and balance fades, these chronic low-level infections can flare up and become very symptomatic. So really, the often on switch in how the purported pathogens are going to affect us is the status of the microbiome. So we have to pay attention to it. We have to learn how to fix it and how to test for it. So remember also, there's these different groups of organisms of commensals. And this is just a partial list, but there are, I just want you to start to think of these in in functional categories, right? So this first group, the Bifidobacterium, the fecal bacteria, and prot Smith sighs, these kind of things, the one that's the most famous, Alecto bacillus, right? These organisms are taking dietary fibers and breaking them down into sugars and short chain fatty acids. Okay. They're taking dietary fibers and degrading them or breaking them down and making these short chain fatty acids that then are the fuel supply for intestinal lining cells. This other grouping of organisms, this other functional grouping of organisms is producing hydrogen gas. Your rose birria, your room in our caucus, your Bacteroides, well, goddess, these are organisms that are producing hydrogen gas. Okay. So you've got a group that's breaking down fiber. You've got a group that's making hydrogen gas. And then you've got a third grouping here of organisms that are consuming stuff, right? They're consuming hydrogen, right? That's being produced by those other organisms. Okay. So not all of these are the achromatic misena philia is kind of in this top three group, but it's actually, it's two chomping on the mucin. It's chomping on the layer of the lining of your intestinal tract, okay? On the mucosal lining, the mucin, the mucous sitting up in there, it's kind of chomping away on this stuff. So you've got organisms that are breaking down fiber, you've got organisms making hydrogen gas, and you've got organisms that are consuming the hydrogen gas. So you can imagine how complicated this gets, right? So for example, let's say that the organisms that are consuming hydrogen gas are low. That could be happening because the organisms producing hydrogen gas are low. And that could be happening because the organism is making the organisms breaking down fiber or low. Okay. So these groupings are functional, but they're all interactive. They're all overlapping. They're all dependent on one another. And this is sort of, you know, community of effects going on here. So if you don't have enough dietary fiber, you're not going to get the organisms that, you know, you're not going to have enough of the organisms that break down dietary fiber because that's their food supply. If you don't have enough hydrogen gas, you're not going to get the ones that live in hydrogen gas, and so on, and so on, right? So these are all dependent on one another. So you start to think of these in terms of functional groups. And the other issue is three bellwethers, m smith i, d pager, and acraman c i'm usin Ophelia. Okay. And the m smith i, hydrogen consuming, and its name implies what? It makes it makes methane. Okay. It's if you want to get really technical about this and you're like a total science nerd, it's actually technically not a bacteria. It's in our K on, which is kind of cool. If we won't have time to get into this, but I geeked out on this over last summer because my sister is a high school biology teacher. We, we were on vacation visiting my mom's family on the Big Island, and we just got into this whole kind of like week-long discussion about all these different organisms. But anyways, m smith a is not a bacteria. So not all these organisms are bacteria. It has this whole different category, right? If you're a biologist or a bio, what do you call it? You know, like an animal kind of person that likes to classify things, since in RK on. So you should read about that too. The fact that it's producing methane is pretty wild. I need deep hider is producing hydrogen sulfide. And speaking of Hawaii, remember the volcanoes blowing up in Hawaii? If you're around a lot of hydrogen sulfide, it's not a good thing. Right? People die from that stuff. But we have this organism in our gut, deep hider, that's actually making hydrogen sulfide. Obviously, it's a good thing in small amounts for human beings, but not such a good thing if you breathe in a lot of it. And then a chromium you see no philia, mutant grazing, it's the one that's like a little lawnmower going across the mucosal layer of your gut, and it's chewing up and feeding on that mew, that mucus. And just like if you're growing a lawn, you need to cut it once in a while, it's not a bad thing that Accra man see I'm usin Ophelia is chewing up the mucosal layer. It's, you know, regenerating it. It's using that as a food supply. It's keeping it trimmed like you would trim the grass. So it's not a destructive organism by any means. It's actually extremely important. Okay. So these are the three bellwethers, emma smith i, di jurat, c'mon see I'm usin Ophelia. You might want to spend some time looking at them. There's tons of research on all those. And then there's these three functional groups: breaking down of fibers, producing hydrogen, and consuming hydrogen. So that's kind of big picture stuff. Okay. So now, this looking for a moment at the labs. And let me show you, where'd it go? Up at all here. So let's first look at what we just talked about so you can see how this gets represented on the lab report. Again, you got to hunt around a little bit for these, but I'll circle them for you so you can see here. We have our page on the GIF X. This is a lab test that Genova lab runs. And you'll see they're classified on this test by phylum. So they're organized like they would be in a biology book, right? By phylum. So we have the Bacteroides phylum, the formaiities phylum. So these are naming classifications that biologists just love, right? They love to name stuff. But we're more interested, because we do functional medicine, don't we? In the functional categories. So that's why I wanted to show you. There's group these groups of organisms. You can group by the function of breaking down fiber, the function of producing hydrogen, and the function of consuming hydrogen. And then the three bellwethers you want to keep your eyes out for, or just review one more time, to soulful Vibrio pager. Okay, sulfur is in the name there. Pygar, deep ID your, people usually call it. Meth a no braver, Brava with Hannah, oh, Brava back to smith i, meth a no. That's the one, remember, that produces methane. K. Again, methane's in the name there. M smith i. And then here's our little favorite mucin consuming guy that's chewing up the mucosal layer of your gut, but in a good way. It's maintaining the lawn. Ackerman sia, you see no philia. So these are the three bellwethers. You want on when you grab this lab report, look at these three first. If they're all three in good shape, then the patient's in good shape. Okay. So that's the highlights. And you could go on and on for hours and days about each one of these other ones, but that's when I kind of give you a bigger picture view. And then I'm going to show you one other thing here. I'm gonna say this second time, which is that when we look at the organic acids test, here's one right here. The compounds of bacteria or yeast origin. Let's talk for a minute about where all these come from. So you can see what I'm talking about. So remember, remember, remember that, sorry, I've got my signals crossed here. There, see, there we are. Remember, remember, remember that there's two things that the microbiome has to have. There's two things that these bacteria have to have to grow properly. One is dietary fiber, because remember that first group feeds on the fiber. You got to have dietary fiber for this to work. And do most people eat enough fiber? No, because people don't eat a lot of vegetables or beans. So number one is dietary fiber. And remember that first grouping, that first functional grouping uses a diaphragm, that offeri dietary fiber. It breaks down that dietary fiber into short chain fatty acids. Okay. Gets this whole ball rolling. So you got to have a high fiber diet, which boils down to vegetables and beans. And then the second category that you have to have is what we're looking at right here. There's dietary polyphenols. So these dietary polyphenols we eat. That's like your blueberries have the blue stuff, right? And your broccoli has an all the vegetables and fruit that we eat are full of these polyphenols. And what's really interesting is that those polyphenols are not for us. And I always thought that the polyphenols were, you know, for human tissue. The polyphenols are what these bacteria, these commensal bacteria feed on. Okay. And you can see here, when they feed on those dietary polyphenols from your fruits and vegetables, the bacteria then release benzoate and hit parade phenol acetate and phenol propionate. See the phenol in there? Phenol dahlia polyphenols, phenol acetate polyphenols, phenol propria eight polyphenols, right? These are all connected. And so when we look at the organic acids test, and we're looking at benzoate, hipa rate, phenol acetate, and phenol propria Nate, as well as a couple of these others down here, what you're looking at is how well is that person doing with their diet? Are they getting enough polyphenols in their diet, enough vegetables and fruit to feed these bacteria to make these compounds in the urine? We can come back and look at the sugars thing in a second, but let's start with this because you really want to know how to interpret this because it's super helpful. Basically, this lets you know if your patients are eating enough fruits and vegetables or not. Okay. So remember what we just looked at. There's our benzoate, our hipper 8, our phenyl acetate, female propionate, maybe phenol, phenol, phenol paradise' oxybenzone, and para exact c, phenol acetate. Okay. Phenol, phenol, if you know, if you don't, right? Phenols. So these markers here from 36 through 41 are looking at the effects of the good bacteria. And where you want to see these markers is in the high end of the normal range. That's not a bad thing. That's not SIBO. Okay. It's the opposite. OSEBO, it's uncie Bo, or D Bo, or I don't know what the word is. Okay. Remember, these are respect. These are showing you, is a person eating enough fruits and vegetables? That they're getting these polyphenols to drive these byproducts up. Honestly, I've been totally honest with you guys, I don't know why, because it's gonna make me look like a but for years, I actually kind of thought that when these markers were high, it was kind of something like CBO. I thought it was bad. It's not a bad thing. These are commensal bacterial markers, not pathogens, not bad guys. Okay. And besides, you're measuring almost all this stuff. It's happening in the large intestine, small intestine anyways. But, um, so my name is this whole grouping here, 36 through 41, again, I'll mention the names, benzoate, hipper eight, phenyl acetate, phenol propionate, para hydroxybenzoic, prayer actually phenyl acetate. These are all markers of a, am I eating enough vegetables and fruit? If that patient is eating enough vegetables and fruit, you'll see high normal levels. That's what you want on this. Do you want low levels? No. Low levels on this test means that they're not eating enough fruits and vegetables. This patient is not eating enough fruits and vegetables. They have low levels. Okay. So low levels on this section is not a good thing. That's not enough fruits or vegetables. You want to see a robust and healthy growth over here. Okay. So the best version of this test would be high normal range here. This would be your ideal patient. And you would say, gosh, you know, Henry, you are eating enough fruits and vegetables. That is just a wonderful thing. And you see low markers here, you know, there's a problem. Okay. So that's step number one. Step number two, indicate. Again, it can mean a lot of different things, thinking about protein digestion, hydrochloric acid levels, but can also be an indicator of tryptophan deficiency. Okay. And try carb all eight, if it's out of balance, if it's high, can be an indicator of magnesium problems. So it's nice you have these extra little markers, tryptophan, magnesium, to correlate with your other data. And then remember, D lactate is a very special marker. So D lactate goes up when there's a lot of bacterial overgrowth. But D lactate in and of itself is a neurotoxin. So a lot of these markers are just markers in and of themselves. They don't cause a problem. They're just telling you what's going on. But D lactate is unique in that it acts as a neurotoxin. So if D lactate levels are up, you've got the potential for brain related problems that are directly related to the gut. Okay. So always look at D lactate. If it's high, you've got potential gut brain connections there. You've got a neurotoxin and high levels. The Clostridium marker is not a marker for C diff. It's another cluster to the organism. It's, you know, it's what it is. It kind of helps you. You might want to give some probiotics if you see that one high. And then this marker here is completely different than any of the others. This isn't marker for yeast or fungal overgrowth. So if anything, this is one that if it's high, means that things are bad. Right? That's bad, bad, bad, bad. But up here, not bad, not bad. I misinterpreted this lab for like 15 years. It's, I'm just saying, it's a little embarrassing. So hopefully you guys don't have to go through that. Okay. Remember, these markers all wet. Sorry, these markers all here, commensal bacteria. Is my patient eating enough fruits and vegetables? Where do you want to see them? You want to see a high normal across the board here. That's your perfect patient, perfect diet. If the levels here are low, you're not getting enough fruits and vegetables. The microbiome is suffering, right? Because the polyphenols from the fruits and vegetables and the fiber from the fruits and vegetables is what's feeding the good bacteria. So low levels across the board here, it means not enough fruit and vegetables, means a weakened microbiome. But I'll put up. Okay. So that hopefully it helps clarify a few things that I wish I had known. And here's another visual that we just saw. Dietary polyphenols, your fruits and vegetables, the bacteria feed on them, and then boom, you get your benzoate, HIPAA rate, phenyl acetate, and feel appropriate. It just because I don't want you to get totally confused. And this is worth the whole hour of listening to me yak here. Let me just say one more thing about benzoate and HIPAA rate because, like, how are you ever going to know this otherwise? So let's see here. I don't know why this one is so fuzzy. It didn't used to be fuzzy. Oh, maybe it's getting less fuzzy. Maybe it's my eyes. Not to the lab. I think it's fuzzy. You guys could vote on whether it's fuzzy or not, but I think it's a little fuzzy. Alright, we'll go back to the other one because I'm confused here. That's not the right one here. And you know, second, there it is. Alright. So, um, okay, one other little factoid. Should this is not the best example, but I'm just gonna draw it on here so you can see it. So this is a relationship between benzoate and HIPAA rate. So you can clearly see where we are in the test. It says compounds of bacterial or yeast origin. Does it say compounds of bad bacteria? No. It really should say compounds of commensal bacteria. All right. They could have put the commensal word right in there, then maybe we would not be so confused. So this is clearly a bacterial marker section. And we just sort of verified that by looking at the details on what this all means, right? That the benzoate, inhibit are a result of bacteria feeding on polyphenols. However, the benzoate and HIPPA rate are cleared in your liver. So this can be a very, extremely, super duper helpful thing to know. And this has saved me in so many cases, you guys. This is like totally worth the price of admission. And this class is free. So I'm, I'm kind of making a joke here. But if benzoate levels are high, okay, you should always see HIPAA rate levels high as well. Let me say that again. If benzoate levels are high, you should always see high levels of HIPAA rate. If you ever see a lab where benzoate levels are high and HIPAA rate is either normal or low, that's a liver detoxification problem. Okay? Specifically to do with glycine and phase 2 liver detox. The reason being that in your liver, your body has the ability to convert benzoate to HIPAA rate, which it will do in order to knock all this stuff down and get it out. So if you can't convert benzoate to HIPAA rate, and that benzoate is high, but the HIPAA rate is either normal or low, that's a major liver problem. So if I was in control of the entire world, which is a possibility, but it's probably not that likely, and I could redo this test, I would put Ben's away and HIPAA rate in two places. I would put it here where it is, that's fair, but I would also put it up here in the liver section because you're very, very often, okay, very, very often gonna see that benzoate is high and HIPPA rate is either normal or low. And you know, boom, you're gonna catch a hidden liver detox problem that might not show up in other places on the lab. So just, you just write that down somewhere in a notebook, whatever. Benzoate high, HIPAA rate normal or low means that you are having a problem with the liver. So you can use these GI markers to also track liver detox capacity. Kind of handy. Dr. Bennett on somewhat controversial. Almost all these markers are controversial. You get enough lab guys in a room, they'll argue about, I don't know, the paper clips, you know? But I find Dr. Bennett all a very helpful marker, except you can have really bad yeast overgrowth and the Dr. Bennett all marker will be normal. So it's not definitive. It's just another piece of data that we add into the puzzle. I had a patient this morning. It's a great story because it's true story. We can call her Ethel because that's pretty close to her name, and that's not her real name. And Ethel, she's the sweetest old lady. Okay? So she has, I love her so much. She does an organic acids test every six months, no matter what. And then she comes in and she's one of these people that reads everything. And she's probably in her late seventies or early eighties. And she's just like, it's like talking to your grandmother, but it's like your grandmother was like ultra cool and really into natural health. So she comes in and she's like, Dr. Kaylis, I saw my labs. Dr. Kaylis, I saw my lab. She's like, all excited. My dear, my Bennett all is a hundred and ten now, which it was. She's like, last time it was a thirty. She says, I know what happened. I know what happened. We built a new home, and I was so stressed, and, uh, and I've been eating sugar for three months, every day, every day. I never eat sugar. And it's so cute. So like her dear Bennett all just shut up and have been stable. We test this woman every six months, year after year after year. It have been stable and great for a long time. She didn't need any sugar for a long time. She's building this house with her husband. They get really stressed out about the new house, and they're moving into the new house, and then she'd sugar every day for three months, and boom, her dr Bennett all goes from a 30 up to 110. I was pretty cool. So anyways, it when it works, it works. However, you will have some yeast or fungal cases where the dr Bennett all is completely normal. So you have to look at each one of these labs in relation to other tests. And then the GI section of organic acids is not a substitute for stool testing. Okay. So you can miss, in other words, you can get some false negatives with the air Bennett all. You have a really bad yeast overgrowth, and it may not show up. Whether that's because it's a different species of yeast or because the lab is just on a cure in certain cases. I don't actually know the detail on why. I just have seen this year after year after year. So if it's positive, it's tended to, in my case, all the cases I've ever had, be very accurate. But you can get false negatives with the air bin at all. Okay. So be a little bit careful on that. Now, another point you didn't want to think about, and this is true for yeast, this is true for all of these organisms, is that any organism that is found as a commensal can become pathogenic if it's over stimulated. So that the levels dominate a microbiome lab profile. So you could have a certain amount of yeast in the person's system that's totally normal and not a problem. They shoot up from a 30 to a 110, and they're all of a sudden extremely sick, and it makes sense that there's an issue there. You can also have an overgrowth of the cardioprotective deep hider. So in the right amount, deep hydro is cardioprotective, but an excessive amount produces what? Remember this one? Produces hydrogen sulfide. Big, big, big problem. That's the gas that's emitted from volcanoes, right? You're standing near the volcano, you don't notice that this gas is coming out, and all the sudden, boom, you're dead. One of my cousins on the Big Island actually works in one of those hydroelectric plants, and they have all these masks and monitors and stuff because this is like a serious problem. It's like light for death with hydrogen sulfide. So again, we're talking about finding tiny amounts of hydrogen sulfide that deep hide your is making. But, you know, if it goes overboard, you're gonna have some problems, and you're not going to be very healthy if it's overgrowing. So the good organisms are all relative. More of a good organism isn't better. It's the right amount. It's the balance of the organism that makes sense. And it's true for if you think about nature as a picture of nature. So my mom is hilarious. She's 81. She's almost, yeah, 81. She's gonna be 82 this year, I think. And her new goal, every time I see her, she's like, Danny, my new goal is I want to see the five major rivers of the world. And so every couple months, I'll give her a bunch of cash, and then she'll take a trip. So she just got back from China. She grabbed all her old lady friends, and like six of them went to China to see, I guess, the Yangtze River. So like that. And then she came back, and then I had a little extra money from some stuff I was doing. So I gave her some extra cash, and now she's got tickets with your old lady friends, and they're going to see, they're going to the Amazon to take a trip down the Amazon. It's so funny. Anyways, that's my mom. So ecosystems, right? This is an ecosystem picture here. You're thinking about these bacteria coexist with one another. They coexist with the pathogen. So with a broader picture that we can take of all this, the broader view that we can take of all this, the more benefit you're going to get. I think the main central question with any patient that you're working with is, do you want to strengthen the microbiome first before you do any pathogen killing and see if that's enough? Or do you want to go after pathogens first and then strengthen the microbiome afterward? But that we really want to get away from these bad habits that many of us have developed of treating the pathogen and kind of blowing off the microbiome part of the correction, not really bringing that system back on. Okay. And again, establishing a healthy microbiome is the long-term goal to help prevent pathogen infections. Pathogenicity of most organisms now being looked at as highly dependent on the state or the status of the commensal population. Okay. And so you want to do this in stages. You want to figure out the complete picture of the pathogens, the complete picture of the commensals, and start to make a go of it that way. Okay. So potential pathogen, the same. I just said this, but was just head again. But when potential pathogens are detected, next question is whether robust, balanced growth of the targets included in the commensal bacterial markers, right? Is are good or not? Generally, it's not the case. So the commensals are going to be part of the overall treatment. And let's look here now. There, there's another big thing that I always get confused by this. So I thought I'd just mention it. As there's also a bunch of opportunistic bacteria that a lot of these different lab companies report. I think almost all the companies report this now in different ways, whether it's by PCR, by culture, you know, so you're clever CLI, your morganella, your Pseudomonas, your sister a citrobacter, and Tarab actor, right? Staphylococcus. You see these on all the different major lab companies' reports. Again, some of them are by PCR, which is a DNA based testing, and some of them by by culture. And so the tricky part about this is that you never know really what to do with these. Like, how bad is it that the person has the clips yellow overgrowth or morganella? You know, and are you going to treat it with an antibiotic? That doesn't make any sense, right? Because these organisms are, you know, the result of antibiotics typically, where the result of suppression of the good bacteria by some force of nature, whether it's an antibiotic or a food or whatever people are doing that's suppressing their good bacteria. So it doesn't make sense to nuke them with antibiotics. Then you're kind of struggling with, could we just strengthen the organisms around them and flush these guys out? You know, and I think you have different levels of potential treatment that can be really effective. So let me show you here. Um, and this is probably not a news flash for any of you guys, but maybe just something that's worth mentioning. Get your thinking process going because I think there's these different layers that you can address this at. Here we go. So at the simple level, you can do prebiotics and probiotics and diet, diet, diet, right? And really try to get the microbiome going that way. That's kind of obvious. If I could spell diet, it would be a little bitter with it. There we go. All right. And the next level up is you can do prebiotics, probiotics, and enzymes, and HCl, and glutamine powders. And if you're gonna use glutamine powders, don't be a wuss about it. You know, give them at least 5 to 10 grams twice daily. Don't give them like a thousand milligrams or something. You really want to crank up the glutamine powders. I'm, you know, five to ten grams twice daily. You know, I learned that from the naturopath that trained me 25 years ago. And then I kind of got to be a wuss about it and start to get people low dosages all these years. And now it's like, no, don't do that. You know, five to ten grams twice daily. You really crank up the glutamine if you want to do something significant. And then you have the option of killing bugs, right? So those are probably your three big categories. Pre and probiotics, diet, diet, diet, get the microbiome going. Second category, add stuff in, your enzymes, your HCl, your glutamine powders. One more thing I'll add in here, which I've had some really great results with, would be bile acids. I've had five or six cases in the last five or six months that I just knocked it out of the park because I really support the person's gallbladder. And these are patients that have been to every doctor on the planet. People just forget about the gallbladder. I don't know why. Why don't people forget about the gallbladder? It's a really important organ. And so again, I've had at least five or six cases recently that were just, you know, made me look like I was a saint because I just aggressively gave the person gallbladder support. So don't ever forget that. Because when the gall, when the bile is not being released properly into the small intestine, it's like bacterial party time. You know, it's just, you're gonna have some really sick and significant stuff. And most all of us are thinking enzymes and C all the time, but make sure in the back of your mind, or the front of your mind, you're thinking gallbladder, gallbladder, gallbladder. Especially for those SIBO type people, especially for those really inflamed gut people who have the bloating, bloating, bloating kind of thing, and they just like treat these gut bacteria, and then you keep coming back. Just really consider gallbladder, gallbladder, call better. Okay, man, I know you think this is a lot of information. Take my year-long class, man. You know, I'm gonna do a promotional thing now. Some, one of the doctors just chimed in, but let me see here, cuz like this is like, if you've ever seen the TV show Portlandia, this is like Dan Landy. I didn't land E. I spent, I spent like 12 years building this thing. And by the way, I've been teaching this class for since 2006. I've never taken a salary. All the money that I make, I know we charge a lot, it's 13 grand for this course. All the money that we get just goes back into building an even more intense software program. I live off my practice, and I take all the money from the training program dollars that you guys pay, and I just keep building this thing out and building it out. At this point, I mean, you know, I don't even know the total tab is. But so anyways, here's the community that we built. If you look at something like clinical topics, you're gonna see, and this is all part of the year-long mentorship. All evaluating technology applications, energy production issues revealed by organic acids, T-cell polarization problems, developing your business plan, marketing plan, power to practice, patient consort of findings. It's just like on and on and on. There's like literally thousands of hours of stuff in here on every topic that you could imagine. When you look at the case study library, you could type in something like, I don't know, GIF X, or microbiome, or let's type in, what's a good one? How about Blasto? Type in Blasto, and we have like two thousand case studies. Case study number seventeen hundred and ninety, treatment plan for a ten-year-old with Blasto. Case study 891, nine-year-old is anxious and has Blasto. Case study hundred and thirty-two, Blasto be gone. Right? Each one of these case studies is transcribed. It's got a video. So anything that you come up against in class from the testing, we have a response for it. Right? And then every week, we have a live call where I'm just like tonight, we view labs and go over all the questions that the lectures have. So we have this massive case study library, or thousands of cases. We have these content and resources section here, which I mean, you could type in anything. Let's see, let's find the search engine here. Yeah, you could type in like legal. I mean, really, could anything. Intellectual property, basic. So this was a really good one. This is an hour-long interview I did with an IP attorney. Super valuable. It's like a five hundred dollar thing right there to talk to that guy for five, you know, for an hour. Advanced clinical rounds, transcriptions. It just goes on and on and on for every subject we have, whether it's legal, or whether it's h pylori, you know, it just goes on and on and on and on. Okay, tons and tons of information in here, all kinds of interviews. And then we have the live weekly calls, the community, and then the regular content. And the regular content is taught in a systems oriented way. Learn about adrenals, neurotransmitters, female hormones, pathogens. We have all the protocols, all written out. So you know exactly what supplements to use. Tons and tons of lectures on each topic. And it's really a pretty intense program. Okay. All right. So now we're going to end the advertisement and back to our regular programming. And we got a few more minutes here. And maybe I should leave it open for some questions. Now, this is worth mentioning. Okay, because this is, this is a conundrum that we face with a lot of cases. I mean, I'm, I'm up against this one a couple times a week, probably. So what if you document on a stool test that they have a protozoa of some kind, right? They have a hysto or crypto or something like that. Is it really gonna be enough to strengthen their microbiome? I don't think so. Honestly, I think there's times when we just have to get in there and kill stuff. And so now the question, though, is you want to be strategic about it. You can still use this microbiome information to your great advantage simply by either pre-loading the program with microbiome balancing stuff, or by after the killing is done, spending it, you know, three to six months really tweaking the microbiome and getting it back on track. And not again, just giving them some probiotics after everything and hoping that it all works out. So in other words, try to think of it this way, like the may think of the main job is to get the microbiome back in balance. And if and when you need to kill pathogens, you do that. But it doesn't take away the fact that you have this bigger picture in mind. And you will find that, and this is a good point here, it's worth highlighting. Parasites exert their invasive actions in the mucosal layer where a host of commensal microbes flourish. Remember this is back to the neighborhoods from the first talk. So multiple commensal microbe metabolic products and parasite degrading enzymes and host immune system factors combined to shape the clinical outcome of these infections. Right? In other words, the the strength of the commensal bacteria, their ability to make enzymes that degrade parasites, the commensal bacteria's ability to modulate the immune system is going to have a huge impact on you being able to clear these bugs. And in fact, if you ever have a patient that has recurring Candida, recurrent Cryptosporidium infections, they

Have H. pylori? It keeps coming back and causing them problems. It's almost certainly going to be you, 'cause you don't have the microbiome figured out yet. And so you don't have these parasite-degrading enzymes. You don't have the host immune system upregulated because you have a lack of these commensal organisms in the mucosal layer.

Okay, this is really, really important in the bigger picture. And, you know, if I take a step back and we look at what we're doing with functional medicine in general, many of the important cases that we have are going to revolve around your skillset and ability to treat the gut. So these are, you know, issues that are gonna, you know, cross over to too many, maybe half of your cases or more. You're gonna have, okay, another way of saying the same thing: In some cases, protozoa affections, infections are accompanied by an imbalanced commensal microbiota that can contribute synergistically to disease progression.

Now, let's see here. Did I have it? No, I didn't have these. Oh, okay. And I don't want to talk too much about the yeast thing. Let's talk a little bit about interventions. So one of my favorites now, 'cause it's like, I mean, I'm actually a favorite for all time, is berberine. What the heck? It has a really great increasing, if it has an effect to increase that *Akkermansia muciniphila*, which is one of those, the one that's out there with a lawnmower thing, you know, chewing up the gut lining. It has a really positive effect on your intestinal permeability. And I always used to think that it was an antimicrobial, but maybe it's a pro-microbial. Who knows what's really right? But anyways, it definitely helps the gut. And that's a really great product, something that I use routinely, you know, almost every day, either berberine by itself or a combination product with berberine in it. And then I'm going to show you some other, some other markers. And then this, look at some questions, okay? For our section on interventions, so let's go back here. Now, remember interventions for the organic acid section. If you see low markers here, increase vegetables and fruit. Straightforward. If *Indican* is high, you can use tryptophan. If *Tricarballylate* is high, you can use magnesium. If D-lactate is high, you've got to kill something, generally, okay? There's something going on. And that, but if D-lactate is high, you should think about the brain and how the brain is being impacted. And then if *Dr. Bennett all* is high, you treat the yeast. Okay? So those are the basic interventions on that section. And then there's a few things you can do here that you should just know off the cuff because they're kind of easy to know. We go to these guys here. And let me see here. Yeah, sorry, there we go. Okay. So if you've got, remember the three bellwethers. If D-hider is low, remember the name, *Desulfovibrio*. Sulfur. Guess what? You can use chondroitin sulfate to bring up D-hider. Is that the craziest thing you've ever heard? Didn't you always think you gave chondroitin sulfate to people with joint problems and then joint achiness goes away? Well, guess what? You can use it for D-hider restoration as well. You could probably use the other sulfur compounds like MSM, but chondroitin sulfate is a sure way to do it. Okay? So you're treating a gut bacteria with a joint formula. I know that sounds a little crazy. It is a little crazy, to be honest. All of this stuff is a little crazy once you get into it.

So *Methanobrevibacter smithii*. *Methanobrevibacter smithii*. Back to her. *Methanobrevibacter*. If it's low, increase *Inulin*. *Inulin* will help encourage the growth. So this guy is *Inulin*. This guy is chondroitin sulfate. And *Akkermansia muciniphila*. Again, low levels of that with a high risk of diabetes. For *Akkermansia*, our good friend, where'd it go? Here it is. For *Akkermansia*, you can use chicory, you can use *Inulin*, you can use FOS. Okay? So you have a bunch of different options when you see these levels that are low to bring them up. On the intervention side, oh, and then we mentioned, I forgot, there's a whole slide on this too, on them. Just restate *Akkermansia muciniphila* also responds really well to berberine. So if you see low *Akkermansia muciniphila*, you can think about berberine as well.

All right, so now let's look at questions that have come in. I'm gonna wrap it up in a minute. Oh, and there's, wait a minute, wait a minute. That's one more slide. I always forget the most important slides. That's the funny part. I get caught up in this stuff. Where'd it go? Here it is. Yeah, there we go. Here, this is our advertisement. So sign up for the class.

Alright, so let me look at the questions now. I'm gonna go back to the top here. Do we need to do both a GI-MAP and then Genova stool testing? Yeah, they're pretty different purposes, right? So the GI-MAP is very good for pathogen detection, but the GI Effects test from Genova has the commensal bacteria, as well as looking for pathogens. So yeah, there's different purposes. Karen, let's see. So yeah, this is all recorded, so you guys can listen to this in the future if you want to go back and take notes again. What do you do for someone who's had their gallbladder removed? I don't give them lifelong gallbladder support. Some doctors do. You would just want to give them, if they're having a lot of symptoms, you know, probably higher than typical dosages of ox bile type products, you know, the gallbladder support product. And all the companies should have something that's specific for gallbladder. And you just may need to have the dosages be higher if they don't have a gallbladder anymore. Let's see. Can we do both probiotics and kill at the same time? Yeah, absolutely, especially if the person needs the extra support. You can do the probiotics. So if you're going to do that, you see the herbs that are killers, the microbiome, I'm sorry, that antimicrobials would be given during the day, and you would give probiotics at night before bed. Oh, and then with benzoate, this is from Rachel, with benzoate, high, and hippurate normal to low, what would you suggest? So I, sorry, I didn't mention that, that was my bad. So for, remember we talked about benzoate, high hippurate, hippurate normal or low, that means they need glycine. But I don't usually give them pure glycine because that's like a pain in the ass to just carry pure glycine. I'll give them a combo liver support product with glycine in it. You hit the other pathways too. I think that's fine. If you want to give them pure glycine, you can, but then I think it's just as well to give them a combination product. Oh, and look at Ann Gibbons and ask a question. Hey Ann, haven't talked to you in a long time. She's the old student. Can you repeat when I sing about *Indican*? Okay, I am. She's an old student. I haven't talked to you in a while. Good to see you're back here. What were you asking in to see what was just saying about *Indican*? All right, let me pull that out real quick. I don't know where else you're supposed to learn this stuff. I'm not saying that I'm particularly smart because how stupid am I? I did this stuff wrong for fifteen years, but you know, where are you supposed to go to figure this stuff out? So let me go through this one more time for Ann and for all of you as a quick review. *Indican* when it's high, okay, *Indican* when it's high is a marker for poor protein absorption, protein assimilation. So you could obviously do HCl or check out their stomach if their stomach's all screwed up. But *Indican* when it's high is also an indicator that they may need tryptophan. Okay? That can help us sleep. Another thing, it's not 5-HTP, but tryptophan. Tricarballylate when it's high indicates that need for extra magnesium in their program. Okay? So tricarballylate means extra magnesium. And D-lactate in and of itself is a neurotoxin. So if D-lactate is high, you've got a gut-brain problem going on there. Okay?

Let's see. So in my experience, how does testing compare between Stool and Great Plains? So I have a massive bias there because my teacher in all this work is Richard Lord, and he's the guy that designed all that, you know, O.V. testing when Genova used to be Metametrix. So I'm a hundred percent only looking at that, you know, O.V. test. So, you know, I don't know. It's like I'm a basketball fan. I'm a Warriors fan. Like asking me when I think about the Cleveland Cavaliers, I think this team just sucks and I hate LeBron. But that's totally biased because I grew up in Oakland and I'm a Warriors fan. So anyways, I don't know. You know, the person to ask, you know, it's an old, old friend of mine, I haven't talked to him in years. Kurt Waller is the doc over at Great Plains. He's a really smart guy. I would, I would call Great Plains and talk to Kurt about it if you want to know about how Great Plains works. I have a lot of respect for Kurt. He's a really fine doctor and clinician, and he's been with Great Plains for a long time. I don't work for Genova or anything like that. I just, you know, use them because my teacher is the one that created these. Let's see. A particular form of magnesium. Well, you know what? You want to hear something cool about magnesium? And we're gonna end on this factoid here, but this is like so cool. So like, you're thinking, you're just sitting there in your chair, you're going, I know this person needs magnesium, but I don't know what kind of magnesium I want to go. Okay? And then you look at their energy production markers, you see the ones on the screen here, and you're like, holy moly, they're really low in citrate. What if I, I want to give them some citrate? Well, wait a minute. Why don't I use magnesium citrate? The magnesium will help their low magnesium, and the citrate will help their loss of citrate. How cool is that? Okay? Well, and what if instead, they had low malate, and you're thinking, hmm, this patient needs more malate, more malic acid, they need magnesium. I could give him magnesium malate, and the malate will help with their energy production, and the magnesium will help with their energy production and all these other things too. So if you want to get all fancy-pants about it, you can pick magnesium. So magnesium that relate to these markers here. If that's just too much bandwidth, then just give them, you know, like a magnesium chelate from any of these companies, and you don't have to worry about it. So a chelating magnesium, you know, usually they'll have it's bound to a whole bunch of these different carrier molecules. You don't have to worry about getting a little particular about it. And if that all falls apart and you just can't figure out anything, magnesium glycinate, it's kind of like a good fallback. Give them some glycine with it. Remember, when you're giving a mineral like magnesium, this is big ol' honkin' molecule, and it's attached to some kind of carrier molecule, and the carrier molecule is absorbed and pulled in. So you obviously never take elemental magnesium. It's always magnesium malate or magnesium citrate. And same with calcium, it's calcium citrate or calcium malate or chelated calcium or chelated magnesium where it's bound to these different carrier molecules. Okay? And you can kind of play around with that if you want to get fancy, but you know, obviously don't have to. But it's kind of a cool way to do a two-for-one special thing.

All right, okay. So I'm gonna wrap it up for tonight. Thank you guys for all these really great questions. Oh, wait, any biomarkers that indicate heavy metal toxicity? One more question here. Um, yeah, of course. Let's look at that and I'll stop. So you can see the, what is it? What do heavy metals cause? They cause oxidative stress. So with a heavy metal case, you're gonna see oxidative stress markers high, like this one here. Okay? What do heavy metals cause in terms of the liver? They're gonna cause liver detox related problems. So with heavy metals, you're gonna see one or more of these detox markers elevated here. Those are probably the main things that you see with heavy metal detox. Antioxidant markers are positive, or the detox markers here are positive. If you're doing ion panels, you can actually see the heavy metals themselves. I actually want to do a series of classes on this. So I'm gonna end on this thought here to answer Karen's question. This is probably the next thing we can get into is that you can do these ion panels, right? These are extra cool. So you can do all the amino acids here. It looks at the minerals. And to answer Karen's question, it'll check magnesium, calcium, zinc, copper, selenium, and then of course, aluminum, arsenic, cadmium, lead, mercury. So these are really cool. These ion panels because you get all the heavy metals, all the minerals as well. You get all the fatty acids on these, all the fat-soluble antioxidants. Here's all the fatty acids, omega-3s, omega-6s. This is like the mother of all tests. There's my favorite patient of all time. She's low in omega-3 and omega-6. Favorite patient of all time. 25-year-old woman, comedian in LA. Put her on omega-3 and omega-6s, super high dosages. Boom. Found depression gone. It's like my favorite case of all time. I just kind of look at this lab sometimes. It's like, yes, it's cool. It's this young woman, she's been depressed since she was a little kid. All we had to do was massively dose her on fish oils and omega-6s and bam, the depression is gone. Didn't even give her a multivitamin. That was it. Just a bunch of oils, and her brain just turned itself on in like two weeks. Anyway, it's a cool case. So these are cool labs. And then some future classes, we're gonna get into this stuff too. Okay? Yeah, and we cover all this stuff in various ways in the class. We're doing more and more ion panels now as we get more into it. Okay. All right, take care, everyone. We'll catch up with you soon. Bye now.