Essential Microbiome Treatments

Good evening everyone. And if you could do me a favor, somebody, and raise your hand if you can hear me, so that I know that my sound is working, so that I know that I'm not, oh, thank you, not speaking into a space. I think the longest I've ever done a class without realizing that my mic was broken was like twelve minutes or something. Anyways, try to get that out of the way first.

So, hey, I'm super excited to be here. Just got back from the Integrative Health Symposium in New York City, and some of you may have been there. And, um, it was a really great thing to be at. And we're going to talk about something kind of challenging and interesting tonight, which is a new talk. I've only done once before, and a new subject area conceptually.

So, a little bit of the background. Many years ago, 35 years ago, Dr. Richard Lord met a man named Dr. Andy Brawley. And they, in Atlanta, Georgia, created a lab company called Metagenics. And those two guys got a lot of work done. In fact, they laid the groundwork for all the functional medicine lab work that is done now. So, Brawley and Lord wrote the book, "Laboratory Evaluations in Integrative and Functional Medicine." Dr. Brawley did the first-ever amino acid testing on blood workups. Dr. Lord did the first-ever organic acids testing. They did fatty acid testing. They started to look at fat-soluble vitamins. They just, Metagenics in its heyday, just released lab after lab after lab after lab.

And around 10-15 years ago, which Lord thought, "Hey, this microbiome thing is pretty important. Why don't we try to make a functional medicine lab assessment for the microbiome?" As always, Andy and Richard were, you know, a generation ahead of their time, right? And so they developed what was called the GI Effects test. Still called the GI Effects test. It's run by Genova Diagnostics. And any other tests have kind of come and go. And there's certainly plenty of microbiome testing available now. But no one has really ever figured out the way that these guys did it. In the, and the idea that Richard had, which was to measure 24 commensal organisms to get a snapshot of the entire microbiome.

And I want to talk about the philosophical reasons why he developed the test, and how you can learn how to interpret the test. It is now the number one selling test in our industry, the GI FX lab. And there is a page on that lab, which I will show you right now. I'm gonna skip around on the slides a little bit. There's a page on that lab that looks something like this, which we have all seen if you've ever run a GI FX test. You're flipping through, you're like, "There's short-chain fatty acids. Mmm, they do, you know, they have Giardia or H. pylori." And they're like, "Oh, this is one page with all these commensal bacteria markers." And you know, it's important, but you have no idea what to do about it. That's what we're gonna talk about tonight. The underlying reasons why Richard designed this test, how to interpret it, what he really meant when he did this. And it's lab data that probably almost everyone on this call has in their practice. He's, you could run, right now, we can take a two-minute break if you want to run and try to find some GI FX labs, you know, lab reports and pull out this page here, because this is what we want to talk about.

Alright, so I'm gonna go back through to my proper slides here. And so Richard Lord and I have been working together for almost three years now. Every, I was gonna say every Monday, but it's like twice a week. I just worked with him all day today as well. And we've been developing curriculum together. He's written three new books in the meantime, including one on the microbiome. Just been a lot going on. And it's been, for sure, the most exciting period of my career to be able to work with gifted scientists like this. And to have him available to review all my cases. And all the classes I teach at the Kalos Institute now are completely permeated with Richard's work. I mean, it's really becoming the Richard Lord Institute of Functional Medicine, not the Dan Kalish Institute Functional Medicine. She's the best thing that could have ever happened for me and for my students. So I try to pass this on to you guys during these free webinars. And if you're at all interested, this is the stuff that's going on. If you sign up for one of my classes, you'll learn about all this. Like, every week we're talking about all the latest research and really how to understand the microbiome, how to understand these other labs at a much deeper level.

So today, I want to talk about patient education talking points. How you can start to get them interested. I want to teach you three things today, okay? About number one, Akkermansia muciniphila. Number two, Methanobrevibacter smithii. And number three, Desulfovibrio piger. So those are big, fancy, long names for three of the commensal bacteria. So if you walk away from today's talk just understanding those three bacteria, it will totally revolutionize your practice and your understanding of this test, okay? And then the bigger picture besides the three bugs I want to talk about is, um, how we can look at the microbiome in the context of overall GI health and a functional medicine workup, okay? So we're gonna look at labs, we're looking, talk about diet a little bit, talk about supplement options, and how you can start to correct the microbiome once you've, you know, gotten the accurate assessment based on your laboratory interpretation.

So this is the punchline. This is kind of like the, what should be the last slide, but I'm just putting it up front. These are the ways that you can treat these different bugs. And we're going to focus on, you know, five different options. What do you do when you see a pattern of low levels of commensal bacteria? What do you see when you see a pattern of high levels of commensal bacteria? What do you do when you see Methanobrevibacter smithii or Desulfovibrio piger or Akkermansia muciniphila specifically? What Dr. Lord calls the three bellwethers, okay? So we're going to talk about low, talk about high, and talk about their three most important bugs on the lab: Methanobrevibacter smithii, Desulfovibrio piger, and Akkermansia muciniphila.

Now, how many of you are still testing in your practices? We all do. How many order stool tests for every patient? Hopefully, most of you. How many people feel comfortable interpreting this microbiome portion of labs? Nobody. There is no human being that can understand that test. It's impenetrable, right? It's expressed in exponents. You, none of us even know what most of these organisms do, or what they're for, or what they mean. And so, or their high, we'd have no contextual framework for it. And there's no way that even if you were like the smartest person in the world and you had read every book on everyone of these bacteria, no human being can sort 24 numbers in reference ranges that are expressed in scientific notation. It says like, you can't do it, right? And so that whole section of the test is unfortunately, you know, taking a back seat. And then people have just sort of skipped through it and don't really know what it means.

So we want to try to talk about this because it's really important for your GI patients with inflammatory bowel disorder, your immune patients, your metabolic syndrome patients, people that have to, you know, cardiovascular problems. Even hormones are affected by the microbiome, right? And so it's a really, really important clinical tool to pick up how to understand this. It is strange, but these gut bacteria actually control our immune system. Can you see this picture here? The gut bacteria, little arrow, right? They actually come into direct contact with our immune system and regulate the functioning of the immune system. A healthy microbiome is going to create a healthy mucosal layer, right? And if that healthy mucosal layer is intact, we're going to absorb nutrients. All kinds of good things are going to happen, right? And a lot of this depends on food. If you have a fiber-rich diet, you're gonna have a nice, thick, healthy lining of your intestine. Do most of our patients have a nourishing, fiber-rich diet? No. If they did, they wouldn't be seeing us, right? And so most of our patients have what you see on there, right there, which is a damaged, chewed up, messed up gut with, you know, bacteria that are out of control in a very bad way. And once, what we're trying to reverse and kind of deal with. And I don't know about you, but in my practice, it's a hundred, well, nothing's 100%. Almost everybody that walks in the door has got a microbiome problem, or they wouldn't be seeing me. If the microbiome was in great shape, they'd be really physically fit and be happy, and they wouldn't be coming to see a doctor.

So when, you know, the thing that this all starts with, test, right? And so you need to be able to convince the patient to do a test. And that's sort of like a bare minimum thing that must have to happen. And so it's a little awkward and difficult, especially to get people to do a stool test. So if you're trying to get someone to do a stool test and they have a digestive tract problem, that's usually relatively easy. You can say, "You have a digestive problem. I want to run the digestive test." People can get their minds around that, right? If you have a patient that has a cardiovascular disease problem, or they're obese, or they have an autoimmune illness, or they have something that doesn't directly feel to them like it's a gut problem, then it can be really hard to get people to be convinced to do a test. And one of the things I learned in my maybe my first or second year doing this work is that if I could get somebody to order all the labs, I could interpret them. I can get people better. If I couldn't get people to order the labs, I was in a lot of trouble. So I think this overcoming patient resistance issue is essential because you gotta get people to do the testing. And if you stall out at that point, then it's just gonna be really difficult.

So I always want to tie the value of the test back to conditions that relate to the microbiome. So if you have a patient and they're diabetic, you can talk about how they got bacteria. These commensal good bacteria have a lot to do with your metabolic health, right? If the person has a problem with cardiovascular disease, you can talk about one of the bugs we're gonna look at tonight, Desulfovibrio piger, and how that relates to your cardiovascular health. You can talk all day long about how these bugs relate to the immune system and autoimmunity. So really, really important to have some basic knowledge about the microbiome so you can tie that back to the test and why the test is important for that individual patient. Once they realize it's important for them, they're going to do the test. It's just, you can usually execute all of this in like two or three minutes. It doesn't have to be a long discussion, right? But it's especially difficult for people that don't have digestive tract symptoms.

Second biggest problem I have in my practice, don't know about you, is motivating people to eat properly. Everybody knows they should eat more vegetables. Everybody knows they should have more fiber. But no one ever does it. And that's thing. And we'll talk a little bit about this tonight. Of the microbiome gives you the talking points to say, "Hey Jane, look at your lab. This bacterial marker is low. This bacterial marker is low. That marker responds to fiber in your diet. We need to increase the fiber in your diet." That's what that right? Or "John, this marker is low. That directly relates to polyphenols in your diet. We need to increase polyphenols in your diet. Get you more antioxidants from fruits and vegetables." Okay? So the lab can be helpful in motivating people to eat properly. In fact, I think it's one of the main tools you can use this section of the test for. In fact, which is super handy, handy, handy, handy.

Now, with why test the GI? You know, my my original lab teacher, Dr. Bill Timmons, when I first met him, 1992, in his practice. In those days, he would not see a patient. He would not talk to a patient until they had ordered and completed a very comprehensive stool panel and a very comprehensive hormone panel. So the way that he worked his practice was, if you want to talk to the doctor, you had to do the testing first. That's how I run my practice now, too. It's really kind of convenient because every single patient that I talk to has already done their labs because you have to do your labs before you talk to me. So super, super important. You know, if you're not at a phase in your career where you can pull that one off yet, then you really have to start to think through who are you going to test? You know, GI tests? Are you going to run GI tests with? So I think in the beginning years, for sure, convince everyone with obvious GI problems to do the testing. If you've been in practice for more than a couple years, you should branch out and usually really start to push to get every single patient, whether they're depressed, have a hormone problem, whether they're tired, or whatever their problem is, really try to push them to get a GI test. And again, the skill set in doing that is being able to tie the GI test back to their individual complaints, especially if there's no GI problems. And you know, the example I think of is like, you know, if I went in to see an orthopedic surgeon, you know, let's say my my knee was really damaged, my knee was really hurt, and I couldn't run or bicycle anymore. I went in to see an orthopedic guy and, you know, I'm saying, "I don't know, I can barely walk. My knee's not working. I don't know what to do." And that doctor said, "Well, I think we should x-ray your right elbow and maybe do an MRI of your shoulder on the right side." I was just think, you just think, "Well, that's crazy. My symptoms are over here in my knee. Don't you want to like x-ray the knee or look at that?" So we're conditioned very much so to only want to do testing or exams for areas that hurt or bother us. And there's a lot to overcome in a functional management practice to convince people to do these tests without GI symptoms. And I understand that, but that's something that I just want to bring up because it's super important.

So in terms of my practice, 50% of the patients that I test have no GI symptoms. But we find the microbiome to be a massive mess, causing autoimmune reactions, causing, you know, metabolic syndrome, causing all kinds of different issues, right, that are not kind of intuitively tied to GI. Another thing that I like to do with patients, this is kind of like my patient communication tips in the beginning of the class here. I call it "Labs as Lifestyle." Because I think it's kind of cool. Labs like show, but anyways, low short-chain fatty acid producing bacteria means you need more dietary fiber. Low polyphenol markers on these, you know, organic acids panels means you need more fruits and vegetables. So I like to make all my lifestyle recommendations based on the lab. Because then people don't look at you and just think it's a generic recommendation. They look at the test. You look at the test. You're like, "Wow, those short-chain fatty acid producing bacteria really low. That's a problem. The only way to get them back up is with dietary fiber, right?" Or "Wow, those polyphenol markers on your organic acids are really low. The only way to get those back up is with more fruits and vegetables." So using the labs as a mechanism to convince people to do better with their food, okay? And that's how I think one of the most important aspects of the test is that it gives us ammunition and scientific data to really push people to want to do better in terms of their diet.

And then we're gonna get really narrowly focused tonight. I just want to bring up that, you know, when you're looking at the GI lab testing, you can think about it in terms of organ function, microbiome status, of course, there's dysbiosis or SIBO, there's pathogens. We're just going to focus on one narrow area, one narrow area tonight, because I think it's something that's not really well covered for most of us.

So here's the page that we're up against. And again, if you, this is a GI FX test from Genova. And used to be Metagenics, but now it's Genova that runs this panel. And these are 24 of the commensal bacteria. Now, this is Dr. Richard Lord's attempt to map out, as best as possible, the 24 key target bacteria that you can measure. That we know, because of all the research behind each one of these bacteria, have a huge role to play in the health of the microbiome. There are, obviously, thousands, if not millions or trillions of these bugs, right? But these 24 all have been consistently in the research as shown to have a really big impact on human health. That's why they picked these 24, okay? Because they're all significant in their own way. You can, over the course of years, learn about each one of these bugs and what they do and how they work and how they interact with one another and all that kind of stuff. Tonight, we're just doing a very introductory thing to talk about the three most important bugs and the dynamic that we're trying to look at when we understand the microbiome. And, um, you know, I've been listening to Richard talk about this now for three years. And we spent three hours today talking about this. And it's, um, I can get it. It's overwhelming conceptually. But I want to try to dive in and and try to, as best as possible, kind of show you the bigger, the bigger picture here that's possible, because I think it's really exciting.

So three simple steps, okay? I'm taking, you know, a someone's life's work and just boiling it down until like a little one, two, three thing here so we can wrap our minds around it. Number one, assess the status of organisms that exist in large numbers, and I'll show you what that means, that produce short-chain fatty acids, okay? And assess the status of the organisms that exist in large numbers and are hydrogen producers. So, in other words, some of these bacteria are supposed to be present in huge numbers, some in lesser numbers, okay? And some of them produce short-chain fatty acids, and some of them produce hydrogen. So we want to sort through that. And I'll show you what I mean by that in a minute, okay? Second item, assess the bellwethers. Those are the three super key organisms. And if nothing else, we're gonna hope you remember those three organisms. And you can look at them on every one of these tests going forward. Just look at those three. If they're high or low, you'll already have something to talk about, okay? And then we're going to talk about treatments using diet and supplements. And if you don't understand everything in this hour, then you can sign up for my training program that's about to start, okay?

And how do you guys do this? So skills: identify the high abundance organisms that are mission critical. And it's crazy that they do this, right? But these organisms take fiber and they turn it into fat. Like, how does that even happen? I mean, I know how it happens. It happens that this is what the bacteria do, right? They take the fiber, it's their food, and their waste products from eating that fiber is fat. And these fats then, you know, are critical nutrients for our gut cells. It's crazy. Others of these, and they're not, they're not, um, many of these organisms do many things. So we're kind of breaking this down to somewhat artificial distinction. But some of these organisms then are very, very active in producing hydrogen. And that hydrogen that they produce is essential for human health. Essential, essential for human health. I also want to start to find, show you how to find the bellwethers and focus on this high-level interpretation in the beginning. When, you know, we can't learn about all 24 of these bugs right now. So I'd line, I would use, if I were you, and say, "Hey, you know, these are the three bellwethers. These are the most important bugs. We're gonna focus on these. These others here produce hydrogen. These guys produce, you know, take four short-chain fatty acids. Uh, and then, you know, these other ones, they can may, you know, contribute to the genetic diversity." So at least have something to say about the other ones without having to go into any detail, okay?

So we're gonna do a little breathing exercise. If you guys don't mind, you can humor me here. So I want you to take, everybody, just take a second. Take a deep breath in and breathe all the way out. And then I want you to hold your breath out. Let's see how long this can last. So even if you just get up to maybe 10 or 20 seconds holding your breath out, you start to feel pretty not great, right? Your organs start to shut down, brain, heart, everything starts to go bad. These organisms, these bacteria that they're so important for our heart and our immunity, to help keep us from getting fat. These organisms, they're the version of air to them, right? These are anaerobes, right? Obviously, there's no air in your large intestine. These organisms live on fiber and polyphenols. Some of them produce hydrogen. Some of them live on hydrogen. They're living in a primarily anaerobic environment, right? There's not a lot of oxygen in your large intestine. So like, as we breathe in and out in our, you know, human world, these guys need fiber, polyphenols, hydrogen to survive, okay? The short-chain fatty acid producers die without fiber. I had, this is a true story, and it's hard to believe. I had a patient about two weeks ago who had not eaten any fruit or vegetables for over 10 years. Shocking, but true. He found me. He got on my diet from my website. At the first consultation, when we were viewing the labs, he had been on my diet for one day, and almost all of his chronic and severe digestive tract problems had disappeared. We're talking about from like, a couple meals with broccoli in him, right? These organisms will come back and start to grow. Or you will kill them meal to meal. Just one good vegetable meal with some broccoli, some spinach, and some garbanzo beans is enough to get these organisms to start to grow again, okay? So when their numbers get, they're not gone, they're just in really small amounts. As soon as you start to feed them, they come back. It's just like a human being who's been holding their breath and now all of a sudden you get oxygen back, right? You're okay again.

So fiber, primarily from beans. Polyphenols from fruits and vegetables, green tea, blueberries, all that kind of good stuff, right? And then some of these organisms make hydrogen. Some of them are hydrogen producers, and some of them are hydrogen consumers. Now you can see where that's going, right? So the organisms that consume hydrogen for their lifeblood, for their oxygen, right? Their oxygen, their air is hydrogen. If the hydrogen producers are not present, then the hydrogen consumers are going to die off. And so we need to just go through this whole chain, right? And have enough polyphenols from fruits or vegetables, have enough fiber from beans in our diet that we feed that food chain here, right? And we get each one of these organisms, the each one of these categories of organisms getting produced. And if one category is off, it's going to affect the ones that are downstream.

So phase number one, you determine the status of the major hydrogen producers and consumers. Again, the hydrogen producers require fiber and they feed through their production, right? They feed the other organisms that are served downstream. And there's also high abundance and low abundance organisms. That just means there's like more of them or less of them. You can see that when you look at the lab carefully, okay? The second phase is to identify the three bellwethers. And let's just take a moment to appreciate their names because sometimes their names kind of give away what they do. Akkermansia muciniphila. You can see the word "mucin" in there. So Akkermansia goes along the gut lining and chews up the mucin, right? In the top layer of your gut, it uses that for food. So Akkermansia is unique. Akkermansia muciniphila doesn't live on fiber. It lives on the mucin in your gut. That's the food. And it's, it's kind of like a lawnmower. If you have a big lawn in front of your house and you go out there and you mow the lawn once a week, why? Keeps the lawn nice and healthy. If you never mowed the lawn, and the whole thing would just fall apart after a while, right? So Akkermansia, you guys out there chewing up the mucin layer, using our, it's eating us, in fact, is living on our mucin, right? And our mucosal layer, and keeping that nice and tidy and neat, just like a good gardener keeps your yard neat, okay? So Akkermansia muciniphila, when it's present, will keep your gut lining healthy. Akkermansia muciniphila is a natural leaky gut repair guy. Like, if you wanted to get leaky gut repair done in a patient, you would want them to have adequate amounts of Akkermansia muciniphila. It's like an inside repair job.

Methanobrevibacter smithii is super important. You talk about that a little bit. You can see "methane" in the name there. And Desulfovibrio piger. You can see "sulfa" in there, is a sulfur-consuming organism. So Desulfovibrio piger, the sulfur in there gives away its food supply. It's sulfur. Like chondroitin sulfate, right? Like anything with a sulfur compound in it is going to feed that guy. And chondroitin sulfate has been shown to feed and boost up Desulfovibrio piger. Inulin has been showed to boost up Akkermansia muciniphila. Inulin. And we'll talk about the methane, Methanobrevibacter smithii responds well to fiber.

So now the different supplements that we're thinking about to manipulate and improve your microbiome: prebiotics, fiber, chondroitin sulfate for Desulfovibrio piger. Berberine helps with Akkermansia muciniphila. Inulin helps with Akkermansia muciniphila. So each one of these, and there's a chart at the end of the talk. At the beginning of the talk, I showed it. Helps in specific ways with these different organisms based on what the lab says, okay?

This is a moment where I talk about my class. We have another class coming up. When is it now? You have to sign up by March 28th. And we're kind of hitting a stride this year, 2019. So the mentorship has really changed a lot. Been teaching this class, this is my 13th year now. And it's very hands-on. Most people sign up for the year-long program. It's doctors who are sending in labs and really wanting to understand advanced lab interpretation, or doctors who are just starting out their practice and just need to figure out a clinical model that they can use. I've got my self teaching all the courses primarily. And then we have Richard Lord who's chiming in and basically like our research and development department and coaching me every week to these higher and higher levels of understanding of the lab. So it's, it's quite a time to be around the Kalish Institute. Richard has, as I mentioned, has written three books in the last couple, three years. And those are becoming a curriculum for my classes. And we have a lot of really great stuff happening now with the teamwork between Dr. Lord and myself. It's, it's pretty awesome. We have a special offer. You can save a thousand dollars if you sign up. And the class starts in early April. Alright, if you're curious, you can contact the Kalish Institute and learn more about the course. It's basically like a year of what we're doing tonight plus a ton of other stuff. So there's a year-long curriculum that's, you know, preset lectures. We have live calls each week where we review your labs. You send in your lab, I look at it, Richard Lord looks at it, I tell you what it means and how to interpret it. We have a community of, that's interactive. It's a very interesting thing we have going here. If you guys are curious, you can find out more, okay?

So back to the subject matter here. Basically, treatments for commensal bacterial markers. You should know when soluble fiber is going to make a difference. It's going to encourage growth, remember, when the levels are low, especially some of these key bellwether markers. Identify when polyphenol supplements and supplements are essential. Now, that would be a slightly different talk. We're not going to cover it in detail tonight. But when you have your organic acids markers from your Nutri-Eval or from your Organix Profile, and if that GI section of the organic acids is low, that means a person needs more polyphenols. Okay? So I'll say that again. When you see the dysbiosis markers or the bacterial markers on Nutri-Eval or on organic acids testing, if those markers are skewed low, it means the patient needs more polyphenols. You can give them polyphenol supplements. You can encourage them to eat more fruits and vegetables, okay? So that's a key. Well, the reason for that is those markers are based on polyphenols stimulating the certain bacteria to grow. And usually, when you're looking at those dysbiosis markers on Nutri-Eval, organic acids, you're thinking, "Oh, if they're high, there's a big problem. I gotta treat it. If they're low, everything's okay." Not the case. If they're low, person is low in polyphenols. That's your kind of secret tip of the day, in case you didn't know that already.

And then you want to talk about the organisms that require sulfur, okay? And then again, in the form of chondroitin sulfate. You can use other sulfur compounds if you prefer, like taurine, right? That's the Desulfovibrio piger, or Desulfovibrio piger. It's the one that responds to sulfur. Do you have Desulfovibrio piger low? Give sulfur. How many times if I had an inflamed patient in my practice, gave them chondroitin sulfate or some kind of sulfur compound for the liver or for their joints, and obviously they get better because of the microbiome, not even really understanding why we're doing, you know, how we were treating it. It's kind of interesting. And then I already mentioned the last one here. The organism that repairs and renews the gut lining has the mucin in its name, remember? That's the Akkermansia muciniphila. And it responds to berberine, as well as to inulin. So already, you're getting some really specific ideas here. These are the organisms that are high abundance bacteria that responds to soluble fiber, okay? And you don't have to memorize this now. I just want to introduce the idea. The idea is that they're at the very top of the gut microbiome food chain. So they're gonna degrade or break down a whole wide range of these complex carbohydrates and turn them into simple sugars. And that's going to stimulate these other classes of bacteria. So you've got the fiber converting into the short-chain fatty acids. You've got the hydrogen producing bacteria that are stimulating the hydrogen consuming bacteria to grow, right? And this whole cycle keeps going around and around.

So as a simple example, if you have a lot of hydrogen producing bacteria present, but the hydrogen consumers are not present, the hydrogen producers are going to max out, right? They're going to get to the point where they can't keep growing. So these organisms all need each other in order for things to work. If you see the polyphenol markers low on any kind of an organic acids test, your dietary, you're thinking about your green tea and your blueberries and cranberries and spinach and all that good stuff. And of course, supplements as well that have polyphenols or antioxidants. And then resveratrol is probably the most famous. If you're thinking about fiber and you need to get the commensal bacteria up with fiber, you've got a whole bunch of different choices of fiber, right? Some people may react, you know, not feel good with certain kinds of fiber. So you may have to mess around with that a little bit. So you find something that's well tolerated, but it means you should. And then there's a few studies in here. I'm gonna kind of skip through these. You can look at them later if you need to. Let's see. Wheat. I'm gonna skip through a few of these slides because I wanna get to the good part. And this slideshow is a little long. I apologize that I didn't really cut it back.

Okay, this is the other one that we need to focus on. So these are high abundance hydrogen producing bacteria. Again, you have to memorize this. It's just the concept. These are all right off that GI FX test. These are the bacterial markers that produce hydrogen. And why is that super important? Well, you think about oxygen. We're talking about earlier with breathing, right? We burn oxygen to make ATP. We then deposit the extra hydrogen molecules from that burn onto oxygen molecules, which makes water. Kind of handy because, you know, water is not toxic to us, right? Water is kind of something we can live with. These bacteria are living in an environment without oxygen. So for them to survive when they are making all that energy and they got all that extra stuff at the end of the ATP production, they have to bind their leftover hydrogen into another hydrogen molecule and that makes hydrogen gas. However, if you want to Google this, please wait until after my talk to Google it. But you can take a note here. Google the, you know, health benefits of hydrogen gas. Their immense, right? It does everything. It's like reading about glutathione or something. Hydrogen gas turns out to be one of the healthiest things in the world, right? So when we have a right amount of hydrogen that these organisms are making, we become very, very healthy. And this is one of the reasons why these bacteria are so important.

So again, when we make energy, the end result is water. When these bacteria are making energy, they have this leftover hydrogen molecule as well. But there's not the ability to mix it with oxygen because they're in an anaerobic environment, right? They're in the intestinal tract. There's not a lot of oxygen hanging around there. So they end up making hydrogen gas, which has many, many, many health benefits. And when you read about the benefits of hydrogen gas, think about that gas is being produced by these healthy bacteria. Every article you read that says how great hydrogen is, is saying that the microbiome is important, okay? This is where the hydrogen is coming from. You can take hydrogen in the supplement form, but you can also make it if you have your gut bacteria working properly. It's very, very important, okay?

Now, where this plot kind of thickens is that there's these other bacteria that need the hydrogen gas to survive. Not only is the hydrogen very good for us as human beings, but it is the food supply for other organisms. So not having the hydrogen gas in the GI system, again, it's like you not breathing. You're gonna have bacterial die-off, right? Organisms that require hydrogen are going to die if they don't have enough hydrogen gas. And of course, this is super important in terms of the production of cellular energy too. So the first group of organisms I showed you, and again, this is just conceptual, don't have to memorize that, it's too complicated to memorize. It is making hydrogen gas. The others rely upon that hydrogen gas, plus the hydrogen itself is really, really good for us. Now, there's other organisms like the Desulfovibrio piger that live on sulfur. Now, without these in place, right? We are going to become inflamed, at risk for autoimmune diseases, cancer, diabetes, obesity. And everything that you read about the microbiome is dependent on this food chain that we're talking about. Short-chain fatty acids converting, you know, from fiber, the hydrogen producing, the hydrogen consuming, and then ultimately the specialized organisms, the three bellwethers.

Alright, so that's the general environment that we're looking. We're looking at again, one more time. You got the bacteria that are gonna, as a group in general, take fiber and convert it into fat, into fatty acids. Those fatty acids then feed those fatty acids, right? It's like, um, it's still a miracle in my mind. I know I already said this, but the fact that, you know, these bacteria can take a bunch of fiber that's like useless to us and turn it into fat that we can burn up. It's kind of a miracle. But anyway, so we take the short-chain fatty acids are the fuel supply. They go into the cells of the intestinal tract, and they're fueling our gut cells, literally our gut lining cells, right? Once that's happening, we get hydrogen gas produced by the hydrogen producers. There's these other bugs that consume the hydrogen, and then this whole cycle continues and goes on, right? Now, that's the bigger context. Now we're gonna look at the three bellwethers because you see this is like something that you can do easily Monday morning, okay? Akkermansia muciniphila, Methanobrevibacter smithii, and Desulfovibrio piger. So remember, Akkermansia responds to inulin. So if you see low Akkermansia, you think inulin. You see low Akkermansia, you think berberine. Desulfovibrio piger responds to sulfur, like chondroitin sulfate or some other sulfur compound like taurine or methionine. And we'll talk about methane, Methanobrevibacter smithii in a sec.

So how do you find them? Highlighted them here on the test. You can see in yellow there. They're just right at the bottom of the lab. Pretty straightforward. Now, here's a little more detail on each one of them. So with Methanobrevibacter smithii, has anti-inflammatory effects. Methane, right? Methanobrevibacter smithii. So it does have a byproduct of methane. It's actually not a bacteria, strangely enough. It's an archaeon, which is really kind of cool. Desulfovibrio piger, already mentioned cardio, helps reduce cardiovascular risk. One of the sort of end products of Desulfovibrio piger is hydrogen sulfide gas. Hydrogen sulfide gas. Now, hydrogen, hydrogen sulfide gas. So if you've ever been to the Big Island of Hawaii, this is where my family is from. So in late 1800s, there was a bunch of Portuguese people that came from the Azores and Portugal, and a bunch of Japanese people that came from Japan. And my, and my great-grandparents on both sides, the Portuguese and Japanese side of my family, ended up on the Big Island of Hawaii working in sugar cane plantations. And so the Portuguese side were pretty well off, you know, they were like what we would call now like senior executives in the company. So they were running these plantations. And the Japanese were imported as, you know, probably kind of borderline slave labor and entered service, you know, servitude, kind of slave labor. And, um, somehow out of all that, I ended up showing up a couple on, like, a hundred and some years later. But anyways, one of the big things that, you know, if you think about the Big Island of Hawaii, is the volcano, right? And when we were visiting, I take my mom there every summer to visit the family. And last year, we were sitting around and one of my uncles works in the geothermal plant that's associated with the volcano. And they walk around, he had his little, he's just come from working as a little badge on. And the badge measures your hydrogen sulfide gas exposure because you get exposed to too much hydrogen sulfide gas when you're working around a volcano, and boom, keel over, get all kinds of neurological problems and drop dead. So they're pretty careful about that, right? We make, where I shouldn't say we, Desulfovibrio piger makes hydrogen sulfide gas. Now, most of the things you think about with hydrogen sulfide gas is like, you know, this is deadly and bad stuff. But it turns out, and really, really small amounts, that hydrogen sulfide gas has profound effects on preventing cardiovascular disease. Who would have thought?

Akkermansia muciniphila, my favorite one, I'm sorry if I talk about it too much. It's the mucin-grazing one, right? So one that's going along, it's living on your mucin. Your body's making mucin, mucosal lining, right? Proteins in the mucosal lining. And this little guy is just chewing that stuff up. It's eating and maintaining the health of your gut. So these don't exist in large numbers. But these three are called bellwethers because when you have a healthy microbiome, all three of these will be normal. Again, the original research that the lab did when they were setting up these tests in healthy individuals, all three of these bacteria were normal. So if you do nothing else, when you look at this panel, look at Methanobrevibacter smithii, Desulfovibrio piger, and Akkermansia muciniphila. If they are normal, you got a solid and healthy microbiome on your hands. If any of these three are low or high, you got a problem, okay? Especially if they're low. It's primarily if they're low.

So as an aside, just because this is like, this is like a science nerd kind of thing. But there's two, you know, there's two domains of life, right? And originally, we all learned this in, like, high school biology class. But they found a third form of life, this Archaea. They discovered them originally and these high-temperature vents, right? And there's deep ocean and stuff. And then they realize that there's one of them that lives in our gut. How crazy is that? And its cell membranes are totally different. Its ribosomal RNA is totally different. I mean, it's such a different organism. They had to create a third form of life, Archaea. That's Methanobrevibacter smithii. It's not a bacteria. It's this whole other kind of life form. It's so cool. Anybody want to read about this? It's really interesting. When it's high, implicated in obesity. Again, this is one of our bellwethers. When it's low, you have a problem as well. So it's a hydrogen-consuming organism, archaeon, okay? It's anti-inflammatory. It's the one that makes methane. You can see from the name, it's got methane in the beginning of the name. So high messes up your metabolism, you get fat. Low, it's a big problem. You can use fiber to start to bring it up. It's a hydrogen-consuming bug. So you get the hydrogen producing bugs to come up. This guy comes up. It's kind of like playing the game of pool. When you shoot a pool ball, you don't hit the real ball that you want to hit into the thing. You hit the cue ball, you hit the white one, and then it hits the striped one, and then if you're lucky, the striped one goes in. So you want to get Methanobrevibacter smithii to go up. You can't target it directly. You target the hydrogen producing bacteria because this guy lives on hydrogen. You getting the hydrogen producing bacteria up is gonna get this bug up. That's how cool this stuff is. Methanobrevibacter smithii.

Here's a sample lab. Oh, now you can see on the top, I also circled, circled Desulfovibrio piger. You can see that is DL, which means under detected limit. So that's low. Methanobrevibacter smithii in this example is high. And Akkermansia muciniphila is normal. Okay? And Methanobrevibacter smithii related to obesity in rats. If you don't care a lot about fat rats, probably you care about children. Methanobrevibacter smithii also associated with childhood weight gain. It's a really, really important bug. Second of the bellwethers I talked about, Methanobrevibacter smithii.

Now, Desulfovibrio piger. High, potential hydrogen sulfide related inflammation, as in IBD. Remember that's the volcano gas I was talking about. Low, you want to add sulfur amino acids because you want a steady, normal release of hydrogen sulfide. And that's what's associated with low risk of cardiovascular disease. So a gas that can be deadly in large amounts, in tiny little amounts, perforating through your intestinal tract, impacting your cardiovascular system, it turns out to be really, really important, okay? And I just thought this was cause this, Desulfovibrio piger, it's a vibrating cell, right? Vibrio, isn't that cool? They named it because it has this vibrating, kind of whipping action. It's also a hydrogen-consuming organism. Hydrogen-consuming. So Desulfovibrio piger high, you should be worried about it. You might, in some cases, if all these organisms are high, if there's a pattern where, you know, there's 24 of these bugs, if you see a preponderance of them are high, it may be a dysbiotic state. You want to use some antimicrobial herbs, right? But in general, if it's low, you're gonna want to use the sulfur amino acids or chondroitin sulfate to bring it up. Again, here's another example. You see the Desulfovibrio piger.

Here, lo, let me just highlight that for you. Here's your deep hider. So DL means underneath detected limit. It's a little confusing the way they do this, but the gray area here is low. So even though the marker is way over on the right, that's a low. Okay?

And then let's see, R M Smith I, oh, that's low too. DL is underneath detected limits again. You see the markers over on the right, but the markers in the gray area, so that's considered low. Okay?

And here we have our Ackerman C. Again, is normal with this example. Low bellwethers. So the whole point of the three bellwethers is that in a healthy microbiome, D Peyser, M Smith I, and Ackerman CMU Sinha philia will all be normal. If you see even one of these three, in this case, there's two that are low, if any one of these three is low, you have a patient that has a microbiome problem and that you should, you know, basically get to work on.

Now, big picture, conceptual concept here, and I don't totally accept this yet, but Richard's been saying this for three years and he's wearing me down. If you have a patient that has Cryptosporidium or blasto and they're highly symptomatic, you know, the the gut response for all of us is to just go after that bug and try to kill it with anti-parasitic drugs or antimicrobial herbs, right? And what Dr. Lord is trying to convince me of, and hence I'm gonna eventually start to try to convince you of this, I'm still struggling with the concept, is that if your microbiome is perfect, that's your idea, that crypto may not cause a problem. And in fact, that it's the imbalance in the microbiome that allows these infections to take place in the first place. And so I think we've all been, and certainly I have been, so focused on killing gut parasites and killing your yeast organisms in the gut, I haven't taken seriously the implications of restoring the microbiome. And so I think that that's kind of a shift in consciousness for me is to look at the microbiome as the centerpiece of this whole scenario. And what happens to a patient if you get these three bellwethers working properly? Maybe you still need to treat the Giardia or H pylori, but it's certainly going to be a lot easier if you have the commensal bacteria, you know, all going, you know, kind of rowing in the right direction with you. Okay?

So I think a fundamental concept with every patient at some point, and we have to stop and test the microbiome and restore its normal function, get all these levels back to normal. Okay? I think that's an essential project. I still in my own practice do a lot of killing of bugs. I do a lot of anti-Candida programs, a lot of anti-H pylori programs. Was my favorite, do tons of anti-parasitic programs. I'm not against that. I do those literally every day in my practice. But I also think it's really important to just have this bigger picture about being able to test the microbiome as well and be able to know a few tricks for correcting it, right? So we're not just kind of stumped when we look at that page of markers and confused.

So deep hider again, reduces arterial blood pressure, right? Can be healthy for the cardiovascular system, has a really healthy effect on the nervous system, has a healthy effect on the kidneys, very important. And here's your deep hider markers, your M Smith I, Acromantula, circled all those. So again, those are the three bellwethers we want to remember. Ackerman's name is Santa philia. If it's high, you can have dysbiosis, right? For any, if there's a pattern of high levels, of course, you can have dysbiosis. If they're low, you can do calorie restricted diets, those helped a lot. You can do prebiotics like inulin to bring the levels up. And a good, remember the Ackermann sia helps feed the other good bacteria. So it's very important overall for our overall health. And it's also, a lot of researchers look at it as, you know, anti-obesity bacteria. It's very important. And there's a lot of research out there. I mean, you can really can't keep up with it. I certainly can't even come close to keeping up with it about all these, you know, effects of these different organisms, like literally every day those studies coming out. This particular one I just mentioning here, it's Ackerman students in affiliate inversely associated with obesity, diabetes, cutting metabolic function, low-grade inflammation. And they've been a bigger picture here, and I highlighted that microbes play an important role in the regulation of host metabolism. Who doesn't want to lose weight, right? Everybody that we work with wants to lose weight. So if nothing else, you should correct the microbiome to normalize metabolism.

And here's some of the mechanism of all this, right? Well, you can see these organisms out there breaking down the fiber, making the short chain fatty acids that are going to keep us healthy. There's not a little snapshot of Akram and Sia on the on the right hand side. You can see the thinking mucosal lining that our Manziel helps maintain. And all the different things that that helps us with health-wise. It helps reduce inflammation, it helps improve insulin responses, it helps your liver, helps prevent diabetes, all kinds of really good things that happen when Akram an SIA is improper numbers. Because our Man SIA being low is the same thing as saying that the bug that monitors and protects your gut lining is low. So low or poor levels of macro Man SIA is going to end up equating to a leaky gut. And then here we go with interventions again for our Man SIA. Berberine and inulin, pretty straightforward, nothing too complicated about that. Most of all the companies that we work with have inulin products and berberine products.

And then quick little summary here about all the general treatments. So there's five treatment options I put up here. There's literally probably several thousand if you really get into this. And today, you know, I talked with Dr. Laura today for almost three hours about one or two labs, maybe I think we went over two labs and maybe like barely scratched the surface talking about two or three of these bacteria that he hadn't really educated me on up to now. So there's a lot going on, right? And we're just talking about the most obvious things are though, generally, other general levels low, use probiotics, etc. You can use obviously, you know, bifida bacteria, actually bacillus, all the basic probiotics, a broad-spectrum probiotic to try to get the levels up along with the dietary changes, right? The fiber from beans. I don't you put a lot of patients on high grain diets, but I do try to get people to eat beans on a regular basis. If you see item number two here, combinations of high and low targets, kind of an imbalance pattern, put in dietary polyphenols or use supplements that have polyphenols in them. If M Smith I is low, again, you're thinking about fiber, okay? If deep hydro is low, you're thinking about methionine or cysteine or Tom marine or chondroitin sulfate, some sulfur compounds. And if a crow man scream is Sano philia is low, you think about inulin, okay? So there's a bunch of treatment options there for you.

We're going to be starting up another class, as I mentioned, in April. If you guys are curious, please come check it out. We review labs over and over and over, over and over and over, week in and week out. It's really fun. We have a really good group of doctors right now and I learned a lot. I think the students and the class learned a lot. And our goal, my goal really, is to just make sure that we get practices up and running and functioning fully. Okay?

Then we got a couple minutes. I'm going to try to get to a couple questions and then we'll wrap it up. Let me just see what we got here. Does drinking hydrogen water help with a bacteria requiring hydrogen? I don't know, but I don't, I, I don't know. I don't know if it would get all the way down into your large intestine or not. Oh, yeah. So fecal bacterial fecal Oh bacterium prostitutes, aye, it's hard to say that one. Is on is on this test. If you're into that one, it is on here. Let's see here. What, what do you do if T Podger is too high? So if any here, now we have a conundrum here. So the because Michelle asked this question, we kind of make it a bigger question, which is, what do you do if a commensal bacteria is high? What do you do if there's a pattern of highs? Well, if it's extreme and it's and they're consistently high, you know, there's very few low or no lows, then you would consider it a dysbiotic state and you might actually want to try to, you know, obviously do all the dietary changes, but then also use some antimicrobials to try to reset things. It's tricky though, right? Because we're talking about a good organism that's overgrowing. Not all these, not all these organisms are going to cause a problem if they're at excessive levels. And sometimes you see patterns where there's several these organisms that are really high, there's a bunch that are really low, and that's just a normal healthy microbiome. That's why this lab is hard to interpret. So let me say that again. There's no 100% way it has to be with the microbiome. So you could have a perfectly healthy microbiome and have five markers that are super high and five markers that are super low. I mean, if you don't consume dairy products, your lactobacillus could be non-existent, and that's normal for someone that doesn't eat dairy. That's why the bellwethers are so important. Because if you see the three bellwethers all present, then whatever pattern you're looking at is okay. So let's make up something here. Let's say the three bellwethers are all present and they're all, you know, in the right numbers, and you have a bunch of highs and a bunch of lows, that's just how that person's microbiome is. Okay? That's why the bellwethers are so critical. Because all the original research they did to create this lab showed that if the three bellwethers were normal, you got a good solid healthy microbiome. Okay? That's our our goal, so to speak.

And then how does this relate to SIBO? Well, all the things that we're talking about are primarily happening in the large intestine, right? And so it's a whole other can of worms. You know, SIBO can obviously be tied into this. And you can have, and probably usually do, have a commensal bacteria problem in the large intestine with your SIBO patients because the same kinds of things are going to set someone up right for these issues. So whether they're overusing antibiotics, whether they have a bile profile production problem, hydrochloric acid, or a pancreatic enzyme production problem, any of those kinds of things is really going to start to lead to either a small intestinal bacterial overgrowth or a problem with the microbiome. So they're all kind of tied in together. The theory would be that if these organisms in the large intestine are just perfect, that SIBO probably is not going to exist, right?

Let's see. I'm trying to through these questions like able to get through them all because there's like a hundred questions here. Um, yeah, then this is, I like this question. So Margaux is like, does anyone really know what low or high for any one person is? No, absolutely not. Like, I mean, we know probably more about like deep space than we do about the microbiome, right? I mean, our understanding of this, I don't even think it started. I think what's happened is that people just realize it's really important. And we have these tests now that are kind of cool because you have the PCR testing, so you can get accurate measurements. But I don't think anyone understands this at all. We do understand, however, that they have these three bellwethers. So there's something to grab onto there. We do understand that some of these bugs are going to respond really positively to fiber in the diet, right? So there's some basics that we do understand, which is I'm trying to talk about tonight. But I don't think we understand what pattern equals this disease or, you know, in any of the levels of detail of this. I think it's the early, early days for us to try to wrap our minds around this.

What's the best protocol for Candida? So I use antifungal herbal supplements for Candida. A lot of the practitioners that I work with are medical doctors. I'm not, I'm a chiropractor. And they are just as happy to prescribe antifungals. So those are kind of the two tacks I think you can go on.

Alright, I think time here. Just want to make sure we end on time. Well, great. I'm sorry I wasn't able to answer all the questions, just a few too many of them. But I'm certainly seeing that you guys are interested in this. If you're totally fascinated, you can afford it, sign up for the class and we'll do more in class. You can submit your labs and to the coursework and Richard and I look at them together and then we talk about them in the actual Q&A calls. And April is the next start date. If you're curious, please get in touch with us. And otherwise, we'll be doing another one of these talks in the near future and I hope to have you join us again. Okay, take care. Talk to you soon.