GI Lab Case Review

Hello everybody, and welcome, welcome to what is sure to be a fascinating evening. Thank you for taking time out of your regular lives to be here. We had a huge sign-up for this particular idea. So, a little bit about myself, then we're gonna get into the class.

So, who am I? That's me. That's Dan. I am, apparently, I'm reading my own file. I'm the embarrassing lead faculty for the Institute for Functional Medicine's Practice Implementation Program. Just shows all that anybody work there? No, I'm kidding. So, you know, we worked for several years with IFM to create this Practice Implementation Program, and it's really great, and it's like a, it's a wonderful thing. And the IFM faculty and staff are like the best people in the world. So, total IFM supporter here. I am IFM certified. I've done research. In fact, we're, we're going to talk about tonight, we researched with the Mayo Clinic, the Integrative Medicine Department at the Mayo Clinic. Can you believe that? We actually did a study on this stuff, exactly what we're talking about tonight. And I use this with patients all the time because people like, "This seems a little sketchy." And I'm like, "Sketchy? Well, let me just show you." Here's the actual copy of the study. It is "Evaluation of Functional Medicine Approach to Fatigue, Stress, and Digestive Issues in Women's." Who cutshall for Mayo and Rochester, Larry Bergstrom, the head of Integrative Medicine at Mayo in Scottsdale, and little ol' Dan did the study. And we proved scientifically that this stuff works, that an adrenal and a gut program makes people better.

And now I'm working with Dr. Richard Lord doing all kinds of advanced lab interpretation curriculum. And so the mentorship training program that I teach now is kind of morphed from the work that I primarily learned in the early parts of my career to include that, but also now include all the work of Richard Lord, who we're gonna talk a lot about tonight because he is the scientist that first imagined the GI FX test. And that microbiome section of the test is, you know, the culmination of Dr. Lord's many, many decades of dedication to our field. And he has retired now, but I have the great privilege of speaking with him every Monday, and we review GI FX tests one after the other after the other. In fact, I just did this this past Monday for over two hours. And who, we're gonna try to get into some of that. Okay.

We also have some other stuff available if you guys are interested. We have a GI Masterclass that you can sign up for. Some of you have already attended that. If you haven't, something you can check out. And we have a mentorship class that's starting at the end of March, and you get $1,000 off if you use this special little code there. And basically, in the mentorship, we do what we're doing tonight. We have you labs every week, the doctors send in, and then there's this huge curriculum and community feature to the mentorship as well. So, if you guys are curious about that, you can contact us. And without further ado, let's take a look at the subject of the day.

And so, we asked practitioners to send in labs that we could review in class tonight so that we could kind of make sense of all this. And some of them are hopefully on the line right now. They may not all be, but let us see if Beth is here. Yeah, it looks like she is. Beth? Beth, is that Beth? Beth, can you hear me? This is the real Beth. Yeah, this is the real me. This is not a fake lab that I just prepared for you. Actually, I think honestly, I don't even know who you are. Is that true? Like, I don't even know who you are. Every met? Okay.

So, let's just jump into it. Just tell us about this patient and what you're trying to do and how I could help with the interpretation. Okay, so he's a 16-year-old diagnosed several years ago, I think at 56, 54, something like that, with prostate cancer and underwent a radical prostatectomy. He had radiotherapy and no chemotherapy, but is on an androgen deprivation therapy. He is super motivated. She climbs Himalayan mountains that have never been climbed before. And this androgen deprivation is really wiping him out. He has a fragility fracture on tibial plateau. So, we're trying to keep him healthy that way. And he's just really saying, "What can I do? What can I maximize while he's still underneath all this androgen deprivation?" And he's also on prednisone because of that. The way that abiraterone works is it shuts off the enzymes that also create cortisone. You don't have all the feedback loop, so you have to supplement with that or you go into crisis. And so, so he's a super good eater. They eat lots of fresh food, all organic. He exercises. In fact, we had to have him back off exercising based on his cortisol test. He's, he's just so low cortisol. All he's got is the final grams of prednisone once a day. And so, just checking all these different things. And was this, this was the first GI map I ever did. So, I'm, it's been a while since I did it, and I'm not sure how to interpret whether it's significant, the findings that we found here. I'm, I'm very new to all of this stuff. Okay.

All right. Well, let's give it my best shot here, right? This. And so, this gives a little bit of chat about the background concepts here first for all of our sakes. So, first of all, you have a patient that's primarily interested in nutritional status and immune function, right? And as we know, the majority of the immune system is in your gut, right? So, if you want a healthy immune system, yeah, you have to fix the gut because I don't know what the estimates are, 60% or whatever, your immune system, that's where it is, right? And then, in addition, if you want to maximize nutritional status, you know, then it's not what we eat, we're what we absorb. And so, you could be eating the cleanest diet, and if your absorption is not so great, then the results are not so great. And I know I personally experienced that when I was in my early 20s. I was a little crazy and I went to Thailand, and I lived in a monastery in the woods, in the forest monastery for a couple of years. And one of the really unpleasant things that happened to me is I got an extremely bad case of dysentery and couldn't move, couldn't walk. I was, I was really, really sick. And I picked up a really horrible parasitic infection. But, you know, I came back to the States years later, after this whole monk episode, I got over that and had a really clean diet, but, you know, never really felt that good. And literally, the literally the day that I treated the parasitic infection in my gut and my gut started to heal, I started to feel the benefits of all these really great foods that I've been eating for a long time. So, anything that's wrong with the gut is going to interfere with the absorption. And it's ridiculous to have a super clean diet if the absorption isn't working well, right? It just, it just is not really great.

So, then, and also, this guy is kind of an extreme example of this, but we're always thinking about cortisol and the adrenal hormones in relation to gut function and gut treatments because when we're under stress, whatever that stress is, when we're under stress, you know, our cortisol levels get all wonky. And one of the first things that happens when cortisol becomes abnormal, whatever that stress driver is, death, childbirth, something horrible is happening in our lives, right? Someone's sick and dying, or leaving a marriage, or something's going on. And those stress hormones go up so much, and they start to get dropped down sometimes as well. And then the net result is we become catabolic. And the first thing we do when we're catabolic is we start to break down tissues. And it's break down the gut lining, right? It's very easy to grab all those amino acids in your gut lining and use them for fuel. And so, as you become more and more stressed, your gut lining becomes weaker and weaker, and the immune response thing that got gets compromised as part of this stress/catabolic state. So, absolutely, we test and correct the adrenal hormones, you know, his initial round, then we go on and test and correct gut function, right? And usually do them in that order. And where I see the, like my naturopathic teacher, Dr. Timmons, would have said that gut is the most important thing to fix. And he probably would have said toxins are the plague of our generation as well. So, you have to detox people. But he never started there. Just because the gut's most important doesn't mean you start there. All right. And you think about there are lots of things in life where the important stuff we save for later. Like, if you're dating someone and you really like them, you don't say on the first date, "Oh, let's get married. I'm totally in love with you." Right? You save that for a little bit later. You know? So, the most important things often we need to put off. And with the gut programs, the more time that you can spend correcting adrenal hormone issues and getting that catabolic state to come to an end for a couple of months, the more likely you are to get a really great benefit from the gut treatment. Okay? So, just kind of staging it out here. And I think learning these protocols is one thing we're talking about that today, but then you also want to learn how to stage this so that everything happens in the right order. Okay? And that when we're looking at complex labs, I think the only way to deal with this emotionally on our part, and also because you got to explain this to a patient, right? Is to let people know, "Hey, there's three stages of GI dysfunction." This is my patient rap. You could have a microbiome problem. The microbiome is disrupted. The normal bacteria are out of balance. You could have GI organ dysfunction. You can have more than one problem at a time, too, right? Or you could have some kind of GI pathogens. Okay? So, three different possibilities. Stage one: the microbiome is out of balance. Stage two: the GI organs aren't working properly. And stage three: you pick up some kind of a pathogen. And you can have all three of these at the same time. And they tend to be progressive. And so, what we want to cover tonight, we have three or four examples, is how do you identify those stages? The normal bacteria out of balance is the microbiome disrupted, right? How do you find that GI organs that are out of balance so you can fix them? And then what do you do about killing stuff, dysbiosis, which is bacterial overgrowth, or yeast, or parasites? So, figuring out which of those three things is present, and then figuring out how you're going to treat them, right? So, let's look at some real-life examples here.

So, with this fellow, well, we already know this is a big cortisol problem, right? So, that has to be attended to. And then the first thing we're gonna look for is the stage one, and that would be the microbiome. So, with this particular lab company, and for those who don't know, this is a GI MAP test from Diagnostic Solutions. Here's the normal bacterial flora, and we can see these are normal and good organisms. Clostridium, it's a good cluster D, and not the bad kind. Akkermansia, very important good bacteria are high. And Bacteroides seems to be low. So, there is a microbiome imbalance. So, this person is in a stage one. The microbiome is not in the best of places, okay? So, right off the bat, you know there's a problem, stage one. Then we're thinking, "Okay, is there organ involvement also?" So, again, this particular lab, they tuck these at the end here, and they have all these wonderful markers: static RIT for gallbladder, lipase for pancreas, beta-glucuronidase, kind of a liver, kind of a gut bacteria, come both. And then the secretory IgA and calprotectin for intestinal tract function. So, gallbladder checks out, is okay. Pancreas seems like it's okay, right? And a secretory IgA is low. So, there is organ involvement. The organ involved in this case is the intestinal tract. So, we do have an organ involved, and we have a microbiome problem. So, let's go back to our little schematic here. And hopefully, I don't want to like dumb this down to the point where it seems dumb, but, you know, when you're talking to patients, they're sick, they're not feeling great, they're not going to remember, you know, all this stuff. So, you got to kind of make it really simple. So, in our day of stage one, this person, yes, they have the bacteria out of balance. Are they stage two? Yes, they have that intestinal marker, or the IgA is low, so there is organ involvement. Now, we're wondering, hang on, is there anything to kill? Is there stage three present? So, we're going to go back up to the lab and start at the beginning again, because obviously the lab's not printed in the order in which I'm talking about it here. And we're scanning, we're looking for bugs. Don't see anything there. H. pylori looks almost as a borderline marker there. It doesn't look too bad. Borderline. Sees the H. pylori is borderline high. Some of these dysbiotic bacteria are just so close to being high. And then there's a couple here that are actually elevated. So, now we go, "Oh, wait a minute. What are these dysbiotic bacteria?" This person has dysbiosis. They have an imbalance, not just with the commensal and good bacteria, not just a microbiome imbalance, which is just the good guys all freaked out. Now they have dysbiosis, which are potentially bad actors that are overgrowing. Now there's something to kill. So, this person has a stage one, two, and three present all at the same time. That's it. End of story. That's the end of the lab interpretation. I don't know, that took like, I don't know, five minutes, maybe?

And that's exactly what I would say to the patient. Right? When the, when you, because I don't know about you, but when I was first starting to do these labs, I would get freaked out. Like, I would order labs and they would come in and I wouldn't know how to interpret them. And then patients would come in and I was just humiliating. You know, my first adrenal panel I ordered came back and it was a stage two, and I didn't know how to interpret it, and it looked kind of normal to me, and I didn't know what it meant. And I literally still have this memory. It was so traumatic. I literally took the lab, I put it in the bottom of my desk drawer, closed the desk drawer, and never told anybody. I never contacted the patient. And I was just like, "I don't know what to do." So, learning how to interpret these, and then equally important, maybe more important, learning how to sit down with the patient, explain this, is like mission critical. Right? If you can't do that, it's just, this is not gonna go well for anyone.

So, again, stage one, two, and three are progressive. So, we're saying the stage one is stress and poor diet has this cumulative effect. It weakens the adrenals, it weakens the microbiome. How do you treat that? You do the microbiome treatments. Stage two: GI organ functions compromised. How do you treat that? You treat whatever organ is involved. And then stage three: What are you gonna do? You're gonna kill stuff. Okay? So, what do you actually do in terms of treatment? Well, funny that you should ask. And this is shouldn't be too complicated. Let me just pull out a program here so you can see this is exactly what I do in the clinic. So, let's say they have a stage one problem, it's a microbiome problem. You can use fiber, you can use prebiotics, which are kind of similar but a little different. Most of the companies now have really great prebiotic products, pre-product products, and you can use probiotics depending on what's going on, okay? So, these would be for stage one, right? Stage one. Now, this person also, well, is in stage two. So, stage in this first stage two, and they had intestinal issues, not stomach, not gallbladder. So, you could do some leaky gut repair because you're trying to repair the gut lining, repair of gut lining. Now, if they happen to have a gallbladder problem with static RIT being high, then you would do gallbladder support, right? If they had a stomach problem, you would do HCl. If they had an enzyme problem, you would do pancreatic enzymes, okay? That would be for organs. So, you can treat the intestines, treat the gallbladder, treat the stomach or pancreas depending on what you want to do, right?

Now, the last one of these, then I'm running, running out of little boxes here. So, let's go back up. Would be a stage three. In this case, this person has, oh, wait a minute. Let me do a better job with this. Hang a second. So, you want you guys to be able to see all this at the end of the day here. That's, let me just grab this. And so, this is my favorite subject is program design, because I feel like we all need to really figure this out. So, stage three is, this person has dysbiosis too. So, you want to do anti-GI, anti-microbials. Which ones? I don't know. Every company has them. I have my favorites. They're all gonna have the same kind of stuff. They're gonna be colloidal silver, berberine, grapefruit seed extract. If you're trying to go after yeast, and maybe acrylic acid, parasites, it may be or Artemisia, black walnut, right? All the companies that we work with will have really good micro-antimicrobials. So, this person has all three of these problems. So, now this kind of zoom out here, and you can see you have a whole bunch of options. You can treat the stage one, the two, or the three. Or with this patient, you could combine any of these. So, how do you even choose when someone has all three? Well, I really like killing stuff. So, I highly recommend you kill stuff with anti-microbials whenever you can. However, if it's your first couple of times you've done this, those are the ones that are most likely to cause side effects, as well as most likely to make the person better faster. So, the kind of high risk, high benefit thing, right? If you're a little nervous, then just do a stage one. Do some prebiotics, probiotics, and fiber. And tell the person, "Legitimately, we're gonna strengthen your microbiome. That is that the root of all these problems. Your microbiome was what got disrupted first. Let's treat that and see if you respond." And in some cases, treating the microbe will allow the immune system to upregulate and strengthen so you can flush out the dis bad bacteria, right? So, you might solve the whole problem using a stage one treatment. And if you want, you can get fancy pants. You could do a killing program and support the leaky gut. You could do a microbiome program and support the leaky gut. So, you could do a one with a two, or two with a three. You can kind of mix and match these and move them around depending on your level of comfort. If you're nervous, just do the earlier programs. Do a stage one. Not gonna hurt anyone doing that, right? If you're a little more aggressive, you want to get the person better faster, and then go for the three. And you could even run all three of these together if the person is willing to take that much stuff. Okay?

So, now let's go back to Beth and see if she has questions. Kathy, there's a lot to think about there, right? But that's the broad outline. Okay. Yeah, I think he's already doing pretty much stage one. And so, then it becomes the question, and this is an old one, if I did a gut heal, I'm kind of leaning towards doing a gut kill and retesting just because the, the androgen deprivation thing is really makes him feel lousy and he doesn't sleep and all that. So, I don't want to risk doing anything else with the antimicrobials, and maybe those two would clear up some of those opportunistic bad guys. Exactly. That's a perfect logical thing to do, right? All right. Thanks, Beth. Oh, and the secretory, the secretory IgA? So, bang, will come up when you get rid of the imbalance or the despair? Oh, sorry. Hey, I'm unique, you by mistake. Yeah, the secretory IgA comes up really slowly, okay? Okay. It's like watching snow melt, you know, on a mountaintop. Yeah, it's good. It does happen, but I wouldn't use it as a marker for progress, okay? Yes, it was a sign that the immune system in the intestinal tract lining is suppressed, either from chronic infections that have worn it out, or it could be from the adrenal related issues and cortisone related issues as well. Got it. Thing. Yeah, don't use that as a marker for progress because it sometimes it takes a few years to get better, just so you know. Okay. Great. Well, thank you. Welcome. All right. Well, that was a good first one. Let's just move on. We got more. Now, you guys, if you sign up for the mentorship, you're gonna have a year of this where you and we go through all kinds of cases, plus you have this massive curriculum. And I don't know, it's like a thrill a minute. Let's see if we can grab Nicole. If Nicole is here. Oh, look at there she is. Nicole, is that you? Yeah. Hey, we talked again. Yeah, twice in the same day. I know. All right. So, tell us about your person here. Not as complicated as the first one. A lady who came from another practice who had been told she had a, she already an infection, and she really wanted the stool test retested. But her main complaint is just chronic fatigue and GI upset, alternating constipation, diarrhea for the past one year. So, we repeated a test and I didn't see the Giardia, but there's a whole bunch of things on her test that then I was kind of confused what to do with it. So, she had Giardia and an earlier test. Was it documented? It was she said that the people have a laboratory service with a veterinarian clinic, and so she just wanted to test him because they were proposing kind of a complicated protocol to eradicate the Giardia, and she didn't want to do it unless it was real. So, she wanted to retest. Okay. She never treated the Giardia. She never treated it. Supposed to Giardia, right? So, in your mind, did it sound like she really had it or no? Do you tell? No, she is around a lot of animals, and she does fostering for dogs and things. She didn't say that she had any travel. I'm not convinced, but okay. I don't want to say that it wasn't there. So, it's a question where, mm-hmm, now, and then under a lot of these symptoms started around the time of high stress here. Yeah. So, that goes right back to the clinical model that I started off with, right? Where, and, um, a close friend of mine just killed himself, you know, like a month ago. That's like the worst feeling. I've known this guy since we were little kids, and like, it's just, anyways, this woman's brother committed suicide. I have a different appreciation for people who go through suicide after Sean died because it's just like, it's a horrible, horrible thing. Anyways, that kind of death experience, right? I'm a sibling killing themselves is gonna throw you into a state of adrenal chorus, which is gonna weaken your immune system and damage your gut, and then, you know, throw a person through these stages that we're talking about. And so, it sounds like her, her digestive symptoms kind of correlated with a big emotional stress, right? Okay. So, that proves them that, you know, in this case, and you see this very often, that you're gonna want to, knowing that, right, the three body systems have broken down in this predictable pattern. So, you also want to treat the body systems in the order in which the problems occurred. So, if you just try to treat her gut without addressing the stress factor, then you're not gonna get to the real cause of the problem, right? Right. So, part of her treatment, we testing and correcting the adrenal hormones, getting that stress response back to normal, which you can do even if someone has experienced the loss of a sibling. You can't, you can't fix that. And then as part of that fix, whatever's going on with the gut, okay? Mm-hmm. All right. So, let's take a look at this here. There's just a little background noise. Kind of meet you for a second. Okay. So, let's take a look now at the rest of the lab. See, and now we have a stress-mediated serious digestive problem, and we're going to work with the adrenals and get that working right. And then we say, "What's going on here?" And then there's little notes here from Nicole: elevated fecal fat, increased pancreatic lipase. So, right off the bat, this is a GI Effects test from Genova. This is the, the brainchild of Dr. Richard Lord, who sat down one day 20 years ago and thought, "Hmm, kind of cool if we could measure the microbiome." Why don't we try to figure that out? And very far ahead of his time, obviously. And still, I think the number one test in our industry that's old is still, you know, classic kind of test. You can't go wrong with this one. So, insufficiency here, they show there's increased fecal fats. So, that's right back to what we were talking about earlier. It's organ involvement. That's a gallbladder problem. And then imbalance here, you'll see, and I'll try to decode this. They, and butyrate, total short-chain fatty acids, that's going to come back to a bacterial imbalance. All right. So, let's go back to our schematic. This is different lab tests, but we're applying the same exact conceptual framework that we just talked about. Oh, sorry, that's my advertisement. Don't forget about the mentorship here. We want to go back to the same exact schematic. Is this person a stage one with a, mm-hmm, imbalanced microbiome? If so, we can treat that. Are they stage two? Are their organ involvements? We've so we can treat that. And then are there GI pathogens? That's kind of like the question mark Giardia. So, one of those three does this person have? So, let's look at the microbiome portion of the lab first. Well, right off the bat, they tell you here because they give you the little teeter-totter thing. And so, you know, it's kind of like a cheat sheet. Right off the bat, you know there is a microbiome problem. And right off the bat, you know there is an organ problem. So, thank you, you know, over for just giving us a little cheat sheet there. All right. But that's look at, let's dig into it a little bit more because it's not enough just to show a person the graphics. So, let's go in order. Okay? Let's look at the microbiome first. And here you go with all the commensal bacteria, right? And that should be pretty easy for any of us to interpret. That was a joke. Most of us can't even pronounce most of these words. Okay, I can say Lactobacillus, that one's pretty easy. Fecal Oh bacterium, putz nit side, that was not so easy. And when I first started working with Dr. Laura, the first thing he did was he was like, "You're gonna have to learn how to, if you're gonna teach this work done, you're gonna have to learn how to pronounce these." And so he made me practice them. It was like being in French class in the eighth grade or something. And, and he was right, because if you can't say these things, then you're not gonna talk to patients about it, right? Here's another one, this soulful Vibrio pager. So, when you're looking at these bugs here, and there's a summary that we've already said, there's a problem, right? So, we already know there's a problem. But when you look at these bugs, you can just eyeball this and you can see, are, is there a pattern where a whole bunch of these are low, or a pattern where a whole bunch of these are high? And absolutely yes, there's a pattern where a whole bunch of these are high. All right. Is this dysbiosis? Kind of, but not really. These are commensal or normal bacteria that are at a balance. So, there's clearly some microbiome problem. We can at least call it that, right? This is a microbiome imbalance. It's not really dysbiosis. Dysbiosis is the harmful bacteria, okay? So, although those terms are confusing and they get used in different ways. So, again, these are commensal or normal bacteria. It's a really clear pattern where a whole bunch of them are high. So, we know there's a microbiome imbalance. And then on this lab also, they give you some other markers here, which are a referendum on the gut microbiome. And it is the short-chain fatty acids. So, as just a strange reality of nature, when human beings eat food with fiber, we don't digest that fiber, but that fiber is used as a fuel supply by the intestinal bacteria, the good guys. And they convert that fiber that we eat into fat. I know that's a little strange. That's what their little bacterial lives are all about. They grabbed a little fiber, they bring it into their little bacterial world, and they chew it up and use it for fuel. And what they dump out is fat, short-chain fats, short-chain fatty acids. It just happens that these fats, butyrate, acetate, propionate, make up like 60 plus percent, 70% of the energy supply that our gut needs. And these or these fats, short-chain fatty acids, have this massive anti-inflammatory and massive immune-stimulating effect that's like hard to even wrap your mind around. So, when we eat fiber, the good bacteria feed on that fiber, and they release these things called fat, short-chain fatty acids, that are really good for us. So, what we're seeing here on the lab, these are low. That is not good. That is a direct indication that the microbiome is messed up. You're not making enough short-chain fatty acids, okay? So, right off the bat, we know this person is what we call stage one. Stage one microbiome. What are we going to do? Treatment: prebiotics, probiotics, fiber to get the microbiome working. Prebiotics, probiotics, fiber. And I love using prebiotics. They work really, really well. It's kind of a new and hip thing. If you're tired of using probiotics, try some prebiotics with your, with your next patient. So, now, second question is, is here organ involvement? Okay. And in this particular lab, let me see. Yeah, oh, here we go. It's right here. You can see the products of protein breakdown seem a little off, right? On a border line there, right? And then the fecal fat is a little bit off. So, we can say there is a problem with some organ involvement in terms of digestive enzymes, HCL, in the pancreas, and in the gallbladder. And then is there inflammation and damage in the gut lining itself? These markers seem to be pretty close to normal, okay? So, we can learn all this again from the summary. I'll go back up there, but, you know, you want to show more than just a summary to the patient, right? That's just not enough to talk about. So, here we go. Fecal fats are off, gallbladder support. That's a stage two. It's an organ imbalance. In the good bacteria, indicated by the butyrate, short-chain fatty acids, and we also saw it in those bacterial markers themselves, microbiome problem, okay? Now, we're just wondering, is your stage three? Because the person suspects Giardia. And so, we go down and we look at the Giardia part of the lab. And again, this is a GI Effects from the lab company Genova. They do a culture here as well. And we're looking for, I think it's on the last page down here. They have all their parasites. And doesn't look like they found any parasites. And it doesn't look like they found any parasites. It's all not detected. So, let's grab Nicole again and see if this is making sense. Shh. Nicole, you there? Yeah. Yeah, it doesn't look like she already on this lab. I mean, it's pretty straightforward on that part. And I think just the support and a beta-glucuronidase, and her being on like hormone replacement, is that something that would also correct by just doing the regular support and some gallbladder stuff? Yeah, you know, gallbladder, gallbladder support is like a secret hidden gem in GI treatments. Like, you know, I know there's two really good friends of mine that are Ben Lynch, you may have heard of him, he's a naturopath. And there's other women, Brizel men, that are just like in the trenches all the time dealing with SIBO type stuff. And both of them independently have told me, you know, gallbladder is the trick. You know, when people have this intestinal bacterial overgrowth, if you get the gallbladder working well, the bile is a natural antibiotic, just all kinds of good things will happen in that. And you know, honey, it could be a, that might be one of the keys to getting rid of her diarrhea, right? Right, right. Yeah, along with every biotics, probiotics, and, you know, maybe some anti-inflammatories, right? That makes sense. It does. Okay. I, good. Thanks. And again, oh, and then of course, testing and correcting your adrenals because this was all initiated by the death of her brother. Yeah, it's a great example of exactly what we're talking about. This is what makes people sick, right? We get in these really emotionally intense experiences, and then our gut falls apart, and then the microbiome falls apart, and then we're off and running in a really negative way. Okay, let's see here. We got another lab coming up. I think there's two more. Robin? There is Robin. Robin, is this you? Robin? Yeah, I'm here. Hey, nice to see you. Hey. Yeah, thanks. Tell us about your probably a person's a kid, like the high school kid, huh? Yeah, this is a high school freshman had some bloody diarrhea. His mother said that she noticed he was always in the bathroom. He was having symptoms of ulcerative colitis for about two years before I saw him. But he didn't tell his parents for like a year because he, he didn't know it wasn't normal. I know. And I guess he was embarrassed. I don't know until he heard a friend of his talking about one of his cousins who also had an inflammatory bowel disease. So, yeah, so he sat on it for a while, and then he's pretty symptomatic, you know, you know, he comes home, I guess one thing that would happen, he would come home from school and have to take a nap and have to, you know, do all that. Well, look at that. Yeah, that's terrible. My first patient, this woman Nancy, that I ever ran a stool test on, she was in her late 20s, because, still, I still remember this. I was like, this was, this was almost 30 years ago. Anyway, she was in her late 20s, she was a PhD student, she was really stressed, and she, that's been diagnosed with ulcerative colitis, and she had just been put on steroids, right, to control it. And I had, I had no idea what I was doing. I just heard that you could do these parasite tests. I really didn't, didn't know anything. And it was way before I started to work with Dr. Timmons. I just ran this random parasite test, and she had Entamoeba histolytica. Yeah. And of course, if you have a histo infection, you take steroids, what's gonna happen? It's gonna get a lot worse, right? And she went back to her GI doctors. They were, I don't know what the right word is, not really embarrassed, but they were friendly about treating it. Between Adia Histo, and she basically, that the, the supposed also to have colitis has disappeared, you know? So, that's a pretty extreme first case to have. And then I, then I, then worked with, you know, probably hundreds of people like that. And it's never that, I mean, I was probably the easiest one I ever had, you know? But I would say, if you can get rid of all the infections, get the microbiome working, and the organs working, you can at least improve symptoms in ulcerative colitis and Crohn's patients. You don't always get a complete remission or correction, that'd be totally unrealistic, right? But you can help a lot. And you can help people get, you know, so they're on less medication, and you can help a lot, right? Yeah, he's getting, we're Emma Kate. Well, the last time I saw him, I haven't seen him for a couple months, but he was getting Remicade every six weeks, and it wasn't enough. Like, he needed it before the six weeks was up. So, I mean, he's, you know, getting some hype and stuff that's not enough. Yeah. So, and this is a very special product. I don't use this very, like, just for everybody, but for people that are this sick, there's a special form of butyrate that's on the market now. It just came out a few months ago, and it's made by Pure Encapsulations. It's called Sun Butyrate. Okay. I haven't used that. Yeah, but for a kid like this, it'll be like a game-changer, like almost guarantee it. Here it is. Sun Butyrate, one teaspoon, three times a day with with meals. Sun Butyrate from Pure. And I, you know, I talked with, there's, um, there's a Dr. GI doctor at Columbia in New York City. There's another GI doc at UCLA Harbor UCLA's facility. And they both had 30 or 40 of their ulcerative colitis and Crohn's patients on this stuff. Just, it clears up the bloody diarrhea in a matter of three or four days. It's like, yeah, it's not, and I wouldn't use it just like as, "Oh, you have a tummy ache" kind of thing, but for someone that's this sick, it's a total game-changer. And let's look at his butyrate levels, right? Because we would only prescribe it if they have low butyrate. Look at that. Yeah. Yeah. Now, that's it. Yeah. So, that would be stage one treatment, right? Because it's, what's the low butyrate mean? It means that there's not enough commensal bacteria breaking down fiber, correct? So, a very powerful stage one treatment, not one you would use all the time, but for someone that's got this kind of problem, probably in a week or two, it's gonna change his life. Okay. That's fantastic. Can I ask you about the baton week you're on a days? No. And I had another patient who was beta-glucuronidase was low. Does that, I mean, what does that mean? Do I worry about that? I don't worry about that. Well, it's a, it's a sign that there's a bacterial imbalance and that there's problems with the clearance of estrogen that are associated with that. But that's gonna get wrapped up in in the corrections that we're talking about tonight. Would typically indirectly clear that. Some people would also do something specifically for it related to the liver or other kind of treatments, but I usually just wait and see with that. So, you don't give the patient too many treatments all the same time. And then, then the other question is that we were agree now. Let's look at. So, the microbiome, we know for sure, right, is a problem because if you to rate is so low. And we can also look at the pattern of the commensals here and see, remember the last one we saw, they were also high. Now, this one is quite the opposite, isn't it? Look how many of them are low. Like DL, DL, undetected, DL, undetected, DL, undetected. DA means, you know, that they couldn't even find it. We need to take the limit. This one is actually on the low side. So, a lot of these are low. So, this person is in the opposite situation of the last one we just saw, one where there's a microbiome problem, but the pattern was they're all skewed high. This is a microbiome problem, but they're all skewed low. Okay? So, what's the solution? Prebiotics, probiotics. In this case, probably this the butyrate instead of fiber. Well, how many of these are low, right? So, it's kind of the opposite pattern to the one we just saw. And then you'll see some of these dysbiotic bacteria here, like Klebsiella, Proteus, are high on the culture. So, there is some things you may want to kill, but you want to be really careful because it's a kid and they're pretty sick. And then looking at the parasites, they didn't find any of the major parasites, right? So, we can treat stage one with the butyrate, prebiotics, and whatnot, right? Maybe some probiotics like something like Saccharomyces boulardii. You can treat the stage two stuff here, which would be, I'll, you know, some anti-inflammatories for the gut. You can see how the gut is so inflamed, obviously. What's happening? What would you use as the anti-inflammatory? Oh, yeah. So, um, so every company that we work with will have a powder, and it'll be GI Boost, GI Repair, GI Revive, GI's Sustained, whatever different names. Yeah. And they'll have a ton of glutamine in it, and then a bunch of anti-inflammatory herbs. Typically, you want to dose come up pretty high on one of those glutamine-based powders, you know, five, 10 grams of glutamine at least twice a day. You know, you usually, usually people underdose those. You know, so you really want to give a hefty amount for me, not forever, talking like a month or two, just really trying to knock the inflammation down and get some repair going. And then if he's in a chronic state of area, the SAC polarity can help a lot as a probiotic. And then the Sun Butyrate is this all game-changer, right? For someone that's this sick. And then I may have my other favorites too, but I was so, especially for a teenager, try to keep it really simple, right? Yeah. I mean, there are other things you can use that are anti-inflammatory, good for your liver, good for your gut. There's berberine, there's turmeric or curcumin type products, there's different kinds of licorice root that are designed as anti-inflammatories. But usually, the ah-1 powders are a simple solution for someone rather than giving them a ton of different stuff. And you can really help this kid, though. And it probably within a month or two, you're gonna notice that there's some significant improvements. Does that make sense? Yes. You know, I have a question, which I think is related, but like, when would you use, like, not in him, maybe, but like the bovine immunoglobulin? Would you ever use that? Yeah, absolutely. So, if you ever want to strengthen the immune response, right? So, specifically, you would think about that. Let me show you. There's markers for that. Oh, here, fecal secretory IgA, right? If your IgA is off, or really, honestly, if your calprotectin or any of these markers are off, if there's inflammation and damage to the immune system, then you can use those kind of immunoglobulin type. But you were in, in his case, I mean, as simple as that, Sun Butyrate would be a game-changer. And then, you know, that like a GI Revive or something like that. Yeah, exactly. What are the powders? The butyrate, maybe some Sac Boulardii. If you want to do some extra anti-inflammatories, you could. To really try to get a little better control by keeping it to maybe, I don't know, teenager, maybe like four products, five products max, and see if you get an impact. And here's another question. I did not test his adrenals. Would you do that in a 15-year-old? Yes. Okay. Well, and you already told me that you should do that because you'll be talking about the stress and the dad lost his job, remember all that? Yeah, I mean, I was just trying to figure out what, when that started, what was happening in his life. So, yeah, if there's a stress component, then you want to check the adrenals for sure. Yeah. Okay. That's a good one. You should. Can you email me on that after you use the program for like, three or four weeks, and just tell me if it went well or not? I'd love to. Okay. Yes, fire me an email to the office. I just be curious to keep track of him to make sure. If it's not working in three or four weeks, let me know. Well, it either way, let me know if it's not working, we can have another plan. But if it is working, I just want to make sure I track that. Okay. Great. Thanks. All right. Yeah, thanks for everything. Okay. I'll do questions at the end, too. We'll save a few minutes for questions at the end. You guys have them, you can start to send them out. I think we have one more lab. I hope you guys are having fun. Enough fun isn't the right word, but hope you're learning something. And remember, let's see, next mentorship class starts at the end of this month. You like this stuff? Sign up. Take my class. It's a really great class. I know it's a little expensive, but it's totally worth it. If you're not into, you know, that level of commitment, and you haven't done.

the GI master class yet. Then, oh, you know, this one is free. Usually, we sell this for 50 or 100 bucks. We're doing this free right now, so you can get it free right now. It'll probably go back to 50 bucks eventually, but free is easy, right? Just go to Kalish Institute dot com backslash GI map and use the GI map code. That was especially we did with the GI map people. I guess it's still going. Yeah, do that and just get the free one. You don't have to watch it right now, just sign up for it and then, uh, you can watch it later before me that price goes back up to 50 bucks. Okay.

Alright, let's see. Susan W. Susan, Susan, is this you? Susan Weeks? Yes, okay. You sent it in a case. Yes. Um, a 98-year-old person. Yes. Wow, accomplishment, right? Yes. All right, so tell us a little about that. This is a retired school teacher who, at age 94, in 2015, developed the flu. The flu was very bad that year. She had had her flu shot, but the flu shot hadn't worked. Finally, on day 11 of the flu, she was admitted to ICU and amazingly survived the flu. However, it was extremely debilitating. She lost her placement in assisted living, required skilled nursing. The flu exacerbated her congestive heart failure, her A-fib. She went to skilled nursing and in the course of being in the ICU, she had a urinary Foley cath placed, and in that spring of five years ago, had repeated urinary tract infections. She had a second hospitalization for exacerbation of her heart failure. She had some vascular dementia in the beginning. This, of course, got worse. She, of the vascular patient, she's had it, spent, she's had high blood pressure, she's had atrial fibrillation, ongoing hypertension. She was repeatedly treated with antibiotics like five to six times in the spring of 2015 for recurrent UTIs due to an indwelling Foley catheter. Also, I'll say she was on a proton pump inhibitor probably for at least 10 years. She was on the Med.

Pretzel. Okay, so, and what are your goals in treating her? Because obviously, is what's your folk, what do you want to help her with the most? Um, improved cognitive functioning. She also seems to have kind of chronic IBD. She vacillates between constipation and loose stool. She has problem, I think, continence. Like one or two things. Okay, one or two. Like, visit their programs. Got to be specific for one or two problems. You can't treat that many at the same time. So, what would you say the top two? I would say to increase for cognitive functioning and also possibly treat the irritable bowel. Okay, perfect. Brain and gut, right? Yes. Partly, so microbiome imbalance, yes or no? We're gonna look. GI organs involved, yes. You know, we're gonna look. And then what kind of bugs are present, right? Yes.

It's just for fun, let's do this one backwards because I'm on that page anyways. So she has a yeast overgrowth, not too surprising because of the persistent antibiotic use, right? Yes. And so right off the bat, getting rid of yeast helps people in dramatic ways. It helps with brain function. A lot of the byproducts of yeast overgrowth directly affect your brain, right? So all those acetaldehyde things, just like when you drink alcohol and you get a hangover, that whole feeling that happens from yeast, right? So you can get a lot of traction on brain health by getting rid of yeast. So I would do some kind of antifungal program. Okay, that would be the stage three. We're doing this one backwards. Stage three. Yes. And, okay, gently, obviously, because she's 98, you wanna make her sick. Just as a random factoid, because we should know these things, this sulfur Vibrio Pijur, you see that guy? Yes. This sulfur Vibrio Pijur, that's one of the good or commensal bacteria that's strongly associated with cardiovascular disease, okay? Right. That's just kind of a random little factoid. And you can improve deep hydride levels in someone who's low, she's undetected here, by giving sulfur-containing compounds like MSM or chondroitin sulfate, right? That's kind of an aside. I wouldn't do that right away because we're not really. Well, that will help her. That will help her microbiome a little bit, but that's probably like a peripheral thing. This is kind of like a little fun fact there, though. Okay, because I think we have the killing that we're gonna do with them with yeast program, right? Yes. And then when we look at her again, we're gonna the cheat sheet front page here, okay? There's the yeast and bacterial overgrowth. So some yeast overgrowth and some overgrowth of bad bacteria. So it's kind of like an antimicrobial, anti-dysbiosis program. Many of those herbs are kind of overlap anyways, right? And then, and then if you wanted to add something to just help with the microbiome, you could add chondroitin sulfate or some other sulfur compound to help bring this up. And then let's see, this, think about it, we, we were trying to treat her, and you really want to focus on brain health, right? As well as the irritable bowel. So I guess I would do, and she's older, so I would give her, you know, I would line it up so that you're doing some of the killing with the antimicrobials against the yeast, and they're also, just to be careful, giving her a little liver support at the same time, okay? In fact, you know what? You could do a two birds with one stone thing here. You could use N-acetylcysteine, which is a sulfur compound to help the liver and help the departure. How's that? Great. Yeah. And so I think it's an antioxidant. Exactly. This is good for your heart, good for your deep eyes, you're good for your liver. And when you're taking someone of that age and you're gonna force her body now to kill and get rid of yeast overgrowth, that's just gonna put a big burden on her liver. So the N-acetylcysteine would serve maybe three or four purposes there. Okay. Interesting. Like when I was, when I was learning this work with Dr. Timmons and now with Dr. Lord, it's a little different, but when I was first learning this work, I think one of the things was to understand whatever company you're working with, Pure Encapsulations, Medi-Herb, Designs for Health, or Thorne, or Molecular, to really understand their product, you know, one or two product lines well, so you can get combination products that fit a lot of different purposes. And then separate from that, in terms of program design, if you start to learn the intricacies like of N-acetylcysteine, like in this case, it helps with deep hydric, as deep hydric need sulfur, it's a great liver support, antioxidant support. And then what was the third thing that we had? You had a cardiovascular disease and a lot of stuff, right? So you're gonna cover a whole bunch of different things with one product. Then you don't need to use as many products, right? Yes. You can support mitochondrial function. Yeah, absolutely. And she's very petite. Yeah, and that's a whole nother subject we talked about some other time, but yeah, absolutely. I would get that started. Okay. Yes. All right. There's a help tremendously. Thank you. You bet. Thanks, Susan.

All right, you guys. So let us, I'm gonna answer a few questions that have come in. Let's see. And you, somebody's got to sign up for the class, okay? I can't just keep doing these things without people signing up. Somebody's got to get inspired tonight and go, hmm, I'm gonna give it a try, right? And if you sign up for the class and you don't like it, I'll give you your money back. You can just, but you can't like try to not sign up for or five months into it, that doesn't work. Sign up for the class, if you don't like it within 30 days, I'll give you a complete refund. You can go do something else somewhere else. But you get a month, okay? So it's a no-risk kind of thing. Let's see. Okay, what's your favorite GI test company? Well, funny you should ask. Thank you, Dad. So I use all these companies in my practice. So I use GI map and I use GI FX, and they have slightly different angles to them, and you need to learn how to master both of them, to be honest. And some doctors have really strong visceral appeal to one of those tests, so to the other. I do the GI FX test because that was Dr. Lord's lab, you know, and he's the master in interpreting those, and we look at those every week. I do the GI map testing also because I really like that test. So, and I, um, if I have a chronic GI patient, I'll usually do both. What do you score gallbladder support? So anything that has some bile in it, right? As long as the person's not a total vegan. And the seat, do you ever use colostrum or other IgG support? Absolutely. Use that all the time. One of my favorite products, actually. Let's see. How long do you give the butyrate? Well, that's a really good question. I don't think anyone knows yet because it's only been on the market for a few months. So I would say until you get total symptomatic control and then try to taper the person off. That's my general advice on that. For colostrum, is the best for low IgA as opposed to high? No, you can use colostrum for low or high. So high IgA means that your immune system is like overly engaged and trying to do stuff. Low IgA means it's collapsed, right? So you can use it in, in either situation. Well, all better bio support again. Every company will have a gallbladder product, and it often is combined with liver products. It's gonna have artichoke and turmeric and silymarin and some beet stuff and maybe some vitamins or minerals in there as well. So whatever company you're using, just pick, you know, just ask your sales rep, you know, what's your best gallbladder product? Let's see. If most of the normal bacteria are high and diarrhea and constipation alternate, could that be SIBO? Well, remember, the commensal bacterial markers we're looking at here are organisms in the large intestine, and SIBO's in the small intestine. So I don't know how to answer that question. It would probably take me a couple hours to even try to answer that question, but the answer is possibly yes. Katherine's gonna sign up. Wow, that's awesome. That was good. Could you repeat the course on GI? That's 49 bucks. Oh, yeah, yeah. Here, it's free. We're not even charging you for any more. So right now, it's gonna go back up. So get where is it? That's not the right slide. Hang on. It's Kalish Institute dot com backslash GI map. Go through the whole thing. It's gonna look like it, the computer is gonna charge you a bunch of money, but at the end, it has this little like coupon code. Put a GI map in there and you get it for free. Okay? And again, if you don't want to watch it right now, I don't care. Just get the free version of it. You can download it and then you'll have access to it because we're gonna make it 50 bucks again pretty soon, and they'd be like, oh man, I should have got it when it was free. Can a nurse practitioner order these labs? I don't know. That depends on the state. But we have, in every one of my mentorship programs, we have one or two nurse practitioners, and they're always like top-flight practitioners. So I am a very strong supporter of training and working with nurse practitioners. With lots, have been lots of them in the program. How does SIBO fit into your approach? So if you get the microbiome balanced, the GI organs working well, and you get rid of all the pathogens, and you still have some significant issues, then you would start to look at things like SIBO as a next step, right? But not as the first step. And I think you'll find with many of your GI patients, if not most, by the time you get the microbiome balanced, to fix every single organ, including, remember, the liver, and get all the pathogens out, you know, you're gonna have a pretty nice solution for that particular person already. Okay. All right. Q recommend bile salts. Yeah, bile salts with a classic, classic, classic, classic way to treat gallbladder. You know what's funny is that when I was, well, if you look at what the really great, great doctors do, they use all the same supplements that we use. They do all the same labs. You know, when I was in my first couple years of practice, one of my patients went to see Dr. Jonathan Wright, who, in my mind, is one of the greatest, you know, integrative physicians of all time. And she came back from her visit to Washington State, and I was like, literally clawing at her, it's like, I want to see the program. What do you tell you do? I want to see your program. What do you tell you do? I looked at the program, and it was like enzymes and probiotics and I can't either kill her or something. And I was so disappointed because I thought because Jonathan Wright is the best integrative physician on the planet, and he still probably was one of the top 10, that he'd have some magical special thing that he was doing. And it was, it, you know, it's like, oh, that's all the stuff that I do. They don't like, I think we're what really separates the great, great docs from the ones that are average is patient communication skills and the sequencing of the programs. Because you can get all the right programs in the wrong order and make people worse. And I think as the decades tick by, you learn more and more about how to sequence things and how to design programs and how to communicate with patients. And, and I think that's really what separates out, you know, the best of the best here. Now, if the GI map code is not working, I'm not sure why that is. Just email my office and we'll clean it up tomorrow if there's a problem there. Okay. Do you order the yeast slide prep to look for yeast? No, I don't do that.

Let's just see here. Kalish Institute. This was a good one. You know, we don't, um, don't do these very often in this way. And you guys, this is a pretty popular version of what we just did. So we'll try to hear it. Here's the thing. Here, Kalish Institute dot com, enroll now. Click on there and then it takes you to the Teachable. Apply coupon code here. Let's try that. GI map. Apply free. Yeah, there you go. That should work. Okay. Just type in GI map free. I like free. It feels good. Okay. The mentorship isn't free, but you know, you're supporting the efforts of our teaching here. So you guys are interested, contact us, we'll get you set up. If not, I will see you probably next month. We'll do another one of these, okay? Take care everyone. Have a good rest of your evening.