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Micro to Macro: The GI Microbiome, the Campus and the World

Albert Kim

Description

Objectives

 

1. Discuss the latest research on the gut microbiome
2. Overseas GI evaluation for the non-gastroenterologist
3. The role of the physician as a mentor: Secular campus ministry 

Presenter

Albert Kim

Clinical Lecturer of Gastroenterology at the University of Michigan in Ann Arbor

Recorded

  • October 28, 2016
    3:15 PM
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Oh everybody. It's been a long afternoon. Thank you for coming here to talk about poop right. What can be more exciting than that. So this is this is this is actually my mission field right here this is the University of Michigan. It's where I am at and might my two passions. I'm part of this and part of the faculty. There are my two passions really overseas missions and secular campus ministries and so whenever I see this picture. I think about this being my mission field and my hope that through this talk today we can I can show you some of the benefits of a couple of the passions that I have. Today really the objectives we're going to talk about the gut microbiome which is the hottest topic in G.I. right now. And like Eric said you probably have had patients at some point and we talked to you about this. Or maybe you've had some questions I'll be going over the current research in the micro biome the latest in fecal transplant patient. And then I will be talking about camps ministries and the G.I. work up in the mission field if we can get to it. So they've got micro biome itself a little bit about the underpinnings of it's the diverse ecosystem of basically bacteria fungus viruses protozoa and their genomes that make up the both the got the G.I. tract as well as the rest of the human bot. The latest estimates in terms of the number of bacteria in your body is about forty trillion cells at any one time and so it actually number out number is the number of actual cells you half. OK so the bacteria out number so in essence we are walking bacteria if you really think about it right. Five hundred to about a thousand species of bacteria are estimated and to. Healthy people may have vastly different micro biome and so research in this area is hot but it has been difficult in some ways to do now we have seen that your micro biome can differ in your birth delivery method. So if you have a natural birth versus C. section you actually have different micro biome your geography will determine this your age can determine this and your gender as well as other factors which we'll talk about today. And so this is a little kind of all pie chart chart I mean really looking at the different. Things that can impact your micro biome including diet and things I'll be getting into those today. So a little bit of history. So this gentleman who looks like they had portraits back in the one nine hundred sixty two he is Eli MC met Nick cough and he discovered lactobacillus basically. And he was actually the first person that hypothesize that seeding the gut with healthy bacteria could actually be beneficial. So he used basically fermented kind of milk and then hypothesize that if you know if you're feeling sick that you can take that and see the got with healthy bacteria as pose a bad bacteria because if you remember you know back then they were taught all bacteria is bad. And then you're on the Nobel Prize in one thousand know it for work and immunity and this is really the first time we're really talking about healthy bacteria. So basically more recent history because in between then and now there wasn't a lot of work done. But in two thousand and seven the and I H launched the Human Microbiome Project and the European Commission and China kind of followed suit and basically they're trying to do. Everyone's heard of the Human Genome Project spearheaded by Francis Crick. And they're trying to do the same thing with the human microbiome let's sequence everything in. See what's there. Right so to date about thirteen hundred reference trains have been isolated and sequenced out of three hundred healthy adults. So basically if you do a pub med search on micro biome I actually made this graph myself and all proud of that. I took the actual numbers. So anyways from two thousand and three. There's nothing one. It's like one study in two thousand and three and from in the last thirteen years you can see the exponential rise in publication on the broad micro biome right to the point where now you're churning out more than six hundred papers a year right. A year and this obviously two thousand and sixteen is not finished yet. So the formation of the micro biome itself you are in essence sterile at birth. Although research is completing they have found bacteria in places where they didn't think they would find bacteria and play Santa and things to that and also in your amniotic you know amniotic fluid that shouldn't be there really. But anyways. We will consider you sterile at birth and then you're colonized by maternal bacteria during delivery right. And actually they've found that you get colonized by skin bacteria if you if you're delivered by C. section and Badger no bacteria obviously if you're delivered magically right. Diet and breast milk actually give you different. Mike different micro biome OK and I'll talk about that a little bit and by age two to three years actually your micro biome looks like it would as an adult. OK. Now absence of this progressive colonization. So it's actually a beneficial thing to colonise because if you don't. It actually places pre-term infants at risk for various G.I. infections the most devastating of course is and that person ties in and true a kaleidoscope. OK so it actually puts you at risk for certain things. If you don't get a good colonization of bacteria. Now. What's interesting here and I just want to highlight a couple studies as we go. Is that this bit O. bacteria you can see that it can actually be associated with health and breast fed infants. This is actually been shown to be a dominant sort of bacteria if you do breast feeding and then there's there hasn't been any clear like let's say benefit of breast feeding. Versus versus formula in terms of the gut market microbiome but obviously studies are ongoing. As compared to term infants This is interesting pre-term infants actually have a different micro biome. Even though they were you know their deliver you know the same mom obviously and all those things to actually have a different micro biome than those are actually are are carried to term and so that is also undergoing research pre-term infants. So there's some interesting research and pre-term infants where they actually took subjects and supplemented their feeds with probiotics in the nicu. OK And they actually solve all that those pre-term infants took the last time to achieve full feeds. And also reduced hospital length of stay feeding intolerance and duration of indirect hyper Billy Reuben niña also increased weight gain and growth philosophy. Is a very interesting thing right. Pre-term infant you come out obviously you've got a different micro biome you supplement their feedings with probiotics and it looks they can improve some outcomes. Also in necrotizing enter a kaleidoscope they this is a intriguing. You know area where they actually gave them probiotics as well. And this actually decrease their mortality from from neck and actually decrease to all cause mortality as well. So there Mary. There may be. Some real benefit their infant colic actually like this is very interesting. I'm not a pediatrician by any means. OK but so with him to call it can we call icky babies right I mean you just got out. You just kind of said I just we just had a daughter my wife and I and we're like please let her not to call it the baby right. Because if she just got a ride out you just got to survive right but actually they did a systematic review and they showed that the use of this probiotic router I actually decrease crying time by fifty six minutes a day that's interesting. I mean that that's a big deal for parents. I have fifty six minutes I mean but you know I know right. Another study showed that greater than fifty percent of infants showed a greater than fifty percent decrease in daily crying time. So this is I mean these are some pretty substantial results and prebiotic formula actually promoted the growth of these and it kind of significantly lowered in Fatah colics even prebiotic seem to make a difference. I'll talk about the micro biome now. So basically it's an increasing bacteria number as you get lower into the G.I. tract. OK stomach is the least colon is most in the small intestines of the middle. You don't have to worry about all the different strains because these will likely change as the as the microbiome project goes forward in terms of what is normal and what is not and there is little wide diversity between populations. This is just a slide obviously I'm not going explain and I don't understand it myself but I just wanted to illustrate that it is a very complex process that got in terms of bacteria in terms of you know in terms of the genome and all those things. OK so the got Michael biome OK so you may have. There there was in the one nine hundred eighty S. or this craze about fungal overgrowth OK and that is now hitting. I would say like a like kind of what can I say alternative medicine. OK And so I have patients coming to me telling me that they were told by natural path Dick doctor that they have fungal overgrowth and they need to be treated and I and I asked them why they were sent to me and that they said well they just told me I have candid overgrowth and you need to go see a gastroenterologist. Unfortunately at this point the testing for this is difficult unless you can actually see it on the scope. You can probably probably culture the stool but everyone has fungus in their body. OK that's the takeaway point. Everyone's got fungus in your body. It's kind of like the bacterial micro biome except it only makes up point one percent of the got micro biome OK So generally immunosuppressed patients are the ones that are will get this significant can do the overgrowth the rest of the people the research is still not there I would I would preach caution in terms of just treating people with antifungals because like I said the numbers just don't bear it out point one percent of the micro biome right so much more likely to have some sort of bacterial imbalance as opposed to a fungal issue but there's two hundred sixty seven distinct fungal taxa Candida is the dominant strain. It's detectable in about seventy percent of adults just sprung I P.C.R. now kind of revolutionize everything. There are limited studies. There's no core microbiome that's been identified and basically the only living fungus that's been studied in detail that may have some benefit and has had some clinical trials is Saccharomyces surveys say OK you know you don't need to remember that. But basically it's actually been shown to improve traveler's diarrhea antibiotic associated dire and I.B.S.. So there maybe something in the micro biome micro biome that can actually help but and this second my C.S. actually isn't some probiotic formulations out there but there might be some benefit here but we don't know yet. And basically there have been studies about how there is more fungal diversity in certain in certain diseases like I said maybe crones have you know some Candida overgrowth and one study in particular that's interesting is that it showed a significant difference between vegetarians in a traditional Western diet this fungal balance and so I'll be talking more about diet and that would be really my transition OK So prebiotics you've heard about them. Basically they are food for probiotics food for good bacteria is what do you buy addicts This usually indigestible fiber compounds. They're resistant to digestion the stomach. They then make it into the small intestine the colon the bacteria in the small intestine the colon eat the prebiotics and then they grow so you're trying to feed good bacteria. It's basically the bottom line. That's what prebiotics are now the prebiotic research is not there but it does look like some prebiotics have been proposed to improve got microbial health. OK but really there is no benefit in something like I.B.S. because these are kind of they contain these for men to pull things that that can cause bloating and things like that. Probiotics this is a busy slide I'm sorry. Basically as you know probiotics are live bacteria that are nonpathogenic. And many of these microorganisms are part of the normal gut flora. So the strongest evidence as of now for probiotic use is really the treatment of acute diarrhea and that's where the best studies are eczema and genital urinary infections are. The only non G.I. diseases that have been really shown. To have benefit from probiotics OK. According to statistics statistics dot com But this is a huge market right because look at that in two thousand and fourteen the sales exceeded one point one billion dollars probiotics if you've gone to the pharmacy and looked at the aisle there's a forty five different brands. I mean I've been don't know you know I don't know how many you know what's what. Probiotics sales worldwide. It's a twenty five billion dollar market. But that but the research is showing only benefit in only a very select number of diseases. And actually the latest there is a latest study that I don't put up there but it appears that probiotics do not benefit healthy people. If you have a healthy got you're having regular bomb was all those things probiotics are not are of no benefit to you. So waste the money you're feeding the industry right. It's when you're sick that maybe opiate benefit. They're not regulated at all at all. OK not regulated at all. I can't stress this enough. I don't know what goes in there. OK I don't know what goes in there. Nobody knows what goes in there. There's only a few that have really been studied. OK. The other thing is that probiotic effects are strain specific So a beneficial effect. Attributed to one strain of of that particular like there's a couple different strains of Lactobacillus there's a beneficial effect with one strain but with another strain there's no beneficial fact. Now some members of the intestinal micro biota also influence the onset of crossing of Genesis and then it's also known that some ingestion probiotics strains to have not been associate with long term colonization survival so the benefit of probiotics is not long term it's only. Prairie. And studies evaluating products and supermarket shelves found that contents do not always correspond with what the label claims including number and viability of probiotic or microorganisms used with caution the most commonly use a lactobacillus to befuddle bacteria. It's worth noting that not all species of probiotics are even part of the normal human got Laura. So that's interesting as well. So you could be buying a probiotic that has bacteria in it that actually shouldn't actually be in your guide. So you need to choose wisely. OK. All right now to the subject that everyone came for write fecal micro biota transplantation or stool transplant. Now this is one of the hottest topics even though it's been around since the fourth century. It is fascinating. It's been fascinating to see if Clostridium difficile at its height had approximately seven thousand of factions and three hundred deaths per day in the United States. Really the transportation has really gained steam in the last ten to fifteen years I would say during fellowship. I was part of a couple of them and we had a really only start of them. My second year felt sure that it was only about four or five years ago and presently only permitted for the C.D.I. R.C. different faction refractory to standard therapy meaning Franco mice in a flash or a you have to actually have failed a couple courses in order to get transportation. But the crazy part is this right to cure rates are ninety percent ninety percent and that has been reproducible across all studies in fact my institution now that is the number that we are hitting ninety percent that is ninety percent of all C. diff patients who have had recurrence and failure on medications that they get a few transplant. They are. Cured cat has also been used in critically ill patients and the cure rate is as high as ninety three percent which is crazy right. The way you do it which I didn't put up there for you know various reasons right. But basically you take donor stool probably within twelve hours. OK of deaf occasion the donor should generally be somebody who's close to you although I will talk about that later as well. And basically what you do is you collect the stool you mix it with some sort of diluting because you use a colon not a school to get to the C. Come in come out and the scope is a very small channel so if you're trying to push stool out through the channels going to get stuck it's not going to get out right. So basically you need to make the stool more liquid you mix it with milk or something like that in a blender. Yes. Don't use that one at home. OK And. And you blend it and then you you get to the see come and then you just push it out push it out through the port on the way out. And that cures people of the stuff believe people really write a recent study though the rare if any side effects side effects or adverse events for now. Other than procedural complications but in IB The patients after stool transplantation there was a twenty five percent disease flare rate which we do not understand at this point. OK and a lower clearance rate in I B D patients. Initially patients selected donors encouraged when our patients choice. And yes frozen banks do exist. You can be a donor to OK alright open biome is one of them and they actually exist. You can actually donate stool. And then potentially actually civil life and. Really if you think about it but. Who would ever thought right. But you have to be rigorously screened body mass index. And a biopic yesterday and you know all the all the things that you would normally consider in things because we don't know we don't know if you know you having some kind of disease. Well actually could actually transfer to somebody because in the in the further you know slides that I'll show you it could be a very real sort of worry. Delivery vehicle and Ostap the appearance of that have increased rate of success believe it or not before they would use an upper end a scope and actually put it into your stomach or do on them or did you know it looks like in the colon is the best. If you do it both ways at the same time one cohort actually achieved one hundred percent success rate and yes there's a future where it's a pill that you ingest and there are studies ongoing right now two studies with two rounds of treatment showed a ninety percent success rate which gets rid of the procedural complications but really you. You have to you know the mind you know you know what I was saying he's at Beth Beth Beth the difficult part right. But this by C. diff. Incidence and mortality continues to rise. And so we really need to think about and I think it's really it's in primetime. Now our institution there's large academic institutions doing this. It's him prime time there's a lot of people small in the money right. So the pharmaceutical companies are smelling the money and they are now trying to develop less invasive ways of really getting rid of c death which actually would be a very good thing to do. It's appear safe and all these but there is some interesting things about the transportation not related to see the. If there maybe some efficacy in I B D. But like I told you there's a real most recent study maybe not. There is case reports of actually non-SI different factions including recurrent U.T.I. from equal I resolving after transportation and recurrent Klebsiella pneumoniae. Actually resolving it was recurrent clumps E.L.O. pneumonia. That was causing recurrent Austyn while latest actually resolving after still transplantation which is very interesting. And it tells you that the got especially a diseased gut with bacterial translocation across the intestinal barrier can certainly act as a seeding mechanism for different different diseases out there and so it kind of really is going to be a very interesting sort of research frontier as to what you could actually do with fecal transplant tissue. OK so the gut micro biome itself has it appears big impact on diseases not related to the gut and I'm going to go through a few of them pretty quickly. Today but it's pretty crazy carcinogenicity So cancer obviously obesity there might be a there might be a link atherosclerosis there might be a link nonalcoholic fatty liver type one diabetes rheumatoid arthritis I mean these are these could all potentially be impacted and actually most recently stroke these could all be most These could all be impacted by your gut micro biome. So. I was very happy to kind of as I was preparing for this talk really think about Adventism right. Health message right and you're like well if the bacteria control everything. Where does the health message come in here right. You kind of there but we believe in the health message Shaimaa And so when we looked at that the impact of died on the micro biome is been looked at and extensively in actually a landmark study show. That the composition microbiota differed from children living in Africa versus in Europe based on the two different diets that they had plant based diet versus Western diet higher amounts you don't need to you know you don't need months approve of. Tallow. Lower amounts of bacteria in Birkenau Faso and the opposite for the Western diet and a number of studies that showed that increased microbial richness with diets higher in fruits vegetables and fiber and the elderly actually showed less frailty OK so your diet you are actually what you eat even in terms of the got micro biome that you actually have differences in your gut microbiome based on what you eat and the benefits of a diet high in fruits and vegetables a plant based fiber diet cannot be understated in those same studies increased bacterial diversity lead to better health. Oh by the way I should add a disclaimer I have some references of the bottom of some of the slides but some of the sides have so many references have in them in my notes. I should know that. So I got references but they're not actual the slide by the way. OK So lower bacterial richness in your gut so a non plant based diet right. Associated with obesity insulin resistance dyslipidemia and inflammatory disorders and actually at the genomic level diet can alter functional metabolism so this is very interesting. They did a study in Japan taking seaweed. That was that was the genes that were in coding enzymes that metabolize algae. OK So you know. Asians fruit. We like our seaweed right. So they took these genes and then they actually tested for them after eating and the genes on the on on the in the seaweed actually transferred into the genes in the gut microbiome do you go to. Saying so on the genomic level those genes actually got in coded into your actual micro biome genes. Based on what you eat which is crazy right. That's crazy. If you think about it that your gut micro biota your actual genetics of your gut microbiology out were changed by what was eat. And then many molecules in foods are substrates for intestinal microbiota. So like I talked about with prebiotics and things in digestible carbohydrates and diets they turn into short chain fatty acids this can regulate a lot of different things. And like I said before. What's interesting about this and I'm glad that NIDA and I don't remember your first name. They they went before me with exercise enhanced gut microbiology old diversity was seen right. And then and everyone understands right. The more diverse your gut microbiome is the better it is because the more resistant it is to changes which means that if something unhealthy comes along. You're actually more resistant to change right and exercise actually impacts your gut microbiome increase diversity in the bacteria positively correlated increased exercise dietary protein. Right. Compared to non athletic control groups. Stressed in the micro biome says it's all coming together right. We're talking about diet exercise and now we're talking about stress in animal models prenatal and postnatal stress actually alter the composition of your microbiota and in adult my psychosocial stress reduce the proportion of bacteria or E.D.S. but increase the proportion of Clostridium is interesting. Right. They actually stressed mice and they changed their microbiota just based on the stress alone also preclinical studies and I.B.S. showed reported reductions in a couple of bacteria. But studies need to further a looser why this is the case but possibilities include stress induced acceleration or other effects of stress on the intestinal microbiota and comes and brings me to this quote from child guidance that says that digestive organs like a mill which is continually kept running become in the field in feeble vital forces called from the brain to aid the stomach and its overwork and thus the mental powers. Are weakened the unnatural stimulation and where the vital forces make them nervous impatient of restraint self-willed and arable if you read this quote you're like wait a second what I eat. Could that actually impact my brain working harder to digest it and it doesn't make a lot of sense right. But actually it does gut brain access so it turns out that the fecal micro biota the gut micro biome can actually alter your gut brain access on a nerve level. An autonomic nervous system level. Multiple mechanisms are shown where you can impact they have pituitary access in terms of the environment of the intestine micro biota you can alter motility patterns how leaky your gut is secretion of your gut and all of these things do to intrude luminal release a neurotransmitter for enter into Kenya other cells in the gut. You can actually alter all those things by altering the micro biota. And the rich and the research has shown that all of these different metabolites can induce an immune response in the local cells within the got these factors then can signal via the after it vehicle pathways and target to well beyond the G.I. tract. So your altered got micro biome can actually impact your nervous system and how you're feeling and high. You're thinking and if you look at is a very busy slide I WANT I WANT I WANT explain in much detail but suffice to say that all of these are all the pathways basically you're got microbiome gets changed or whatever it gets taken up it induces all of these nerves and things to fire and this actually feed feeds back to the brain and can actually change what you are feeling and how you're feeling it and it actually can change the pathways. So one study showed the depletion of the got micro biota during adulthood This is a mouse study actually results in deficits of spatial memory and it increases your sensitivity and a degraded display of depressive symptoms. So I actually took the mice. They took their gut flora away. They altered it and the mice showed behavioral changes just crazy increased depression and also deficits and spatial memory. They also found that there was altered Sara Tonin concentrations based on the gut microbiota alone and changes in brain derived new neuro trophic factor a hallmark of altered gut brain signalling and other studies introduced injection of bacteria increase gastric B go in there signaling right and sympathetic nerve activity and long term treatments probiotics actually reduce anxiety and depression related behavior in mice. Let me be very clear in mice. And in another mouse model antibiotic induced changes this is interesting and behavior were independent of God and we are sympathetic to me. As interesting right. And one catch that they actually cut the bagel nerves and then my. But the animal and then gave them antibiotics and they had behavioral changes independent of whether the Vegas no was actually even working or not. So there are pathways that we don't even know about that are actually. Impacting behavior from the gut microbiota. Finally autism. So they have mimicked autism in mice. OK And they have altered the micro biota of these mice and they've seen that giving them probiotics actually reverses behavior abnormalities of these autistic mice. OK So very interesting stuff. Now we talk about obesity. We know this is an epidemic one point nine billion people around the world. What they've found is that there's a couple different things out of a pound. But some of the preservatives in food can actually alter your microbiota us. So again what you're eating and the neuro behavioral changes attributed to obesity were actually transferred with got micro biome transplantation such as depression and dementia in mice. The other thing is germ free myself been shown to remain mean despite a high fat sugar rich diet. So they actually depleted. They took my eyes depleted their they made them germ free they gave them a high sugar high fat diet and they didn't gain weight right. So you could see the micro biota actually impacts or weight gain potentially and there was a landmark study that showed that there's a sixty percent increase in fat and insulin resistance resistance and mice within two weeks of transplanting got micro biota to germ free mice. Despite reduced food intake. So mice getting transportation they actually it's an increase in fat and insulin resistance so those and then they did some twins studies and it looks like there might be some energy harvesting differences. So if you have a different microbiota you may be extracting more or less calories from your diet based on what bacteria you have in your gut which there is implications in terms obesity for that. And also the famous or more famous study they reported a case report of somebody who underwent a transportation procedure and then our I don't know if it was for cedar for something else but as a translation and got a forty one pound unintentional weight gain from an obese donor. Which is fascinating. Which would stink right. I mean you know what I'm saying. But see it. So there is there stuff we don't understand right now that's basically bottom line but that is fascinating stuff. A randomized trial. They did basically supplementation of probiotics and they show nine percent greater weight loss and one group versus the other. OK but we've got to take this all with caution. Right because the latest study they did a pooled analysis actually out of my institution. Recently it was actually in August of two thousand and sixteen. There is no clear common characteristic of the Michael populations or microbiomes in the digestive systems of obese people they make them different from the microbiomes of those with the healthy weight. OK So right now even with these case report sort of things mouse models and things at this point we do not have any smoking gun silver bullet sort of thing where microbiomes are any different between any statistically significant difference between obese people and nano piece people but obviously the research is ongoing and there are some compelling sort of things that we just talked about. Atherosclerosis so so they actually elucidated this novel pathway that that link dietary Lippitt intake the intestine micro biota and then beating to atherosclerosis and pathways have also been proposed for stroke. OK so there is. There could be some impact on atherosclerosis as well. So basically. The bottom line for the got the gut micro biota as I go forward in my presentation is that obviously the research is ongoing. There has been an explosion in the literature and will summarize in a little bit but there is a lot of exciting things I've always truly believed in my heart of hearts that G.I. is the center of the universe and it's proven it right now right. Anyways I'm just kidding but but really I think there is a lot of impacts here in terms of diet in terms of how you process that diet. What a healthy gut actually means. And I think I think the more and more research it comes out the more and more our health message gets validated. Even on a bacteria genome level right that actually your diet and all of these things can impact and positively impact or negatively impact even the gut micro biome and the bacteria that you have in that guy and that can directly lead to a whole lot of different alterations and pathology in different diseases in your entire body. I want to talk a little bit about you know how this is kind of how my time in an academic medical center and things have really kind of transferred to one of my real passions which is the necessity of secular campus ministries as you know eighty to ninety percent or you may not know this but probably about eighty to ninety percent of Adventist young people in high school end up going to a secular university for college. And that's a conservative estimate was eighty percent or more. Which is a staggering number if you think about it. And nobody is ministering to that we are putting a lot of our resources into abit of study cation which you know I was a product of until it's. Rape. I love my time I would try to send my children to advice acacia as well but there is a deeper and we wonder why the young people are leaving right now. She eighty percent of them are going to non at Venice institutions and really a ministry needs to exist to reach the students and colleges really when you make decisions about your beliefs for life. And it's something that I've been involved in for it since college going to secular university at Michigan and also medical school and it's something I'm very passionate about. I feel that there is a potential role of physicians and health care providers in campus ministries right. It just like you think about the micro biome and just like you think about how the pack tear your in your gut can actually lead to far reaching consequences in the rest of your body right. I feel that that is the same way in terms of in terms of how college students in secular campuses can add the impact on the entire Body of Christ and we don't really think about that often. Right. And just like with the micro biota you know with greater diversity you actually are healthier right and just like if you have alterations and imbalances in that micro biota it can actually lead to disease. Right. We have we have altered it we have we have diversity all of these things and all think we are taking advantage of it and so for me as a physician and having been a resident all these things I feel that we are physicians and other health care providers who are uniquely suited to mentor to serve as mentors to the interactions of the wide variety of secular individuals on a daily basis. I think that you may have a better idea of balance on our balance but better idea of really how to interact with that than maybe somebody who's not in the same environment who's going up in the by. Ball so to speak. And I think that physicians also the educational background that are generally seen as legitimate. I said generally right. Because you never know but generally seen as legitimate by students where they're trying to get hired. They're trying to you know graduate all these things and you can give them advice of physicians have the means to make a difference. But really it takes sacrifice and I think you know you know we there's not enough of us I think in the in academic medicine. And I feel. But you don't need to be an active on medicine to actually impact secular campus because all of us actually live near secular campuses. I believe. OK. And so when I was a resident I actually like what I went to Rocky University Rochester. When I was a resident. We actually tried to start a campus ministry and all we did to start one. Was all I did was I just cooks and cooked is a relative term. I tried to make. Lunch for the college students every Sabbath and my apartment all throughout residency actually as a small sacrifice though you think oh man how do you have the time but really if you put the priority you can do it. OK And we did that in a Sabbath afternoon Bible study. That's what we did eat at my place Sabbath afternoon Bible study right. We started with less than ten we topped out at thirty five right over the course of the six years I was there. It can be done it can be done and I was uniquely in that situation because as a resident. Compared to all the students I was at least making a salary right. And I could at least sacrifice the little bit that I had to be able to just give people a meal and then have a simple Bible study afterwards. Right. And there are we actually there are there. Our there is actually one of our baptisms of who has not Adventists to start with is actually in medical school in New York right now. And all of these there are actually there was another student good friend of mine who was think about leaving the church and he's graduating from seminary this year for Manders. And so these are the differences a you can make just based on where you are and I on my first flight I pointed out Michigan I said that is my mission field and a lot of a lot of times we don't think that way. We've talked a lot about this weekend and scrape and going forward that you know we talked a lot about how to reach your patients and that's very important. Right. That's the first which is how to reach your family. But to me it's how to how to be a mentor to physicians as a mentor and that's one thing in terms of college campus ministries right. Secular campus mission to how to how to be that. Because really you know you can provide Bible study guidance you could provide a place to meet and we have the opportunity to mentor those that are considering a career in health and there is explosive potential of campus ministries as an X. nineteen where Paul went into the synagogue and then in verse nine he actually writ departed from them with through the disciples reasoning daily in the school of Tire ran a switches for all we can tell a non-Christian school and so Paul went to this public school and the reason with them for two years and what happened so that all who dwelt in Asia heard the word of the Lord Jesus both Jews and Greeks did you get that right. You may have seen this verse before but you think oh Paul just traveled around nation that's how he spread Christianity right. But actually it was his two years of time in the school of Tire and this. And that's how all of Asia heard the word of Jesus how you impact college students you teach them during the two years the Paul was there and they go to the world. They go to the world and so you. You have college students are trying to make a decision of what they're going to believe for the rest of their lives and eighty to ninety percent of our young people are getting no guidance at all about what to believe in their lives right because they're going to non Adventist institutions. So we need to be able to reach those. Because you can impact the world they go all over the place all over the world. The last thing I want to talk about is another I think of five minutes the last thing I want to see I drew you into fecal Transportation and now I'm hitting you with ministry right. OK so the last thing that I want to talk about is another thing near and dear to my heart and that is overseas missions overseas medical missions. You've heard about them throughout but I want to give you a quick G.I. primer on this. So you know at least what to take with you. OK. The majority of your. Majority of your diagnoses overseas doing a quick overview is going to be infectious we know that because you're probably going to be in a developing country right. So it's probably going to be infectious know the area in the common diseases. Particularly infections that are endemic to that area and have the necessary anti-microbial to deal with the specific disease LA Times we just kind of try to get Will we can get before we go on a mission trip right you get look for donations or whatever. Some people give sit bro you know whatever it is right but it's actually better to really think about like broad spectrum things that can actually treat a variety of diseases and have a lot of those so you actually have something to be able to treat people with right so this is a kind of a less if bacterial super flocks in gives. Given prevalence of travelers are Rio obviously if it's bacterial you think it's bacteria or something and actually it's beneficial for the people with you on the trip as well because somebody is going to get diarrhea. I guarantee it. You might get diarrhea. OK And you're going to go at that point. The other thing I want to tell you about is G.I. P.C.R. now exists. So this is interesting. So so for the longest time for decades. We just stood still culture which is the worst test ever but I've had like one positive stool culture out of like the five hundred that I'm literally it's those kind of numbers. We now have a G.I. P.C.R. panel where you can actually send it off and they check this entire thing by P.C.R. and it comes back within like two days or something. Way faster than the store culture and there are efforts underway to actually make this available for overseas countries which will actually be very helpful it checks for like everything everything you can think of anything that can be P.C.R. even like acute bacterial diarrhea you can actually get it diagnoses. So I've actually had a couple of these come back positive. And so this this may be a beneficial tool possibly down the road for four mission trips parasitic infections are very common. And the band is all or Al benders all in sufficient quantities is something that I would recommend having been on having been on multiple mission trips as a medical doctor tinitus all for anti protozoan. Prezi Quanto all for tapeworm and then I would note that if somebody comes in and they've been having chronic diarrhea post infectious irritable bowel is always a possibility right. And so with that it would be bloating change in ball habits abdominal pain lasting for about zero to six months after a G.I. infection which you presume that they would already have and for post infectious I.B.S. your treatment will be a low fat map diet which for those of you who don't know what that is you can talk to me afterwards. There's a specific diet this when shown to improve I.B.S. type symptoms and the other thing would be possibly right facts meant for post infectious irritable bowel syndrome. And as a final thing for reflux heartburn. I would probably have some. Like prior to the comment dissolve on hand knowing that you're only going to give short courses to these patients H two blockers are actually also likely cheaper and in fact we were in a pinch. We had someone who was I mean allergic reaction and one of the mission trips and we actually use some from zero to Dean because there's actually a touch one receptor across reactivity and so you can actually use it potentially in allergies well. Or an allergic reaction. It's not going to work as well as Benadryl obviously but but but that that's another benefit issue block is likely cheaper so keep that in hand because you're actually going to get people that come in with heartburn in the developing world as well. But obviously lifestyle interventions are the best lifestyle interventions are the best for Harper and I'm actually happy about the studies that have come out about P.P.I. with chronic like potential kidney issues and things down the road. I'm actually happy about that because it's going to force the U.S. an American. Section change their diet and do lifestyle modifications for reflux as opposed to just seek a pill. OK so you can ask me about P.P.I. stuff later if you want to go conclusion. I'm on time. The gut micro biome appears so far reaching impact in the body and I hope that I've shown you that today. Diet appears to have a significant impact in determining the got micro biome as well as exercise and stress. More research is needed. Obviously. I mean despite the explosion and research but exciting possibilities really lay ahead in terms of interventions that potentially could be taken to help people actually be resistant to disease. There's I should add this one study that was done I just heard about it. One of our one of our labs they actually have found. Or they tested in a mouse model. They were like giving my sequelae. And then they gave them like a specific probiotic and people that got a specific probiotic the mice actually didn't get equal life. So there's some like potential you know I think if you think about it as medical missionaries if you're going to go overseas and you could take something that could prevent you from Guinea coal as pretty awesome. Right. I mean that's you know that could potentially really change a lot of things especially in developing countries fecal transplant Titian for C. diff appears reliable safe and effective at this point and FICO transportation for other things including obesity are ongoing. I don't know if I mentioned but there is there's a trial out of Harvard at least in face to right now where they're giving pills that are you know I mean from the stool bank and looking to see if you can actually make people less obese by giving them the pills over an extended period of time because if you're logically following me today you would think oh if there is some difference although the latest study didn't show it you could do a few transplants somebody who's who's who's obese and potentially get them weight loss and it be better than gastric bypass right. But that's probably it ain't that so important. Sure. Right OK campus ministries provides a potential for the health care prior provider to impact the world. It's really something that has really impacted my life I think there is potential for that. And if you want to discuss that further. I'm also available for questions and that is it. I'm not going to talk about micro biota forgot micro biome and G.I. diseases because I think y'all be bored out there minds right now are there any questions. Yes. Oh inserting like prebiotics are actually inserting food into. Fiber fruits into the gut greens. One would the there I don't think there'd been any studies because you would presume that eating that would be enough to transplant it but oh oh OK I see what you're saying they can ingest it all right so like somebody like a T.P.N. depend a patient or food. So I don't think that they have done studies on that. Well what are my thoughts on that. I mean you know there may be you know we saw there may be some benefit of crude biopics and maybe altering the gut flora through a prebiotic route only. And so I do think that you know fiber kind of falls in the prebiotic thing so they're potentially is something there. I think the other issue is that if you're if you're going to be impacting actual absorption. Right. The majority of the absorption actually takes place in the small intestine right. So C. diff is very receptive to fecal transportation because it's primarily involved in the colon. So that's why it works where you just do the call and ask a PM leave in the colon and then you're done. But I think that first of the absorption things like that with a preview prebiotics and things that that remains to be seen. I think as to whether you can and like I would think that you are impacting small intestine stuff might be more beneficial but that would be my thoughts on that and the other questions. Yes Yes Or. Lactose intolerance and it's increase in terms of. Just like just overall in terms of prevalence. So I would say. Right. Particular in children so yes so I think that there's probably some micro biome changes probably that are maybe impacting that there's probably I'll bet some food processing things that are impacting that. As well and I think that that is an area that hasn't really been studied yet. And so we'll see the other thing that I want to note in case you all did know this research is probably about ten years or ten years five ten years old but at least ten years ago out of the twenty two million tons of antibiotics that were used in the United States. So twenty two million tonnes per year of antibiotics using the United States. You know how much was used in humans to two million tons you know you know what the other twenty million tons were talking to administrate So it's an obvious answer but so that so the crazy so you think about like bacteria resistance all these things all of these different things. Altering the gut micro biome and things like that. It follows that there may be some potential there. Yes yes. So so that's an actually a great question actually didn't put that in a slide but they had done studies on gastric bypass and micro biome and it appears that there is a change in gastric bypass in the micro biome for the surgery and actually there is probably some weight loss potential in the micro biome that actually contributes to weight loss in gastric bypass So the answer would be yes. There appears to be a difference and in gastric bypass surgery in the micro biome yes yes or small amounts of I'm sorry. Oh oh I do not believe I saw that but but the SO. This is like there's like four thousand studies out there. And so I do apologize I have the time to go through all them but there might be something there. But I did not come across that in my research that there was a gentleman your good. Yes or yes yes. What do I expect to see yet you know I'm not part of that. So I don't know but I can presume that they're going to be looking at differences between meat eaters versus not I was excited when I was starting to look at this because I was like you know I thought in my head all of this would be a great study for the Adventist you know Adventist health study but like you said the researcher is there. I mean it's plant based plant based the better you go. Yes or yes ma'am. Oh yes so. So what I was saying that at this time the scientific research that the literature doesn't support. I don't think taking probiotics in a healthy individual right. So so I'm saying that probiotics supplementation itself while there probably isn't harm. I'm not saying it's harmful but it's not showing an actual benefit in health do you go in. I'm saying. So certainly not harmful. So I would I would say that it actually in order to get a healthy microbiome the best way to do it is right but if you want to supplement with what the probiotic just choose the right one though the thing that I was talking about in overseas and things is that there is potential at this point. And there's been a few studies on this but potentially if you're going into somewhere and you're going to get acute diarrhea probiotics may actually help you help to stave it off but but that's tenuous this point. Yes. That's a good question as well. I should of yeah right. So so that is so really the to do too. Studied probiotics at this point is B.S.L. number three. Which has lactobacillus strains that's number one number two is a line. OK. Now more probiotics three probiotics brands are going to be studied as time goes on but those are the ones that I tell patients have actually been studied. In antibiotic induced diarrhea. I should have said this as well it does appear that taking probiotics may be beneficial to Bilis bacillus type probiotics so I'd probably say that if you should probably try to get one that has lactobacillus in it that may potentially help you in terms of an antibiotic. But like I said the research also is evolving in that area as well. So I wouldn't take it as gospel per se but that would be my recommendation yet needa overgrowth Yeah yeah I don't I have not heard of any follow up studies to that and I have not and I have not heard of any. And the microbiome studies related to either frequency of eating or frequency of you know when you're eating. I would say that that's an intriguing concept and certainly I think somebody is going to study it at some point because of the literature and the current and the chronology and and obviously where where it does seem to make a difference as to you know how much you when you read all those things but no I have not seen a falsehood. Yes sir. So that's a good question. So Goodin gluten sensitivity is a whole nother topic and actually each slide that I showed today from microbiomes is a lecture in and of itself just you know but the latest study in gastroenterology which was a month ago on Celiac disease. I'm going to take celiac disease and it is a topsy turvy not well defined concept at this point. I would take celiac disease latest study a month ago and Gusher ology showed that with celiac disease. The test of the micro biome it actually day actually had alterations between nonselective these patients as you act as these patients so active these patients have increased Pseudomonas. And the increase pseudomonas actually lead to increased sensitivity of gluten passing the intestinal barrier which is very interesting. Whereas the non celiac disease patients did not have as high levels of that and so they were more resistant to gluten being taken across and tested barrier so it looks like there may be some changes actually attenuate and potentiate celiac disease in terms of sensitivity correct. So small bowel Sudha motorists they took and culture and they looked and then and there may be something there in terms of action test one barrier and then test so sensitivity to gluten based on your micro biome Yes. Yeah yeah. Yeah right. Sure yes. So I think I think I mean one of the important things is were not students right. So in order to have a campus ministry you do need some dedicated students. You need a core. And trying to find that core it can be challenging in some cities but being able to find that core is probably the most important step because I really I really feel like our our role. You know if you're motivated enough yes you can go and start a campus ministry somewhere but really I feel that our role is really support and being able to provide that provide the backing that students lack like students might not have the money to be able to provide meals for other students but that's just not part of even if you're med school whatever. So then you can provide that there might not have a stable place to meet because they're all leave living in the dorms. You can provide that up like a home away from home. Right. So in terms of the Bible study aspect. I feel that you need a core of people the core of students that can really kind of buy in to like evangelizing their campus and then from there for me I actually spent my time building up the core. That's a way that the Sabbath afternoon Bible studies initially were designed just to get people excited about studying the Bible are Advena students already and then once you get the advent of students and your core and you build them up they will find the ways to reach other students just different topics Actually I did not do. Daniel and Revelation almost at all that might be heresy. You know I'm just kidding. But but but really. We eventually got to. Danno revelation after two years. OK but but initially in terms of building up your core. I tried to focus on those topics. This sounds weird but just that people will be excited about studying you know and finding in the Bible. So like I didn't focus really say on. Did you know like like let's say whatever you shouldn't kill or you know so some call it a sort of commandment but really really it was like OK like taking a story or taking a passage and then really breaking it down and being able to like show that there's so much more to Bible study than just you know so taking like a common story for example you know maybe like Akin or something like that and you take your leaders and you talk about a can and show that you know you know different things from there. And so really the things that excite you in Bible study. I kind of took that I'm like oh it is exciting for me. Maybe I can give that passion to the students as well and really the core I believe of secular campus some issues really Bible study right. It's not inviting the secular or it's not inviting the people to church. That's that's like we believe that same vandalism and that's that is evangelism of that's not really the venue you need to change the way they think you need to change or God needs to change the way they think God needs to change their hearts and so the way to do that is study of the word not some sort of you know you know because they could come to church and not like it and that's it. Never come again. But if they're convicted of the message to Bible study. They'll come to church on their own right. They'll just show up on Sabbath and we. That's the way that we did it and the other questions. Oh yes. One more. So in today in looking at this. I actually chose to focus more on bacteria. So I don't have educated answer for you on the fire all aspect but I think that certainly more research has been dedicated to bacteria than virus but there is probably some stuff there in terms of how the how the viruses are living in our body actually live in balance with each other so of course I can't give you an educated answer. Yeah you can email me. I think I think I can I can do that. OK I'll be I.E. sorry zero to four at yahoo dot com zero two for yahoo dot com This media was brought to you by audio first a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse or if you would like to listen to more sermons lead to visit W W W audio verse or.

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