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Microbiome and Clinical Dysbiosis course

Excerpted video and transcript from Video #1

Dr Vasquez introduces the CE/CME course "Human Microbiome and Dysbiosis in Clinical Disease" (Main page) (PDF syllabus)
  • Transcript excerpt: "Hello, everyone. Dr. Alex Vasquez here with our program on Human Microbiome and Dysbiosis in Clinical Disease. This is the video series that accompanies the printed monograph. In that monograph, you also have most of the printed presentation slides and you also have password- protected access to more than 12 hours of additional video to help you understand and clinically apply this information.

  • What I'm going to do right now is focus on what I consider to be the core highlights of the information. I'll walk you through some case reports so that we can apply that information clinically because of course, the emphasis of the program is the translation of basic sciences into clinical practice. You'll find this to be particularly relevant for patients with diabetes, obesity, insulin resistance, and cardiometabolic disease, fibromyalgia, chronic fatigue syndrome which has recently been renamed systemic exertion and tolerance disease. Also, I will discuss some neuropsychiatric conditions such as autism and chronic pain and depression and of course, major emphasis will be placed on the autoimmune and rheumatic disease such as psoriasis, rheumatoid arthritis, lupus, Sjogren's syndrome, and multiple sclerosis.

  • This slide provides a listing of the core content and you might also use this as a mental checklist. We start with a pretest and that allows us to assess baseline knowledge. It also allows us to assess the overall effectiveness of this learning program. Then we have the printed monograph and then of course now we are entering into the video series and the video presentations. After we've gone through the pretest, the printed monograph, and the video presentations, then we access the final exam and that gives you a chance to complete the program and print off your certificate of achievement. Again, taking our focus back to the video presentations, we're starting right now with number one which is pathophysiologic mechanisms. I'll also talk about microbes, molecules, and morphology.

  • This slide provides you kind of a general outline of the presentations. Each one of course will have its own title and introduction. I'll go through a few necessary repetitions such as notices, disclosures, definitions, and goals; then we'll dive into the core coursework that will include at least one contextualizing case. Then towards the end, I'll provide a summary review, and we'll conclude each video.
        Generally, as many of you know, I try to present my information in kind of a conversational style. What I found with this new information on microbiome and dysbiosis is that it is so detailed and so intricate that if I deliver it in a conversational style, it will double the amount of time necessary to get through this material. What I'm going to do instead is focus on just what I consider the most important highlights, recalling that you've got the printed monograph that provides a lot of the more intimate and intricate details. You also have with that monograph access to 12 hours of additional video and you can of course with this video format always pause, replay, and review the material any time so that you can learn this material not simply at your own pace, but also to your particular level of expertise that you'd like to gain.
        For example, if you just want to go through the program, become familiar with the material, print off your certificate of achievement, you can certainly do that. However, if you want to review the material more than once, you can do that as well and that allows you to define and actualize your particular desired level of expertise with this material. I think you'll find this to be a very efficient delivery system and again, that allows you to use your time for other purposes or to gain additional mastery over the material. 

  • A few notices and disclosures are listed here. All of this material is of course copyrighted. I publish this in my books and some of the material is also protected by trademark. The scope of delivery of this information is intended for licensed healthcare providers. This is not individualized healthcare advice and the doses that I list are for adults, unless specified otherwise. Again here, overviewing the core material of the program. We've got the printed monograph, and we have the graphics and presentation slides that are printed in the book. Now we're starting the video series, and then we also have the pretest and the post-test and I want to encourage you to look at the pretest and post-test not simply as a hoop that you have to jump through, but as a chance to really understand and interact with the material at a deeper level. Additional notices and disclosures are provided here. I have worked as a consultant researcher and lecturer for Biotics Research Corporation. Some of the treatment recommendations I mention may be considered to be off-label or unapproved by the FDA. All of the content has been validated and sourced from peer-reviewed research and of course; we follow ethical guidelines in the formation of these materials, and you'll see the core ethical guidelines listed at the bottom of this slide. Again, the intended audience for this material includes health science students and doctorate-level licensed clinicians. As we go through the material, I may reference an occasional magazine or newspaper article, but again, the core material is always sourced back to peer-reviewed medical research.

  • We're all encouraged to practice evidence-based medicine these days so I want to review what the four pillars are of evidence-based medicine and those are 1) patients' preference and autonomy, 2) clinicians' expertise and experience, 3) scientific research, and 4) the socioeconomic and clinical conditions in which we find ourselves applying this information to patients.

  • Primary goal of this work is of course clinical action and clinical application. When I first started publishing and presenting on this material about 10 years ago, microbiome was not even a word in common parlance. These days, we see that word used not only in the peer-reviewed research, but also in an increasing number of articles intended for the general public. So whether we are clinicians or the general public, this is a conversation that everyone's having these days; everybody is talking about dysbiosis and microbiome. However, one of the things I've noticed is that beyond several commonly repeated concepts, I don't see this information really being translated in detail into clinical practice. That was part of what encouraged me to go ahead and update and restructure my own information so that we could really make this very important information on the microbiome and the role that microbes have in health and disease actionable and applicable to our daily lives and to our clinical practices. For example, microbiome is a very important concept, but doctors cannot treat and correct concepts. The concept has to be deciphered into actionable assessments and interventions for it to have clinical value. As I state again here, more briefly and perhaps more clearly, you can't do anything with “the microbiome” because you can't treat concepts. Microbiome is kind of a conceptual structure, we may say. We have to break that down and decipher it into things we can actually manage and apply clinically. Only when the concept is deciphered into a manageable set of the most important components can we then actually work with it. The goal is not to convert clinicians into immunologists, microbiologists, or inflammologists, but rather to define specific concepts and to describe consistent themes so that clinicians will be empowered to assess patients far accurately and treat them more effectively.

  • Let's get into that structure and then into the material. What I think is needed here in order to understand and master the microbiome or anything complex for that matter, is a structured approach, one that is well-(g)rounded and comprehensive, based on pattern recognition, but also flexible and amenable to expansion in the future when we have additional information. I actually learned this concept from reading philosophy and in particular the work of Friedrich Nietzsche. In his compilation of notes entitled Will to Power which was published a year after his death, he wrote, "In order for a particular species to maintain itself and increase its power, its conception of reality must comprehend enough of the calculable and constant for it to base a scheme of behavior on it." As we progress through this introduction, I'll show the intellectual structure that I've developed for what I call the functional inflammology protocol. The second component in that protocol is addressing the microbiome and dysbiosis.

  • On this slide, I show you an example of two articles that are available online, which I published back in 2006. Again, as I said before, the concept of dysbiosis is valuable in itself and research on the microbiome is important, but these concepts lose their value if they cannot be translated into practical and actionable understanding. Clinicians cannot treat concepts. Again, what I'm trying to do is take my 20 years of study of this material and really give you the gems, the pearls, the highlights, and the structure so that you can apply this information with clinical effectiveness.

  • Moving on now into the actual core material, we're going to start with some definitions and terminology. Microbiota refers to the actual, individual microbes, whereas microbiome is slightly more specific in talking about the DNA or the genome of those microbes. A popular estimate that I'm sure you've read is that the human body contains more than 10 times the number of microbial cells than of human cells and that the entire microbiome accounts for about one to three percent of total body mass. That comes out to about three pounds or approximately 1.5 kilograms. The majority of microbes cannot be cultured; that's why we see increasing use of various technologies such as DNA-based testing. Symbionts are the bacteria that live in or on us and either have no effect or have a slightly beneficial effect. Pathobionts are bacteria that live in or on us and are particularly predisposed to become pathogenic in states of injury, mucosal breach, or immunosuppression. Probiotics are the good bacteria that we can consume orally in foods such as yogurt, kefir, or kimchee/kimchi or in pills and powders in the form of nutritional supplements; these have beneficial effects. Prebiotics are the food that actually fuels the growth of the probiotics; so prebiotics again are a food source for the probiotic or good bacteria. When we combine probiotics with prebiotics, we call those products synbiotics. Dysbiosis is commonly defined as an alteration in microbial patterns, which is kind of a quantitative or numerical description, and I disagree with that definition and I'll show you my own definition. I think the definition of dysbiosis needs to consider not simply the microbial balance, but also the host response to that microbial balance and again, I'll walk you through my definition on the following slide. Some of the terms that we use from immunology include antigenic, which is a contraction for antibody generating and immunogenic which is a much broader term and that of course means immune response generating. 

  • Now I want to show you my definition of dysbiosis and I want to help you expand your conception of dysbiosis as we talk about the microbiome in clinical practice. My definition of dysbiosis has been for many years that dysbiosis is a relationship of non-acute, noninfectious host microorganism interaction that adversely affects the human host. Typically with dysbiosis, we of course do not see the classic signs of acute infection such as fever, redness, or swelling and usually the location of active dysbiosis has no signs or manifestations or such findings are nonspecific. For example, many patients with GI dysbiosis, even severe pathogenic GI dysbiosis, have no major clinical GI symptoms, just as patients with sinorespiratory or genitourinary dysbiosis do not present with manifestations of an upper respiratory tract infection or a urogenital tract infection. 

  • On this slide, I'd like to review with you some very important learning objectives and these include understanding the role that the total microbial load (TML) plays in the genesis and perpetuation of what we used to call chronic inflammatory diseases in which I'm going to encourage you to call sustained inflammatory responses. You know of course that when we use the term chronic inflammatory diseases, we're kind of resigning ourselves to the belief that the disease itself has a life of its own and it's going to be chronic; whereas if we redefine it slightly and instead of saying chronic inflammatory disease, we say sustained inflammatory response, then I think that gives us a chance to really engage with the disease process in a more active manner to understand and decipher and then address what are the factors that are sustaining this patient's inflammatory response. When we engage more actively with the material, I think that actually gives us a chance to engage more successfully in our clinical practices. We also of course want to be able to define dysbiosis beyond its microbial definition and I think that when we do that, we'll end up with three core components that we can use in our anti-dysbiosis protocol. 

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