Transcription
Hello everyone, and Dan Kayla's here. We're going to talk about blood sugar control. And for those of you that, um, first time you've been doing with these, my name is Dr. Dan Kalish. I've been in practice, let's just say over 25 years, and I just turned 56. I'm not sure exactly how that happened, but I'm doing functional medicine for a long time. I'm just getting good at it. I'm telling you, it takes 25, 30 years to figure this stuff out. It's kind of complicated, and I'm on a roll.
We have a practice. I work on the phone with patients all over the world. If you're interested, you can talk to our health coach, Jennifer, about, uh, if you're a good candidate to work with our clinic or not. And if you're here today listening to this, then we're going to focus on insulin resistance, the lab testing behind figuring out how you're burning carbohydrate, what's happening with your blood sugar, and why all that even matters.
So, in the world of functional medicine, one of the worst things that can happen to the human body, and this is well, actually, I should just expand it. In the world of human physiology, one of the worst things that can happen to your body is you can have, as if you have high levels of insulin on a regular basis. It's the most corrosive, inflammatory, destructive thing you could imagine. As a result of long-term exposure to a problem with insulin, then, of course, we can develop pre-diabetes and diabetes, and then the blood sugars are high, and it's even a greater escalation of problems. But there's a progression to all this, and it's an issue that I see in at least half the patients I work with, maybe more.
And when I had gone through all my clinical nutrition training, and I learned all this kind of stuff, you know, from all these different doctors, and then I actually started practicing, this is like 1992-93. I couldn't believe the impact that blood sugar control had on patients. Like, if you control your blood sugar, you can reverse insomnia. If you control your blood sugar, of course, you start to burn body fat and you lose weight. Sugar cravings go away. Inflammatory conditions go away. It's really quite remarkable. And it's all because if you're not making the right amount of insulin all the time, you're going to, you know, have some pretty serious ramifications of that.
So today, I want to talk about a couple of lab markers in particular, lactate or L-lactate, and pyruvate, and how we can test for these kinds of issues before you become diabetic, perhaps even before you become pre-diabetic. You will see these markers, um, being positive and causing a really big problem. And, you know, when we look at, you know, the symptomatic picture of this, when it's really extreme, we see neurological problems like depression, anxiety, you know, the brain is just not doing very well. We see people obviously who are just exhausted all the time, right? Because they can't maintain this energy supply that the human body needs. So we'll talk a little bit about this.
Let me maybe make this a little bit bigger so you can see it. What is insulin resistance in the first place? What we're talking about is in a normal situation, you consume from a meal, right? Your body gets sugar or glucose, and then it gets either burned up for energy or gets stored in your liver, right? And when you have a problem with this, there's resistance, right? Insulin resistance means that your body makes insulin to try to. The role of insulin then is when the sugar levels go up in the blood, your pancreas squirts out some insulin, and the insulin is designed to take that sugar out of the blood because high blood sugar is dangerous, right? Take that sugar out of blood and put it into storage. And if your body is insulin resistant, then it's very difficult. The body resists the action of insulin. So trying to cram that sugar or glucose into some storage area doesn't work very well, and so then your blood sugar stays high, okay? And that can cause again, a whole host of problems.
So what we're looking at today are these markers that appear on organic acids testing that let you know that there's a problem. And I'll zoom in on this so you can see it real clear. And these two markers are called pyruvate and lactate. And why is this so important? Well, you can see if you eat carbohydrates, not types, you know, not just like Snickers bars and sugar, but any kind of carbohydrate, right? You know, it could be a grain, it could be a bean, it could be a vegetable, it could be a piece of fruit. When you eat carbohydrate, convert this food into glucose, and your body then converts, uh, the energy, right, that's coming from the food into pyruvate and lactate. That pyruvate and lactate then eventually get converted into what we call acetyl-CoA, which is then converted into energy. And this is what allows you to move and think and do lots of stuff, okay? We also obviously can consume fat and convert fat into energy, and we can also consume protein and convert it into energy. But today, we're talking about these two markers here because if pyruvate or lactate are high, that's going to block your body's ability to make energy out of carbohydrates. And that's going to lead to pre-diabetes, diabetes, insulin resistance syndrome X, there's lots of different terms for this, you know, challenge in terms of dealing with your blood sugar. And again, the result could be anything from headaches to exhaustion to body fat building up to, um, not being able to get sleep, to sleep well at night. It's a very essential process that you can control your blood sugar.
Now, what's quite fascinating about this to me is that there are very, well, you can obviously just eat wrong and cause this to be a problem. I don't think you need to do an online online webinar to figure that out, right? Um, you know, if it's, if food is the problem, just figure, go find a health coach like Jennifer or someone else and eat well, you know? But what we're talking about here are people who are already eating well or have tried to eat well and can't eat well, and they still have a problem. Weight loss resistance, insulin resistance because pyruvate or lactate are sky high, and this whole system is just gummed up. And for many people, if not most people in that situation, it's not about what you're eating, it's about your genetics. And there are many, many genetic conditions or snips, we call them genetic disorders, genetic problems, that lead to either pyruvate or lactate being extraordinarily high, which means that you're going to have this problem even if you're eating pretty healthy food. And I'll show you some examples of that on how it works in the labs in a moment.
So let's just cruise around. I'll show you a few other things here. And, you know, when I was, um, working with my teacher the other day, and he was giving me a little quiz, and he said, um, what's the most important thing in the human body? The most important thing that happens in the human body? And I knew it was kind of a trick question because there, I don't know, it's just so hard to answer that, right? And he said, vitamin B1, thiamine. I think, okay, why? Because if you don't have vitamin B1, you die. You'll die immediately. It won't be a painful death because you'll be dead in like a few seconds. You have to have these B vitamins like B1, B3, you have to have biotin, you have to have pantothenic acid in order to make energy. And if all of a sudden all the B1 disappeared from your body, you would not even know it because you'd be dead so fast, okay? Because your energy production would stop. So these are the most essential body processes that we're talking about here. This is not just kind of like a nice to have this working kind of thing. These are really, really critical body processes.
So when we eat fats, we take fatty acids into the cells, and from them, we can make through this whole process called beta oxidation, cram them into the mitochondria and make energy. Then we also take sugar or glucose from food that we eat and also make energy out of it, okay? So we're primarily focusing on glucose today, but it's important to recognize that these other mechanisms that are going on as well, including how we burn body fat, let's sort of a separate discussion, okay?
Another view of the same thing, basically, where we're taking carbohydrates or glucose, we then store them as glycogen, okay? And storage, if there's excess, your body stores them as glycogen. Your body also then can convert them into pyruvate, as you saw on the first diagram, which enters the mitochondria and gets burned up as energy, right? And we can also make lactic acid or lactate from the same pathway, okay? When we look at the labs, hopefully this will kind of sink in a little bit. Pyruvate, lactate, you want to see what's happening ultimately getting these molecules into the mitochondria so we can make energy and you can move around and think and be happy and do stuff, okay? We also can take fat, and when we eat dietary fat, we can take that fat, convert it into free fatty acids, and it enters right into the mitochondria where we can make energy as well. In fact, fat is a preferred fuel source, right? You can make a lot of energy out of fat.
And here's another way to look at it, and just to prepare you for the labs, which we'll take a glance at in a moment. Here's our lactate that we're talking about over and over, and our pyruvate. And now these fancy enzymes, and you can tell something's an enzyme because it ends with an "ase." Ace. So here's lactate, lactic acid, that gets converted into pyruvate. And what makes that conversion happen? This enzyme. And it's named for what it does. It's lactate dehydrogenase. It kind of dehydrogenates the lactate. And when you do that, that enzyme's done its job. That lactate mysteriously is turned into pyruvate, which is kind of a little miracle in itself that even happens, right? When you need to take that pyruvate one step further, there's another enzyme named after what it does, pyruvate dehydrogenase. Again, "ase" means enzyme. And that enzyme converts the pyruvate into acetyl-CoA. And then once you get the acetyl-CoA, the energy is converted into the Krebs cycle, and we make a ton of energy, and we walk around and do stuff.
Now, thiamine or vitamin B1 is important in a whole bunch of these steps. So is niacin or vitamin B3. So is pantothenic acid or vitamin B5. B5 operates right here. So if you do not have these B vitamins in sufficient amounts, you're going to have a problem. That is the easiest thing in the world to fix. You could just stop watching this video right now if you want. If you think you have this problem, buy a good quality B complex from some doctor that you know or a friend who's a doctor. Get a good quality one that's a professional brand only. Don't go and buy it from like the health food store or grocery store or something. Get a good quality B complex and start taking it, and you'll get better right away. So if you have a simple nutrient deficiency, just taking B complex will bring all your energy back. You'll lose weight, and you'll feel better. That's not what we're really talking about now. You can figure that stuff out with diet and some simple supplements.
What I want to talk about now is when you have tried to eat well and you didn't lose weight or you didn't get more energy, and you've tried to do all these basic supplements and they didn't work, and why would that happen? Because these enzymes here are defective. Two separate issues. One is you could be deficient in a nutrient. I don't even meet people like this. They don't pay to see doctors like me. They go out, they take a good quality B vitamin, and they're better. Patients that come to me, see me, have in typically enzyme defects. It means this enzyme, the lactate dehydrogenase enzyme, or this enzyme, the pyruvate dehydrogenase enzyme, ain't working. It's broken. And that is a genetic disorder, or these are genetic disorders, which can be caused by a whole wide variety of what we call snips or genetic defects, not just one, but there's many, many genetic defects that can screw up an enzyme. Okay? When you see these pathways like this, each enzyme can have one, two, three, five, ten. And you add that up, and all of a sudden you get somebody who's got a problem with their blood sugar that they can't figure out just by eating better because they have a genetic defect with the enzymes. And that's what we want to talk about, okay?
So let's look at some labs. This is not the most obvious or easy thing to figure out. This is an organic acids test. I run this on every new patient. Costs about three, four hundred bucks. It's a urine sample. And just for the two markers we're going to talk about today, this test is worth the money. Here you see pyruvate, and below it, you see lactate. So this particular patient of mine had extraordinarily high lactate. That means they can't break down lactic acid or lactate. Their pyruvate was high too. That means they're not doing really well at breaking down pyruvate either. So how much energy are they going to be making? Not much, because you need to break down lactate and break down pyruvate, turn them into acetyl-CoA to make energy. And this is, you know, what we all learned in chemistry. I'll just show it one more time so you're familiar with it because you should know how your body works, I think. Here it is, just as a reminder. We take that carb and we want to make energy out of it in a citric acid cycle. If pyruvate is high, it means it's backed up here. It's not going forward. If lactate is high, it means it's backed up. This is, this is a block here. So you're going to be tired and overweight and get headaches and have sugar cravings because this is not moving through. Pyruvate and lactate being high is a problem.
So, and what we're talking about specifically are these enzyme defects that happen because of genetic disorders. This is like cutting-edge stuff, right? We didn't used to know all this, but now we can measure these genes and everything's really, it's like a whole new world. So high lactate, extraordinarily high lactate, could be a nutritional deficiency, or it could be an enzyme that's broken. How do you fix all this? Well, it's right here. B1, thiamine, B3, niacin, chromium, chromium, lipoic acid, and CoQ10. However, if you have the genetic version of this, you're not going to just be able to take a B complex and make this work. You have to see a doctor. They have to do the test. You have to figure out exactly what part of this is not working right, and then start to fix it.
So you'll have some patients. I had, we had several patients in class today, and I teach these doctor training programs. We had like two or three people in class this morning that had low pyruvate and sky-high lactate. The treatment for that is a little bit different. That means that they have a major enzyme block that has to do with converting lactate to pyruvate. I had a patient of my own yesterday who had the opposite. She had low lactate and extraordinarily high pyruvate. It was like up at a 50 or something. So she had a different enzyme defect, a different block in her metabolism that needed a different correction. Hence, the ordering of these tests. These genetic disorders that interfere with pyruvate and lactate have been known about for decades. If you Google genetic disorder pyruvate, you could read the rest of your life and probably not get through all the scientific literature on that subject. If you Google L-lactate genetic disorders, it'll pop up. It'll say lactic acid areas, and you could again, probably never read all the scientific articles that have been written on that on that one subject, okay? Because this is really important because this is the foundation of obesity, cardiovascular disease, diabetes. These are really important markers here. And through functional medicine, we can test these, figure out which one's wrong, is lactate high, is pyruvate high, are they both high, and exactly what nutrients do we want to use to target them to get your sugar mechanism, your blood sugar burning mechanism to work again.
And what happens with that? If we can do this properly, and this is the real problem, then you can have a relief of depression, relief of anxiety, can start to sleep well, and start to burn body fat. All these really good things happen if we can sort through the challenges that are, you know, involved in that.
So let's just look at a couple other tests real quick. This is not the most intuitively obvious thing to figure out, by the way. This took me a few years. Let's see where this person's at. Oh, here's a really good one. Look at that. Okay, so L. These are just random tests I pulled. I didn't really plan this. L-lactate with this patient, super high, 33. Anything above an eight is considered high. 16 is the absolute cutoff. This person is double that. So this is a genetic defect with the ability to use or metabolize or break down a lactate. Where's the pyruvate? That's normal. This person doesn't have a problem with pyruvate. The whole problem is with lactic acid or lactate. What does that feel like when lactic acid builds up? You get achy, and your muscles are tight and sore, and you stretch, but you never feel better. It's that feeling like you just worked out, but it's like there all the time. This acidity, this buildup of lactic acid, it's just a living nightmare. People feel horrible. Not only do they have sugar cravings, but their body feels like it's on fire with achy pain, and it's not a really good thing. So there is a whole group of snips or genomic or genetic problems that can lead to these extraordinarily high lactic acid levels, and there's books and books you can read about this if you want to get more into the detail. But this is pretty straightforward. How we treat it, we use B vitamins, lipoic acid, carnitine, depending on which marker is not doing well.
Let me just show you in one or two more examples. Uh, let's see. Oh, well, I don't know. This one's normal. That's not a really great example for this class, okay? Not everybody has this problem. Maybe that's what, uh, my my line should be here. Not everybody has this problem. This person is perfect. Okay, this is the person that has perfect blood sugar control. Um, good for you, whoever you are. Um, kind of screwed up my talk, but anyways, that one's normal. Okay. Point is, not everybody has the problem, I guess. You know, when you get to be a doctor after a while, you start to think everybody is sick, you know? Um, this is why I go based on the labs, not my personal opinions. Oh, here's an even worse one, right? This is funny. So now look at the pyruvate and lactate. Now pyruvate is really low, and lactate's in the normal range. That's a whole different world of pain and problem. If you're not making enough lactate or you're not making enough pyruvate, that's, um, not necessarily has nothing to do with the B vitamin deficiency. I'll show you what that means real quick here. Oops, got the wrong thing there, sorry. Uh, if you're not able to make enough pyruvate or lactate, that typically means that there's a deeper problem with your blood sugar, and that this whole mechanism is not working further up, okay? From the chain that we're talking about today. So that's a different level of suffering and pain that people go through there.
So, quick summary, right? Number one is pyruvate and lactate are super important. You want to be able to burn them up for fuel to have normal energy production throughout the day. If you have a mild version of this problem, taking a B complex will solve it. We take one or two B complex from a good professional brand, and you'll feel better within, you know, a few weeks, probably two weeks, and you'll be better. If that's not working and there's something more complicated going on, then you need to do some lab testing. And the way that process works is you come in, you talk with Jennifer on the phone and see if it's a good fit or not. If yes, then you sign up for a new patient consultation on the phone. We talk to you. Jennifer will help you order all your labs. When the labs come back, I'll get on the phone and I'll tell you what the labs mean and design a program to start to fix this problem. I do all the patient consultations myself. New patients all start with Jennifer for their orientation sessions, and then I do all the actual interpretations and workups. And once you get a program from me, then we'll recommend certain supplements and lifestyle changes, diet changes that you can use to start to get your blood sugar back on track, okay? That's how we work at KalishWellness.com. If you guys are interested, you can go check out the website and get signed up for a free consult with Jennifer, okay? I hope that was helpful. You learned a little bit today. We'll catch up with you next time at the next health chat. Bye for now.