Transcription
[Music] [Applause] [Music] Mr. I different than sit here. How's this down now? Can y'all hear me now? Okay. Can you guys hear me now? Go down. Oh, whoo! Thank you. Got it. Got it. Sorry, sorry, sorry. My new headset didn't work. So much for that $400. Back to my old. That's it.
All right, well, I better start from scratch because no one's been able to hear me yet. So, Dan Kalish, end of year. I'm excited. Best year of my career. So many amazing things have happened. Number one thing I have to say is I'm partnering with the IFM for functional medicine, and we are launching my practice plan, which, of course, I'm going to start teaching in January. And it's the best thing that's ever happened to me. I go to all the IFM meetings now. I am hanging out with the faculty. It's the most heart-centered, healing, and wonderful group of human beings I've ever met. And I, you know, I've been going to IFM seminars for 20 years, but just to be behind the scenes now and to meet everyone there, it's just an amazing group of human beings.
So anyways, we're launching a class together. Beco-branded. It's on my platform. I'm teaching it, but IFM is supporting us in the endeavor. It's an online class about how to build a practice, basically. And so you guys would be seeing a lot of marketing around that coming out in the new year. The launch date for that is going to be January 22nd for those of you that are interested. Okay.
And so then, on another note, you know, I want to also kind of end-of-year reflective thinking about what is functional medicine about. And when I really get down to it, it's about a movement for social change. And I think about my family, my family history, and I realize, whoa, there's like four generations of Kalishes that are interested in this social change thing. My grandfather, Max Kalish, was an artist. He was a very, very famous artist in the 1920s and '30s and lived in New York City. Had a huge studio on 57th Street, employed dozens of people. And he made art. He made art of laborers, right? He made art for the labor movement. And I realize now, wow, Max was the dude. You know, he wasn't just an artist. He was an artist that was making socialist art to lead the solutions movement in the '20s and '30s. And we really needed a movement in the '20s and '30s for labor. We need one right now in the United States.
My father, Richard Kalish, was an academic. He, you know, researched and wrote on the area of death and dying. And with this one quote, I grabbed off one of his projects. So one of the things Dad did was he wrote the Shanti Project's original grant. It was one of the first organizations in the world to train lay volunteers to treat what mainstream medicine does not and cannot treat: isolation and loneliness. And Dad's career was all around death and dying and caring for people who are dying. I'm like, damn, you know, Dad in the 1950s was leading the charge promoting the death and, you know, support for people in a different way at the end of their lives than then was being delivered now at that time. You know.
And, um, you know, myself, third generation now, I realize, wow, it's like a Kalish thing, isn't it? You know, I grew up in Berkeley, California. I went to Antioch College, super liberal school. Their symbol is an turkey symbol. I ended up in the early '20s in a gnarly little hut in this monastery in southern Thailand. And, you know, it was all about spiritual change, getting rid of all the belongings and trappings of the world. And, and, you know, trying to figure out how through spiritual practices and we can make the world a better place. And then, you know, it would occur to me, McGee, this lecture recently is that, wait a minute, you know, there's there's something else that's happened. And maybe that's translated down, you know, even another generation to my son. And my son, for those of you that, you know, follow any of the stuff in my personal life, he's in college now. And, you know, it's pretty intense kind of thing that he's off on his own. But, you know, he launched a group called Tutors for Opportunity and ended up, you know, with his own nonprofit organization when he was like 17 years old.
So, you know, this whole thing that we're talking about here is really about movement for social change. And how does that relate to functional medicine? Well, it relates really directly in a lot of different ways. Number one, because in order for our to get better, they have to eat healthy food. In order for people to eat healthy food, they have to have access to organic farms. In order for organic farms to work, you have to have, you know, the ability to, you know, kind of not support corporate farming and whatnot. You know, not support companies like Monsanto. And so I think a lot of what we do in functional medicine is, is really a social change movement. It's not just a health movement. And I'm just kind of now realizing that in the twilight of my career here, that that's really what this is all about. And maybe that's what I've been about the whole time. You know, it's like you wake up at age 53 and you realize, oh, this is what I've been doing the whole time. Maybe now it's gonna start to make a little bit more sense for me.
So let's take a look at some patient cases here with that as sort of like a background. And I wanna show you what it's like when you're in the live class. And this is what we do. We just spend all, you know, the whole hour every week and every group going through all the cases. And I might be kind of fun to just do that in a setting like this and kind of turn you guys on to some clinical tidbits. And then in the context of working with patients, I also want to talk a little bit about patient program design and and how we can feel so facilitate that process. And I think that, you know, as I work with people, I realize more and more and more now. And I did a little Facebook post on this yesterday, but I want to expand on the Facebook post. I realize more and more now that what what is really happening here is, is 100% predicated on listening skills. You know, I mean, give me a break. Functional medicine is not that hard. You know, we kind of get people to eat healthy, you know, trying to be able to go to sleep on time. It's like running a kindergarten or something, right? These are not complicated concepts. And once you get used to the lab interpretation, if you don't know how to interpret the labs, take my class. Let's see, try to do it. But, you know, once you get used to the lab interpretation stuff, that's not even that hard either. You know, the hard part of this job, and the important part of this job, is is developing the listening skills. And it's a 100% a listening skills job. And I know it is because I get patients all the time. They've seen other doctors who did an equally good program, to anything I would have done, and it didn't work because the doctor didn't have good listening and communication skills.
And so I think that the take-home message there, and this is something I really want to kind of blaze into all of our brains, is that we're paid for what we know, not for what we say. Can we say that again? We're paid for what we know, not for what we say. And so what do I mean by that? You know, what's the deeper implication of that? Is you can say one thing. Like in the very first year of the training program, we had this one doctor, and he said one thing to this patient. He told her to go on a gluten-free diet. She had Hashimoto's disease. She never came back. And it was at the end of the six-month class, and we were kind of looking at all our patient cases in the class. And he's like, Kalish, guess what? I finally figured out what happened with that patient. He thought she didn't come back because she didn't want to do the program because she didn't want to take all these supplements he recommended. But she didn't come back because she listened to one thing that he said, and she reversed her Hashimoto's disease by getting off of gluten. And so at the end of the six-month class, this woman came back into his clinic and said, I just wanted to tell you, my Hashimoto's disease is gone now. I want to thank you for all the help you gave me. He's like, well, you didn't do anything. I didn't do anything. I just met you once or twice and you did some tests, but you never followed up. And she's like, yeah, well, I went off a gluten and the disease reversed. Why didn't really bother coming back? So it's what we know. And you can say one thing that will change a person's life. And I think what happens a lot, especially in the younger years, in the first five or ten years of doing functional medicine, is that we think that people are paying us to do to do stuff and to stay sup and to design complicated programs. When in fact, it's quite the opposite. And they're paying us to sift through all the that's going on and find out the two or three things that are really going to make them better. And to not do an excessive program and to streamline things. So the better we get at this work, and you see this across the board with all functional medicine doctors, the less that you end up doing. And in those first five years, you end up doing too much, understandably, because you're not sure what are the things that you should be doing that are important, right?
And then, kind of a core layer this, and this is all a spin-off on on on the Dao De Jing. And there's a verse in the Dao De Jing that says, "Those who speak do not know, and those who know do not speak." So if you know a lot, you don't have to say a lot. You just have to say the right things. Okay. And this plays into an another example on the opposite side of this. I'll show you a little diagram on this. I'm just gonna skip around a little bit because there's a couple different powerpoints I'm going to choose from. But, you know, on the on the other side of this, we've got, it's not really a problem, but it's a situation, which is that we're dealing with patients, you know, human beings who have their whole own thing going on, you know, independent of what we want to have happen. They have their own, you know, what I call here in this diagram, patient perspective. And then we have our perspective for how we want to design a program over here, right? Here's our stuff, here's their stuff. And somehow these two worlds have to kind of collide in a good way.
In my life now, and this happened to me yesterday in practice, I can see two clearer kinds of patients. One is a patient who is overly detail-oriented. As soon as I hear the term FODMAP from a patient, you know, I know, oh, okay, this is like an overly detail-oriented patient. And why would somebody be on the internet non-stop trying to research their health problem? Because they're not getting better. And whatever they're doing is not working, right? And so when these people come in and they're overly consumed with details and they're like, eating everything perfectly and nothing's working and nothing's getting better, I want to then take away that stress from that person, you know, by myself taking over the details so they don't have to manage them. I think about, you know, I'm doing my year-end tax stuff now. And David Lefkowitz, God bless him, is my accountant and has been since I was, I don't know, forever. He's been my accountant. And, um, Lazlo, being my father, is his older Jewish guy, and he just kind of takes care of my finances and makes sure I don't buy too many cars or whatever I do with my money, you know. And so anyways, and I look at my tax forms, it is so complicated. If I was trying to figure out my own taxes, why here, I would make so many mistakes. It would cost me so much money. It's the same exact thing with a patient. If they're trying to figure out their own health program and design their own thing based on internet searches and Doctor Google and all this kind of stuff, there's no way that they're going to be able to design an effective program. And yet that's where we see a lot of the people coming into our practices is they're trying to self-treat. And we need to, for that kind of a patient, remove the burden of treatment. Listen really carefully. And then be really directive and let them know that you're gonna take over the burden on them, like David does my taxes, right? I just sign them. I don't even really read my taxes, to be honest. I glance at them, and it like, looks like about like last year, and I just sign the thing. And I want, we want that kind of relationship with our patient where we're designing the program, we're analyzing the labs, they're not allowed to have their own opinions about what treatment should be because they're not going to have good ideas. And we're kind of taking that burden away from them.
If you have a patient who's not detail-oriented, then that's even easier because they don't, you don't have to pull them out of that detail kind of quagmire. But we want to just make sure that we're on that page. Okay. And then when I look back on my first five years of practice, because I was so interested in the details of this work, because when I was an undergraduate, I took physiology classes for fun. Like, I'm not kidding. My friend, I took so many science and physiology classes for fun that I ended up being my minor. And I had a minor. If you look at my official diploma, I had a double major and then a minor, and I had a degree in physiological psychology because they didn't know what else to call it because I took so many human physiology classes and philosophy. That was my actual, you know, on my diploma, wherever that thing is hanging somewhere. And so I totally, in those first five years, was so into the details of the physiology that I just assumed that everyone else would be equally into it. And so I over-explained everything to the point where I didn't notice that people's, you know, eyes were kind of glazing over and that it wasn't really what they needed. Some people need a certain amount of detail, but figure out who those people are and don't assume that the patient's interested in the level of detail that you are. You want to figure out where that patient's coming from.
I think the easiest example to understand this, because we've all been in this situation, if you ever been on a first date with somebody, right? If you've been married for a long time, maybe it's been a while, but you can remember vaguely back sometime in your past when you're on a first date. That's the same. You're at a restaurant. If you're on a first date at a restaurant and you're ordering wine, you don't just look at the waiter and say, you know, bring us your best bottle of red wine. You look at the other person that you're interacting with, whoever he or she may be, depending on your gender and sexual orientation. You know, you do, I don't know, you say, you know, what kind of wine do you enjoy? You know, what do you feel like drinking? And, and you wouldn't say, you know, I really like red wine, could we get red wine? You would ask the other person what they want to have happen, right? And it's the exact same situation when we're working with patients. It's, you want to get a sense of what they want to have happen and let that lead the conversation so that you're not pushing upon them your orientation, whether it's, you know, overly detailed or utterly detailed or whatever it may be. So I ask a lot of questions about patients in the very beginning, trying to get their learning style and understand where they're coming from before I jump into my whole spiel about what I want them to do. And so I have a pretty good understanding. Like, and this week was interesting because yesterday I had a patient who's a research scientist. And he calmed down when I started to talk about details. And then I had a patient who was anticipating becoming a mother, right? She's not pregnant yet, but she wants to get pregnant. She's really anxious and nervous about everything to do with everything. I can't, I drink coffee, what about this, what about that, you know? And for her, I'd to pull her out of the details and just calm her down and let her know, hey, you know what? You're gonna be a great mom. Most of this is just based on you being a good person. You have to worry too much about how much broccoli you eat the next couple months. Your diet is already pristine. And she had like the perfect diet already. You don't have to take it to another level. That's just, you know, calm you down.
So I think the primary goal as we're getting into program design, and we're gonna look at some cases right now, is understanding where that other person is coming from so you can orient the program appropriately. And you can orient your communication to that patient properly as well. And this is a skill set that I had to learn. It's not like an easy thing to figure out. But I think if we talk about it and you all think about it, you can practice it and get better at it. And think about other examples of times when you're in a communication situation and you're trying to, you know, have a relationship with someone, right? We're building a relationship with our patient. And that should be something that's familiar to us from other human experiences that we have dealing with people in general.
And a couple of quick notices here before I get into the case. We're starting a new mentorship class in February. That's the next one coming up. It keeps getting better and better. We have a really good group of doctors. You've been listening to these for a while, you know that. Talked about this all the time. Very proud of the community that we built. We have thousands of case studies. We have just the best group of doctors in the world. And the lectures are getting better and better. In this, what's going to happen in 2018 that's new is I'm bringing in a whole new set of content that's based on the work I've done with Richard Lord in the last two years. So we're going to have revised information and updated information on the GI FX test analysis, commensal bacteria, how to test and correct the microbiome, which is pretty revolutionary. I don't think that information is is out publicly anywhere else. For those of you that don't know Richard Lord, he's the man that developed the GI FX test. He's the man that developed the organic acids or Nutri-Eval test. He's really the lead scientist in our profession. And he has been gracious enough for the last couple years to give me two years of his time in order to train me to teach his work. So we're going to have the microbiome stuff is out of this world. And I don't think it's ever been taught before. It's about 10 years of Richard's research on how to test and correct the microbiome, which is incredible. We have to do some lectures on that in the new year. I'm sure we'll be scheduling that. And then more advanced work on Nutri-Eval/organic acids type stuff. So the lectures are going to be massively redone and kind of upgraded to a more advanced level, to be honest. So those of you that are more advanced, I think you'd be very at home in terms of signing up for some of these courses next year.
Special offer. We have. We always like a discount because I like discounts. If you use this particular code, VIPFEB2018, VIPFEB2018, you get a couple $500 off the class. It's already very reasonably priced, but we get a skip a price break just to incentivize people to sign up. And that'll be happening in February. All right. So all that being said, here's what a typical class is like. You're in the corner, you're in the training program, you're in the community, you're reviewing cases on your own, you're looking at the lectures. And then every week, we have an hour where we go over cases together. And you've got a couple of them here that I picked out that were recent. And we can just skim through a few of these so you guys can see what they look like.
So the doctor will submit a form, looks just like this here. This is submitted by Cat. Patient is age 47, she's a female caretaker, little bit of medication history, under a lot of emotional stress. Main complaints are fatigue, dry skin since getting off a primer, and no physical stamina, depression, hormones, sad, mental health issues. And then we run three different tests. Adrenal panel in this case, here's a cortisol and DHEA test. And we'll go through this. I'll show you how I do the workups. A GI test in this case, it's a GI-MAP. Those of you that aren't familiar with it, GI-MAP is from Diagnostic Solutions. That's David Brady and Tony Hoffman's company. And they do PCR tests for GI pathogens. Really great test. And they look for all kinds of bugs, Crypto, Histo, Giardia, H. pylori, all of our favorites. And this particular patient had a series of opportunistic bacteria, the ones that can trigger autoimmune/fatigue type problems. And she had low enzyme issues, secretory IgA, low gluten sensitivity, you know, all the kind of usual stuff that we see. And then we ran her organic acids and looked at all these markers.
So in terms of how I analyze these, I just show you real quick here. I'm always thinking about the patient experience and how to make this. It's like I'm perpetually on a first date, right? We're always trying to figure out how that's gonna work for this other person, not for me, but how this is going to work for this other person. So I think in terms of systems and organizational structures and in terms of program design, in terms of these three body systems, right? Neuroendocrine, GI, and then detox. And then my favorite representation of this, because the students in the training program really like this, is to look at it like this. So in this particular situation, we have a person with an adrenal problem, with some microbiome/gut related issues, a bacterial overgrowth, and then we're going to check out on the organic acids what's going on in terms of detox systems, oxidative stress, nutrient replacement, all this. But I always test all three systems and I always work on them in this order. So starting off with neuroendocrine, getting them feeling better, focusing on the GI, which is usually the heart of the problem, and then focusing on detox, which is again, usually the heart of the problem. So I don't know if you can really choose whether more of our patients have GI problems or detox problems. Everyone has them both. So we end up kind of doing both of these. So these are not in the order of importance. In fact, I think the detox issues many of us face are probably more important than the neuroendocrine issues. But these are the order in which I treat so that we're getting patient buy-in and patient improvements and symptoms initially, then whacking away at the GI issues to get that cleared up, and then detoxing the person once you think that their GI tract is working pretty well. And certainly for a lot of the patients that we work with, detox is the most important thing. So in that sense, we're kind of saving the most important thing for last, you know?
So again, just a quick review. We got the adrenal lab. In this person's case, they have low cortisol. And my staff picked a hard one. This is, they're throwing me a curveball here. I don't know if any of my staff are on this call, but thank you, where we are, Larissa, for doing this, because this is a hard one. This is a low cortisol, but look, the DHEA is high. Ouch. That's not easy. So we'll interpret that in a second. I don't think they did that on purpose to screw me up tonight, but it's kind of funny. That's a hard one. And then on the gut side, where there's some pathogens, I mean, some bacterial overgrowth and some other issues on the GI. And then we can look at organic acids and just see what the heck's going on there.
So I'm kind of now. Richard's my, I've been working on this for two years, but we have, I hate to say that two years boils down to like four simple things, but it does. And so I'm going to show you after two years of hard work, what he and I have come up with as a solution. And actually, this was my idea, but he is lying. He signed off on it. He said, okay, Dan, that's alright. So when you're looking at the organic acids, I've broken it down into four categories: cell metabolism, or we can say cell energetics. This is the same for a Nutri-Eval. Cell energetics, right? Then neurotransmitters, then liver, liver detox, and GI/bacteria. Really, it's bacteria for the most part. So that entire organics profile can be boiled down into four different phrases here. It's not words. Cell energetics, neurotransmitters, liver, and GI. Let me show you how that works. And I'm going to kind of zoom out so you can see because part of this test is so intimidating, it's just so complicated. But now, you know, you can't really can't even see it, right? So that makes it a little easier. Won't get so emotionally involved.
These first 21 markers are all really under the rubric of cell energetics. It's that simple. Mitochondria, how you make energy. That's it. Oh, that's half the test right there. So let's look at that half. It's broken down into fat burning, carb burning, and energy production, the mitochondria themselves, right? How we burn energy. Boom, boom, boom. And then the last series of markers, the last seven over here. I have a new way of looking at this, you guys. This is like revolutionary to me because it says B-vitamin markers here. And so I've been thinking for 24 years, 23 years, oh, this is a B-vitamin marker section. But if you're looking at this from a cell energetics perspective, you can look at that in a totally different way. And I know this seems a little silly, but reframing this completely changed my entire attitude towards this whole test. So I want to share this with you tonight because you can use. I'm very happy if you use this. If you like this idea and you use it with your patients.
Now let's look at this diagram just for a sec. And remember, and this is what we're talking about. These are the first 21 markers. And we're talking about fat burning up for fuel, glucose burning up for fuel, and citric acid cycle. So we're talking about fat metabolism, glucose metabolism. Oh, but what's this over here? Amino acid catabolism. So breaking down fat, breaking down sugars, breaking down amino acids. And from those, we make energy. And from these markers, the so whole first 21 markers on the test. So rather than calling this B-vitamin markers, I'm rechristening this amino acid catabolism. Amino acid catabolism. And why is that so important? Well, okay, well, screw B vitamins. We know B vitamins are super important. But you can figure out B vitamins easily. You can just give somebody some B vitamins. And in fact, I give every patient a B complex. That is not a hard thing to figure out. It's hard to figure out amino acid catabolism, though. In other words, what's happening with amino acids in that person's system? Do they need more of them? Do they need less of them? So start to look at this whole section of the test as an amino acid breakdown. And in fact, cross out the B-vitamin markers in your mind. And looking at the earlier portions of the test, you can see how you can translate this. I'll just emphasize this for a moment. See how it says fatty acid metabolism, carbohydrate metabolism? Now, here we're going to put, instead of B vitamins, amino acid catabolism. It's about how we break down aminos and whether we need a lot of amino acids or not. So then this portion of the test turns into an analysis of whether the person needs large dosages of free-form amino acids, as well as, of course, also being a B-vitamin marker portion of the test. But anyways, of course, I know. And I know. I mean, like, duh, physiology 101, the B-vitamin markers are showing you how, you know, protein catabolism, amino acid breakdown is going. But just reframing it that way in my mind really changed the nature of the test because it changes the nature of the treatments. It's not just about giving B vitamins. It's about cranking up amino acid levels in people. And you get results when you start to do that. You give these people free-form amino acids, in tryptophan, you will see life-changing results that you would never get if you just did the B vitamins. It's like a factor of 10. Okay. So it's the first 21 markers. That's what it's about. Then this section is on neurotransmitters. And then we have oxidative stress and liver detox, which is the toxic liver section. And then the GI section wraps it up. So remember, this whole test can be broken down into four areas: cell energetics, the first 21 markers, then neurotransmitters, liver detox, and GI. That's it. So they have to be overwhelming and complicated because when you're actually trying to design a program, and all, let's look at a program in a minute, you've got to keep it simple. So number one, you can explain it to patients. And number two, you don't get totally overwhelmed yourself. We want to prevent doctor overwhelm. Life is hard enough without us being overwhelmed just because of a bunch of lab findings, right?
So again, another profile. Here's an adrenal test. It's kind of get you familiar with how I do this. Here's the GI, again, the GI-MAP. This person has H. pylori and Protease and a little bit of Giardia, a little bit of yeast overgrowth. And then organic acids. So these three tests in sequence, it's how I do things. And so I want to show you one. We'll go back. Let's analyze each of these separately. Let's do the first one first. I just want to point out one thing on the adrenal thing in case you've ever seen one of these. This will be handy thing to know going forward. If you see one of these, remember I pointed out that we've got this low total cortisol, but rather than being low, the DHEA is high. And that's a little bit of a curveball. In order to interpret that, it really helps to look at this particular chart. And this brings me back to my early days of training, 25 years ago. And I don't know any of you guys that were around back then. You remember Diagnostics? And the the man that started Diagnostics was Dr. Elias Ilya, or is it Ilya Elias? No, it's Dr. Elias Ilya. And I used to go to all his seminars. I had all his tapes, you know, so back in the days of cassette tapes, believe it or not. And everyone would listen to cassette tapes. And this is a diagram that Dr. Elias Ilya did gather many, many years ago. He was one of the first people in the integrative medicine that did the salivary adrenal panels, initially out of his garage in Los Angeles. And then he later went on to move up to northern Northwest US, you know, in Washington State, and started the lab Diagnostics. And he was a wonderful man and a wonderful teacher. He has left us now. But here's his chart from way back when. And so this particular patient, well, let's go through what normally happens when people burn out. First, oh, yes, Susan, to answer your question, if low B-vitamin markers, yes, they need more amino acids. That was the punchline. Yes, thank you for clarifying that. Low B-vitamin markers means give B vitamins, but even more importantly, give them the amino acids, free-form amino acids, and tryptophan.
So when we start to burn out, high cortisol, high DHEA. You can see the DHEA along this axis, the cortisol here. They're both going up. That's a normal stress. That person, as the stress gets worse, the DHEA starts to drop. And then if it gets even worse, the cortisol starts to drop. And then they end up in what we call renal fatigue, adrenal burnout. Down here, where they have the number four, which is low cortisol and low DHEA. If things continue, there is what I think of as a last gasp of the adrenal glands. And even though the person is downtrodden with really low cortisol, the DHEA cranks up and cranks up again. And they end up over here in what they call like a Phase Six. That is low cortisol, super low cortisol, but high DHEA. That is not a good thing, right? Because after that, things get really grim. So in other words, if you have low cortisol and low DHEA, that is not good. If you have low cortisol and high DHEA, that's another level of badness that just happens. Okay. So these are, you know, progressively getting worse here. And then DHEA drops. So it's this weird kind of patterning thing. So now let's look again at this lab. And we see clearly. We don't see anything. Do they have the wrong thing out there? We see clearly here that, uh, sorry, I've got too many open. Sorry, gang. What can I find that? Let's see. Other isn't it just kind of came over by itself? Low cortisol, high DHEA. So this person is in that phase six. So that's not a good thing. And you want to support the adrenals there. It would, there would be healthier if their DHEA was low. Okay. That high DHEA means that something bad is happening. Um, still do the basic adrenal protocols, cortisol, DHEA, etcetera, you know.
All right. So let's look at this other case now. That was kind of a standout little factoid from that one. So another thing that comes up in in just about every case that I work with these days is this decision about, are we going to work with the adrenals, the thyroid, other hormones? Are we going to work with neurotransmitters or the brain? How do we know which one do we do? Do we do one? Do we do both? You know, adrenal or thyroid support versus neurotransmitters? How do you make that decision? And I test everybody for all these things. So we're constantly every day looking at labs, trying to figure that out. And here's a good case study because this is a case of mine. It just came through recently. And I still practice two days a week. I was thinking about it earlier today. I'm just starting to get good at this, you know? And I can't really appreciate doctors in their 70s and why they don't stop practicing. It's not about the money or the fame, you know, I'm kidding. It's, it's really a, it's really just about honing your craft, you know? It's probably their same reason why the Rolling Stones still play concerts. You know, they clearly are not about the money and they've gigged enough times, but you just, it never gets old, you know? So anyways, this particular lab. Cortisol is lost. Some is normal. There's some low levels during the day, but the DHEA is normal. So the adrenals are not in great shape, but they're not nearly as bad as we often see. And then we look. Cut down and look at the neurotransmitter portion of the test real quick here. And this is the real patient. I don't make this stuff up. This is just like what shows up in my clinic. Every single neurotransmitter marker elevated. Every single one. That's a problem. So this is a brain that's inflamed. These bottom three markers are inflammatory markers. And a brain that's stressed. So again, the adrenals were not in great shape, but the brain is just outstandingly bad. And so clearly, in this case, I would work with the neurotransmitters as the initial go-to thing and put the adrenals on the shelf for the next step, a little bit later.
And you could have an opposite situation. Let's just show you what would be opposite to that. Let's say that the total cortisol, let's say the cortisol total sum was like a four on a patient like this last year. This is an American guy. When I talked to him, he was in Panama. He sounded a little sketchy. And he was doing something about buying and selling gold in Panama, but he was gonna fly up to Los Angeles because he had a movie deal. Anyways, this guy was really like this character. But he had a total cortisol, four. Total cortisol sum, not one reading, but the whole day was a four. That is not a good number. And his DHEA was down like below a one. Okay. So for someone like that who has an extreme adrenal problem, and the neurotransmitter levels were fine, you would start with the adrenals, right? So you can look at the lab and see how egregious the particular markers appear. And making a decision based on that. If it's kind of a tie, or you can't tell, you can always do both programs simultaneously. And this person also has H. pylori. So we want to think about treating that. You don't have to treat H. pylori in everybody, but, you know, when people are inflamed and going through this much in terms of nutrient deficiencies and whatnot, it's probably worth thinking about treating H. pylori. And let's look at the other aspects of the test. So remember, this person had pretty normal DHEA, but the cortisol is a little bit off. So not, not bad on the adrenals. They have H. pylori plus some random bacteria. Then we want to look at these other four areas. And what are the other four areas? This is exactly how I explain it to patients, by the way. Cell energetics, or if you want to get fancy, you can say just mitochondria. Cell energetics, or mitochondria, neurotransmitters, liver, and GI. Those four areas. So remember, the whole first 21 markers are about cell energetics. And what we have here, high levels that show fatty acid and carbohydrate related problems. Extremely high level here. So we see something going on in the Krebs cycle. Same with down here. And another way to think about this is the more low markers that you see under cell energetics, especially related to the B vitamins, but also to that earlier section, the more likely that person needs free-form amino acids plus tryptophan. Because in order, if you're not, if these, if these numbers are all quite low, it means, think of it this way, I think of it like it's like a wheel that's spinning, or it's like some kind of movement is happening here with the citric acid cycle. And so it's obvious if you're throwing off a lot of citrate, there's a block there, right? If citrate levels are really high, something is blocked. And so the citrate is going up and it's not transferring through. But what if all these numbers are low? What if there's just low levels everywhere? It means the wheel's not even spinning, you know? And potentially there's not enough mitochondria to make these reactions happen. So when Dr. Lord first set up this test, the organic acids test, it was exclusively designed in these sections to look for high numbers. In fact, if you look at it here, they don't even flag the lows. They put a little DL there, but there's no red mark, right? In fact, it's all green. So when this test form was originally developed, the concept of low levels being a problem wasn't in anyone's consciousness. That, what they weren't aware that that could even be a problem. And again, this carries over to this here. Most of these markers, you'll see some of them have seen how the red here in a case. Some of these that are low are problems. But really, it's the pattern. Any of these that are low can contribute to this two metabolic state, right? Where there's a shutdown in the mitochondria being able to function. And I, you know, they didn't know when they didn't start this test up 35 years ago, they were going to discover this as a problem. So high levels mean there's a backlog, there's nutrient deficiencies that we can rectify. But if you have a massive number of low levels throughout here, either there's not enough mitochondria, or they're just not working and they're damaged. And that person's then, how would that person feel? Incredibly tired, right? So in other words, there's a scale here, kind of where a high level, this patient isn't too bad. A high, a series of high markers indicates you're going to support them nutritionally with what the lab is telling you. But if there's a large number of low markers, it's an even worse situation. Those people are even more exhausted, have even more trouble losing weight because their mitochondria are either damaged or just no longer present. Okay. So that's cell energetics. And then we talked about this one. You can break it down into two components, right? We've got the first three markers here that are stress-mediated neurotransmitter issues. And then these three here that are inflammatory related. Okay. And then this person's got both. That's amazing what people get through, you know? And then you look at the liver detox markers. A couple of them are on the low side, you know, not the worst thing probably ever seen, but definitely need some liver support, but not like calling your attention too loudly.
So then when you get into program design, so I'll show you real quick how I do this. And I'll answer question two while I'm looking for this document. So tryptophan and 5-HTP, I are two of my biggest sellers. And we use them in completely different ways. And it took me over 20 years to figure this out. So I wouldn't just be more than happy to share it with you and save you all some time. Let me try to draw it out here real quick because it's a good question. And appreciate you asking it. Let me see. The exact question was, could 5-HTP be used instead of tryptophan? So let me just show you why use 5-HTP, why use tryptophan, which I can never spell for some reason. So 5-HTP will convert to serotonin at an unlimited rate. So if you really need to crank on someone's serotonin, you need to use 5-HTP. Tryptophan will convert into serotonin, but there's an enzyme that shuts down the conversion. So you'll only get a certain amount of serotonin out of tryptophan. For most people, it's enough. For some people with a lot of brain issues, it's not. So those are one difference there. Another difference, which is relevant to what we're talking about right now, is, and I'm going to ask this as a quiz question because this is what Dr. Lord does to me every Monday. He tortures me for hours. He asks me questions. So here's a question. Raise her. If you know the answer, type it into your box. And I don't know. I'll send you like a free bottle of vitamin C or something. So the question is, what's the number one rate-limiting step for protein synthesis in all tissues except for collagen? And if you've been on these seminars before, you probably know the answer is, oh, it's tryptophan. Okay. You don't believe me? Look it up. So if you're trying to get mitochondrial production stimulated, 5-HTP isn't gonna work. You have to use the tryptophan. So if you've got a mitochondrial case and you want to get these amino acids to kick in, you give free-form amino acids and then toss in a little extra tryptophan. And Sam, I appreciate the humor. Sam's listening. He's one of our smarter, sharper students. And for some reason, he's doing some extracurricular stuff listening. He did tonight's call. Like he said, I'm hoping doing well. Okay.
So program design, right? Which is the whole point of this. Sorry, he's taking me 47 minutes to get to the point of tonight's lecture, but hopefully this is helping. And by the way, this is that everything is recorded, right? So you guys can listen to this later or whatever. Now, number one, this guy won't go back to where we first started. Number one, patient walks in the door. I'm in a good mood. It's a good day. And I've meditated for three hours and things are all, you know, flowing great. This was like yesterday. So I'm determining number one memory. It's like the first date. I'm not telling the patient this is what you're gonna do. I'm asking, what kind of wine would you like to have? And I'm trying to assess, is this a detail-oriented person that is
Already so deep in the details that I need to calm them down. And or is this a non-detail-oriented person, and they just want the punchline of what to do? That's my first kind of thinking process, and that's gonna completely change how I explain the program to them. And if I don't explain it properly, they're not going to do it. This whole thing falls apart.
And so if it's a detail-oriented person, I need to speak in enough language of details to calm them down, but not give them more details to obsess on. So I want to de-escalate their detail mind, right? Calm them down and let them know subtly. I don't say this obviously, but let them know subtly, "Dude, I know like a thousand times more than you will ever know. I have done this with 10,000 patients. I've taught a thousand doctors. I've built a thousand clinics. I've seen hundreds of thousands of these labs, and you will never even come close to knowing a fraction of what I know." But don't ever say that. But it's implied. Remember, "those who know do not speak; those who speak do not know." So I don't say that ever. I don't need to say that because it's just implied in my attitude, like, "Calm down, this is gonna be okay. I know what I'm doing. You can let go of the details because you're paying me $500 an hour to take care of that for you." Just like I pay David Lefkowitz $400 an hour to do my taxes. I don't come back and question him on deductions. You know, I'm like, "It looks about right. Sign here. Thanks, David." Okay. So we want to kind of have that kind of confidence. And how do I know David's so good? We've been doing taxes for 40 years. He's got all kinds of famous clients, and he's been doing my taxes forever. I just know that he knows what he's doing, right? We have to. And he's never told me, "Dan, I know more about you than accounting, and I'm a CPA." And you know, I'm, you know, Ben. He's just, he just embodies that. You look at, first of all, you walk in his office, and he's got these two huge monitors. He's the size of Texas, and he's in there typing away. You're like, "Oh man." And he's got a penthouse office in San Francisco, downtown San Francisco. So you go up to the penthouse, and he's sitting there with his crazy hair, and it's two big monitors, and you're like, "Anyone could afford this office, it's gotta be pretty good, right?" So you just kind of know he has that knowing. So remember, "those who know do not speak." We're not saying a lot, and we're assessing that person. We're listening and we're assessing that person. And then you get to the punchline. We actually designed the program. Okay. So in, in these cases, we had, oh, and here's the next decision-making. No, let me go back to this guy here. This is just kind of what's going through my head every time I work with a patient. I'm thinking, "Am I gonna go down the adrenal path and thyroid and kind of work on hormones and adrenals and thyroid are kind of in this box to me together? Or am I gonna go down neurotransmitters and we'll focus on there?" And what do the labs say? Do the labs point me in one direction? If I'm confused, I can do both. If the patient's up for it, they can have a glass of red wine and a glass of white wine. You take, you can do both. And there's certain characteristics of each of these programs. Our transmitter protocol is kicking in a matter of days or weeks, and that's nice there. And thyroid programs usually take weeks or months. So if you're going for a quick response, that may point you in one direction. If the patient's desperate, a lot of patients I work with, I'll say, "You know, there's neurotransmitter program would work within days or weeks." And they'll say, "Oh, well, I've been feeling horrible for so long, I don't mind if it takes a little while." And other people are just desperate to feel even a little bit better. So taking again into account where that person is coming from. Adrenal and thyroid take longer, and our transmitters are faster. Does a lab show a preponderance of findings in one area or the other? And then taking all that into account, looking at the person, and figuring out, you know, how you gotta actually design this program. So the other variables I think are really important, and I just ask people these questions now rather than me trying to guess. I'm over, kind of guess. It's like, you know, "Is it better to have what I would call a robust program that translates into tons of supplements, or a minimal program? How fast do they want it to go?" The more stuff I give them, the faster it's gonna go. If they're in a rush, give more stuff. If they hate taking pills, so they don't have a lot of money, I won't give them as much. We have a patient right now, and Dubai, then we just shipped out, you know, a $7,000 supplement order in this box, like, you know, like it had a flat-screen TV in it. And so in her situation, just clearly living in this, you know, you know, $50 million home in Dubai, money is not an issue. And in her mindset, you know, more was better. I have other patients who are equally wealthy, and they don't want to take a lot of stuff, and I might send them, you know, a program that has like five supplements in it for the whole six months. So again, I'm trying to customize the protocol so it fits with that person. There are some people who will calm down and feel better if you give them more stuff, and there are other people where it'll absolutely flip them out, and they'll be unhappy that they have to take all that, regardless of their financial status.
Okay, now let's see here. Yeah, when I would, and I don't always do this, but when I was on the phone with a Dubai patient, so I have an international phone practice. We work with people all over the United States and, and all over the world, really. And I saw her house, I was like, "Oh man, that is incredible that you actually lived there, lady." But I do, you know, I don't assess the number of supplements that I recommend to someone based on their income. I would never do that because it's a personality trait kind of thing. And I'm a minimalist by by nature. I feel like the better I do my job, the fewer supplements I recommend, the less stuff I say, and the more impactful I am, right? So I want to be minimal, but I acknowledge that not everyone else is a minimalist, and some people will actually feel better if I give them more stuff. So I want to assess that. And in the early years of doing this, I guess, yeah, I just gave everybody the same basic programs. So I forgot to turn my phone off. You know, and now I've learned over the years, it's like being on a date. I want to know what that other person wants so I can customize it to them and not just give everybody a really big program and not give everybody a minimal program, but make it, you know, tailored and personalized to that particular individual. And this is where we get into the individualization and customization of the programs. And the other fact, and I really want to emphasize this because this is a trick that I use now that's really, really effective is to tie a lifestyle change to every supplement you give. So if I give mitochondrial energy support, I'll say, "This is only going to work if we start to improve your exercise," which is true because the exercise will give them more mitochondria. If I give them an adrenal supplement program, almost say, "This will only work if we de-stress you. Let's get you signed off on that divorce. Let's get you into marriage counseling. Let's get your child into a drug rehab program," whatever it is that they need to do to de-stress them, right? So if it's a GI program, I'll say, "This is only going to work if you cut out gluten and sugar and dairy while you're on these supplements." So every supplement program I give is tied into a lifestyle change, and that is a really nice way they do it. And who's going to spend $200 on a bunch of adrenal stuff and then not follow through on the stress reduction? And who spend $500 on a three-month mitochondrial program and then not work out, right? So you, you trap them into doing the lifestyle change because it's spending so much money on the supplements, and that's a way to use your leverage to get behavioral changes. So that can be really effective.
So after all that's being said, I love the DHEA drops for adrenal cases, and I've been using these for 25 years, and they work really well. You haven't got turned on to these yet, they're really great. Pregnenolone drops as well. This is a typical, like, stage two protocol. The patients get a little freaked out about that then. And you guys are welcome to use this too, I guess it would only make sense if you're using my protocols. But if people get, are getting freaked out a little bit about the whole, the whole issue of taking DHEA, I'm pregnant alone, then I pull out my Mayo Clinic study, and it's hard to argue with the Mayo Clinic. At least doctors argue with the Mayo Clinic because it was only 25 people or whatever. But patients aren't gonna argue with the Mayo Clinic. They're not gonna look at this and say, "Oh, kind of a cheesy, second-rate organization, this isn't a very good study." So I pull out "Evaluation of Functional Medicine Approach to Treating Fatigue, Stress, and Digestive Issues in Women," Sue Cuts, all Larry Bergstrom, Daniel Kalish, Division of General Internal Medicine, Mayo Clinic, Division of Consultive Medicine, Mayo Clinic. A lot of, kind of hard to argue that the Mayo Clinic has gone wrong. And this often calms people down and makes them realize, "Okay, this program is gonna be okay. I'm going to take my DHEA and pregnant alone the way I get my DHA am pregnant alone from a company called Bio Matrix. You may find in other places too, other companies have it." And then if we're gonna do in our transmitter programs, I use a lot of tyrosine, and I usually dose it reasonably high unless a person's hypersensitive. And then I use a lot of this herb called Mucuna. This is one of my number one sellers. If you're not familiar with Mucuna, should check it out. Several companies have it, and it's very effective for boosting up catecholamines. I couldn't run my practice without Mucuna. It's really a fantastic product, and for dopamine, epinephrine, norepinephrine, all that stuff. And then, like I mentioned earlier, either 5-HTP or tyrosine or tryptophan, depending on your, your ultimate goals there. If you want to get the serotonin levels super high, tryptophan is going to be a little better option. I mean, a 5-HTP will be a better option. If you're wanting to work on mitochondria at the same time as you work on serotonin, and tryptophan can be better. And then some people, even if they don't need super high doses, just just respond to one of these better than the other. You can't go wrong, and you just kind of, there's no way I don't think on a lab to tell which one is better for serotonin. The only differentiating factor is if they have a mitochondrial problem, you want to use the tryptophan. Okay. And again, I'm not shy about this. Let's say that we're using the 5-HTP. I carry it in a 100-milligram dose, and you know, I'm putting people on at least, you know, two or three of these at night. So we're getting people up to that, when I would consider like a therapeutic dose of 300 milligrams a day. I start there. That's a little aggressive. But and then on the tyrosine, I don't really start that high. Usually, I probably start on the tyrosine at somewhere between 3,000 and 4,000 milligrams a day, if that's what they need. And the DHEA, just so you get a sense of dosages here. DHEA dosage is it's 1.2 milligrams per drop. So that's low-dose DHEA throughout the day. And key is with the DHEA and pregnenolone, don't give it all at one time. Never give it all at one time. Low dosages spread throughout the day make a huge difference. And so these are some of the secrets that I use all the time. And this would be a combination program if you want to hit the brain and the adrenal glands at the same time. This would be the protocol to do it.
Okay. And then I'll just show you one more thing here. I've never seen, let's see. I've never Mucuna mess the adrenals up. I think it's theoretically possible. I never seen that happen. I have a slide on this. I want to show you guys where to go. Here it is. And so in this particular patient's case, right? We're working on the adrenal cortex, I.e., cortisol made in the cortex, and DHEA obviously. And we're working on the adrenal medulla by working with the catecholamines using tyrosine and Mucuna. And it's not in this diagram. We're working on the brain because obviously the brain also uses or relies upon dopamine, epinephrine, and norepinephrine. So you can get a really integrated program. And I'll tell you, I do these all the time, every every day of the week, because I don't practice every day of the week, but this kind of a protocol, I just kick-start just about anyone, you know, assuming that you have the labs to verify that there's problems there. Now, one last question here. I use, right now, I get the Mucuna from Designs for Health, and they have a product called OPA Boost. And I started off the dosing at one, three times a day. And be careful with OPA Boost, it packs a punch. Be careful if you, if you're gonna go above that, you just do it really carefully. But again, Designs for Health, OPA Boost. The reason why I like that one, it's the most concentrated, you know, in that it's, um, you don't have to give that many pills to make it work.
Alright. So now we started off with a message for social change. Now I'm telling you should sign up for the class. It does keep getting better and better. It's gonna be a good year. Got a lot of great materials coming out. If you've been on the fence for a while, you know, you can make this your year and sign up. And we basically have two courses. You know, I have the mentorship, which is six months. We do adrenal, GI, female hormones. And then separately, we have the advanced class, we're calling it, which is organic acids and GI FX. Alright. And so super excited to have you guys on here. We'll be doing a lot of free webinars next year as I just browbeat you all gradually into signing up for the class. Alright. And we've got, don't for my practice plan launching with IFM in January, which is, you know, for me, the culmination of my career. And I feel like I don't even know how to explain it. But when, when I'm working with the IFM people, I feel like I'm working with like the best people in the industry, and I'm doing important work. You know, I feel like I'm kind of out of my own little corner, and now I'm, I'm working with, you know, a broader, a broader purpose. And that was my idea of starting this talk with the idea of a mission for social change because I think that's what we're on here. We're not just about patient care, really about trying to transform the culture. And, and part of that involves the transformation of the culture of medicine. Alright, have a great rest of your week, folks. We'll catch up with you at the next webinar next month. Alright, bye for now. Oh, we've got a question here. Hang on. Michael, the IFM program is around $7,000. The very first launching of it in January is discounted to $49.95, and then it's gonna go up to the normal seven grand. So if you're interested in it, and you can go to my website and look at my practice plan, and there's a lot more detail there. Let me show you. Hang a second. I didn't prepare slides on this, but uh, I can show you. And you can also just call my office, and we can give you some little tips on it. But if you go to the Kaelers website here, and you go to classes, you'll see my practice plan right there. $7,500. Learn more. And you click on that, and that'll be a good description of the class, kind of tells you about what's in it, and some video and whatnot about the course. Okay. And then for people who are patients or interested in working with me as a patient, you can go to Kalish Wellness dot com. And that's a way to reach me there. Kalish Wellness dot com. There I am, my charming self, smiling away. I don't think I look bad for 53. Although if you look at really old pictures of me, I used to have hair, and now I'm bald. But I'm in denial of the fact that I'm bald. And the thing I said, you know, when you're when you're bald like I am, you don't see the lack of hair, you know. And so I still walk around thinking that I have hair. It's really weird. And then once in a while, I look in the mirror, or, you know, what happens a lot is someone will take some pictures of me and post him on Facebook or something, and I'll go, "Who's that guy? Like, kind of looks like he's bald." Well, that's me. Here's an old picture of me, and from when I used to work with Dr. Schwarz. Mine. Let me show you here. Oh my gosh, I just saw this the other day. Oh, there I am. See how much hair I had. Look at me. How cute. No, it's Dan in his 30s. Wow, that suit is really dated. I don't have that suit anymore. Full disclosure, that thing is gone. This is a 15-year-old picture. Anyways, have a great evening, you guys. Take care. Bye now.