Mentorship Miniseries - Lab Analysis for Microbiome and Weight Loss Resistance

Good evening everyone. I can see you streaming in through our webinar, which is great. Names keep popping up on the screen. I am Dr. Dan Kish. We are here in our Autumn Mentorship Miniseries, and we're going to talk about something that's a kind of a little complicated. It's lab analysis for the microbiome and weight loss resistance, and it's an interesting subject. And it's, uh, lab-based, but you have to like stretch your imagination a little bit on this one. And so we'll take our time. We'll look at some slides, then we're going to spend the majority of the time looking at some lab tests, so you can start to see how this all ties together.

So for those of you that are brand new, of which there are many, which is wonderful, welcome. And I will introduce myself, and then we'll get into the topic for tonight. So who am I? Hi, I am Dan Kish. I've been around for a long time. I've been doing functional medicine since 1992. The Kish Institute, we've trained upwards of 7,000 practitioners now, and it's an interesting ride. You know, we have a focus at the Kish Institute on practical application. My main goal is to take practitioners that are interested in functional medicine and show them the business skills and the, uh, lab modeling, lab interpretation skills, supplement program design skills, patient education skills, so they can be super successful.

And so I've also, along the road, done a bunch of different things. We had a group of Mayo Clinic doctors take this, uh, take my mentorship class, like 10, 12 years ago now, and we did a research study with Mayo Clinic on the Kales method, which was an exciting year of my life. And I've worked now for the last 12 years with Dr. Richard Lord developing more advanced lab curriculum. A lot of the ideas tonight are from Richard Lord's mind, let's say. And, uh, I am IFM certified. I've been in practice forever. And, um, I'm mostly interested now, though, in helping you guys learn how to work with patients, kind of shifting my career now. I'm almost 60 years old in a couple months, so you get older, you start to think about things a little differently, and wanting to impact, you know, our profession in as wide a way as possible.

So when I get a new mentorship student in our one-year program, and I, and we just had a new class started this fall, and when I'm able to talk to them and see that I know for sure at the end of the year, they're going to be super successful in functional medicine, that's the thing that I really want. And so we're looking for new mentorship students. If you guys want to sign up, we're starting a new group right now in November. We're also offering, uh, our cardiometabolic boot camp, lab interpretation boot camp, and you can scan that QR code if you're interested in signing out. You get a discount if you have this code. And that is a, uh, session. It's a lot of material getting into how to interpret nutrval, metabolomics, the omics test, or organic acids from a cardiometabolic perspective. And you learn about all the different pathways and how to support patients. And that's starting in November, as is our mentorship class, too.

Okay. And then we'll be wrapping it up for the year. We'll have a whole agenda coming out next year for you that we're working on now. So we've been partnering with Rupa Health for the last couple years. They're, I think, the best technology solution that's come into our profession. Maybe the only thing that beats Rupa is maybe online scheduling, but they're probably even better than that because they save so much money in terms of staff time and energy in terms of ordering labs. You can order all your labs from one place. You will see in the labs I'm going to present tonight, almost all the doctors that we work with are using Rupa. And so they, if you're not familiar with them, they have 30 plus different lab companies. You can order every single lab kit from every lab company all at the same time with a click of a button. And then they, you know, amalgamate it all. They put it all into, um, an online accessible thing for you and your staff. So it takes most, they probably do 98% of the heavy lifting for lab ordering. And if you've been around for a while like I have, I used to have almost a full-time staff member doing this stuff because you have a high-volume lab-based practice. It is a lot of work. And Rupa basically does all that for free. And they have a better interface and a better system than I ever developed. And I worked hard on developing lab, you know, distribution systems of my own. So anyways, it's a great group. I'm really excited to be working with them. And if you scan that code, you get $100 off your first order with Rupa. Go check them out. And we've got a bunch of educational things we're doing with Rupa right now, too. For those of you that are interested, uh, if you go over to Rupa, you'll see the latest talk I did with them about a week ago. There's a whole curriculum around that too for lab ordering.

Okay. All right. So we're going to talk about the microbiome and how it relates to weight loss. And a lot of this just boils down to what you're actually eating and how food is processed in your gut. And a lot of this is counterintuitive, too. So we want to talk about anti-inflammatory markers on Gaps. We want to talk about oxidative stress markers on the different metabolomics tests that you guys are running. Well, a lot of thinking about CoQ10 and how that relates to mitochondrial function. And then when we look at the labs, when I figure out exactly which markers on the GI tests and metabolomics test are going to show a need for fiber and polyphenols in the diet. And then how polyphenols relate to mitochondrial health. And that's kind of like the surprise.

So when this, I was surprised by this about 10 years ago. Richard Lord was doing a lecture. It was one on, what was it? Just me and Richard on the on the webinar, you know, just the two of us. But he's lecturing me. Clearly, it was not a discussion. And about an hour, hour and a half into the discussion, he gives me the punchline. And I'm like, I can't believe that that's true. And he says, yeah, here's the research. Teddy line. So I'm going to give you the punchline right now. So in case you don't listen to this whole talk, you'll know exactly what we're talking about. And the punchline is that when you eat dietary fiber, it's not for you and your body, it's for the gut microorganisms, the trillions of little gut organisms to live on. And they take that fiber and they turn it into to fat. And we'll talk a lot about that process because it's a strange process, but it's like critical for human survival and the human brain and everything.

And then the second thing is that when you eat polyphenols, most of them are molecularly too large for you to actually absorb. So every time you chomp down on a blueberry, it's not going into your body directly. It's food for your microbiome. And we are measuring polyphenols on organic acids testing. So if you're ordering an OAT test from Great Plains, now they're called Mosaic, or if you're ordering a Nutrval from Genova, or metabolomics from Genova, or if you're ordering an Omic's test from DSL lab, the GIAP people have the organic acids too now. Any of those organic acids tests, you're actually measuring polyphenol metabolites. You may not know it because they're never really represented that way. But we'll get into that because they're kind of been dumbed down to be dysbiosis markers. But that is not really what they are. Okay, they're polyphenol markers.

And then once you understand that, you're like, wait a minute, you mean that that has to do with my metabolism? Yeah, because one of the most, not the most important nutrients in your mitochondria working properly is CoQ10. Okay. And the punchline to this whole talk is that CoQ10, the biosynthesis or production of CoQ10, upon which your entire metabolism rests, the final step in CoQ10 production is under the control of a polyphenol called four-hydroxybenzoic acid. Acid. And that's something that a lot of these labs actually measure. Okay. And if not, you're measuring these other polyphenols, which are very similar, like benzoic acid and whatnot. And so you can see basically if the polyphenols are there or not, which is going to directly impact the person's metabolism.

So then treatment-wise, if you're wondering, okay, what are the treatments for this? Dietary fiber in supplement form and polyphenols in supplement form. And eventually getting the person to eat dietary fiber and eat polyphenols as the long-term solution. But the short term, you're actually using fiber and polyphenols as treatment. This is represented in a product that I actually designed a few years ago. I don't know, was a while ago now, five or six years ago, called Poly Prebiotic Powder. If you can imagine that. I'll show that at the end.

So when we look at protocols, so there's actually supplements specifically designed for this. I know there's at least one because I'm the one that designed it. And we put the best fibers and the best polyphenols together in a powder. And you just, it's a prebiotic powder, basically. Patient just does that a couple times a day, and then all the magic happens. And you can easily get fiber and polyphenols from any supplement company. You don't have to buy the stuff that I designed from Pure. It's from Pure Encapsulations is one that I made up. But if you look at the ingredients on there, you can get that from any company. It's polyphenols and fiber. Just a convenience that it's together. And I'm going to skip some of these slides so we have more time for, uh, lab interpretation.

I'm assuming you guys know why the microbiome is important, but just in case. Cardiovascular disease prevention, hormone-related problems, obviously GI conditions that half this country has, diabetes-related problems. All this stuff is directly under the control of the microbiome. And then what we want to do ultimately with these labs is use the polyphenol markers and use the, uh, markers on the digestive panel for gut bacteria as a means for making what I call these labs to lifestyle change. So if you're just telling somebody that they should eat broccoli and blueberries every day, and telling somebody that human beings need a half a cup to a cup and a half of beans every day to get enough fiber to be, you know, survive and be healthy, nobody ever does that. But if you have a lab that says, hey, your polyphenols are low, I think we need to crank up the blueberries. Hey, your dietary fiber is low. How do we know? Because these commensal bacteria are low, and that's what they live on. Okay, well, then we're going to have to crank up the dietary fiber. It's a complete motivating, motivating force to have the lab showing that the person's got a problem. Allows you then to do the lifestyle coaching. It's the same lifestyle coaching for everybody. Everybody needs fiber and polyphenols every day. But when you have a lab test that shows that the person needs it, complete game changer for patient motivation, patient enthusiasm, patient compliance.

So number one, low short-chain fatty acid producing bacteria. If the fat, the short-chain fatty acid producing bacteria are low, then a patient needs more dietary fiber. You can also supplement with butyrate. And we'll look at these bacteria when we look at the labs. Okay. You also have some of these lab tests that look at butyrate itself, the short-chain fatty acid levels. And if they're low, then the person needs butyrate. And more importantly, the person needs dietary fiber because the gut bacteria need the fiber to make the butyrate. Supplement first, get the lifestyle changes in place. Eventually, the supplements stop, and then the diet takes over.

Low polyphenol markers. This is on organic acids again. Great Plains or Mosaic has these markers. Genova has them. DSL has them. Anybody that's running organic acids, Nutrval, metabolomics testing, you're staring at these polyphenol markers every time you do one of these labs, just didn't know what they were. I'm going to explain that today. Okay. And those low polyphenol markers mean what? Not that their gut is in great shape. It means that they're low in fruits and vegetables that are rich in those compounds. The confusion is that the polyphenol markers on these labs are generally considered dysbiosis markers. So you would assume if they're low, then it's good. But it's not true. If they're low, it's bad. And why don't I just look at just, let me just show you that really quick, and we'll come back to the slides.

So here's a, this is an Omic's test from Diagnostic Solutions, the same company that does MAP. Okay. And they have a section, it's at the very end of the test. You got to scroll all the way to the end. And it's strangely titled. Where is it? Where is it? See, it's way at the end. I told you it was way at the end. Here you go. Microbial metabolites. And it's then subtitled polyphenol microbial metabolites. These are gut bacterial markers that are derivative of polyphenols. And sometimes you can tell from the name, like they have a, a phenol in the name. And I'll show you some of those on the other labs. And then this one right here, four-hydroxybenzoic acid, is going to become very important at the very last minute of all these slides. Okay. So remember that one. These are polyphenol markers. If these are high, it indicates potential dysbiosis. However, if these are low, see that low? See that low? See that low? Is that good? Does that mean that there's less dysbiosis? If these are low, it doesn't. So everybody assumes, and I assumed this until I met Richard Lord, everybody in the industry that's interpreting these, not the lab companies, lab companies know, but we don't know. The doctors don't know that. Okay. High is bad. Oh, that's all in red. You know, and that means green is good. Not the case. Not the case. So the whole point of tonight's talk is to disavow the value of that mental pattern that you have these dysbiosis markers. If these markers are low, it means the person's low in polyphenols. That is extra bad. It's really bad. It's bad to have dysbiosis, but it's really bad. Maybe you could even argue it's almost worse to have these markers below. But it's confusing because the labs don't make them in red, you know, so it looks like it's green, so it's good. You think, oh, the lower the better. That is not the case. Not even a little bit.

All right, let's look at another one here. So this is a metabolomic from Genova, also has organic acids on it. And let's look at, oh, that's not a good formatted one. Sorry. Hang on a second. Let me find a better one. Here we go. Nutrval again from Genova, similar to the metabolomics. Okay. And you look at the section here, and it's titled, let me show you the polyphenol markers on here. What are they called? Are they called polyphenol markers? No, they're called dysbiosis markers. Why? Because they're markers of dysbiosis. That's a very reasonable thing to call them. When these are high, we are upset because we think our patient has dysbiosis, which they do. So that's not a good thing. But now this kind of drills down into the inner workings of these labs here. Let's make this really big so you can see it all. All right, you ready? Now let's look at the names of these markers. Dihydroxyphenylpropionic acid. You see the phenol in there? That's a polyphenol derivative. 3-hydroxyphenylacetic acid. Is there a phenol in there? I think there is. 4-hydroxyphenylacetic acid. That's another polyphenol marker. Benzoic acid. You just have to trust me, it's a polyphenol marker. And HPA acid is a polyphenol marker also. So these are all markers of dysbiosis? Yes. But really, you could also put on here, slash polyphenols. So if these markers are categorically low, that could be that there's no dysbiosis. But if they're extremely low, that could also mean there's not enough polyphenols in that person's diet. And we're going to learn soon about how important those polyphenols are in terms of regulating metabolism. So high markers, dysbiosis. Low markers, can be normal or can be a serious problem. Okay. That's probably enough of those to look at, right? We could just look at one more, just real quick. Which one is this? This is a metabolomic from Genova. It's almost the exact same format. Okay. And here's our dysbiosis markers. But now you know these are, you want to substitute dysbiosis in your mind because dysbiosis is judgmental. It's judgy. Meaning that dysbiosis is saying it's putting an assumption on the markers that they're bad. So I don't know what it's like if I mean, it's like calling a marker a dysbiosis marker. It's like dissing it. I was going to say, but that's not even a funny joke. It's just like it's a put down to the marker. It's like, hey, you're a dysbiosis marker. If you're positive, it means that there's dysbiosis. That's not fair. If you want to be more objective about it, I mean, they're doing it because they're trying to describe what it means when they're high. So we understand that, right? So the lab is trying to tell you, hey, when these markers are screwed up, there's dysbiosis. But the truth of the matter is, they're polyphenol markers. And if they're low, it's like zone 10 critical bad thing. Okay. Dysbiosis marker, high polyphenol marker, right? But really, what they are, polyphenols are low. You got a really big problem. And I'm going to show you a little bit more about why that is so important. Uh, here, let's go back to the slides.

Oh, and then that's not all. Also, when you're looking at your stool tests, when you're looking at your various stool tests, if you see commensal bacterial markers low, if you see commensal bacterial markers low, then that's a problem too. Or if you see butyrate low, then that's another problem. Okay. So I'm assuming you guys, uh, well, we'll look at those when we get to the labs, but we'll look at a bunch of stool tests too and see those. So we're going to skip over some of the slides because we got other stuff to deal with. Not too worried about that. Let's just get into some of the organisms.

This is the one that's the most popular. It's also my favorite. It's a lot of people's favorite. Akkermansia muciniphila. It's named for what it does. Mucin or mucus. Fil, filia, like Philadelphia, loving a city of love, right? It loves. So this organism loves mucus. It lives on mucus. In fact, it eats the mucus in your gut lining. And it's like a lawn mower that's just keeping the lining of your gut super fresh by chewing off that top little layer of mucus. It encourages the strength of the gut lining. It prevents leaky gut. It is an anti-inflammatory and immune-controlling thing that's just like, couldn't get better. And they found in extensive research studies that high levels exist in thin people, and Akkermansia muciniphila is lower in obese people. And all these labs that you guys are doing, if you're a GI-MAP person or a GI-Effects person or a Doctor's Data GI 360 person, they're measuring Akkermansia. So you can see if there's a problem or not, and then you want to boost it up. And there's lots of articles on this if you like to read, as I do. Functions of Akkermansia muciniphila and type two diabetes and related diseases. This just came out a few months ago. And here's a direct quote from that article: "Akkermansia treatment improves host metabolism." Isn't that what we're after? Yes. Insulin resistance and metabolic syndrome are the most prominent characteristics of type 2 diabetes, and Akkermansia muciniphila alleviates metabolic syndrome. Alleviates metabolic syndrome by improving glucose, lipid, and bile acid metabolism. And then they go into all the mechanisms for why that happens. Akkermansia muciniphila treatment improves host metabolism. What is Akkermansia muciniphila treatment? Prebiotics, like fiber and polyphenols.

And here's another little schematic of all the things that go into Akkermansia. But all the, the bad stuff here, right? If your Akkermansia is messed up, cognitive impairment, problems with your liver and fat, obesity, hypoglycemia, atherosclerosis. It's like all the bad things that happen to people. Your brain going, your liver going, getting fat, having sugar cravings all the time, and then your heart blowing out on you. This is all the bad stuff. Another article, this an older one. Commensal bacteria at the interface of host metabolism and the immune system. People have been studying this for a while. And there's thousands of research studies on this. I just pulled out a few. So we have some interesting quotes here from that article. Okay. "Recent studies have highlighted that alterations in the composition, alterations in the composition of commensal bacterial populations are linked to multiple metabolic and inflammatory diseases in humans, including, but not limited to, IBD, obesity, type two diabetes, atherosclerosis, allergy, and colon cancer." I don't know about you, but I don't want to wake up one day and have IBD, obesity, type two diabetes, atherosclerosis, allergies, or colon cancer. I mean, none of those sound very good. And these are serious disease processes, right? These are like major problems that come out from serious imbalances in your gut.

So now when we look at the stool testing, we're going to analyze commensal bacteria. If they're low, it's a problem. And we want to correct that. How? Polyphenols and fiber. You could use probiotics and butyrate also. We'll design some programs so you can see how the program design part works too. Okay. All right. So then I've discovered something new. It's called tea. I never was a big tea drinker, but now I drink tea. I don't know why. It's just like a new thing. This is like some kind of licorice tea or something. Licorice eucalyptus tea. My acupuncturist said I need it. So I'm doing what my acupuncturist says. Who's Jordan? Thank you, Jordan, for being my acupuncturist. Okay.

So commensal bacteria extract energy from food. So commensal bacteria, the good bacteria, break down carbs in whole plant foods, and they turn the fiber into fat. The best source of this kind of fiber is beans. Black beans, pinto beans, garbanzo beans, hummus, any kind of bean. Lentils, I think, are the best. But any kind of bean will do. A half a cup to a cup and a half per day, day gets you all the fiber you need. But that fiber is not for you. That fiber is for the gut bacteria. They convert that fiber, they use the fiber as a food supply. And what they dump out into your gut, to your body, is fat. It's strange that that's possible. Can you imagine you, I mean, any, like, could you like invent something that could take fiber and convert it into fat? I mean, that'd be pretty hard to do. This is what these bacteria do just for a living. These short-chain fatty acids then are both a fuel. They fuel 60 plus percent of the gut lining's energy needs. And they're signaling molecules. And in other words, they, they control a lot of stuff like immune regulation and inflammation. And then when these short-chain fatty acids like butyrate travel from the gut to your brain, they control the brain's rate of BDNF production, brain-derived neurotrophic factor. They control basically how your brain cells are growing, whether they're growing well or not. It's crazy. And this was mentioned in one of those earlier articles that I just showed you. Acetate and butyrate, the short-chain fatty acids from fiber bind to receptors on cells in the GI tract lining and regulate fat storage and appetite. They regulate fat storage and appetite. You just don't see anything better that could happen. I mean, it's really like fiber is almost like a drug, and polyphenols are almost like a drug. They have this intense effect body-wide. Remember, it's not just on losing weight, it's all this stuff here. This is from the other article. This is, uh, from these guys, the Akkermansia guys. This article here. Cognitive impairment, that's the brain-derived neurotrophic factor. Fatty liver, obesity, hyperglycemia, atherosclerosis. All these things are controlled for if you get the commensal bacteria right. And this is not some naturopathic concept. I mean, it was a naturopathic concept 100 years ago. They're the ones that, you know, knew this. Nowadays, though, all this scientific research is just proving the same thing. Okay.

So there's this, the fiber part. And then there's this, the polyphenol part. So commensal bacteria feed on the polyphenols from the diet. That's your blueberries and cranberries and green tea and, okay, maybe chocolate. Okay. Maybe you can see the commensal bacteria measured on the GI test. All of them measure it. We'll look at a bunch. And then you can see the polyphenol markers on the organic acids or metabolomics. Again, here's the process for the polyphenols because this is the mystery part. You eat the polyphenols, and there's just basically a bunch of vegetables and fruit. They're trying to show you there. Here are the polyphenols. They're kind of big, molecularly large structures. They're going into your mouth, mouth into your gut. And then your gut microbiome is feeding on them. And then they're making all these polyphenol metabolites which have anti-cancer, anti-diabetic, anti-inflammatory, brain-modulating, and cardiac-modulating effects. That's what we're measuring on the test. We're measuring polyphenol metabolites. If they're extra high, it's bad because it means you have dysbiosis. But they're not dysbiosis markers, they're polyphenol markers. So if they're low, it means you're at risk of cancer, diabetes, being inflamed, having your brain mess up, and having some kind of atherosclerosis cardiac event. Okay. So these polyphenol markers are important to keep in the high normal range too. High dysbiosis. Too low, at risk for all this stuff. And we have the testing already. You guys are already ordering all these labs. It's just a matter of interpreting that section in a slightly different way. Again, same thing. High bacterial markers, if they're elevated, it usually means there's dysbiosis present. You can treat that in a variety of different ways. Poly, polyphenol markers, high, you're going to treat that. Uh, yeah. And if they're low, then you're starting to think about a lack of polyphenols in the diet.

So just a little reminder here, if in case this is new or you haven't thought about it this way, is that when we eat the fiber, there's certain bacteria that then convert that fiber into short-chain fatty acids. And then there's other bacteria that start to make hydrogen. And then there's other bacteria that start to consume the hydrogen that these guys made. And once the hydrogen producers grow and grow, the hydrogen consumers grow and grow. And if there's a balance here, then the whole thing works out and everything gets kicked into gear from dietary fiber and polyphenols. Okay. And so whichever organisms you want to try to fix, you have to start here. Whether you're looking at hydrogen consumers, hydrogen producers, the ones that do the short-chain fatty acids, you know, it all starts with the food that we're eating. Or in the short term, if you have patients that are in bad shape, you're going to supplement.

Here's a list of the high abundance commensal bacteria that convert fiber to fat. And you've heard of a lot of these. The, the famous one these days is Faecalibacterium prausnitzii, that one right in the middle there. And that one's kind of famous now because low levels of Faecalibacterium prausnitzii have been implicated with long COVID. But it's also, before COVID was sort of famous, as one of these I'm converting fiber to fat organisms, as is Bifidobacterium, Lactobacillus. Right, you've heard of most of these. In fact, you can use these in supplement form as well. Well, if you have patients that have this problem, the Bifido and the Lactobacillus. And again, here's just to reiterate. Here's our polyphenol markers. Remember? So there's another schematic that just shows it differently. Dietary polyphenols, the bacteria feed on them, and then we get benzoate, hippurate, phenol acetate, phenol propionate, all those ones that we're looking at on the lab. See, LBA have the name phenol in them. Some don't, but these are all polyphenol metabolized or breakdown products. And that's very easily and accurately measured on organic acids. Okay.

Now, let me, let me reverse these slides. Let's start with this one first. Okay. So I, we just got to take a deep breath because this is going to get intense for a second. Okay. All right. It's kind of like the very beginning of a Formula 1 race where you're like, oh my gosh, that the first 30 seconds, there's so much happening. And there's been a couple times where the two Mercedes drivers crashed into each other and they're both out of the race. You're like, oh my gosh, like we're like a minute into this thing and the whole team is up. Okay. So deep breath. Here's CoQ10. So CoQ10 is responsible for moving electrons along the electron transport chain, which is the really, the critical, or a critical step in our metabolism. So if we say, and this is, uh, a call and response thing that Richard Lord used to do with me, and I'm going to do it with you guys. So he would say, mitochondria, and I'd say, metabolism. Or metabolism. And then he would want me to say something back. And he started off, you know, 10, 12 years ago, with the three most important things for mitochondria. Three most important nutrients. What are they, Dan? And I'm like, I don't really know. Magnesium, CoQ10, and oxygen. Magnesium, CoQ10, and oxygen. He said it like 10 times. Magnesium, CoQ10, oxygen. He clearly wanted me to memorize it. And then every week when we would talk, he would say, mitochondria. And I'd say, oh, magnesium, CoQ10, and oxygen. So it was like drilled into my brain. Oxygen is easy. You don't have to buy oxygen. You just have to breathe. So you got to get people exercising and breathing deeply. Okay. Or doing breathing exercises or exercising or both. But magnesium and CoQ10 are the critical nutrients for the entire functioning of our metabolism. Okay. And you also obviously need B vitamins and amino acids and other stuff. But magnesium and CoQ10 are like the weak links. If they're, which they often are, then metabolism falls apart. Okay. And we are measuring CoQ10. Hopefully, you're measuring CoQ10 on your testing that you're doing, and you're measuring how the mitochondria are working also.

Now, this is a slide that Richard put together for us on how CoQ10 is made. So remember, CoQ10 is, if I say mitochondria, metabolism, you should think magnesium, CoQ10, oxygen. Magnesium, CoQ10, oxygen. So this is like right up there, top three most important things for metabolism. It's made from this various complex pathway here, starting with acetyl-CoA to HMG-CoA. There's a medication class of medications that are commonly used called statins, which block this enzyme right here, which in turn blocks the production of cholesterol. So statins lower cholesterol, but they also interfere with the production cycle, uh, or the pathway of CoQ10. So people who are on statins, you need to be extra careful with. Doesn't mean they have to stop their statin or statins are bad, but you need to be extra careful that their CoQ10 levels are adequate. Right. And so as you're going down, and there's all these complex pathways, and this is my favorite one right here, geranylgeranyl. Geranylgeranyl. I just think that sounds really cool. And, uh, there's actually a supplement you can get these days, but anyways, geranylgeranyl. And then all of a sudden, right before we get to CoQ10, right before that's made, this final step, you see what that is? Four-hydroxybenzo. Also known as four-hydroxybenzoic acid. That's a polyphenol metabolite. So your body can make this stuff, which is good. But your body relies upon the extra polyphenol metabolites coming from your diet to get enough to make enough CoQ10. So if you don't have the polyphenols, you can't make CoQ10. And there goes your metabolism. And the reason why I'm picking on this one little pathway, because there's lots of reasons eating healthy makes you skinny and eating bad makes you fat, right? But this pathway is something that we're measuring already. So you might as well, you know, know this. So that when you see these polyphenols screwed up, you can start to think about mitochondrial function and CoQ10. And you can get these polyphenol markers to be better with fiber and polyphenols in the supplement form, and then eventually from the diet. And then you can also obviously use CoQ10 if you need to. Okay.

And I'm just going to show you a few other slides. We got a fair amount of time still. So I'm going to just show you this one other slideshow real quick. And this is just a refresher for those of you that haven't studied this for a little while. Let's take a minute just to show you the pathways here. This is all what we're testing for. So it helps to just see behind the scenes here a little bit. Well, that's a cool slide, isn't it? But that, that's not really what we're talking about. I got to stay focused here. Yeah, this is it. Okay. This is probably the best one. So here's your mitochondria. Mitochondria. See that outer membrane, inner membrane? And if you remember from school, there's complex one, two, three, and four. And then there's this stuff called ATP synthase. So this is how we make energy, how we make ATP. Your body has to take these electrons and move them along from complex one to two to three. And there's a carrier that does that. That's called CoQ10. And there's no other carrier that can do that. So CoQ10 grabs an electron and brings it over to here. It goes back and grabs another electron and brings it back. And it does that in, I tried to calculate how many times in an hour and I couldn't really figure out the math. But in a minute, the last study I looked at, in a minute, in one minute, in one brain cell, 4.3 billion times. In a second, one second has happened four billion times. So I don't know how long in a, how many times in a minute, in an hour. It's a lot. Okay. So there's a lot of electrons moving here. And the only thing that can move them along is CoQ10. So if you're low on CoQ10, this, this whole concept just falls apart. And there's no backup system. So you're just not going to make adequate ATP. And then what's going to happen if you don't have your mitochondria working? You're going to have cardiovascular problems, you're going to have brain problems, you have liver problems. You know, all these things are going to happen because your mitochondria are not functioning properly. All right.

So then, let's see here. Oh, just is a reminder, if you came late, our cardiometabolic Health boot camp is starting, uh, soon, like next week. It's two months. It's a lot of material to get through, but it's really rewarding. If you like today's talk, this is totally relevant. Okay. So you can scan that QR code and get signed up if you want. All right. And let's see here. Now. So now I've pulled up a bunch of labs. So now let's do some lab analysis and program design. Well, this is easy. We're right at the right place. Let's just start with this one. So this is, uh, Nutrval from Genova. And on this test, here's our polyphenol markers. See, I didn't say dysbiosis markers because that's all judgment-oriented. They're not good, they're not bad. They could be good, they could be bad. In this case, they're bad. Has a lot of dysbiosis with this patient. But if they were low or undetected, the green is all not good. If they were excessively low, it would be bad. It would mean there's not enough polyphenols present. And you need some of these polyphenols, as we just saw, some of these metabolites from these to make CoQ10, to make your metabolism work. Look, look at a couple of these. Here's another Nutrval. This one's not doing so well. Look at that. And we'll do one complete program, but I want to show you a variety of tests first, so you get a little feel for it. Oh, well, look, I randomly picked this. I swear this was like from class yesterday. I swear I did not pick this one on purpose, but look, this is a perfect example of what we're talking about. That was really lucky. Okay. Let's see. Wait, wait, wait, wait. Where did I go here? We'll come back to this because we're going to come back to the mitochondria thing in a second. Okay. But here's our dysbiosis markers. Okay. And there's, you know, one or two that are high. But look at these. These are low. That one's not even detected. That's not good. It's not good. Not all green is good. Okay. If they're too low, it's a problem. Too low is a problem. And then, in fact, you could look because this test measures it, uh, this person has adequate CoQ10. So it's not showing up there. But now we're looking at the mitochondria itself, and the citric acid cycle is all screwed up. Okay. So this patient needs CoQ10 to improve their mitochondrial function. And you'd want to work on their diet, fiber, and polyphenol supplements first, then dietary changes to follow up. And that's an adrenal test. So we don't really need that, do we? Okay.

So let's take a look at at a couple of GI tests next. And you'll just jump out at you and you'll be kind of hopefully excited about this a little bit. Uh, here we go. So now we have a second phase here. We talked a lot about these polyphenol markers that should be kind of drilled into your brain by now. But now we want to look at the commensal bacteria and the short-chain fatty acids. So this is a GI Effects test from Genova. And you can see quite clearly here, they measure this. This is not like really too difficult. Short-chain fatty acids. If these are low, then you have a problem with the good bacteria. The most important of these is butyrate. I guess they're all important. That was a little judgy of me, wasn't it? But anyways, butyrate, I think is the most important. I'm just going to say it. And you can get butyrate in a supplement form. So if you see low short-chain fatty acids of any type, you can use butyrate. They don't make acetate like in a, in a supplement form. So that's one way to know. And then you can also look at the commensal bacteria on PCR, which is right here. And you can see as there's a pattern where they're low. And let's just look at them and see. Well, these, these are commensal bacteria. These are good bacteria. These two are low. DL means under detected limit. So these are all low. I'm circling the low ones here. Um, DL, DL, DL. Yeah, like a lot of them. One, two, three, four, five, six, seven, eight, nine. At least nine, 10 of these are low. So what does that mean? There's not enough commensal bacteria. You need to give polyphenols and fiber in supplement form. Then get that into the diet. That's going to then improve short-chain fatty acid production, butyrate production, the brain, the heart, their metabolism. That's going to get their CoQ10 production to be better because you rely upon these polyphenol metabolites for CoQ10 production and so on. Okay.

Now, some of you also order this other test that's super common and popular, which I'll show you an example of that, which is called the GI-MAP. And grab one of those. Oh, no, sorry, that's the wrong thing. Sorry. Oh, no, that's right. I was right. Okay. Ready? Here's a GI-MAP. And they have a big fat section here on commensal bacteria, strangely called commensal Keystone bacteria. Okay. So now if you look at this section, you're thinking, hmm, is there a metabolic problem here with the microbiome? Well, yeah, that's low. That's low. That's low. And these two are low. And there's our Faecalibacterium prausnitzii, our friend. That's the one that's one of the abundant, quote unquote, ones that converts, uh, fiber into fat, which then helps regulate your metabolism and all those other good things. Also, Bacteroidetes and Firmicutes. That's a whole another long story. But there's lots of research on the Bacteroidetes and Firmicutes and how they relate to obesity and weight loss. And they do strange things with mice, like they take a mouse that has no microbiome, and then they put like a fat mouse microbiome in that mouse, and then they put a skinny mouse microbiome and a different sterile mouse, and then they can basically make mice fat or skinny based on what microbiome they put in them, which is kind of disgusting, but anyways, it's interesting. So this matters a lot. If you want to study this, Bacteroidetes and Firmicutes, there's lots of studies on that. Okay. So what do we want to do? We want to get these commensal bacteria to come up, just like with the polyphenol markers being low, we want them to come up with fiber and polyphenols. And then we want to fix the metabolism.

So let's look at that. And then I'll design one program. But let's just find a complete program here. Okay. This one's pretty good. Let's just use this one. Okay. So this oxidative stress, high mitochondrial dysfunction, somewhat methylation, not so great. And we're focusing on the mitochondria, right? And then we'll do a combined mitochondrial gut program. So here we have problems with the, uh, citric acid cycle itself. Lipid peroxides are high. And then if we, we zoom in here and we want to look at the parts that are, you know, directly connected to metabolism, it's all in this one section right here. So fat metabolism looks good. Carb metabolism does not look good. Alpha-hydroxybutyric acid is high. That means they're having, they're having blood sugar problems, as do these two markers. And then under energy metabolism, there's two that are quite high and one that says borderline high. So a fair number of problems with the mitochondria making energy that we want to correct for. And we're going to, uh, assume this person has this test that we just looked at here, where the commensals are low. So then this is putting together a complete program. Uh, here. And I'm telling you why I'm finding this thing. If you join the mentorship program, you're going to do this like four or five hours a week for a year. And by the end of that, you get really good. And if that's like overwhelming to consider, then just sign up for one of our boot camps. And at least we'll get a hold of you for a few months and start to get all these concepts of lab interpretation drilled into you, you know. Um, here we go. How about this one here? Yeah, that'll work.

All right. So now, and I'll just sketch out what we've got here. We've got low commensal bacteria. And we saw that both on a GI Effects and a GI-MAP, you can, it's common. And I just pulled up random ones again. This is like a common thing you see all the time. So that's, uh, from the stool test. So we want to then use the foods for them, fiber and polyphenols, and butyrate and probiotics if you feel like it. Okay. So let's look at that. Some of these are common products and some of them are a little uncommon. Not everybody has butyrate. That's kind of hard to find. The good forms of butyrate are hard to find. But let me show you the one that I was involved in, Poly Prebiotic Powder. Uh, so from Pure Encapsulations. Try to say that 10 times fast. Poly Prebiotic Powder from Pure Encapsulations. Oh, that's pretty good. I didn't used to be able to do that. I took a lot of practice. Oh my gosh. Get out of there. And if you don't use this product, that's fine. I'm not going to be upset. I won't even know. But you get something similar. And you can see the ingredients here. Fiber. Okay. See all that? And then the polyphenols, cranberry, blueberry, and pomegranate. Scoop twice a day. Prebiotic extraordinaire. You're hitting the polyphenol markers and the short-chain fatty acid and stuff, all that the same time because you got the fiber cranking out the short-chain fatty acids and the polyphenols to help with the CoQ10 production and all that anti-cancer, anti-heart disease, anti-brain degeneration stuff that polyphenols do. Okay. So that is a prebiotic with both everything in it, basically, that you need. One product. If not using that, if you don't use that one, then you a separate, uh, typically a fiber product and a separate, uh, polyphenol product. And then butyrate. So butyrate is sort of cheating in a way because in the short term, you're just giving them the butyrate. They don't have to have their microbiome like turn around and be better. This is dosed typically at one teaspoon three times a day. Okay. And that's like basically giving them a fake microbiome for a little while while they get their act together and they start to eat better. So those are the two kind of hero products I think are super important. So I'll put that here. And let's just say what's in there. That's fiber and polyphenols in case you want to use something else. And that would be one scoop, two times a day, away from meals. And then the butyrate. That's just again, replacing what's missing from their microbiome being screwed up. Butyrate is quite an amazing product. Um, and then you could use a probiotic. But let's say we don't. Okay. Because we got other stuff that we have to deal with. Then we also saw that there were problems with the mitochondria, right? The citric acid cycle was messed up. They had, uh, problems with carb metabolism. And so we want to get energy production working, carb metabolism working, getting them so they can be in a place where they burn fat. And then for that, you can use Metabolic-X. And that is a general all-purpose. Let me show you here. And again, if you guys.