How to Correct Detoxification Pathways: Organic Acids Part 5, Phase 1 and 2

Good evening and welcome to our talk on detoxification. I'm not going to run the camera today because I'm having a bandwidth issue with my office email, my office internet access, so I don't want to choke up the bandwidth with the camera. But anyways, hopefully this will communicate well and you guys can hear me clearly. If someone could just raise their hand to make sure the sound is working, I do have a new computer setup and we're working out the glitches a little bit with it. All right, thank you, and it sounds like we're running, so let's go.

Uh, this is a huge topic. There's a bunch of slides I put together. Some of them I'm going to zip through kind of quickly. You, help, help, happy to have you listen to this later if you want to kind of refresh. But, um, I want to throw a bunch of information in here just for clarification of all the different things that we're talking about. Organic acids, part five. There I am on the streets of Oakland, California, pretty happy here in Northern California. We have a great life, very fortunate to have all the things that we do, and, um, also to happen to have the best basketball team in the entire world. Pretty excited about that as well.

Anyways, outside of basketball, yes, we did complete a study. Yes, it was with a couple of practitioners at the Mayo Clinic. Um, yes, I'm working on a second research study now, which I'll tell you about as soon as we get things moving along a little bit better. And, um, really excited to be in this functional medicine field at a time right now when so many things were happening. I see functional medicine very much as our platform of physical health that we're rebuilding, but the platform is there for a purpose, not just to sit around. The platform is for the emotional and spiritual growth of our patients.

I had a patient today. It was a woman that came to see me from Iran. Pretty long trip. She came out from Iran and, uh, is visiting some relatives here in the US and decided that I was going to be her doctor. And she said, this a true story, it's just happened like an hour ago. Um, she said that, "Dr. Kish, I had a dream about you." I'm thinking, okay, this could go good or bad. I'm not sure it's going to go. She said, "I had a dream where I was rising up and becoming healthy, and there was someone who was pulling me up to be healthy, and that person was you." Because I said, "How did you find out about me? Why'd you come from Iran to see me?" She's like, "I had this dream about you." And, um, anyways, wow, what a great image. You know, that here we are as healthcare practitioners, and our job is to like help people rise up to this level of health that they can attain. And I think that, um, you know, we're we're kind of spiritual guides for our patients. We want to act in that, you know, role of being a healer in the true sort of divine sense of the term, and not just about lab testing and just about all the supplements that we use. And of course, my whole practice is lab-based, but this woman got it. I mean, from Iran, she kind of got that, you know, what's behind the the lab testing and the science is an emotional and spiritual perspective, and that's what we're really looking towards as practitioners, I think, for ourselves and and and for, um, all the people around us.

So on a more practical, nuts and bolts, grounded level, you know, there was, um, a survey that was conducted by Emerson Ecologics, and they were very generous in sharing the information with us about what a doctor is worried about all the time. And, um, I thought this was really fascinating because this is what we sit around and worry. I worry about this too: finding new patients, patient compliance, and retention. Those are the first two, uh, first and second most important worries that we all have. Um, and they're directly related. You know, and this is one thing I just want to point out, um, from a business perspective, is that finding new patients is a problem if you don't have good patient compliance and retention.

So I'll show you a short story about my practice. About two, three years ago, I hired a business consultant. She came in, she fired my whole staff, we moved the office to a different city, we rehired a new group of people, and we set up all these wonderful business systems and really modified and upgraded my clinic in a dramatic way. And one of the things that happened was I immediately had a two, three-month waiting list, and that has continued to the present day. And, you know, I'm looking at all the numbers like a year later, I'm thinking, why am I, why is my waiting list so long now? Used to have like a week-long waiting list, now it's like three months. Well, guess what? The people that are coming in are staying longer. Okay, we're doing better at patient retention and better at patient compliance. So my new patients, as they come in, are lasting a lot longer than they used to. Used to be people would just drift away really quickly, and now they're staying around longer. So it gives me, as the doctor, the appearance of feeling like I'm busier. We're not any busier in terms of more new patients coming in the door. We're just holding on to our existing customers for a longer period of time. So if you're in a mode where you feel like you need to be finding more new patients, it's very likely that you have a patient compliance and retention problem, and you should look at, um, at those issues in your practice.

And this is something that I found kind of interesting because this is the stuff that stresses all of us out day to day, right? And this is the kind of thing that we don't want to worry about: clinical, uh, challenges. They found with this, um, managing complex patients, which is what we're talking about tonight. And then something that we've solved really quite elegantly here at the Kish Institute, which is finding a community of interactive peers. Finding a community of interactive peers, okay? And so I just want to show you a couple things. This is a community of interactive peers. This is the Kish Institute. This is what you get when you sign up for the class. You can access to all these really cool people. It's not just about me being a teacher, it's about this whole community of practitioners that are posting questions, interacting with each other, responding with one another, and, you know, leading the charge in terms of work. And then in terms of patient retention and all that kind of stuff, we have a practice management module now. All right. And in this, uh, I think it's in the sales section, in the sales section of our practice management module, we talk about patient funnels, lead funnels, and we have a whole section on the patient life cycle, how you can retain patients, keep them around for longer, okay? That's a whole module section that we have now.

So the interesting thing to me about it's all these videos and all this stuff you watch and you learn how to do all this stuff, okay? So the interesting thing to me about the survey that Emerson conducted was that these are kind of, I, I, I've seen these challenges in practices for real, and we've developed solutions for them at the Kish Institute, right? This is one of the things that I want to convey. We can help you figure out this whole patient compliance and retention thing, and we can help you figure out how to be in a community of peers, and not just a bunch of people sitting around at a seminar spacing out on their iPhones, but a people group of people who are actively building functional management practices. It's kind of where we're at now, okay?

So on to the subject matter at hand. We're going to talk about organic acids testing. Once again, covered all these materials before. Uh, just quick review. We talked about the metabolic imbalances, environmental stressors. You know, two big categories. We're kind of into the environmental stressors now, obviously. And you can divide up these organic acids markers into different sections. So I like to color code this whole test. Red is neuroendocrine, orange is GI, green is detox. So as we look at the test, we're thinking about it from a body system perspective. There is micronutrients you can use to balance each finding on the lab, but more importantly, there's a bigger picture that we're trying to convey throughout this series of what's really going on, what's the dysfunction in the physiology that is happening based on on what the test is showing you, okay? And that's what I want to kind of focus on tonight with the detox issues. So we'll talk a little bit about the four horsemen, and we're going to get into organic acids markers, in the specific markers towards the end of the talk. I'll show you what those are and how they work for detox. But I want to also think about this in a body systems approach. And I constantly get students in the class saying, "Well, uh, you know, I found this, uh, methylation marker on the lab. How does that fit into the program?" Or, "I found this phase one, phase two detox marker. How do I integrate that into the existing program?" And I'll tell you, when you're sitting down at a seminar learning this stuff, that's one thing. But when you're sitting in front of a patient, and a new patient who you're trying to impress, and you're trying to figure out what you're going to actually get them to buy from you, and you want to be sure that that's going to work, it's a whole different another level of actual implementation, right? And so as you look at this test, try to focus on it in sections. What's neuroendocrine? What's GI? What's detox? And in general, the treatments work one, two, three. Neuroendocrine lead off, GI focus second, and then detox, once the GI systems are working well. And there's a really clear reason for that order. Um, it ensures patient compliance, it prevents doctor and patient overwhelm, and it also helps make everything kind of smooth out, so you're not creating a brand new program for every new patient.

When we think about toxins and what do toxins cause? Well, they cause inflammation, absolutely. They cause catabolic physiology, of course. They disrupt hormone systems. Many of these are endocrine disruptors, right? They throw off all kinds of things and throw us into a catabolic state. They generally, as a result of a whole bunch of different variables, can trigger insulin resistance. And of course, one of the main things you probably associate with toxins is that they generate oxidative stress, which in turn damages the mitochondria, which in turn causes insulin resistance, which in turn causes more inflammation, right? It's a sort of cyclical thing. But what I find is that pretty much every patient that we're working with is inflamed, catabolic, has an insulin problem to some degree or another, and has some oxidative stress. So these four horsemen are issues that we're dealing with day in and day out, and are often things that we can treat, right? You can treat each one of these separately, um, as part of the program. That's the whole point.

Okay, now again, when we're looking at the test, we break it down in a color-coded way, and we're going to talk today about the detox portions of the lab. And so that would include the detoxification markers, the oxidative stress markers, and the methylation markers. Now, you could argue that methylation should go over here with the brain, or I mean, there's lots of, but I just did this for convenience sake, and this is how I look at patients. And, you know, in all fairness to, um, my ideas on this, when I was talking to Dr. Ben Lynch a couple months ago, who's like one of the world's foremost guys on methylation, right? Like Ben Lynch is so smart, it's even hard to have a conversation with him because he's thinking so hard, and you're, you know, it's like, oh my gosh, how do you even keep up with this guy? It's like going for a jog with an Olympic sprinter or something, you know? He's really, really smart. But one of the things he said about methylation is, "Dan, you know, a lot of people try to treat methylation too early in the process, and it makes patients really sick." And he, it's going on this whole rampage about how methylation is often not the first thing that you want to do, even if the person has a methylation defect. And that really just gave me another shot of confidence in the protocols of doing neuroendocrine, and then GI, and then dealing with detox and methylation issues once you've got that person in a pretty robust and healthy place. Not always the thing that you want to start off with. Detox, not always the thing you want to start off with. Methylation. Now, we're not saying you never do that. We just saying that you have to be careful because if you get someone methylating too early in the healing process, you can make them worse.

So we're going to focus on phase one, phase two detox. How organic acids testing can throw you into this. I do believe very firmly, uh, from my, I don't know, 23, 4 years in practice, that toxin exposure is rapidly becoming the plague of our times. Okay? And I'm sure during the time of the plague in Europe, they probably had something that they talked about that was a plague of their times before the plague. But I mean, we're in the middle of this particular toxin exposure experiment with the human race. I don't know. I mean, at least when the plague was happening, they knew everyone was getting sick and why. You know, there's some weird disease going around right now. I mean, three-quarters of our population and 90% of our doctors are in denial about why everyone's getting sick, even. And so this is like a plague that no one can see or something. Toxin exposure is a really big deal. It's probably, I would say, for the coming up generation of doctors, going to become the pressing problem. For my generation of doctor, my teacher's generation, it was a really big deal, but it now is becoming, you know, widespread to a point beyond what anyone could have imagined. When, when Dr. Timmons was training me, they had special detox clinics they ran in Mexico. They had one in West Virginia. They had all kinds of things for detoxification, but it was extra special patients that had to find these extra special clinics. Now we see this issue just rampant across the board in kids and adults, and it's an issue that we're all going to have to learn how to deal with.

8,000 new chemicals being released into the environment since World War II. We have babies that are born now, pretty much 100% of the babies born in the United States have 50 to 70 toxins the day they're born. We have women who are breastfeeding that are dumping toxins into their kids. I mean, it's just like a nightmare all around. There's no doubt that this is a big problem, okay? And that there's many different categories. There's everything from heavy metals to pesticides, from industrial chemicals to herbicides and solvents, right? We breathe these things in, we eat these chemicals, we drink the water that has these chemicals, right? They're pretty unavoidable and inescapable, no matter how careful you are.

The big picture concept they always talk about is body burden, which is the accumulation of toxic chemicals in the body. You know, what's the total amount that we're accumulating? Um, where's it all coming from? Doesn't really matter. It's all going to end up in your tissues. And eventually, the average American estimate now is somewhere between 4 and 700 toxins in each one of our patients' bodies. And for our patient population, it's probably on the higher side. Right now, the problem is that, or one of the big problems is that many of these toxins are lipophilic, or fat-loving, okay? And they're made to be lipophilic. That's one of the ways that they work better when they're, you know, being used in an industrial context or as a chemical agent. But unfortunately for human beings, lipophilic toxins love the fatty tissues and they seek the fatty tissues in the body to attach themselves to. And unfortunately, again, there's a really large collection of fat tis, fatty tissue in the body called the brain, okay? And the bad news is that a lot of these toxins end up directly in the brain, in the brain, not close to the brain, but in the brain where your brain cells are. And it's not a pretty picture.

I think about it as if you walked into like a Crate & Barrel store. For those of you that are international, I don't know, Crate & Barrel is just like this American chain store that sells dishes and glasses and stuff. Whenever I walk into a Crate & Barrel, I'm always a little nervous because there's always this big wall of glasses, and you feel like, well, what if I tripped? I would break all these glasses. But imagine you're in a Crate & Barrel store or store selling dishes and glasses, and you took like a bowling ball and 15 tennis balls and you started to throw them all around the store, right? You just completely crash and destroy all the dishes and glasses and be a big mess. That's kind of what happens when neurotoxins get into the brain. They don't delicately move around and caress your brain cells. They destroy them, kill them, right? Toxins kill, destroy, maim, eliminate brain cells. It's a really big problem, and we see this manifesting in a variety of ways in our patients, okay?

So what's the the situation? Here's the scenario: Chemicals enter the tox, chemical or heavy metal enters the body. It's lipophilic, fat-loving. It gets into your brain. It starts to actually physically confront the neuron. It's just like a human being attacking a human being in a war. Whether they shoot them or stab them or blow them up, doesn't really matter. The neurons are actually being destroyed, okay? In response to the destruction of neurons, we have these reuptake ports that start to close, and they force a change in the neurochemicals to be outside the cells more so, okay? It's a strategy to try to survive what's happening. When there's a lot of neurons being destroyed, enzymes eventually start to break down the neurotransmitters. So we end up with low levels of synaptic neurotransmitters, as well as a bunch of toxin-damaged neurons that are dead and not working properly, okay? And that's what I call a broken brain.

And what does that mean? That means depression, anxiety, compulsive overeating. Uh, if it's a kid, it could mean autism or ADD. If it's an adult, it could be, uh, increased risk of Parkinson's or dementia. If it's someone in their middle adult years, it could be, um, panic attacks and anxiety and uncontrollable appetite. So a broken brain can manifest in a lot of ways. Now, that I very carefully screen every single patient for this problem. I find it, you know, more than half the time, probably three-quarters of the time, someone's got some kind of level of toxin-induced brain damage. Now, it's not always so severe that it's an autistic child, you know, but it could be something as mild as, uh, social anxiety. I had a patient today, social anxiety. I mean, that could be directly a result of the brain labs that we ran here, okay?

So because this is a, an amorphous issue in a lot of ways, and it's hard for us to see these toxins and perceive that there really is 4 to 700 of these chemicals in every human being's body in the United States at any one given time, you know, it's, it's abstract in a lot of ways. So when I talk to patients about it, I try to think about things that are, um, understandable. Like, we all know that there's been an increase in heart disease, right? And there's the chart on it, just, you know. And we all know that that increase in heart disease was a direct relationship to diet patterns, exercise patterns, and stress. We all know that there's been an increase in diabetes. The same exact thing. And we know that diabetes has been increased not because all of a sudden the pancreas has started to not know what to do, but because people are getting more and more overweight and more sedentary. It's a, it's a disease of modern lifestyle, as is heart disease, right? You can see the graphs on all these diseases. And we, the same thing with autism. We know that autism is on the rise, and we know that it has to do with an increased exposure, uh, increased, you know, damage to the of the brain due to some kind of exposure to, uh, various kinds of toxins and dietary issues. We know depression is on the rise. All these different things.

So the thing is that with the toxin-related problem, it manifests in so many different ways that it's tricky for us to identify because you could have, like I said, a middle-aged adult who's depressed because of environmental toxin exposure. You could have a child that's developing autistic tendencies because of this kind of a problem with toxins. You can have an older adult who's developing Parkinson's disease because of exposure to toxins. And we don't really have a way of looking at all this in a holistic manner. We don't have a way of grouping together all the brain issues that are results that are a direct result of of neurotoxin exposure, let alone all the hormone issues, the thyroid problems, the testosterone problems, the estrogen problems that we see every day, day in and day out in our clinics that are a direct result of endocrine disruption, right? Of the sort of endocrine side of the toxin exposure.

So we talked a little bit about the brain and how it's impacted by neurotoxins, but many of these toxins also act as endocrine disruptors and they cause inflammatory problems. They may literally block a hormone. If it's a xenoestrogen, it could block the effects of estrogen or exaggerate the effects of estrogen. You can have effects on testosterone or thyroid that are purely toxin-related. They're really well-documented. So toxins can cause either brain problems or hormone imbalances. And we see these brain problems and hormone imbalances literally every day in our practices. We're seeing the manifestation of the toxin problem, but because it's so convoluted and spread across age groups and different kinds of conditions, you may not just instantly tie it together as we can easily tie together diabetes or heart disease and see what the trends are. Okay? If we could like graph together the trends of autism, Parkinson's, uh, toxin-related depression and anxiety conditions, it would just be this massive graph of badness that would show an increase in all these problems that are directly related to our chemical exposure, okay? So that's kind of the the groundwork. Lays the groundwork for what we're trying to discuss, and obviously, this is something that's getting worse, not better, as time goes on, okay?

So if there's a toxin-related problem that's going to weaken the immune response. You know, old school naturopath theory held that exposure to heavy metals like mercury would lead to and fungal overgrowth in the digestive tract and digestive problems. I think that's very much true. Why? He said that detox-related issues or toxin-related problems can directly impact the thyroid and its conversion of T4 to T3. Can also impact the adrenal glands, etc. Okay? So we have all this as the background. Kids with the problem, adults with the problem from ADD all the way through dementia and Parkinson's, and older people with brain-related issues. From young women, 15 to 20-year-olds who are no longer having a period or don't have a normal menstrual cycle because of endocrine disruption, all the way up through women who can't get pregnant because of toxin exposure, to women who are having hot flashes and night sweats, or men who have very low testosterone and low sex drive. All of this because of toxin exposure, right? So that's, we basically see it all around us all the time. But because it expresses in so many different ways, it's hard to tie that together. And in fact, it took me 8, 10, 12 years to kind of put together of this pure in my mind and realize, oh, I'm seeing toxin-related exposure problems every day in my clinic. I just kind of never thought about it in an integrated way in that way, okay?

Now, the nice thing is that the solution is basically the same for everybody. As varied as the problems can be, we're going to run the same kinds of labs and do the same kinds of corrections, whether it's a 15 or 18-year-old kid that can't study and sit still in class, or if it's, you know, for a 37-year-old man who's depressed and has low testosterone because of all this, okay? So we're going to talk about a bunch of the solution issues. We're going to look at some labs and some of the individual findings. I'm going to kind of fly through this, see if we can get you guys interested in all this work.

So the importance of methylation. And remember, we're talking about on the organic acid test, we can track methylation, we can track the detox markers, and we can track oxidative stress. Let me, let me, let me just split back for a second. So show you, I'm talking about the test here. Sorry, I'm going to flip around a little bit, but I just want to show you the actual lab, the sections of the lab that we're going to talk about. Remember, detox, there's a bunch of detox markers, there's six of them. Oxidative stress, there's two markers for oxidative stress. And then there's two markers that tell you about methylation. So six markers for oxid, six markers for detox pathways, two markers for oxidative stress, two markers for methylation. All together, in my mind, that comprises the detox system. I'd say one other thing, which is that it's really important that we have ATP or cellular energy for the detoxification to run the detox pathways. So maybe kind of lump that in there too. But part of organizing these labs and presenting them to patients is trying to simplify, because otherwise, if you show the patient really what's going on, just their head will pop off, you know, it's too much information.

So on the methylation side, could be anything from anxiety to fatigue to obesity to insomnia to fertility, and we can track all this on the lab. I'll show you the two different markers in a moment. Oxidative stress, again, we can track this on the labs. I'll show you the two different markers. Oxidative stress will be triggered by toxin exposure. Methylation problems mean that you're not able to detoxify properly. You don't have that methylation step in place to make all that work. Oxidative stress means that the toxins are triggering oxidative damage in the tissues. And when oxidative stress is happening because of environmental toxins, what's actually getting damaged are the mitochondria themselves. Left-hand side, you see a healthy mitochondria. Right-hand side, you see a mitochondria that's been ravaged by toxins. Why? Toxins cause oxidative stress. They get in there, they start to penetrate, and they hit the mitochondria. What do they cause? Free radical damage, and that shrinks our ATP supply or ATP production. It's like your engine that's propelling the vehicle forward is being damaged, okay? Because this is the engine of the cell, right? This is how we make our energy. And if the energy production portion of the cell is being hit by a lot of oxidative stress because of toxin exposure, then our energy production levels drop. And ironically, that then makes it harder to detoxify. So, in other words, oxidative stress generated from environmental toxins slows down your ability to detoxify because it decreases your ATP supply. Bummer. It's a cyclical and very negative problem, and a lot of our patients are sort of trapped in this.

Again, as I mentioned earlier, one of the sort of most worrisome areas of the body that a toxin could damage would be if a neurotoxin got into the brain and started to hit neurons and destroy them, okay? That's a big problem because that's going to lead to all kinds of depression, anxiety, etc., etc. Now, we also see in the test, and this is back in the neurotransmitter section, but something that's worth pointing out here, kind of take you back there for a moment, that you'll see inflammatory markers, kynurenine, quinolinate, that are directly related to neurotransmitter issues, and that you can have many different things that are driving that inflammation, including toxins, okay? So sometimes a person's inflamed because of toxin exposure, and again, you see on the dopamine side of all this, picolinate or quinolinate can elevate in response to inflammatory damage, and that starts to deplete brain chemicals. So you can have damage to the neurons themselves, so that the brain is losing neurons, they're being damaged or destroyed, killed, maimed by the neurotoxins, and then you can also have depletion of the brain chemicals because of toxin exposure. Also, it's a bad combination. Depleted neurotransmitters, damaged brain cells equals a really bad combination. Just like if a wire was not working properly, it was all frayed and messed up, that's what ends up happening to the neurons in an environment where there's not a lot of neurochemicals, okay? That's the double whammy.

I want to skip over that slide. It's kind of complicated. That's more about drug use. Endocrine disruption can happen also. Just want to point out adrenal glands, thyroid can be affected. The gut can be affected by toxins, especially mercury, causing yeast overgrowth. We can be more inflamed. We can have more problems with insulin resistance. Women can have problems with their female hormones. All this can come about because of toxin exposure, okay?

So, um, we're starting a new class, July 20th, which is almost at my birthday, kind of exciting. And we have a really robust section. I'll show you real quick here on organic acids now that I developed. So the class has changed quite a bit recently, and we've got, it's much longer, meaner, better, and bigger than it used to be. And one of the things that I did to really beef things up quite a bit is add in like an extra four modules on, uh, on the subject of organic acids. And I'm running an organic acids test on literally on every new patient that I treat. I'm also retesting people now on organic acids on a regular basis, which is even more fun.

So here's what the course content looks like. We cover adrenals, GI, food, female hormones. Then we have four modules looking at organic acid, toxins, the brain, energy metabolism. So for example, in the toxin section, whole series of lectures that goes through all the different issues. We also have a practice management section now with six modules on business strategy, operations, patient communication skills development, sales, and marketing. You can do things like, and these are all available when you join the class, okay? Learning how to get scripts to speak to patients, patient intake skills, follow-up skills, all this kind of stuff is in there, okay? So again, we have two semesters of clinical content, one section with six modules on, uh, business practice building, that kind of stuff. And then we have the community, which features a couple thousand case studies, a really cool interactive group of people who are talking about stuff all the time. Let's say we type in toxins here, we have a search engine that'll pop up assignments, cases, discussions among class members, everything from patient checklists to various cases. And a really cool thing that we have now, but here you go, look, look, toxins, phase one and phase two, and what to do. That's a good little talk you could listen to. And then case studies, or, you know, doctors present case studies in class, and we record them all, transcribe them all, so you can read about all the experiences of other doctors in treating these kinds of situations. Build gives a lot of confidence to be able to do that and see that other people are doing that too, okay?

So anyways, if you're interested in the class, we'll be starting another one in a month or so. We really encourage you to sign up if you haven't yet. And it looks like you get a special offer too. If you sign up for the Kish mentorship, oh yeah, we're doing this for the rest of the year. I think you get the practice management course and all the clinical stuff together, okay? Um, we're probably going to break them out into separate classes, but anyways, it's a very good deal. Get $500 off of enrollment if you mention this webinar that you're listening to right now. And if you're just kind of curious, want to talk with one of our staff, give us a call or email, and we'll get you set up so we can talk with you.

There's also a new thing we created recently. It's called Kish Method 101. $397. And it's an introductory eight-hour lecture series. Gets into everything that we cover in the bigger class. Gives you an idea of how this all lays out. We've got lots of information in there. Includes a call with me and, um, you know, hopefully kind of gets you ready for building up your functional management practice. So we have both practice building stuff in there, as well as, uh, you know, introduction to all the clinical. That's the Kish Method 101. It's like $400. All right, back to detox.

Do you remember this? If those of you that are old enough, we used to have this poster on my wall. This is from Metagenics. I'm sorry, from Metagenics. That's a great image though. They created this millions of years ago. How old am I? But I still like to use this. Reminds me of my youth. So the idea here is that, hey, if your gut is toxic, that's going to be hitting your liver in a not-so-great way, and that's going to mean, you know, problems for your brain. And this is all the buzzword now, you know, gut-brain connection and all this sort of stuff. It's real, and we see it in our patients every single day, okay? Why do we want to detoxify? Want to protect the nervous system, but protect the hormonal system. And it's pretty complicated. I'm going to jump into some of the labs here, um, and some of the basics. But detox pathways is phase one and phase two. And let's look at that in detail. This is the stuff that really matters here.

So phase one, cytochrome P450 enzymes dominate. Phase two are what are called the conjugation pathways. We all learned this in school: sulfation, glucuronidation, amino acid conjugation, all this kind of stuff, right? So the key point here is that there's nutrients that make all this work to take that lipid-soluble, remember that fat-loving toxin, to break it down into an intermediary, and then eventually to excrete it as a water-soluble waste product that can just get flushed out in the sweat, in the stool, or in the urine. That's what we're shooting for. Water-soluble toxins that are water-soluble to begin with are going to get flushed out by you drinking water and by stopping your exposure. Not so worried about those. We're worried about the fat-soluble ones that are stuck in all of our patients' bodies, okay? And they're stored in adipose tissue or fat. And when people start to lose weight, they're going to dump these toxins out, which can be good or can be bad, depending on how the weight loss is going, how quickly it's going. Yeah.

So the nutrients that are required, you can see here, the B vitamins, antioxidants, and the sulfur-containing compounds. So just think of it in three categories: it's plenty of B vitamins, antioxidants, and sulfur-containing compounds. And the sulfur-containing stuff are the amino acids, right? Glycine, taurine, N-acetylcysteine, cysteine, methionine, okay? B vitamins, antioxidants, and sulfur-containing compounds. And the last test screens for B vitamins, antioxidants, and sulfur-containing compounds. So this is not like, I'm wondering what's wrong with my patient. This is a, "Oh, I see this is going on on your lab test. Let's get this fixed." I must have looked at six or seven of these organic acids profiles just today when I was in clinic, and it's a joy to be able to say, I had this one young woman, how old is she? I don't know, she's like 25. It seemed like a kid, you know, was 25 years old, and her organic acids profile was perfect. And the mom is sitting there, and this girl is sitting there. When she's 25, but she's the mom still drags her into the clinic, you know? And I'm looking at her, saying, "They have the most beautiful organic acids profile I've seen in months." And she's super happy. The mom is kind of proud of her daughter. Her diet is great. Let's get her out of here. She doesn't even need to come back for another year kind of visit, okay? Now, this young woman was not doing very well when she first came in, obviously, but we built her up to this point, and it's really wonderful to see on a retest someone who's come that far, okay? And I use this test again on every single patient. You'll see all kinds of things. I also had a patient today who had major phase two liver problems, and five of her six pathways for phase, uh, uh, for the detox pathways we're about to look at were shut down. Five out of six. I had a couple patients today who had mitochondrial problems that are going to screw all this up. And I had one patient today who had oxidative stress related issues. Guess what? Programs are totally different for each one of those situations. So it really makes a difference to have the labs. And if you do this wrong, it can make people sick. We'll just talk about that because this is the classic mistake. I've made this mistake hundreds of times. You've probably made this mistake whether you know it or not. Everyone's always made this mistake. And the classic mistake is we upregulate phase one, and we don't realize that phase two is just not working that well. So what happens? That's not a good thing because you get these intermediary metabolites building up. Why? Because you're cranking away on phase one, but phase two isn't taking that last step. So the intermediaries build up, they build up, they cause secondary tissue damage, more free radicals, and the person gets worse. In a good old days when I was first learning how to do this, we used to call this like a detox crisis. And in fact, one of my teachers would be like, "Yeah, this is good. You're having a detox crisis." He was like, later on, we learned, no, that's not good. This is a detox crisis, but it could be avoided. We're upregulating phase one and phase two is cut. So we're making the person worse. So key is that these intermediaries between phase one and two can be more damaging than the original toxin. All right? So just be careful. Labs help to prevent you from making those kind of mistakes. I've made that mistake more times than you could count, believe me. I had years of making that mistake. Not pointing fingers at anyone, but I just want to point this out so you guys don't have to go through that.

So oxidative stress as measured by the test. What does this all mean? We have these great markers. We're going to look at in a minute to talk about this, okay? Free radicals are causing damage to the normal cells of the body. That can lead to anything from cancer to heart disease, DNA damage, right? Which is kind of code word for cancer-related problems. You can have inflammation and free radical activity together. So there's tons of free radicals, there's tons of oxidative stress, there's tons of inflammation. Maybe the person is tired all the time because of that, or they have joint pain all the time because of that, right? So oxidative stress can manifest in everything from joint pain to chronic fatigue. You can have liver damage as a result of tons of oxidative stress. Now, the oxidative stress markers, they don't tell you where the oxidation is coming from. It just tells you that it's going on. And I guess we're supposed to independently figure out where it's coming from. But what we're worried about to a large extent is oxidative stress that's hitting the mitochondria. I mentioned that already because that shuts down our energy production, and that makes us unable to detox because we need energy to detox. So you really want to protect the mitochondria. And all this. Now, organic acid testing is a way to measure each one of these things.

So let's just look at how, how the measurement stuff goes. Remember, we're looking for three biggies here within the liver: B vitamins, antioxidants, and the sulfur-containing compounds. And then separately for methylation, we're looking at B12 and folate. So there may be five major players in all this. Doesn't have to be more than that. That's plenty. You realize there's five major variables, and anyone could have anywhere from one to five of those. There's many different combinations. I don't know how many, but someone could probably figure that out with a calculator.

So now when you're looking at the detox markers on the lab, we're thinking about things like arginine or glycine or magnesium, methionine, or antioxidants. This is how the lab reports them as specific individual micronutrient deficiencies, okay? And that's a really great way to track this. However, we also want to see it on a systems level. So we're going to look at the little micro version, and then we can look at the bigger picture version. So with the actual organic acids test, you might see orotate is high, and then lab guides will tell you on the report, "Oh, that shows arginine and magnesium deficiency." Or you might see that sulfate is high, and that shows that the person needs antioxidant support, and you should identify where that, uh, toxin is coming from, and they need some sulfur-containing compounds. Or alpha-hydroxybutyrate is high. Alpha-hydroxybutyrate is high, okay? They need N-acetylcysteine, glutathione, and other sulfur-containing amino acids. Okay? So the lab gives you little hints about this as you do the rep, as you look at the reports. And here's some examples of individual markers, and then we'll, uh, in a moment, get to, you know, kind of tying this all together in a bigger picture kind of way. But just to break down the individual markers, there's, uh, two-methylhippurate, which indicates problems with xylene exposure. Turns out if you study xylene for a while, it's everywhere. It's like car fumes, paint, new carpets, new cars. Anyone who's in a car basically is exposed to this stuff. Orotate is another marker that's a, a sensitive marker of your liver's capacity to convert ammonia into the non-toxic urea that you can then dump out. So again, detox pathway related. Orotate, glucarate, similar overall liver detox function, indicates your liver working to remove toxins. Alpha-hydroxybutyrate, again, this one's related to glutathione synthesis, okay? Again, detox. Pyroglutamate, I see this one elevated all the time. It's going to show the person's burning up or using up, depleting their glutathione. So you're going to want to support them nutritionally. Sulfate, my favorite marker. It's, uh, I don't know why it's my favorite. I just like it the most. Uh, it's an indication that total body glutathione can be low, and they need sulfur compounds, okay?

So now when we look at the actual lab, let me show you that section here real quick. Here we go. So here's the detox section here, okay? And here's all the markers. Two-methylhippurate, we just talked about. Orotate, glucarate, alpha-hydroxybutyrate, pyroglutamate, sulfate. And you don't have to memorize them or know that much about them, to be honest. They're all kind of tracked right here under the detox section. You just have to know that if there's a red H next to it, it's a bad thing, and that you're going to want to work on that specific pathway and get it working better. Now, what I would caution against is over-analysis and looking at, for example, a specific arginine deficiency as being the only thing that you're going to work on. If you see an arginine marker positive, it means you need to work on the entire detox system. It's very rare that you'll be successful with a single micronutrient in a system that's as complex as this, right? And let me show you a couple other examples here. Uh, where'd he go? Okay. So we also have methylation markers, as well as oxidative stress markers. And then we talked about the detox indicators. Remember, those are the three big areas that we're looking at. So let's look at each one of those in turn. Under methylation, you'll see these two markers here, and this is a really easy section to interpret. There's methylmalonate and Figo. Figo, everyone calls it Figo, I guess. If we try to pronounce the word, something like forminoglutamate, forminoglutamate, or Figo, and methylmalonate, okay? These are markers for folate or B12 related problems. And in my way I teach these classes and the way I work with patients, I just kind of toss that under the detox section. Of course, it's important for your brain and neurotransmitters and other things too, but we had to put it somewhere, so I put it with detox, and it makes sense in that area. And then.

We have these markers down here, okay? Numbers 28 and 29, hydroxyphenol lactate N2 and 8-hydroxy-2-deoxyguanosine. That one's also called 8-OHDG because no one can pronounce 8-hydroxy-2-deoxyguanosine. 8-OHDG, that's the shorthand for that one.

And if you just go to PubMed, don't do it right now, listen to the rest of my lecture, but at the end of the lecture, go to PubMed, type in 8-OHDG, research, cancer, heart disease, diabetes, something like that. You can be in PubMed for the rest of your life trying to read all the articles on 8-OHDG. It's a very well-researched marker for oxidative damage, okay?

Again, this one here is Figo, Figlu, Figo for MOG glutamate. We have methylmalonate. Those are the methylation markers. And then we've got these two oxidative stress markers.

Now, as you're wondering, well, why is he talking about this and why does this all matter? Remember, methylation, oxidative stress, and then the detox markers themselves can be combined so that you can create a just super wonderful detox protocol for your patient.

So let's go back. Now that we've seen that, let me skip back a little bit here and show you the liver picture and see if this makes more sense now, okay?

Okay, now remember we talked about phase one and phase two. Now we see, oh, wait a minute, we have Figo and methylmalonate, and what's that going to tell us about B12 and folate? And there they are, just sitting right there. We also had all those markers related to, uh, liver support, right? The, the liver detox section. And where does that relate to? Well, here they all are: sulfation, glucuronidation, glutathione, measuring all these different processes. Glycine, taurine, glutamine, anthranilate. These are the solutions.

And then those oxidative stress markers tell you all about the antioxidant protection status: vitamin A, vitamin C, vitamin E, selenium, CoQ10, right? All the things that we use as antioxidants. So we're directly measuring B vitamins, phase two support, and antioxidant support with this lab. So now you can see you can assemble the components of a detox protocol knowing exactly what that patient needs. So you avoid some of the common pitfalls and you can get some really excellent progress.

I had a patient two days ago. This is a really good story. Uh, I don't have her labs here, but you have to trust me on this one, okay? So she ran her initial series of labs. Five out of the six detox markers were screwed up. We reran her test a year later. They were all clear. She came in and she's like, "Dr. Kish, I'm worried about my liver. I'm worried about my liver." Every time, every time, every day, this woman's like, worried about her liver every day. Not because of the test, she's worried about her liver. Every day. Before I did any testing with her, she's just worried about her liver and liver damage and all the metal in her mouth and all this kind of stuff. This is what she worries about.

And so I said, "Well, look, Joan, we did this test a year ago. Look how messed up your liver was. And now we just got this one in this week, and look, it's better." The sense of relief in the room was palpable, right? All of a sudden, this woman was like, "Oh my gosh, my liver's okay now." I'm like, "Yeah, you did this program for a year. You took all the supplements like I told you to, and look, it worked."

"Now I can say, Joan, let's do this test a year from now again and make sure your liver stays healthy." And then she's like, "Dr. K, what should I do?" "Well, why don't you take a little liver support? Not the full program. We just give you one thing for your liver. We'll retest you in a year and make sure that it stays healthy." Okay?

So you can use these tests in a variety of ways. Tell you if you're using good quality supplements and you get your dosing right, you're going to, when you retest people, you're going to see differences. I retest people every day and I see, I have patients this week where I got like 2014 Organics profile, 2015 Organics profile, and their 2016 Organics profile, and you just watch people gradually getting better and better. I mean, it's pretty remarkable stuff. Really, really works well. Of course, patient complaints get better too. B vitamins, methylation, phase two, sulfur compounds, and antioxidants.

Okay, now let's go back to the labs that we see in the pictures and let's look at some more cases. All right, so let's look at this one entirely. I only looked at part of it so far, but let's kind of dissect this for a minute. So B vitamins, we talked a little bit about. There's right there. Methylation on this person was okay. Oxidative stress, they have one marker there and two markers under, uh, detox. So these are all going to be what I would consider, you know, sort of toxin-related issues. We want to get the person B vitamins, antioxidants, and phase two support. All those things.

I think we have a couple more labs. Let me look at these tests. Here's another test. Here's a good one. So remember we talked about methylation? Here's methylmalonate is high, and that means that this person needs more B12. Is B12 important for detox? Absolutely. How do we know? We just saw on the picture with the liver. So you know it's right, you know it's real if it's in the picture.

Detox indicators, oops, orotate, glucarate, pyroglutamate, and sulfate, all messed up. Three of them are high, one is low. Okay, low is really bad for sulfate, means you don't even have the sulfur you need. So what does this person need? Well, if you're going to look at it from a micronutrient perspective, you might say, "I'll just give them some arginine and magnesium and maybe a bottle of N-acetylcysteine." But really, what we're saying is that the whole phase two mechanism is like collapsed. So you want to give them a combination product that includes taurine, methionine, and cysteine. Every single supplement company that we work with has a phase two liver support product, okay? And you want to just vary the dosage of that depending on how much of a problem the person has. So whether it's support liver from BioMatrix or detox aminos from Designs for Health, or whether it's a heavy metal detox from Ortho, whatever the product is, the phase two product, they're going to ramp up the dosages of it in accordance with how many of these markers are positive. You see one marker positive, probably give them two or three a day. You see four markers positive, I dose people as high as nine a day on some of these phase two products, nine capsules a day of a combination product, and really start to clear this out quickly, okay? Along with some B12 and folate. And this person also needed some energy support. So you don't have to carry a million different products. You don't have to make this too complicated. The more markers you see positive, the higher your dosages go. I mean, it's that simple. Don't want to tell you how long it took me to figure that one out.

We'll come back to this in a minute because there's some other stuff there. Let's see. I think we have more. Uh, no, sorry. Hang a second. I want to pull up another one here. Give me one sec. I got a couple other labs lined up here I want to use. Let me just close this going here. In the meantime, you can look at our advertising. This is kind of like when you're watching Hulu and you have to wait for the ad to clear. But you know, I highly recommend with Hulu, they just pay the extra five bucks and get the ad-free version. Um, we don't have an ad-free version of these seminars. You're kind of stuck with listening to the advertisement part. But you really should take the class. I firmly believe in this class. We just had one of the most skeptical doctors of all time who really didn't think that this was going to be a good class for her, and she just graduated. And I just talked with her about the class, and she was so happy. I browbeat her into taking the class, is the truth of the matter, but she's so happy that she did that.

All right, here we go. Wow, look at this. I don't even make this stuff up, you guys. This is just like straight out of my clinic. Can you believe this? All right, so let's look at this. See, ly overwhelming lab in the light of the stuff that we just learned, okay? Strictly in terms of toxins, this person's energy production marker system is just completely shut down. You've got five markers that are very high. This is worst-case scenario. Doesn't have the energy to run phase one and phase two. Problem right there. B vitamins, are they important for detox? Yes, we just saw that. Folate, remember that's our Figlu marker for MOG glutamate, essential for detoxification. What happens when you have a lot of toxins building up in the system? Some of them are neurotoxins. And what happens then? They damage the brain. Is it a surprise that there's all these brain markers? Not at all. We're seeing the expression of the toxins in terms of the damage they're causing on the brain.

Wow, look at this guy. This is amazing. The detox markers, four of the six are elevated, and both of the antioxidant markers are high or very high. This is a body in crisis, y'all. Now you want to look a little more detail at this. You can see the breakdowns here. Energy production, not doing well. Doesn't have the energy to get rid of toxins. B vitamins, as well as folate, compromised. Can't clear toxins. The damage occurring to the brain shows up under these neurotransmitter markers. Of course, you're going to be depressed and anxious with all that's going on. Oxidative stress markers, remember I mentioned 8-OHDG elevated, other antioxidant marker elevated as well. What does that mean? A lot of oxidative stress. Where's that oxidative stress coming from? Gut and toxin-related issues. And then we see his poor liver just struggling to keep up all these pathways. So this fellow has every single thing that we talked about tonight, all in one human being. But you're not always going to see it that bad. Sometimes you might just see one section of the lab messed up, and it allows you to be really targeted and focused in how you're going to get that person better. Um, and I, you know, it wasn't until the last three, four years where I started to run organic acids profiles on every single new patient that I really started to piece together how important this is. And, you know, I think most of us in practice, we use, um, we use, um, organic acid testing as like a backup plan. It's like when things aren't going really well, I run that as an extra thing on hard patients. But you run on every single patient. It's really quite phenomenal in terms of the results you can get.

All right, so let me show you here what we have. I want to show you one more thing and then we're going to wrap it up. Let's see here. We sh about individual markers. We should get some labs. I look at dozens of these a week now. It's really exciting. I'll tell you, I don't get tired of it at all. Oh, quick announcement. July 13th is our next talk. We're going to talk about one of the big breakthroughs in GI testing now, how to use the GI-MAP test. This is really important. If you guys aren't using this test yet, should listen. This is important. There's some new technology that's come down now in terms of, uh, PCR testing, using DNA-based tests. I know it's new, it's a little innovative, but something that you should know about and run a few of if you haven't yet, okay? That's a, a pretty important class coming up in July.

Okay, also, we just published this research study, uh, where we looked at, uh, six months of patients in my practice. We took 25 women, put them through my basic practice, basic protocols, really got some really wonderful results. If you're interested, we can send you a copy of the research study. Um, it was done with myself and Sue Cutell and Larry Burstrom at the Mayo Clinic. And oh, if we're talking about why do people take our class? They want to implement. Everyone that comes to join our class wants to implement functional medicine, and they want a clinical model, or they want a business model, or they want both. They want the how-to part of it. That's what we do, and we're really effective at doing this now. It's been 10, 11 years, a thousand doctors. We know what we're doing at this point. We don't take a ton of students every year. We're pretty selective about who comes to us, and so we have a really great community. If you're interested in doing this, you should check it out and see if we're a good fit for you or not. I'll be very honest with you. If I don't think you should take the class, I'll let you know if it's not a good time for your career or it doesn't seem like a good fit, you know, because we're interested in and the right people taking the class and then supporting you in whatever way we can. If you don't end up signing up for my course, I can recommend some of the other courses that are out there. I know pretty much all the other teachers. We're all friends, and it's not a big deal if you end up taking someone else's class. We're all in this together, okay? We have lots of new content. There's live Q&A calls every week. We go over labs, and there's just a wonderful community of people that we're working with now, okay? So sign up for the class, set a call up for me if you haven't done it yet.

And we just want to wrap up with a final thought here. So when we're looking at program design, right? We've talked tonight about energy production, mitochondrial energy, talked about detox pathways and oxidation and methylation. So in order to detox, those phase two pathways need to be working well. You need to have plenty of antioxidants. You need to be able to methylate. That's not happening, toxins build up. And what do they do? They start to generate inflammation that either damages the mitochondria, or potentially damages the brain, or can damage the adrenal and thyroid connections, okay? So this detox system, when it's in disarray, triggers neuroendocrine problems. Patients come in on the neuroendocrine side. They don't come in saying, "I think I have a detox problem." They come in saying, "I'm depressed, I'm overeating, I'm anxious, I am tired all the time, I have no sex drive," right? They're talking about their adrenals, their thyroid, their brain, their mitochondria. That's what they're suffering from. But what I'm trying to focus on is that many of those problems are coming from detox-related issues that are ricocheting over that neurotoxin that's damaging that brain cell, that endocrine disruptor that's hitting the female hormones or testosterone, that inflammatory response damaging the adrenals or converting, you know, preventing the conversion of T4 to T3, or all that oxidative stress that's hitting the mitochondria, right? So fat, fatigued, depressed, tired, all that stuff, low sex drive, is often coming in its origins from a toxin-related problem, okay? And that's kind of the take-home message. And we treat in this order. We look at neuroendocrine and getting the person feeling better first, then treat GI, get the GI tract ready so it can handle the dump of toxins, and then we start to detoxify using those techniques that I went over today, okay? And it's not that complicated.

I'm going to end on a final thought here. It really isn't. Let's go back. Let's go back. Oh, you know, let's look at this one because this poor guy has every problem. So it's easier to look at someone that has every problem. So when you're looking at a detox case and you're looking at an organic acids test, just think: Do they have the energy they need to run the detox pathways? Yes or no? Are they methylating? Yes or no? Forget the brain for now, that's a whole different talk, isn't it? Look at the B vitamins. Look at the antioxidants. Remember methylation, antioxidants, and then phase two. And then you can start to design programs based on that. And here's all the phase two stuff here, okay? So hopefully it doesn't have to be completely overwhelming or confusing in order to get this done.

I can't believe the hour is up already, but it is, and I got to respect some time here. I'm going to answer just a few questions. Um, yes, this is all recorded for those of you that asked, and, um, happy to send out the recording. You can listen to it again. How do you address patients for a toxic but react to many supplements? That's complicated. You know, that involves figuring out what's the entry point into that individual problem, person's problem, and that can vary from, uh, something like lipoic acid to vitamin B6, you know, depending. Um, oh, someone asking about giving amino acids before doing the organic acids testing? Yeah, if you have someone that's got, um, across the board, really low organic acids readings, it may be that they're low in amino acids. Obviously, like this patient here, that wasn't a problem. But if you're cautious, um, you can give someone a couple weeks of any protein powder right before they do the organic acids test to get accurate results. And then, um, yes, if you're interested in the research study, we'll send out a link perhaps for everyone so you guys can read it. I'm pretty excited about the research study. I'll show you here, um, out of the original group of patients, we found 19 GI tract infections at the end of the six months. When we retested, we cleared 18 of them. Can you believe that? Really knocked them out left and right on the GI side. We got better results in terms of less stress, better energy levels, less pain. It was really across the board a really positive, uh, result in terms of what you can do with functional medicine. I'm going to take about half of the credit for this and the protocols that I designed, and the other half of the credit I'm going to give to, uh, Carrie Brooks, who was a nutritionist that just browbeat and hugged these women until they all stopped gluten, dairy, soy, sugar, caffeine, and alcohol. A few of them didn't follow the rules, but the majority of the women in this study stopped all that stuff for six months. And of course, they felt better because they weren't drinking coffee, booze, uh, you know, eating crappy food. I mean, so the lifestyle changes were clearly a big part of all the results, right? And we'll try to, um, send out copies of this to those of you that are interested. All right, if not, um, you can come to the website or just email us, we'll get a copy too.

All right, if you're thinking about the class, set up a call with me. I would love to talk to you about it. Tell you more about what we're doing at the Kish Institute. And, uh, otherwise, we'll see you for the GI-MAP session next month in July. And I hope you have a good beginning to your summer. Take care, everyone. Good night.