Transcription
Hello everybody and welcome. I am Dr. Dan Kalish, and I am here today in partnership with Genova Diagnostics. And I want to thank them for helping coordinate this webinar to talk to you about adrenal stress profiles, programs that work. And I was thinking about it this morning, you will be, if you should choose this mission, the third generation of practitioner to use these programs.
So in the 1980s, my teacher Dr. Bill Timmons went to Germany with his partner in crime, Dr. Elias Ilyasilia. And those two guys were at a German trade show, and they saw this technology that was, whoa, it was salivary adrenal hormone testing. They brought these test kits back from Europe. They set up a lab in Elias's garage in Los Angeles, and they started to run the first functional medicine-oriented adrenal stress tests in the United States.
I came around in the early 1990s. These guys had been at it for a decade, and they had perfected not only the lab testing part, which is now commonly done by other labs like Genova, but the protocols. And so what these two folks did is they took hundreds and hundreds and hundreds of patients, and they tested their adrenal glands on day one. They gave them various different programs, and they retested their adrenals 90 days later. And they tried to figure out what programs would not only improve how the patients felt, but improve the follow-up lab testing. And that's exactly what I'm teaching you today. So not one milligram of difference between the protocols I'm talking about today and what I was taught by Dr. Timmons and what Timmons and Elias figured out in the 1980s.
So this goes back quite some time. And when we say programs that work, that's kind of a bold statement to put on a webinar, you know. And and and I don't know, around 2014 or 15, five doctors from the Mayo Clinic, which is arguably, I would say, the most important research organization for medicine in the world, took my training program. They took the mentorship class. And towards the end of that class, in fact, one of the doctors took it twice, but towards the end of that class, we all decided, hey, we should study this stuff because that's what they do at the Mayo Clinic. And so I actually did a research study, took a year of my life to do this with the Mayo Clinic on these exact same protocols that we're talking about today. And they work. They work like clinically for generations, and they work, you know, when you're looking at it under the lens of what the Mayo Clinic does in terms of intense research. Interesting stuff.
And I want to try to communicate to you today as much as I can about how these programs are designed, why they're designed this way, and give you a conceptual framework for how they work. And then we're going to pause after the conceptual stuff. I'm going to take a sip of water, and then we're going to get into looking at a couple of labs that just came in this week and designing a couple of programs so you can see how the program design part goes. Okay, so conceptual for a little while, then a break, and then lab review, and then program design. That's what we're going to do today.
So welcome. And the most important thing, I think, for, you know, for our purpose as clinicians, is how to develop our program design skills and then how to make the lab test that you're doing, especially these adrenal labs, be a referendum on lifestyle changes. So I'm just going to mention this briefly. The rest of this class is going to be about the labs, but I have to mention lifestyle because 80% of functional medicine is lifestyle. And why do we always do an adrenal test in every patient? Because it tells you about dietary factors, emotional stress, physical stress. It tells you about inflammation in the body. It tells you whether they're getting enough rest or not. It really shows you a lot of information about the four lifestyle factors that we want to control for: diet, exercise, sleep, and meditation.
And so an adrenal lab, in its essence, is great for designing protocols, which is what we're focusing on. But it's even more important as leverage to say, gosh, your cortisol is high at night. I think we need to talk about you doing a five-minute, five-minute meditation at night so we can lower that cortisol. Or your cortisol levels are abnormal at noon and afternoon. That's a blood sugar handling problem. We need to talk about what you're eating and how you're eating and how to get your diet to be cleaned up. Or you see super high cortisols, and you can tell the person, you know, we really got to figure out this stress factor. What are we going to do that's going to reduce the stress in your life? So these labs are used for program design, as we're talking about today, but even more importantly, use the cortisol testing to change the person's lifestyle. And it's much easier to say, your cortisol is high at night, we need to lower that because that's frying your brain cells, so you need to meditate. Then it is to say, I just think everyone should meditate at night, right? This gives you some leverage over the patient so you can get them to do what you want.
Oh, and this is a slide about me. I am the founder of The Kalish Institute. We've trained thousands of doctors. Been doing this since 2006. I told you about the Mayo Clinic. I also work with Richard Lord on a regular basis, who's a leading scientist in our field. And I actually am, if you can believe it, certified. I passed the exam. And, uh, and, uh, it was kind of hard, anyways, with 30 years of clinical experience, right? That's me. I'm Dan. Most of what I do now is teach other doctors how to do this. Oh, and we have this partnership with Genova. We're releasing all these really cool classes. We've never done this before. So if you're interested at all in the adrenals, take your phone out, scan that QR code in the upper right-hand corner, and that'll get you access to the information on the Getting Started with Adrenal Labs class that I'm going to be teaching in a couple of weeks. It's a six-week course. It'll, it's kind of what we're talking about today, but over the course of six weeks, so you can actually learn how to do it, get some feedback. There's going to be live calls with me, so you can ask questions about the labs. I'll help you design the programs. It's really a program design kind of workshop/class. So we want to make sure that you guys get through that first 10 or 20 tests and you really understand how to interpret them. Again, you can scan that QR code and you can join us with the Genova class.
Okay, so let's think about what we're really doing. We want you to understand that these programs are incredibly effective, and you can get a program design that resets or restores the HPA axis. That's the goal. That's what Timmons and Elias tried to do. They looked at the first lab, they created programs, and they wanted to have it such that when the program stopped and they retested, there was an improvement in HPA axis function. It's a resetting process. It's not a forever process. It's a short-term program to reset the stress response.
The Mayo Clinic study, as I mentioned, showed that this is what happened. There were some exceptions in the Mayo Clinic. There are some people who actually didn't get better. Out of the 25 patients that we looked at, two of them had pretty intense grief or loss experiences. One of them, her father and her grandfather were both dying. They were in different hospitals in nearby cities, and she would work all day, go visit her dad, go visit her grandfather, both of whom were dying, and then go home and deal with her three kids. So there was no way that her adrenals were going to get better from a bunch of supplements because she was just had too much going on. The other patient that didn't get better was going through a divorce. It's a six-month study. What are the odds, right? When we started the study, she started her divorce. So these programs are incredibly effective, assuming that you've got the lifestyle stuff in place.
Here's a copy of the study: "Evaluations of a Functional Medicine Approach to Treating Fatigue, Stress, and Digestive Issues in Women." Sue Cutshall from Mayo in Rochester, Larry Birdstrom from Mayo in Arizona, Scottsdale, and me, little old Dan. I'm the one that did all the actual application work, and Larry and Sue were there for the brainpower. So I was the one in the clinic every day working with the patients to make sure that this all happened. And it was wonderful to see validation from a group like the Mayo Clinic that Dr. Timmons and Elias were right. They were, they really figured out something. And I think the last one standing. So they both are long dead. Um, and when I was in my 30s, you know, everyone did their classes, they had a surrogate, they were going all around the country, all around the world teaching. They're both dead. The lab that they, you know, used to run is basically shut down. And so I'm trying to carry on this tradition of teaching these protocols, and that's why I get in front of you guys and do these webinars, right?
So these are the products that you're going to want to learn how to use, in the order of importance, kind of: DHEA and pregnenolone. That's them. Those are the mainstays. Those are the key ingredients. Those are the secret sauce. And, and how to make these programs work. The other products we're all familiar with: herbal support, phosphere, licorice, adrenal glandulars, vitamin C. But it's really the use of DHEA and pregnenolone and getting the dosages right that's going to move the needle the most in the patients that you're working with. So we're going to focus on that for a lot of the class.
And here's a sample program. You can use DHEA and pregnenolone in capsule form. That's what this program is. You can also use DHEA and pregnenolone in liquid form, right? And so DHEA, preg, multi-pack. Now, obviously, every single program is different because it's based on the lab. But I just wanted you to see what a complete program could potentially look like. And that's a lot of products. Not everyone's going to take that many, but that's sort of a typical program if you want to go aggressive on this, okay?
Now, we talk a little bit about the stress response, and we get through these slides relatively quickly so we can get to the fun part, which is actually looking at the labs. Okay. Uh, now, so obviously, it's stress that initiates the cortisol and DHEA problem, as well as a surge of catecholamines. That is the stress response. And this gets us ready to either fight or to run. And our normal functions start to shut down. And if you're locked in this stress response all the time, it's guaranteed that your digestion is going to get screwed up, okay? Guaranteed. Absolutely guaranteed. The more adrenal stress there is, the more gut problems there are going to be. And what we're trying to do is stop this catabolic or breaking down process and push the person so they can start to build up or heal or repair. That's really the goal.
And so if your patient is doing a Lyme disease program, or a mold program, or a leaky gut repair program, or a female hormone program, and they're still catabolic because their adrenals are screwed up, they're not going to get better to the extent that they potentially could if you stopped the stress response from interfering with everything. This was an essential tenet of Dr. Timmons' work: that the adrenals or stress are at the core of all these different conditions: cardiovascular disease, cancer, diabetes. And so we're not going to cure any of these diseases by fixing the adrenals, but you're never going to get a complete resolution of a problem if the HPA axis is just doing its own dysfunctional thing. So we want to get the person into a healing space where they can start to build new structures and repair things, build membranes, build proteins. And that's going to require getting them out of this catabolic position that they find themselves in.
So catabolism comes from, and I have some slides just to let you know, if you're new to this, new to my lectures, I have some slides that are kind of wordy. You can take a picture of them with your phone if you want, because I'm not going to read them all. But if I think it's important, I'll put it in a slide, and and you can grab a snapshot of it, okay? Um, catabolism is a process where we're breaking things down. We're breaking things down into smaller things. The problem with an adrenal case is that part of the breakdown process is to break down proteins for fuel. And where do those proteins come from? They come from muscle tissue and from the gut lining. And so the more stressed we are, the more catabolic we are, the more damage happens to the gut lining. The other connection between the adrenals and the gut is that cortisol regulates something called secretory IgA. And sIgA is the main immune response in the gut lining. So as you're stressed and your cortisol is not doing well, your gut immunity falters, and you get leaky gut because you're tearing the tissues apart. Not a good combination.
So we want to get people to be anabolic, to build them up. We want to build proteins, we want to build gut lining, we want to build, you know, cell membranes, all that kind of stuff. And most of the people that we're working with are in this long-term catabolic state. And so how's that going to affect them? I don't know, they could have joint pain, they could have an immune system problem, they could have some chronic inflammatory, bloody, blood kind of thing. So the adrenals being dysfunctional doesn't really let you know what's going to happen symptomatically. It's just where is that person the weakest, where are things going to break down? And it's really quite interesting, actually. We'll show, I'm going to show you a couple of cases in a minute where you just get these completely different problems from the same amount of stress.
So creating an anabolic state is more than just about the supplements. So lifestyle-wise, we want to make sure that people are getting adequate sleep. Very important. You want to make sure that they're getting regular exercise. So in two exercise, limited amounts of zone five. We want people over exercising. And you have to get people into strength training. You have to get people because strength training is anabolic, right? Strength training is going to be what helps us build up. Matter of fact, I just did my strength training session before I got on this webinar. So I may seem a little, uh, overly energetic, maybe because I just worked out. But it's really, really important to have strength training three times a week for all these patients. A lot of the chronic patients couldn't lift a five-pound weight, so that's not going to happen right away. But this is like an aspirational thing that you want to really move people towards. And every adrenal patient, in the beginning, you want to help them maintain stable blood sugar and avoid things like alcohol and sugar. These are kind of obvious.
And then, you know, what we see as the biggest problems really are the emotional stresses that throw people off: abusive childhood, you know, like sexual abuse or physical abuse in childhood, being married to an alcoholic. Uh, we had a guy in the mentorship class, uh, this week, one of the patients that was being presented, he works seven days a week for at least 12 hours a day for as long as he can remember. I mean, is there kind of a question as to why he's falling apart? So the lack of exercise, and then the most devastating thing of all is emotional loss and the spiritual disconnection that many of our patients suffer from. And so all of my great teachers, Dr. Richard Lord, Dr. Bill Timmons, Dr. Glenn Frieder, Dr. John Lee, they were all heavily spiritually oriented people who thought that the spiritual life and spiritual connections were absolutely critical for human health. None of them were out there, you know, talking about that, but it's how they lived their lives and how they treated their patients. So every great healer I've ever met has a profound spiritual connection themselves, and they're helping to transfer that to the patient. So we just want to let people know that you have to talk about this, but if you're living it, people are going to pick up on the energy that you're putting out, right?
Okay, so main triggers for HPA axis problems: emotional, spiritual disconnection, diet-related, especially blood sugar-related things, insulin-related problems, and then inflammation. And by hidden inflammation, we mean inflammation in the gut the person is not aware of, and inflammation in relation to the liver, environmental toxins, and those kinds of things. And that's why we do additional labs. So part of a complete workup is an adrenal lab plus a gut test plus a metabolomics test so you can see all the different variables that relate to that person's, you know, particular patient's condition. We're just obviously talking about adrenals for today.
Now, here are the skills that you want to focus on over the years. I'm not saying this is going to happen in the next half hour, okay? But your lab interpretation ability, you always want to be working on that, developing that. I still am working on that every day after 30 years. It's still something I work on. Lifestyle coaching and motivating your patients. Being able to present the labs to the patient. That's kind of where the rubber meets the road. If you're really good at interpreting them, but you can't explain them to a patient, you're in trouble. And there are many people that have come through my mentorship program who are really, really good at interpreting labs and are really, really bad at explaining them to patients. Okay? It's a skill you have to practice. You have to learn how to communicate at a really simple and basic level to motivate patients to make changes. So lab interpretation has to be there, but the communication and the problem-solving that all has to be there as well.
So what do we talk about? I'm saying an adrenal program, what does that even mean? Well, there's supplements, depending on what stage they're in based on the labs. There's the lifestyle changes. And then there's obviously presenting the program to a patient. Those are the variables that you need to control for. So when we get into the more detailed nuance part of this, there's the terms adrenal fatigue, adrenal exhaustion, HPA axis dysfunction. They come in and out of favor. But what we're actually really talking about here is that the brain is not working right. The brain is not communicating properly with the adrenal glands. That's the central problem. So you want to address the problem at the level of the brain. And that's what Timmons and Elias spent their whole careers investigating. It's the feedback loops that really matter.
Now, separately, we're also going to recommend you treat the adrenal glands directly. And that's with the nutrients that the adrenal glands need, like magnesium and pantothenic acid and vitamin C, and the herbs that really help the adrenal glands work better, like ashwagandha and rhodiola, all that. But when Tim and Elias did their original research, what they really saw change the feedback loops and make the labs better were the specific products like DHEA and pregnenolone, phospherine, and licorice root that could, that they could actually manipulate the levels of cortisol and DHEA with. And if you manipulate the levels for long enough, the brain sees these normal circulating levels and it starts to mimic that pattern again itself. So think of this as an HPA program. The hypothalamus and pituitary to the central player. You don't get stressed, and then your adrenal glands themselves react. They're under the instruction of your brain. So you want to treat the hypothalamus-pituitary-adrenal axis in its entirety. But we're going to separate it out: brain part, adrenal glands themselves part. And we'll have that theme throughout the class here.
So here's the, here's the pathways that we're talking about. So we're under stress, and we're all under stress. Everybody's under stress. I mean, I think there's a pandemic that's just ended recently, or is it still going on? I don't know. There's, you know, there's enough stress in everyone's life to explain why they might be having a problem with their adrenals. Um, so you have this HPA axis. You've got the adrenals down at the bottom here, and the brain is sending these signals down. The adrenals are making the cortisol, and then they're sending the, the brain is reading the blood levels of cortisol and seeing what's happening. And there's this feedback loop. So the brain understands that its instructions were followed. What we're doing is mimicking the normal feedback loop. We're trying to reset the normal feedback loop. It's not like a reservoir of cortisol is empty and we're trying to fill the reservoir up. No, it's more like a software problem. It's like a glitch in your laptop, and the software is not right. I mean, you're going to fix that? Not really. You have to get an engineer in there, an electrical engineer, to mess with the code. We're messing with the code. We're changing the amount of cortisol and DHEA that is circulating in the bloodstream to mimic normal. We're trying to mimic normal. And the brain sees normal, and the brain doesn't have a mechanism for understanding this is an outside impact, an outside influence. So the brain starts to do what it's supposed to do, and it resets.
It's hard to really explain how well this works unless you, until you get into it. Once you've done 20 or 30 patients with these programs, you'll be hooked. Okay? You have to just trust me. The first 10 or 20, you may think that this is a little sketchy because you have to see, we have to get good at designing the programs, and then you have to see a bunch of people go through this, and it takes a little bit of time. Okay? It takes people, I don't know, takes most students three or four months and just say 20 or 30 cases to really figure this out, and then they're hooked the rest of their careers. Then they use these programs the rest of their careers. So, um, the key products produced by the adrenal glands include cortisol and DHEA from the adrenal cortex. But then there's also epinephrine, norepinephrine, and dopamine. I just want to mention that because they're made in the adrenal medulla, and of course, they're also the catecholamines. And dopamine are also made in the brain. Some cases, you'll see that you have to address the catecholamines and cortisol, DHEA. We're just mentioning that today, we're not really talking about it. But if your programs aren't working well, that could be one of the variables that you need to control for, okay?
So the impact. I'm going to skip through some of these, okay? Here we go. This book is kind of a must-read. Tom Gilliams. It's sort of the standard book on the adrenals, and you can Google it and buy a copy of it. It's like $30 or $40. If you don't have a copy, you should really buy it. And I took some images out of here, but Tom is one of the leading researchers in this area, and his book is just brilliant. He really got into this stuff and he understands it. So here he is, Tom Gilliam's PhD. Okay, this is out of his book. The concept being that stress is going to throw off the adrenal medulla, and that's where the catecholamines are produced. And the adrenal cortex, cortisol is made in the cortex, hence its name. Yeah, we're focusing on this side of the equation today. There are organic acids tests that you can do, or metabolomics or NutriVal tests that you can do that measure the catecholamine metabolites. And sometimes you need to work with these two systems together because they're both involved in the stress response. And I'm going to skip through some of these slides here because we're not going to talk too much about this today. Here we go.
Cortisol is really what we want to focus on. So, and those slides are all out of Tom's book, so just read Tom's book, you can get all that information, right? So cortisol is central in regulating the immune system. It regulates blood sugar. It changes a woman's fertility. If cortisol levels are out of balance, obviously, it's going to help with bone formation. It's going to help with metabolism of fat. So if cortisol is out of balance, you have body-wide responses that are quite negative. And the symptoms of stress can vary such that you may or may not realize that it's cortisol that's causing the problem. So we just recommend that basically people test everybody that has, every new patient, we run this test on, okay?
And we already talked about emotional stress. So the, the emotional stress is kind of obvious, and you can talk to people and figure that part out. What's really tricky to figure out, though, is dietary stress because some people are eating in a way that seems relatively healthy, but they're actually not regulating their blood sugar adequately, or they have a past history of problems. And if you have unstable blood sugar, cortisol is going to be responding to that all the time. So you have to get the diet under control. And then the inflammatory part of this story is that you have to have any kind of hidden inflammation source dealt with. And that's usually going to be the GI tract that is inflamed, or a buildup of chemicals or heavy metals that's impacting the liver. So there's additional testing you need to do. But you can always, with every case, just run an adrenal panel and just start there and get some decent results for most people. And then as you advance in your understanding of the labs, you can add in the GI testing and add in the NutriVals and those kinds of things.
Now, one of the central ingredients in these programs is going to be DHEA in a supplement form. And if DHEA levels become abnormal, it's going to impact immune function, memory, and focus. You use DHEA to make estrogen. You use DHEA to make testosterone. So you can have sex hormone imbalances, and the list goes on, okay? And you can use DHEA to great effect to help improve the HPA axis. People, and everyone's heard of DHEA, many of you might have actually used it quite a bit. But pregnenolone is the secret, secret ingredient in this secret, secret sauce. It would be like the ingredient that's not even listed on the label, you know, they didn't even tell you it's in there, okay? So pregnenolone is super, super important. It's really kind of the controlling factor in these programs. And nobody uses pregnenolone. In fact, some companies don't even make it and sell it because there are so few of you that actually buy pregnenolone. Go figure. There's a long history to it. I won't get into it, but it's, I, it's one of the most effective products for people who are under stress, but it's just been generally ignored.
You also need these other nutrients on board now, like B5 and C and all these other things, okay? But it's the preg and the DHEA that really matter the most. So now we want, and we mentioned this already, when we look at the labs, this should make a little more sense. We want to balance these feedback loops. We want to support the health of the adrenal glands. So that's a whole separate program. One is for the brain and the feedback loops. That would be like the software correction. The other is just supporting the health and physical function of the adrenal glands themselves. So what does that mean, really? That means that the glands exist in time and space, right? And they need certain nutrients, and they respond to certain herbs, and they have their own little lives going. So separate from that correction for the brain, which is what the DHEA and preg and phosphere and liquid are for, you should also support the adrenal glands themselves so they can rebuild and repair. And I'll show you some slides on that in a minute. And then keep in mind about the catecholamines, the lifestyle, and then reducing stresses from these other areas so we don't get myopic about this. But the key ingredients, if this is all you learned today, I think you'd be super far ahead, is just how to use these four products, okay? DHEA and pregnenolone. Those dosages are going to vary depending on the labs, but they're going to be a part of pretty much every lab. The one contraindication that's sort of a big one would be if it's a female or male that has a history of cancer that's related to hormones, probably don't want to give them hormones. But outside of that, for the most part, own, if it's a child, you don't want to give a child hormones. But for the most part, outside of that, you know, you can use DHEA and pregnenolone with just about everybody.
Licorice root extract in a liquid form, and it's important to note this is not DGL, not deglycyrrhizinated licorice root. This is the glycerated version of it. Licorice root extract, not DGL, licorice root extract in a liquid form is used to raise up low levels of cortisol. You see a low cortisol on a test at noon, you give the licorice root a few hours before that. DGL is used for gut programs, a whole different product. Phospherine, phosphorylated or phosphatidylserine, is used to lower cortisol. So if you see a high cortisol at bedtime, you give phospherine a few hours before that. So licorice root brings it up, fosterium brings it down. Now you're able to manipulate the rhythm. And if you do that for three months or six months, guess what the brain thinks it's doing? It and it starts to repeat what's the normal pattern. So you're, it's like hitting a reset button, you know?
DHEA, super important, kind of core part of this. And DHEA does a lot of other things. So people use DHEA routinely as like an anti-aging product to prevent bone loss, to help with your heart, and all that stuff. And I'm very supportive of that. But we're talking about DHEA in a completely different role. We're talking about small amounts of DHEA spread throughout the day to reset the feedback loops. So you can use much larger amounts of DHEA for other purposes, but for the feedback loop resetting, we're trying to mimic normal production, which means that it's like a couple of milligrams, a couple of times a day, small, small, small amounts. Two, three milligrams, three times a day, small, small amounts. In fact, there's no supplement company that makes a two-milligram DHEA. So I usually use these liquid drops for the purpose of correcting DHEA. But again, if you're trying to boost testosterone, you might give somebody, I don't know, 25 milligrams or 50 milligrams of DHEA in the morning to boost their testosterone. We're not talking about that. We're using DHEA spread throughout the day to mimic or copy what should be being produced internally. It's a very unique use of DHEA, and most people use it, you know, in higher dosages for a different purpose.
Pregnenolone is made from cholesterol. It's the first of the steroid hormones. And all those pathway charts that you look at, and now nobody uses pregnenolone. So you don't have any pre-judgment about pregnenolone. But we're using it in this case, again, very low dosages, maybe eight or ten milligrams, three times a day. The three times a day part is super important because we're trying to mimic normal production. And your body doesn't wake up in the morning at, you know, 6:45 in the morning and go, oh, I'm going to make all my DHEA and pregnenolone right now. No, it makes it bit by bit throughout the day in different amounts depending on the time of day. So we're trying to copy that. So you have to spread the dosages out, or it won't work. Now, I'm not against single DHEA all in the morning, like I said, people do that all the time. They give you 50 milligrams of DHEA in the morning to boost your testosterone. We're not using it that way. We're trying to keep the dosages so low that we mimic internal production or what's missing from the internal production.
And here's a basic timeline of how this usually plays out over the course of a year. So, oh, that says weeks, oh, sorry, over the course of 12 weeks. So a three-month period. I have another one of these that's for the year, but this is for a shorter term. So in the beginning, you start with the consult, you give them the adrenal test. While the adrenal lab is out at the lab, and you're trying to get the results back, you're waiting for that, you're going to do all the lifestyle coaching. That's usually a couple of week period there. So you do lifestyle coaching on a regular basis while you're waiting for the lab to come back. And then once the labs are in, you start to do the program. And then somewhere between a three and six-month mark, you stop everything, all the protocols stop for a few days, maybe a week, and then you retest and you see how much improvement you got, okay? That's the goal. These are short-term programs. These are not designed to be done for long periods of time.
Two types of treatments. I've been saying this over and over the whole time, but I'm going to say it one more time because this is the most important part. Does treatments for the brain? That's HPA axis correction. That's for restoration of feedback loops. Dosages are low. What do we use? Remember DHEA, preg. DHEA, preg. And then licorice root to bring up cortisol, phoserine to bring it down. Just those four products. Those are the four products that are used for the HPA part of this. DHEA and pregnenolone in super low dosages that mimic internal production. Licorice to bring up the lows, fast steering to bring down the highs. Those are the four key components of that part of the program. Then there's a whole separate program that's going to be running, and this is what most people do for the adrenals. This is for healing the adrenal glands. That's your vitamin C, your B vitamins, especially B5. That may include glandulars if you're into glandulars. If you're a vegan type person, then you hate glandulars. That could include adaptogenic herbs, the rhodiolas and ashwagandhas and ginsengs of the world. Those are more directly for healing the adrenal glands. And you can run these programs side by side. That's really what we recommend. So you're healing and repairing the adrenal glands. Remember, you're getting them out of that catabolic state into an anabolic state so they can build up and heal and repair. And you're resetting the stress response that's been thrown off.
And here's a picture of the adrenal glands. And here's a picture from Tom's book about the pathways that we're tweaking here. And one of the most important things you can do from a lifestyle treatment standpoint is like, you see how this is right here? It says light hitting the retina when you wake up in the morning. When your patients wake up in the morning, one of the main instructions you want to give them for resetting the adrenals is for them to get outside and get exposed to, you know, sunlight as soon as they can, first thing in the morning. If it's sunny out, then maybe it's five or ten minutes. If it's cloudy out or overcast, or they can't be in direct sunlight, then maybe it takes more like 20 minutes. If you can even just get people to do this for five minutes, it'll start to make a difference. But that exposure to light is what creates the feedback loops in the first place, right? So, and we're trying to reset the feedback loops. So the most powerful initiator for all of human history of our circadian rhythm is our exposure to light. So first thing, and it doesn't count to sit in a, you know, in front of a window with a light coming through the window and driving your car. Doesn't count. You've got to be physically outside. You don't want to stare at the sun. That's bad. Everybody learned that in like second grade. So let's just assume that your patients are smarter than that. Maybe you need to tell them, don't stare at the sun. That's not what we're trying to do here. Remember in second grade when there was an eclipse and Mrs. Myers told you not to stare at the sun? Yeah, that's still true. Don't be a, once you're outside, expose to light, not staring at the sun, okay? You want the light, and the light is going to completely change your HPA axis.
If your patient's like super compliant, got that part down, they're out every morning for five or ten minutes outside, then you can have them give the, the advanced version then is to repeat that around noon. So again, if you're working inside, go outside around noon for five or ten minutes and get exposed to light then as well. You'd be shocked how much this helps people. In fact, we had a case last year in the mentorship where the entire case resolved with this one little trick, and the doctor was on the phone on the webinar in the mentorship group, I can't believe this. And then we're like, I know, Jason, is that he's like, yeah, like that was easy. I'm like, was it though? But the patient didn't know. This is really important. It seems kind of silly, but it's pretty important. And then, okay, now I think now we can get into the testing itself. All right, so this is where I get, I'm going to drink my glass of water here. So we're going to segue. That was kind of the theoretical part. Now we're going to look at the tests. I've got some examples, and I want to design some programs so you guys can see how that works, and then we'll have time at the very end for questions, okay? So you can type questions into the little chat thing, and, um, I can try to answer as many as I can.
Features of an adrenal stress index test. This is obviously from Genova Diagnostics, and they have a bunch of different versions of this. There's a four-point cortisol. I would recommend you, if you're going to bother doing the test, you're probably best to do the four-point cortisol and the CAR, cortisol awakening response. It's a little more expensive, but it's really, really worth it, okay? If you want to save patients money, you could just do it without the CAR. That's okay, too. It's going to map out your circadian rhythm, how much stress that the person is under, how they've been able to recover or not. It's pretty convenient. People do it at home. You don't have to get your blood drawn. It's important to let patients know this is not a medical test. We're not testing the adrenals like an endocrinologist would. We're not looking for Cushing's disease or anything like that. These are tests for lifestyle, not for, you know, a disease process or a rare endocrine disorder. But it's going to let the doctor know exactly what you need to do to reverse the impacts of stress.
So when you're looking at these tests, you want three things in mind, and I, they're, they're each important, they're kind of connected, but any one of these problems that gets triggered means the person needs a program. All right? So you're not going to necessarily have them all. Cortisol Awakening Response problem, you got a problem. Cortisol daily pattern problem, you got a problem. And DHEA levels, there's a problem, you got a problem. So let's look at these different things, and then we'll look at a couple of tests.
So this is a normal rhythm, and it's really quite incredible what happens when you wake up in the morning. And I'm going to change the decimal point here just to make this a little easier to understand, and then I'm going to put my glasses on so I don't get a headache from squinting at the screen. How's that? So this is a point two, but I'm going to call it a 20, okay? So you should wake up in the morning with a cortisol of 20 or 0.2 is what the lab says. So around a 20, and then it should drop throughout the day to the nighttime level of, let's call it like a two. So there's like a tenfold decrease in cortisol. And people do not perceive that. People don't wake up in the morning and think, wow, I have 10 times more energy than I did last night when I went to sleep. Not at all. You just have this normal sense of energy throughout the day, and at night, hopefully, you get tired and you go to sleep. But this rhythm is hardwired based on our exposure to light and dark. And until we can find a different planet to live on, we're kind of stuck with this rhythm. This is ingrained. And so we want to identify for each patient where are they not in this rhythm and then reset it, okay? If it's high at night, you're going to use phoserine to knock it down. If it's low at noon, you're going to use licorice root to bring it up. You've got these levelers here, okay, level it out so it works properly.
Now, here's a typical depleted person where their cortisol levels have been exhausted, and you can see in the, in the graphic here that their levels are low. Oh, it's sad. It's just sad looking at it, anyway. So people like this don't feel very good, all right? They're going to be, they may or may not be tired, okay? They're not always tired. In fact, a lot of times they're completely wired. So someone like this could have anxiety and, you know, trouble sleeping and all kinds of problems. So just because the cortisol is low doesn't mean they're tired, but it means that they're at the end of this whole process where the HPA axis has really fallen apart, okay? So that would be low. You'll also have some patients that have high levels of cortisol, and that's in the earlier stages of the stress response when you're still able to crank out huge amounts of cortisol. So obviously, in this situation, you want to bring the cortisol down. And what is it that does that? Well, you guys know already, it's phoserine. You want to use fosterine to bring this down, fosterone to bring that down. And every company, every supplement company has a different version of this. Sometimes it's actually just fosterine itself, or you can use some combination product that's designed to lower cortisol, but that would be the gist of the solution there.
And then with these folks that are super low, you want to bring them up. Remember, it's licorice root. So first thing in the morning, taking licorice root will bring that cortisol up. Taking the licorice root at noon will bring that one up. And you never want to take licorice root at night because even if the cortisol is low at night, you don't want to mess with it because it can interfere with your sleep. So licorice root is really just to be used either when you wake up, or with breakfast, or with lunch, or maybe around two or three in the afternoon, that'd be the latest you'd want to do it, okay?
And then there's the cortisol awakening response. Cortisol Awakening Response. It should be around 50%. If it's quite a bit out of range from that, then you've got a problem as well. And it can be blunted, where it's decreased, and the CAR can be accelerated. We had one just like this this morning in class. It can be overly done like that, right?
So now, before we look at the actual labs, I was going to mention for those of you that joined us late, we have a boot camp that's six weeks long starting in partnership with Genova in September, in a couple of weeks. And if you're interested in this topic, you can grab your cell phone and hit that QR code and scan it and get all the information that you need to sign up for that class. It's going to be six weeks of what we're doing today. You're going to be able to, we're going to have live calls, live Q&A sessions where you submit your labs, your patients' labs, or your, you, your labs, yourself labs, and we're going to get into the weeds on how to interpret these tests, how to design these programs, uh, and just review cases after cases after cases after cases. There's a whole curriculum I put together too, which is pre-recorded that you could listen to. And you listen to that, and you show up in class, and you bring your labs, and you learn how to actually design programs and implement this stuff in real time, okay? So it's a six-week class. It's the first time we've done this with Genova, so it's kind of exciting, and I hope a whole bunch of you sign up.
All right, so now let's see here. It's lab time. Let us look at labs, okay? So these, I don't know why I do this because, you know, I could just fake it and just show any kind of lab from anywhere. But I'd like to have ones that we just reviewed in class for real. So this.
One we actually just reviewed in class yesterday. It's a brand new test, and I don't know why it just makes it relevant to me in some way. So I'm going to read out the history here that the doctor submitted.
So in the mentorship class, we have a year of doing this, right? We review, we review a GI testing, adrenal testing, and nutrival or metabolomics test. And so what doctors do is they submit their cases and, uh, uh, then we review them. So let me just show you this one. This came in yesterday.
So it's a 69-year-old retired male on a bunch of medications, and he's got this low energy problem where his arms and legs feel weak, but you know, debilitatingly weak, like, you know, like he's not doing well, weak. All right. And here's what his adrenal lab looks like. So it's a 69-year-old. In the morning, the cortisol is incredibly low. Hang on a second, I got the wrong one there. Uh, I grabbed the wrong pen. Sorry, I put too many pens in front of me here. We go. That's the right pen. In the morning, his cortisol is super low, and then it's not that much better at noon. In the afternoon, it kind of creeps up a little bit, and he normalizes at night. But I mean, this is, remember we said that you're supposed to be up here? I mean, it's just got a fraction of the amount of cortisol you're supposed to make. And look at his DHEA. DHEA is under a 10. This is the worst one of these we've seen, you know, probably all year. Uh, 69-year-old guy. So his background though is that he's mega successful. I don't know what his industry is, but he's like super rich, runs his company's, company, companies, whatever it is, and his go-go-going. So he's not on the couch with a chronic illness, you know, he's just, even though he's exhausted, he's just driving himself even further into the ground here. Not what we want to see.
So now we want to bring this cortisol up. We want to bring this cortisol up. We want to bring this cortisol up. And we want to leave this one alone. I'm going to reset the rhythm. That's the HPA axis correction I went on and on about for like half an hour. How are we going to judge the success of this program? We're going to stop after three to six months, stop all the supplements, and retest and see if it worked. We also want to get his DHEA up from underneath the 10, which is abysmally low, into the green zone here, you know, let's say a 200 or 300 or 400 or 500. So he's got a long way to go with the DHEA.
Okay, so now let us look at a program. So this is what we call a stage three adrenals, and that is low cortisol, um, three of them anyways, right? So right back to where we were looking at before. We're going to use DHEA. And I like the drops. You can buy these from a couple different companies. So DHEA and large amounts. I'm going to say this three or four times. This is important. DHEA and large amounts lowers cortisol. Large amounts of DHEA drop cortisol down. So if someone already has low cortisol, you don't want to give them large amounts of DHEA because it's going to lower their cortisol even more. Bad. So two drops each drop is like a milligram or two. So a couple of milligrams. It's 1.2 milligrams per drop or one or two milligrams per drop. So a couple of milligrams three times a day. If you give the entire amount in the morning, it's not going to work because we're trying to mimic normal circulating levels in the bloodstream by giving these tiny little dosages throughout the day. That's the whole point of this. So you can't look at the lab and say, oh, you need 25 milligrams of DHEA and give it all in the morning. When you can do that, but that's a whole different purpose. This purpose is resetting the HPA axis.
Then we're going to use pregnenolone, which is our secret, secret sauce ingredient, remember? And now he's quite exhausted, so you're going to want to have 12 to 15 drops of the preg. Again, it's like a milligram or two per drop. And again, you have to spread the dosages out or it won't work. The preg helps support the cortisols. The DHEA helps with the DHEA. And then he was low, uh, morning, noon, and afternoon. So we're going to use our licorice root drops when he first wakes up, with breakfast, and with lunch. And remember, you don't give them at night because they can screw up sleep. Never do that. So the licorice is going to help bring up the low cortisol. The DHEA to improve DHEA production. And the preg to help support the cortisol. And then always use a multi-pack of some kind. Have different versions of that that I use, but you have to have a multi-pack with all the vitamins and minerals and stuff. And then in general, you want to use vitamin C with flavonoids. And if this list is getting too long, then, you know, you can just reduce it. And the multi-pack should have B vitamins and minerals and all that stuff in it. Oops, sorry, I hit the wrong button there. And then you might also want to use some kind of herbal adaptogens. Those help people a lot. Depending what brand you use, one or two of those with heat like that. And again, the multi-pack should have tons of bees, tons of magnesium, a bunch of antioxidants, all that extra stuff that you need to make these programs work. If you're not using the multi-pack, you can separately use minerals and vitamins and antioxidants. Okay, minerals and vitamins and antioxidants, and maybe even some fish oils to make this work. All right. And then lifestyle, all that stuff that we talked about. So let's look at, or right on time.
Okay, now here, uh, our second case is a 32-year-old female nurse. Acne, eczema, gut problem, exhaustion, and anxiety. Feels like there's no hope. That's not a good thing. And here's our nurse, nurse's lab. Wow, look at that. Again, we reviewed these in class this week, but, you know, we, it goes so fast in class, I don't really have time to completely digest everything. But check this out. 315 increase. Remember, it's supposed to be 50%. I don't know, compare that to anything else. That's like six times greater than it should be. So I don't know if you woke up in the, I don't know if you went out for dinner and you had a Big Mac. I'm not recommending this, this is an example to get your attention. You had a Big Mac. Okay, that's not the end of the world. You probably get sick for a day, but you'd be better. But what if you went out for dinner and you had six Big Macs? That would be like your stomach would blow up, you know? So this is a really large surge of cortisol. So right off the bat, the cortisol awakening response tells you there's a big problem here, no matter what else happens on this lab. We already know, remember I said in the beginning, there's three things: the cortisol awakening response, the DHEA, and the cortisol rhythm. So right off the bat, you know there's an HPA axis problem because the CAR is off. Now, her DHEA is almost low, or as hanging in there at the very low end of the normal range in terms of the ratio. Okay. And then the cortisols, we can see are quite high in the morning, and then there's a little bit of a spike right here. So we want to bring down that cortisol and bring down this cortisol at the afternoon and leave the others alone. And then we want this CAR to reset. So the whole HPA axis needs an overhaul.
Uh, so let's go back to the program here and we'll go down to a different program. So we can design two of these. So this is our 31-year-old nurse, anxiety, doesn't feel like going on anymore, depressed. She doesn't sound like she's in great shape. So DHEA. Oh, remember what I just said? That DHEA helps lower cortisol. So does she need help lowering cortisol? Yes, she does. So now we can be slightly more unrestricted with our DHEA. We could double the dose. Why? Because we're still only giving a few milligrams a day. It's still like four or five milligrams a day, but it's going to, the large amount of DHEA there will have the effect of lowering the high cortisol. This is what Timmins and Elias figured out. These slight variations in dosages really matter. You don't need that much pregnenolone for one of these cases. They're not burned out, they're not depleted. I don't know, six or eight drops maybe at the most, just a token because you don't want them to burn out. She's still cranking through the preg, but, you know, just a little bit. And then do you want to give the licorice? Well, let's look at the lab. No, because the licorice brings the cortisol up. Licorice would make her worse. Don't want to give the licorice. Imagine giving the licorice to someone with a 315 CAR? No, no licorice. You want the phosphoserine to lower the high cortisol. You want to calm the system down in the morning and in the afternoon. So we go back to our program. No licorice. So I just put here licorice, no, no, no, no, no, no, no, no, no, just so you don't get that wrong. Phosphoserine, or phosphorylated serine, usually that's like 100 milligrams. She needs it first thing in the morning to knock down that high, and then she needs it at lunch to knock down the afternoon. Okay. So a multi-pack. That's your B vitamin. I'll just put what's in there. B's, magnesium, zinc. You have to have antioxidants. You have to have. So a really powerful multi-pack. Any good multi-pack is going to cost 60 to 80 bucks for a month's supply. If it's cheaper than that, then it's probably not strong enough. And then we want to add in the vitamin C with the flavonoids. A couple of those. Now we're getting into just things that are good for the adrenal glands. It's not HPA axis stuff at all. Maybe some herbal support if you wanted to adaptogens. And you might want to do blood sugar support. We do that a lot with all these programs. So blood sugar support. And what does that mean? Well, that's going to be lipoic acid is usually one of the main ingredients, and that's at 300 milligrams two times a day. Chromium, you may add into that. So some blood sugar support. And every company will have like metabolic support or metabolic boost or metabolic whatever. That's for blood sugar support. So you can add in the blood sugar support. And I probably should have put it in this guy's, poor guy's program here. Uh, blood sugar control. We'll call it support, right? Support for blood sugar control. That's an essential part of these programs.
Okay, so then for the fellow, the fellow with the low cortisol, we're bringing it up using DHEA in small amounts, preg and larger amounts, and licorice root. And then we have the general support for the adrenals, the multi-pack, the C, the herbal support, blood sugar. For the poor nurse of ours here with, uh, super high cortisol and ridiculously high CAR, we're using more DHEA plus the preg. No, no on the licorice. Phosphoserine to lower the cortisol. Some B's. I'm sorry, the multi-pack, vitamin C, herbal support, and blood sugar support. Okay, so those are the basic programs that you can do. And I'm glad I actually picked those relatively at random, but it worked out because you got one example of a high, one example of a low. And just to mention before we go to questions, if you're interested in actually learning how to do this for real with real patients and you want to submit labs that I can review with you, join our group six-week boot camp. We're doing in conjunction with Genova starting in September. You can scan that QR code and get you all the info you need to get started.
Okay, now we are at the one-hour mark. So I'm going to take a pause here for a moment. And I understand you guys need to take off because you got patients, whatever. But I'm going to answer questions for a few minutes. And then extra time we have. So everybody's asking for brands. I can't really say that on these calls, so sorry about that. You have to join the boot camp. I'll tell you every brand and every dose in the boot camp. And this is not an average, you know, promotional thing. I'm just not allowed to say brands on these calls. Um, I'm sure if you hunt around online for all my other talks, there's somewhere out there where I tell you what the brands are. Um, thank you. Let's see. I was just scanning here for questions. Um, so intermittent fasting can be challenging for that guy that had the low cortisol all the time. I don't think it would help him very much because he can't even make cortisol. And so when your blood sugar is unstable, you need to release cortisol to stabilize it. And so be careful. Intermittent fasting is generally for people that are healthier, you know. Um, anybody that has any of these adrenal problems, immediately has some kind of compensation that's occurring with the thyroid. You have to, right? And so because the thyroid and adrenals are working together all the time, so if the adrenals are super screwed up and cortisol is really high, you've got down-regulation of thyroid. Give it's a given. It has to be there to a certain extent, whether it's bad enough on the thyroid side to show up on blood work or not, that's kind of debatable. But many, many people have thyroid problems that were induced, that were created by the adrenal problem in the first place. And so correcting the adrenals can correct the thyroid separately. Some people just have thyroid problems, right? And their, their thyroid is, is just the primary issue, and it's not an adrenal issue at all. Oh, yeah. And we will send you follow-up emails with the QR codes and all the details for those of you that want to sign up. Okay. Uh, for sure, that's coming up. Phosphoserine dose is 100 milligrams typically for what we're talking about. How is my HPA axis? That's a good question. You ready? But what is my life like? So I wake up around four or five in the morning. I do my Taoist meditation practice for, I don't know, an hour. Sometimes I can't tell how much time has passed, half an hour, an hour, two hours, whatever. I have a sauna and a cold plunge. So I do an hour alternating sauna and cold plunge. And then, um, then I exercise. And I do throughout the week, I do strength training three times throughout the week. I ride my bike as much as I can because I love riding bikes. I do a pretty intense stretching and core strengthening program maybe three or four times a week that takes me about an hour to get through. So I get through all that stuff. Um, I eat pretty good, you know, we go to the farmer, we buy our food direct from farmers all the time, and it's just amazing to get fresh vegetables and fruit that way. So we get a lot of farm-fresh stuff, like literally from the farmer. We call them Farmer John because his name is John. That's really his name. You go to a Farmer John stand on Saturday mornings and pick up all the food that he grew that week. So we eat pretty clean food. Um, I'm not a vegan. I'm a, I would like to be a vegan, but I'm not. Um, so I eat meat. I really like meat. I had pork last night. Anyway, so I eat meat, but not, not too much of it. And so my adrenals are pretty good, but my lifestyle is dialed in, you know, I have the time and energy and focus to kind of do that. But for most of my patients, you know, they're not able to spend three hours every morning just attending to their personal, spiritual, emotional, and physical needs and do a cold plunge, that's on, and all that. Okay, but thanks for asking my daughter. I appreciate the question.
Let's see. Yeah, exercise and cortisol, that's a good question. Kimberly's asking. So if the person's completely exhausted, like our 69-year-old guy, you don't want them training for a marathon. So cardiovascular exercise, if you go beyond somewhere between 20 and 40 minutes, is a major stressor for cortisol. So you got to earn it. So if I do an hour or two-hour bike ride, I've got to earn that. In other words, the two-hour bike rides I do are stresses on my cortisol. And if you're already screwed up and you're already stressed, you got to be really careful with cardio that's longer than, let's say, 40 minutes. Shorter cardio workouts are fine. But if you get too far into it and you're working too hard, you're going to stress the cortisol. So I said earlier and repeat, zone two exercise, you can do for sure because you keep your heart rate really low. But zone five needs to be done carefully if you're in a stage three. Now, if your cortisol levels are super high, then exercise is a whole different equation. You want to use exercise to lower it down. So you want to do meditative, yoga-ish kind of relaxation, relaxing exercises to try to bring the cortisols down. Once your adrenals are normal, you can work out super hard. And I've done these programs with hundreds of professional athletes, and they work really well for people that are working out hard too. Okay. So if the thyroid and the adrenals are both a problem, you should address them simultaneously. If you think that the thyroid is a problem because of the adrenals, then you can usually correct the thyroid from doing the adrenal programs anyways. Okay, by themselves, right? So if someone has high testosterone, you don't want to give DHEA. You want to get the testosterone under control first. So with normal free cortisol and low metabolized cortisol, you need to look at the DHEA, and that's the tiebreaker there as to what you're going to do. Okay. That's a little more detail here. But if you're, if you really have labs that you want to submit, just take the boot camp. It's not that expensive. I don't know what it costs, but you can look it up. It's not very pricey. It's something we price it so everyone can afford it. Okay. And you can, you know, we can go over your specific labs in that case.
Oh, and I'm going to mention one more thing before we wrap up, which is that there's a new thing that started happening in the last, I don't know, six months, which is that I've been talking about doctors ordering tests on themselves, and now everyone's doing it. We have entire classes that are filled with doctors submitting labs on themselves, which is great. So if you're thinking about your own health and you want to be on this planet for another couple of decades in a healthy and great way, test yourself now. Run an adrenal stress profile from, uh, Genova, right? With the CAR. Splurge by the CAR for yourself. So, um, that way, I didn't mean CAR, CAR, but, you know, the cortisol awakening response. So get the adrenal stress profile with the CAR for yourself. Order it right now today because by the time this class starts, you'll be getting the results back in, and we can go over your test in class. That's my final call out. And I hope that many of you join the class. And I hope that the class is full of doctors submitting their own labs. We get you guys super healthy and fit. Okay. I take care, everyone. Bye for now. Thank you.