Challenges of Assessing Small Intestine Gut Dysfunction: Organic Acids Part 4

So, we are now doing part four of organic acids, challenging challenges of assessing the small intestine gut dysfunction. This is kind of, probably the most difficult part of functional medicine, in my opinion. Figuring out what, if any, digestive tract infections are present in your patient. Are there yeast, bacteria, Clostridium markers? With other kinds of testing, we'll look at at the end of the evening, are there parasitic infections?

There's a new sensation sweeping the nation with PCR testing, using DNA to test for parasites, bacteria, and yeast. There's three lab companies now that are focusing on this area for us as clinicians to get better results. We have the organic acids component that we can add in as well. And so, it's like a golden age now. I mean, I'm sure like in the '20s, they didn't call it the Roaring Twenties in the middle of the '20s. We look back on the '20s and kind of, you know, romanticize it. But it's really definitely right now, this year, a golden age in functional medicine. The technology is going forward, the lab testing companies are supporting us, the research is happening. You know, and maybe it's early days and not all the technology has been worked out. Absolutely agree with that. But, you know, it's really inspiring.

So, we're going to jump right in. And again, if I was going to think about my most difficult cases over all these years, and what distinguished me from every other doctor that this person saw, and, you know, how it is, you guys see this in your practices too. They've seen ten or twelve doctors, they've been around to every clinic. What distinguishes me in my practice, in my most vocal cases, is the ability to detect and successfully treat GI infections. This is, to me, the heart and soul of functional medicine, combined with perhaps toxin-related issues, which we're going to talk about in the next session, next month.

So, this is me. I've been in practice for a while. I've trained a lot of practitioners. We've done all kinds of research and teaching and traveling, and I'm really involved in functional medicine. I just got back from the annual IFM conference. It was in San Diego this year. Just, I can't say enough good things about IFM. These conferences have all the best speakers. When you go there, you meet all your friends. You see a whole bunch of new doctors that you haven't met before. I was at vendor booths, supplement company booths, lab company booths, talking to all the people in our industry. Really been important to get out and to meet people. And I'm inspired every time I go to the IFM annual meeting. This year, we had a booth, the Kalish Method. The Kalish Institute took up our own booth out. So, I'd actually had a place to meet with people. It was really, it was a really good conference. I encourage you guys to go if you haven't been lately. You should really do that every year.

So, a little bit about, you know, what's the philosophy here? Physical health, a sore platform for emotional and spiritual growth. And, you know, my, my background in all this. Originally, at age 18, I was in the Zen temple in Japan, being trained by a bunch of Zen monks in how to do meditation. I went back to Asia at age 20 to 23, after my father died, and I lived in a Buddhist monastery in southern Thailand and I studied with the monks there. In Japan, it was a Zen master Harada Roshi, one of the top Zen masters over the last 100 years, was my teacher. And in Thailand, it was Ajahn Buddhadasa, one of the greatest Thai masters, again, of the last hundred years. And, you know, when I came back from all those trips to Asia, and maybe over two years of formal monastic training, I had an exit interview, you could call it that, when I was leaving the monastery with one of the senior monks. And here I am, I'm 23 years old, no, 25 years old by that time. I'm thinking, okay, I'm going back to the United States. I'm gonna give, give up this monastic lifestyle that I love so much because I feel like there's something I have to do back home. And he really coached me and counseled me in a wonderful way and encouraged me to take a path that was basically, this is a basic Buddhist idea, right? The path of service. You know, basically, that was his coaching. Make sure that you stay in service. And now, you know, 30 years later, I'm really happy to say, yeah, every day I wake up and I'm in service to my patients and service to the doctors that we train. And I feel really like I can have a spiritual and emotional foundation in our lives and do this work. We don't want to neglect that component.

And here's some statistics that were put together by Emerson Ecologic. For those of you that don't know Emerson, I'm sure most of you do. They're a supplement distribution company. They carry every brand you could imagine, hundreds of professional brands. You can buy stuff from them. They have really great service, really good shipping. But one of the things they did was they, they did, you know, poll, a questionnaire. And and they wanted to, and IFM did this too, by the way. If you go to the IFM website, you can look up Tom Blue, a business consultant that's working with IFM. Did a study that was funded by Pure Encapsulations, again, on, you know, what are the barriers and what are the challenges that are facing functional medicine doctors. And I've got a copy of that that we watched on Saturday live that was given by Tom. And there on the website, they have like a 40-minute discussion of this. I encourage you, if you're running your own business, which we all are, you should listen to the Tom Blue talk on the IFM's website. Should think about what we're talking about here, which are the business challenges that we face. Because if I look back at the men and women that I trained with 20, 25 plus years ago, some of the brightest, most capable practitioners were some of the worst businesspeople. And absolutely miserably failed and weren't able to be successful in practice and had to leave the profession of functional medicine. And I really created the Kalish Institute as a buffer so that those of us like myself who have mediocre to poor business skills can get the business training that we need to sustain a profitable practice.

So here's what doctors are complaining about. Finding new patients was the number one complaint. Patient compliance and retention, number two. Understanding online marketing. I was just working with my marketing team. We have a YouTube channel. I don't even know how it works. I don't even know how to barely get on Facebook, to be absolutely honest. Establishing your brand and niche. You know, these are all the things that people are confronting. So, just want to bring this up because I want you all to start to think about what are the business challenges that you're facing. We're here for clinical knowledge, but if you're not really successful on the business side, how many people are you going to be able to help? Okay. Again, managing complex patients is kind of what we're talking about tonight. And what I feel like we've really addressed. With although, you know, when I look at this, this is why I got so excited about this study that Emerson did. Because when I look at this, I say, wait a minute, doctors in our training program don't have these problems. That's why we have a community, right? If you just look at, like, I don't know, simple stuff like finding work-life balance, establishing your niche. These are all the things that we're trying to teach everybody. The Kalish Institute, right? This is the whole point of the classes, including these free webinars. Managing complex patients, finding a community of interactive peers, creating clinical protocols or patient systems. This is exactly what I'm teaching. Are the things that are the major concerns for people. So, I really want to encourage you guys, if you've been thinking about it, to sign up for our class. We're starting a new class May 25th. And if you've been thinking about it for a while, you should jump in. This is going to be an action-packed group of doctors. If you join, you'll see what I mean. You're going to have some of the top doctors in the country are going to be in this group that's starting. Alright.

So, let's take a look at what we're talking about for now. Organic acids testing. Now, number one, right off the bat, we've got this concept that these tests are not always what they appear to be. You know, and there's different levels of interpretation. You can interpret these tests at a superficial level to say, this indicator for the gut marker means that the person has a bacterial overgrowth or yeast overgrowth and leave it at that. Or you can interpret the test for a deeper meaning, meaning that, you know, what does it mean in the deeper sense of what's going on for this person that they have a gut dysbiosis, that they have a yeast overgrowth? Where is that coming from? And what does that mean? Okay. And we've reviewed these before. We talked about metabolic imbalances, environmental stressors, right? This test isn't a way divided into these two general sections where we're looking at metabolic rate, everything from how carnitine works to how blood sugar control works to mitochondrial energy expression. And the second part of the test, we're looking more at psychological issues, things like homovanillate, elevated, indicating high catecholamines. There's a toxicology section that shows the impact of chemicals and heavy metals. And then an example of, you know, the gut-related function. We're going to look at D-arabinitol, yeast overgrowth, and this kind of stuff. Now, in terms of what we're talking about tonight, specifically, let's take a look here. The common mistakes. And we've talked about this in the context before, so I'm going to skip through some of these slides a little quickly. But I want to look at this one so you can see the bigger picture context. So, when a clinician is confronted with a list like this, which is just simply a list of every organic acids marker on the test, what are you going to do with this? And how are you going to explain what's going on with each one of these markers to a patient? We're focusing tonight on the orange section here, in terms of GI. But I think what is the most important thing for all of us is to understand the thinking process and to be able to communicate this information to patients. The accuracy, accuracy of the test is clear to me. The effectiveness of our protocols is clear to me. What's fuzzy for all of us is how we're going to interpret and design programs. And so, I want to focus on that tonight.

So, as you all know, if you've heard me talk before, I keep this really simple because every word that I utter in every doctoral training program I do is the verbiage that I imagine that you could use talking to your patients. So, rather than talking about oxidative phosphorylation, cytochrome P450 pathways, like I used to in my first year of practice, we talk about things like, "Did you eat enough vegetables today?" You know, "I think your liver might have a problem with phase two." Right? We want to keep it really simple. And nowhere is this more important than in a GI tract because the GI markers here can get kind of squirrely and they're usually terms that we're not so familiar with. But I wanted to think about it from the treatment standpoint. What are we going to do treatment-wise? Really, we're looking for: Are there bacterial problems? Clostridium problems? Yeast overgrowth? What are you going to do for treatment? How is that going to impact what you want to do with the diet? And then looking at that bigger picture of the context of this, that we have three body systems: neuroendocrine, GI, and detox. And a very finite, limited, or finite number of potential solutions. That's the beauty of functional medicine as well. Anything can cause anything. If you boil it down to its simplest form, there's a very limited number of intervention options. And if we learn what those are and we can sequence them, you can design really effective programs.

So, the ways the test can be interpreted. You can look at it in terms of physiological damage. And I prefer that. It's the four horsemen. You can look at it on a body systems level. We're going to focus on that tonight. You can look at the organic acids markers, the individual markers. We're going to skim through that quickly. And certainly, when we get to the case studies at the end, we'll talk about common case presentations and how you can actually implement. At least 50% of my practice these days is based on interpreting results of organic acids profiles. It's become my major go-to tool in combination with my neuroendocrine, GI testing I do. Okay. And we'll look at some case studies at the end.

So, the four horsemen again: inflammation, catabolic physiology, insulin resistance, and oxidative stress. These are four bad things that happen to every chronically ill patient that we work with. And there's simple solutions for each one of these. So, being able to lay this out and figure out which of these four you may want to focus on can be a beginning step in understanding how to design a program. And if we're talking about the organic acids test, you're going to see inflammation, catabolic physiology, insulin resistance, and oxidative stress light up like a Christmas tree when you look at the lab results. So, when you see elevated markers on the organic acids profile, it's reflecting the four horsemen.

You can also look at the test as a section by section, right? In a section by section way. There's a neuroendocrine section to the test, a GI, and there's detox. We'll talk about detox next. Today, we're going to focus on the GI.

So, the challenges of assessing the small intestine, really should say the digestive tract here, because it's the stomach, small intestine, large intestine. We all know gut inflammation is one of, if not the main driver of chronic illness. And, you know, when I was at a conference recently that Dr. Ben Lynch put on, it's the CHIP conference in Phoenix. And wonderful conference. You guys didn't go this year, you should for sure go next year. Some amazing speakers there, including Dr. Lynch himself. But, you know, if you were, I just imagine if I had brought like a 12-year-old kid with me to the three days of lectures with the 20 or 30 experts, and at the end of the three days, I'd asked that kid to explain to someone what, what did everybody talk about? It was pretty obvious that every doctor on the stage said that stress, GI, inflammation, and toxins are driving every single condition. And it didn't matter if they're talking about SIBO, Hashimoto's, multiple chemical sensitivity, or ulcers, right? We all know that stress, GI, and toxin issues are driving all these.

So, the ability to test and detect GI problems, I think, is the great mystery for most of us. And I would, you know, say that the majority of us, myself included, are missing the majority of GI infections in our patients. Even if you're doing the best quality testing, and if you're not testing GI function on every new patient, you're missing more infections than you're catching, I guarantee you that. So, I really want to expand our understanding and realize that every single patient, it's not an optional thing. Every single patient has to do GI testing, extensive GI testing. Doesn't matter if they have toenail fungus or they're depressed. Doesn't matter if they've ever had a digestive problem or not. The GI tract has to be ground zero. Number one thing that we check before we move anywhere else. Okay. Imagine that you got on an airplane and you're going to fly it at London from New York, and they didn't check the fuel in the tank and you ran out of gas. Okay. It would be like, you know, you should have checked that first before we left New York. This has to be checked before you go and do anything else. Before you adventure out into hyperbaric oxygen land, or before you start doing IVs, or think about how you're going to treat Lyme's or methylation defects. You have to check the GI tract. Ground zero on every new patient. If you start to do that, you know, and create increased results. I mean, if you just do GI testing on every patient for like six months or a year, you'll never turn around and you'll send me an email a year from now saying, "Wow, that was right. Thank you." How do I know this? Because I was taught this by the teachers that trained me. I didn't make any of this up. I was as resistant to testing everyone for GI infections as, as, as many of you probably are.

And we want to talk about GI assessment. Includes, obviously, stool testing. And we'll look at that towards you in the class. But organic acids is a great way to catch GI problems that may be missed on a more traditional stool test that we do in functional medicine. So, yeast overgrowth, common to be hard to find on stool testing. We all know we're just banging our heads against the wall. Why isn't the yeast showing up on the stool test? Those test tubes that they put the stool samples in are not very good at preserving yeast organisms. So, it's not the lab company's fault. Usually, by the time they get the samples, it's, there's not a lot of viable yeast for them to do a culture on. So, it's a common issue. We're missing almost all the yeast overgrowth in the patients that we're working with. The organic acids is a nice backup to accompany a stool test to look for this. And you guys know all about yeast overgrowth from antibiotics. It can be a major problem. It can cause all kinds of symptoms from migraines to foggy brains to sinus infections, right? So, usually, when we see yeast overgrowth, whether it's on an organics test or not, means that we want to dig deeper. And you'll find that the majority of people with yeast overgrowth have other kinds of digestive tract infections as well.

Now, still testing for Candida, again, it doesn't necessarily tell you everything about the yeast organism that you need to know. And the way that I think about it is, is with this slide here, which is that there's three basic levels, or levels of severity perhaps, of a yeast overgrowth, right? Number one would be that there's a commensal yeast overgrowth. It's limited to the inside lining of the GI tract. So, if you imagine a doughnut and you're sticking your finger in the hole of the doughnut, you're in the hole, but you're not in the actual doughnut, right? So, you're in the lumen, but you're not in the gut lining directly. Invasive yeast now is the beginning of leaky gut. Now, those yeast organisms are sticking their little tendrils into the gut lining. It would be like if you stuck your finger into the doughnut hole and then you jammed it up into the edge of the doughnut, right? Now, the invasive organisms, the invasive organisms are invasive and they're in the gut lining, poking holes in the gut. A more severe problem, systemic yeast overgrowth. I've never seen in my clinic. These people are usually not, you know, being able to walk around or draw, right? This is a medical issue. They're usually to be hospitalized. They're going to have immune-related problems. So, systemic yeast means a person's, you know, in the medical system for sure. And we don't really treat that. But in our world, we're oftentimes dealing with commensal and oftentimes dealing with invasive yeast. The problem with invasive yeast, of course, is that if it's invaded into the gut lining, it's even less likely you're going to see it on the stool. Right? So, you can have some of your worst yeast cases that are least likely to show positive on the standard stool testing that we do. Again, organic acids can save the day in that regard.

So, in terms of treatments, pretty straightforward. You guys know how to do the Candida treatments. It involves diet, lifestyle, this kind of stuff. And then now, let me say what you hear here we go. All right. Let me, let me talk a little bit about this first. When you're running, and this is why I do my clinic with every patient, right? We do the neuroendocrine evaluations, we do a GI test, and then we do organic acids. Now, you're going to have, I mean, I want you to be able to trust the organic acids, but also let you know that the shortcomings that you're going to see. So, you might have 10 cases where you find pathogens on the stool testing, but the organic acids urinary testing looks fine. That can happen. It's a little frustrating. But the organic acids is not going to catch every single problem. And oftentimes, you're going to see a dramatic result on a stool test and the organic acids may look like it's normal. The reverse can happen as well. A stool test can look normal and the organic acids test can be positive. There's many reasons why you can get false negatives on the organic acids testing. The main reason, the most common reason, is because people do have the bacterial overgrowth in the gut going on, but it's not registering on the organic acids test simply because they don't have enough amino acids in their system to make the organic acids so that the test will be accurate. So, if you have a gut infection patient with demonstrated pathogens on a stool test, but the organic acids normal, that's most likely an indicator that they're very deficient in amino acids, and hence the organic acids test is not going to be giving you the results that you want. You will also see the opposite. You'll find that stool testing in many cases will miss all these infections, and yet you'll see it on the organic acids. I've learned very much to trust the accuracy of the organic acids in terms of if there's positives. But again, there is this big problem with false negatives if the person doesn't have enough amino acids in their system. Pretty simple way to overcome that is to give patients amino acid powders or protein powders prior to doing the testing with them by a couple weeks. Okay. It's an easy thing you can do.

As I mentioned earlier, our next class starts May 25th. We have spent, well, I've been doing this training program for 10 years now, I think we're going into year 11. I upgraded the entire protocol list. I upgraded every single class, every, everything. And it took about a year and a half. We released that new version in January. It's now a one-year-long class. The expanded content is pretty incredible. It definitely is the best work I've ever done. We have an amazing online community of doctors of every stripe, from medical doctors to chiropractors, naturopaths, acupuncturists. It's a really wonderful group. We have a live Q&A call every week where we go over all your cases. It's case-based learning, right? We're just looking at cases, looking at cases. There's several thousand now, reach case studies in the library. Let me just show you the community that we spent these last couple years building. It's the best online platform of its type, I believe. Here's the community feature. When you join the class, you enter into the community. We have a stream here, kind of like Facebook. You can see the other practitioners, what they're talking about. We have a very large content library, again, with literally thousands of cases. So, if you're just curious about, I don't know, how about organic acids, you type that into the search engine, you'll see dozens and dozens of cases, classes, lectures that all revolve around organic acids testing. You can watch case studies, you can listen to lectures, etc., etc. Also, within the community is the groups of the different classes. So, we take in small groups of doctors, no, usually around 10 to 15 doctors at a time. And each one of them has a class assigned to them. So, you get to know the other doctors in your class really well. You can interact with them. You can also interact with the larger community. People post really great questions online every day. And we have all kinds of interesting doctors that are chiming in and answering questions. So, it's not just about me teaching classes.

Here's the content from the class structure point of view. We have two semesters. Semester one goes through the basics: adrenals, which in my world, adrenals is code word for stress, diet, exercise, sleep, thyroid, insulin, right? Adrenal encompasses the whole kind of endocrine side of the neuroendocrine HPA axis dysfunction is really what that should be, or you could even call it, you know, HPT, HPA axis dysfunction. We get into GI pathogens, food, and female hormones. In the second semester, we cover organic acids, detox, brain, and energy metabolism. We have a practice management section of the course. Now, as if that wasn't enough, we have six modules: business strategy, operations, communications, sales, marketing, and then how to implement all this. It's a pretty amazing training program. It's a year-long. You get resources like you can't believe. And we actually make people create amazing practices. I'm really dedicated to helping support you all, making sure you do that. Okay. And classes start every two months. We're starting another one May 25th. It's a year-long commitment. And it's a pretty exciting time to be doing this. You get some special offers here. I created a Kalish Method 101 kind of introductory class. If you guys are interested, you can sign up for that. It's $397. It's 8 or 10 hours. Gives you a basic exposure to all the methods that we use in the full training program. We've got a live event coming up tomorrow. Yeah, it's tomorrow, okay. If you're around the Bay Area, come down, check it out. We're going to have cocktails. I don't know if we're going to have martinis. I only drink martinis. Hopefully, we'll have something fun to drink. But more important, we're going to talk about practice building, how you guys can implement all that good stuff. And then if you're curious and you just want to talk to somebody, check us out. info@kalishinstitute.com. If you've been thinking about signing up for the class, go for it. It's time. You know, don't hesitate too long. The one complaint I get from students is like, "I don't know why I waited so long to do this." Right? Okay.

Class starts next week. Organic acids markers, GI system. Now, this is the fancy-pants version of it. Benzoate, hippurate, if you don't, acetate, HPA. And again, well, you don't really need to know all that. And certainly, patients can't even pronounce half of that. And you don't need to know this either. So, I'm just going to skip through it. I put the slides in just so you can see how complicated this can get. But what you really need to know is the basic meaning of these tests and how to explain it to a patient. Okay? Now, most of the time, when you see a high marker, most of the time you see a high marker, it means something bad is going on. So, a high marker on the GI section tends to imply there's a lot of bacterial overgrowth. In some cases, it can also imply that phase two liver detox pathways are not doing so well, or there could be a Clostridium or yeast problem. Okay. Why that's happening, we don't know. The organic acids doesn't like magically, like a Ouija board, tell you why the markers are. Benzoate, hippurate, if you don't, acetate, mentioned all these. Right? Hydroxybenzoic acid is kind of a special one. I'll pause on this slide. And it can mean a lot of different things, including enzyme deficiencies, HCL deficiencies. If you see an indican marker pop up, that should be like, alert, alert, you know, maybe something else going on. And Akins is extra important. T-lactate is a good one. Okay. And then my favorite, probably because it's a yeast marker, and this one has helped me with a lot of cases, is D-arabinitol. So, there's two or three of these markers I should stand out. I would say indican, D-arabinitol, probably are the two that I always look at first. Okay. But when we look at cases, you'll see what I mean. I want to kind of show you some practical applications stuff on this case.

Alright. So, in the next class, we're going to do next month, is going to talk about detox pathways, getting into toxins, chemicals, heavy metals, the disruption of the endocrine system, and how so many of us have neurotoxic exposure, have endocrine disruption because of chemicals and heavy metals. How we can analyze that using organic acids and start to really cure, heal things, and prove things. In my estimation, you know, this is probably the up-and-coming and soon to overtake GI problems as much as the most important thing that we can do in practice. You know, I think our patients are becoming more and more toxic. And this is going to become something that we just have to deal with with everyone that we're working with. Used to be there were some toxic patients, some that weren't. I think now we're kind of moving into an era where we have to deal with this with everyone. Okay.

So, let's do the fun part now. Let's cut over and look at some labs. And I want to, because the GI markers are not very sexy or fun, I want to try to show you this in the context of how it really rolls out with patients. So, you have some practical application to think about. Now, remember the context here. And I'll show you with these cases here. Here's the obviously the organic acids profile. But for each one of these patients, we're also going to look at a standard stool test. Okay? We're going to look at a GI-MAP test. That's what I mentioned earlier, the PCR testing or DNA testing. So, you get a bigger picture. And in my clinic, we would have also done adrenals too. So, let me show you, give you like a context slide so you can see the context. I'm telling you, if you have a model and a plan, and you just stick to it, and you repeat the same tests on every patient, and you don't make a different decision because one person has one symptom and one person doesn't, you'll get consistent results. The hardest thing that we can do, the hardest thing that we can do, is decide to run a lab that doesn't seem to fit with that patient's symptomatic expression. And yet, that's the most important thing. So, every patient that comes in my clinic does all three categories of tests. We check the neuroendocrine, that's adrenal, thyroid, sex hormones, brain. GI and detox. If they're 82 years old and have gastroesophageal reflux, we check the neuroendocrine, GI, and detox systems. If they're 15 years old and they're depressed, we check the neuroendocrine, GI, and detox systems. If they're 27 years old, they want to get pregnant, we check the neuroendocrine, GI, and detox systems. And I learned this from my teacher, Dr. Timmons. And guess what he did? He was even stricter than I am. You couldn't talk to Dr. Timmons or really even enter into his office in any significant way until you had done your neuroendocrine, your GI, and your detox test. He honestly didn't have the time or even interest in talking to anyone until they had done their neuroendocrine, GI, detox testing. And so, I kind of took that to heart. And after, I don't know, six, seven years of watching Dr. Timmons doing it that one way, I was like, I guess this is like the better way to do it. But I can go through maybe the things that happen if you skip the GI test. Well, first of all, the vast majority of people with GI inflammation have no GI symptoms. So, whether the symptoms are not in a GI tract is, is zero information, right? And if you miss the GI infections and you miss the GI inflammation, then what happens? The adrenals and thyroid will never get better. The energy metabolism, mitochondrial, so, you know, function will always suffer. The sex hormones will always be horrible. And the brain will just degenerate gradually. The GI also, if it's not left, if it's left untreated, will generate endogenous toxins, which will trash your detox pathways, create oxidative stress, probably destroy your methylation, make you inflamed and nutrient deficient. So, if you don't fix the GI stuff in the beginning, you're always going to have neuroendocrine and detox problems just plaguing you all throughout the patient's treatment. It's not particularly expensive or complicated to do the GI testing. It's probably the most important thing that we can do, even if the patient's other problems seem more important.

So, let's look at some labs. Alright. And I guess we should look at the GI part first. But, you know, it's all in a context, isn't it? So, here's an organic acids profile. Now, so many ways you can look at these. But let's just keep it simple. We see an aura here, it's elevated. Ethylmalonate, that indicates a carnitine problem. Probably they're tired, maybe a little overweight. Beta-hydroxybutyrate, not processing carbs real well, probably have some sugar cravings, get a little tired in the afternoon. Fulmer and malate, they're not, mitochondria are making energy properly, for sure. They're a little tired. So, you know, you can kind of put a story with each one of these. I would say overweight, blood sugar unstable, tired all the time. Does that sound familiar? Do you have any patients like that? And then some B vitamin markers showing up. Oops, a little bit of a problem with serotonin. Get a little bit of brain involvement. And then we come to what we're talking about tonight. A one marker for liver detox. And then what we're talking about tonight, which are three markers under the GI section. So, now we can get into some of the, like, what causes what thinking. And I think again, just as a take-home, if you develop your, your just the way that you think about cases, I think that to me is what's made me a better practitioner versus what I actually do. You know, and one of my teachers, Dr. Budding, said this like 25, 30 years ago. I never forget it. You got to imagine Dr. Budding. To some of you, may know of him. Curtis Budding is one of the greatest chiropractors ever. This guy could adjust people's skulls like nothing else. But he's really good at clinical nutrition too. And he said, "Dan, people pay you for what you know, not for what you do." And I, he taught me this lesson one day when I referred to a friend of mine to Dr. Budding's practice. Again, this is like 30 years ago. And my friend was a professional guitar player. Couldn't play guitar because his elbow pain was so intense. Couldn't pick up his guitar, couldn't play. Career-ending injury, right? Is in LA, went to see Dr. Budding, who was a chiropractor as well as a, you know, clinical nutritionist. Budding looked at him, one adjustment, walked out of the room. My friend comes back, he's like, "I don't know what happened. It cost me like three or four hundred bucks, but I can play guitar again." So, it may have taken Budding two seconds to analyze the situation, five minutes to fix it, but my friend was paying for what Budding knew, not for the, you know, amount of stuff he did. And I think in functional medicine, we're all guilty of wanting to do more and do more and do more. But it's doing the right thing at the right time that really makes the needle move. And so, if you have a patient and they come in and they want to get pregnant, and you tell them to go off gluten and take this antioxidant and this mitochondrial repair product, and they get pregnant in three months, even though you only talked to them once, you know, what's the value of that? That's how we have to look at this. What's the value of the service that we're providing? And that's nowhere, you know, as important as with the organic acids test because I just don't want you guys to think, you know, we can't do this test because it's so expensive or or things like that creeping into your head. Okay.

So, again, let's look at the, the bigger picture here for a sec on this bit. Well, let's look at all the labs and I'll come back. I'm going to tie together the bigger picture so you get the idea here, right? For that particular patient. Also, this person has an H. pylori infection. Oops. Well, that's not good. Okay. And that's going to be contributing to the symptoms. And then on a GI-MAP. Now, let me just take a deep breath and tell you a little bit about, most of you, I'm sure aware of this. There's three lab companies now in our industry that are doing PCR testing. And this means that they take a stool sample, they amplify the DNA, and they look for various pathogens. This one is a GI-MAP from a lab company called Diagnostic Solutions. There's another company called DRG Labs that's running these. And Doctors Data added the PCR testing to their labs as well. So, we have a lot of choices now. And it's a new technology. It's not totally proven, but I'm finding it very helpful in my practice. It's not a substitute for old-fashioned stool testing where there's a human being looking under a microscope. But again, we're developing these new tools in our profession. And this is something you should all be aware of. This particular lab found C. diff. By the way, I run a PCR test and a standard stool test whenever I can on patients. They also look for potential autoimmune triggers on this lab. Look at this, guys. Can you believe this? One person, D. fragilis, D. nana, and C. diff. Before Candida markers positive as well. So, we're sort of swimming in a sea of GI infections, right? And then let's look at again, for going back up here, what are the ramifications of that? And this is where organic acids testing can really tie things together from a patient education perspective, as well as from a clinical perspective.

Now, like I said earlier, half of my treatments now are coming based on the organic acids. So, let's just sort of summarize what's going on with this poor human being. And I don't even care, to be honest, what their symptoms are. As a matter of fact, the less that I care about what their symptoms are, the better my clinical decision making becomes. And, you know, your first five years in practice, you're just learning things. Years five to ten, you're pretty, I was at least, I think this comment kind of overconfident. You feel like you know everything. And then by year ten to twenty, you're like, questioning everything. When you get into the 20-plus years of practice, like I am, you realize you know nothing. Like, seriously. Not just a little bit of nothing, like you knew nothing. And in fact, now I have a new strategy. When, when I go out with my girlfriend, we're driving around, you know, and this always happens, we wouldn't find a new restaurant because we love to eat really good meals at good restaurants. And, you know, the GPS isn't working. Um, and I'm like, "Oh, you know, it's to the left." And then I'll always preface that with, "But, you know what? I'm wrong half the time. Could be to the right." So, at my age, in my stage in practice, I absolutely know how often I can be wrong. And I know that my personal opinions are the least accurate way to assess things. And so, I base all my programs on labs. Labs don't lie. Labs are pretty accurate. Labs can miss things, but if you're aware of that, you can be in a really good position. Okay.

So, when I would just like to acknowledge, as my 20-plus years in practice thing is that, yeah, like Dr. Budding said, people are paying me for what I know. And I know a lot. But what I know, and my clinical decision making, is purely based on labs. And that keeps me honest. That keeps my personal opinions out of things. And by the way, my personal opinions, half the time anyways. What we're looking for with this case, functional medicine-wise, what's the underlying cause of this problem? Isn't that the whole essence of functional medicine? Absolutely. Were they sexually abused as a child? Leads to all kinds of gut problems, obviously. Did they grow up on a high sugar, high antibiotic diet? Is it the GI infections or toxins? Is it epigenetics or genetics? Is it a structural problem? I had a patient today, it's amazing she's even alive. She crashed at age 19. She crashed a car. She ended up on her side, the vehicle flipped. She ended up on her side, the vehicle flipped. Her arm was outside the window and was crushed, and her head, like the car was like resting on her head. It's amazing she's still alive. Clearly, she has some structural physical trauma to the head and neck that's, you know, part of what's going on with her immune system. Also, stuff. Is it a sleep-related problem? Is it too much or too little exercise? You know, what's the underlying cause? And you can see, I tucked down the way at the bottom here, Lyme, old, viral, and bacterial problems, all the things that, you know, we don't want to do what's because they're so complicated. Okay. And always try to deal with the basics first. But my understanding of functional medicine is this. This is what we're shooting for. But the underlying cause, triggers, physiological damage. These are my four horsemen, right? Inflammation, catabolic physiology, insulin resistance, oxidative stress. That physiological damage occurs because of some underlying cause. But hey, we can treat physiological damage whether you know what the underlying causes are or not yet. You can still treat inflammation, oxidative stress, catabolic physiology, and insulin resistance, even if you don't know what's causing it. And these are different kinds of treatments that are done for different reasons. The lab testing will show you clearly if these are markers or not. If the markers for this are not, like for example, oxidative stress shows up clear as day on the organic acids profile. Mitochondrial dysfunction shows up clear as day on the mind, on the organic acids profile. Nutrient deficiencies show up in spades on the organic acids profile. You can see all the results of inflammation, like we saw in this patient. Carnitine marker, that's a classic sign that the person's inflamed. Okay.

Now, if the physiological damage happens for long enough, body systems start to take a hit. The adrenals, the gut, the liver, the brain. And now we're into a higher level of treatment where we're focusing on the thyroid, we're focusing on the neurotransmitters. We're honing in on a body system and treating that system specifically. That's a third level of treatment. And then the fourth level of treatment would be symptomatic. Are they overweight? They just want to lose weight. Are they tired? They just want their energy back. Are they depressed? They just want their depression to go away. So, just for a moment, let's look at this one lab from all these different perspectives. What's the underlying one case, underlying cause, physiological damage, body systems, and symptoms? Okay. Now, and this is kind of unfair because this is actually my patient. So, I know I figured this out. Okay. And we're kind of cheating here a little bit. It's like looking at the test answers before you take the test. But, um, the underlying cause, the problem this person was, they had multiple digestive tract infections. And that became pretty clear. They weren't sexually abused. They weren't an alcoholic. They just had all these GI problems, okay, because of a ton of stress. So, that, that's kind of like the underlying cause. We knew that. The physiological damage, let's look at the organics profile from that perspective. And let's look at the organic acids from the perspective of controlling symptoms. Because when people lose weight, get more energy, and are no longer depressed, they're enrolled and they want to progress with us. They want to get things done. So, we want to eliminate symptoms while we're looking at and dealing with the underlying cause. And much of my career has been doing one of these or the other. I had my first five years where all I did was treat symptoms. I learned about functional medicine as, you know, more deeply and understood that I was now supposed to be finding the underlying cause. And I had a five-year period where I, Mrs. Lab, embarrassing to admit now. It's about as embarrassing as my whole second marriage was. But you do things sometimes and you're just not really thinking clearly, right? So, for a long time, well, the second marriage was seven years, and I was a really long time. But for about five in my practice, I would like actually tell patients, "I don't treat your symptoms. I just want to find the underlying cause." I thought that that's what we're supposed to do in functional medicine. I would actually deny people symptomatic treatments. So arrogant, stupid. I did this, you know, because I thought that this was the only thing I was supposed to do. Now I understand, wait a minute, we want to move seamlessly between treating underlying causes, physiological damage. You better know how to deal with body systems really well because that's mission-critical. And then you really need to.

Know how to control symptoms because that's where people are coming to us for, okay? Ultimately, that's really what they want. And if you can move seamlessly between these four different kinds of treatment, you're gonna be super successful, and your patients are going to be really happy, okay?

So let's look at the lab again for a moment with that in mind. Underlying cause, we found on the stool testing multiple GI infections. But remember, weight gain, fatigue, and mood. Do we see some indicators that show why they'd be gaining weight? Absolutely. Ethyl malonate means that their carnitine levels are inadequate. They're not able to burn fat. Similarly, insulin levels not doing so well. Beta-hydroxybutyrate means that carbohydrate metabolism isn't, carbohydrate metabolism is not working well, okay? So these two markers here mean lots of body fat. Tired is sitting right here. Energy production, the mitochondria aren't working properly. And a little bit depressed, maybe not a lot, but a little bit, is sitting right here.

Now, when you look at hundreds and hundreds of these labs a year, you, this is what's happened to me. You just begin to appreciate how accurate these tests are. I mean, these tests will pick up things that are just phenomenal. And, you know, if you understand how to interpret them, again, not just on a one-to-one basis like, "Oh, this marker is indicating that, must mean that," but on a systems basis. Isn't this what we're doing? We're doing systems, body systems medicine. We're doing medicine that's based on a concept of systems. There's an underlying cause, there's physiological damage, there's body systems that we want to treat. And we can also use the organic acids profile in this case, patient's case, to treat weight gain, fatigue, and depression. And those markers just, boom, they're just right there, okay?

And then, okay, so you're thinking, "Well, sounds easy, but how would I actually do that?" It's really not that hard. For the depression marker, number twenty-five, 5-hydroxyindoleacetate, you'd use 5-HTP in its various forms with, you know, things like B6 and all the other nutrients that are required. To deal with the energy markers, you simply want to support the Krebs cycle. Every single supplement company in our industry has wonderful products for Krebs cycle intermediates, and they're going to have, what, CoQ10, magnesium, B vitamins in it, etc. And then for the fat burning, this person needs carnitine and some blood sugar support so they can keep their blood sugar stable, start to shuttle fat, and make all this work.

Yeah, I was going to show you quick, like, how I would educate a patient about this. Again, remember I said earlier, everything I say, everywhere I go, every talk I do, is the exact language that I would explain this to a patient in. So, remember, the patients, this is our patient here, is overweight, tired, and depressed. We're all worried about GI infections and treating them, and we know they have all these horrible infections that's going to happen later. By the beginning, we want to get some symptomatic relief, okay? So let me just show you a little visual on each one of these. This, we got the tired one here first. So, why are they tired? Well, there's two markers that are showing up. Oh, actually, let me do this other one first, sorry. I think this might make more sense if I go here first, and then we'll come back to that one. Here we go.

This all really centers around patient education, you know? So, "Why am I overweight, doc?" "Well, your carnitine is insufficient." "How do I know that?" "Your ethyl malonate is high. That means that you're not taking fat and burning it up for fuel. That means you're going to store body fat, which is unsightly, and also makes people tired because it's, gives you more energy when you can burn fat." "Why is my blood sugar less able? I'm craving sweets, I can't seem to stay away from all those carbs, they look so good." "Your beta-hydroxybutyrate is high. If that's happening, it means you're not taking acetyl-CoA into the citric acid cycle or Krebs cycle to burn it up for energy. So there's a block here, there's a block here. This one makes you store body fat. This one makes you crave carbs." "Yikes, that sounds like me, doc, doesn't it?" "Why am I tired all the time?" "Well, your fumarate and malate markers are really high. That means that you're not moving forward with energy production here. So that means you're going to be exhausted all the time. Your mitochondria aren't able to make energy."

So here we have this picture. Why am I overweight? You can't burn fat. Why am I craving carbs? Beta-hydroxybutyrate is elevated. Your insulin processing isn't working well. Your blood sugar's not maximized and the way it should be. Why am I tired? Well, you can't make energy inside the cells either. And every one of those things we just saw on the organic acids test.

Now, if the person's clever enough to want to take it to the next level, and I would say all my patients are because people are just like ridiculously smart these days, then they're gonna say, "Well, I know you're gonna treat." Well, that does. They come back in as a month, two months later, they're like, "Wow, I lost a few pounds." "Hey, Dr. Dan, my energy levels haven't been this good since 1973 when Carter was present or whatever." "I'm Reagan, or who, Nixon, whoever's president, right?" You know, they're just feeling great. And, "Yeah, my mood is, it's not all the way better, but I'm really not that depressed anymore." Then we're going to want to start to think, "Okay, well, wait a minute. I'm glad the symptomatic improvements happening. That's why you came here. But remember on those initial labs when we saw those GI infections?" All right, Sally, Sue, John, George, whatever the person's name is, it's time for us to go after the underlying cause of these problems, which is your GI tract infections. And this is, kill all these things. This is, kill 'em dead. Let's just make that happen so that you don't have to stay on these supplements that are helping control your symptoms. I want a long-term, permanent solution for you. Let's go after the underlying cause. This is exactly the sequence in which I do it. And of course, I don't have time to talk about it tonight, but I also do a lot of work on the body systems as well, okay? But hopefully, this is like a schematic framework, a program design framework. You can start to see.

Let's look at one more case and see if that helps it sink in. All right. And I'll tell you, if you do this really well, patients get it, they love you, they'll enroll in the program, they'll make it happen, you know, they'll be wanting to do this. Another case here. Organic acids profile. Bunch of markers. You got a glucuronate marker, folic acid is not so great. 5-hydroxyindoleacetate, again, some serotonin problems. A little bit on the detox side. Oops, they have one intestinal bacterial overgrowth marker and a yeast marker. The D-arabinitol, okay? So we look at the organic acids again, can kind of glance and see there's a couple things going on here, a few things going on there. But really, where we're going to hone in on this one, because it's a good marker to work with and we don't see it all the time, is yeast or fungal overgrowth. So when the yeast organisms like Candida overgrow, they leave behind as a byproduct of them being broken down, D-arabinitol, which shows up in the urine. And this patient was up at a 60. The cutoff is like in the high 20s, low 30s, I think, okay? So they have a fairly big yeast overgrowth. I've had some patients up like 120, 170. Some people have a really severe yeast overgrowth. Stool testing, Blastocystis hominis. Oops, that's a problem. Stool testing with a PCR, Blasto found on that one too. It's kind of nice when they all match.

All right, so let's go back and look at this again. We have typical patient GI infections, something going on with a gut. This time, it's a yeast overgrowth. And then how is it manifesting symptomatically? Now, there are certain cases, and I've seen this, I see this like once a week, twice a week in practice, right? I'm gonna try to explain this concept because I've never heard it taught before. I think it's just because I've seen so many of these tests now that I, you know, I'm at the point in my career. For a long time, my first 20 years, I was teaching things that I was taught. And I'm thinking, I'm trying to teach things that I've learned, you know? It's kind of cool. But one thing that I've learned is that this is really, really important for organic acid. So I want to emphasize this. This doesn't happen all the time, but sometimes you're going to get a test back and you're gonna see something that looks relatively innocent, like in this case, it says glucuronate marker. And you're gonna think, "Ma, okay," you know, as a marker for liver detox going up there, phase 1, phase 2 liver detox is an issue in this patient. And wait a minute, oh, there's a methylation marker too, there, showing up with a folate thing. And then you're gonna think, "Wait a minute, let's look at how does that work in the body for real?" Now, I'm not saying this happens all the time, but there's a fair number of cases I get where there's a single marker or two markers like that that reveal the main problem that the person is experiencing. And some of this is gut feeling, some of this is just practice, you know, having done this so many times. Some of this is, I don't know, I don't want to use the word intuition because I, I think it's more than intuition. I think it's that we're sorting through massive amounts of information and coming up to conclusions that maybe don't make sense to our rational mind, but at the same time, are incredibly accurate. And I'm learning now, as the years go by, to really trust that kind of information, to really trust it. Would never do anything foolish and risk a patient over, like a whim or anything like that. But what I'm talking about is, you know, us being able to access information that's on the labs that is a little deeper than just the labs themselves.

Now, I want to show you, here's a picture of my mom. I just want to show you this real quick because this is the best example of this I've had in a while. So, Mother's Day, we went out looking for wildflowers. And there's a flower called the Mariposa Lily. This is true, straight, it's just happened a few weeks ago. So the Mariposa Lily, they thought it was extinct 30 years ago. Someone found one of these on Ring Mountain in Marin County, California. Turns out these, these flowers only exist on Ring Mountain in Marin County, California. They only bloom in the month of May, and it's a really rare event, right? And so my mom is really into botany, and my sister is a science teacher. And so we went on a hike, Mother's Day, to find the Mariposa Lily. And who am I? Am I a botanist? No. Am I a science teacher in high school? No. Do I care about Mariposa Lilies? Not at all. I was doing it because it was Mother's Day, and it was my mom, my sister, and I was kind of trapped into doing this hike with them. I loved them, obviously, but would never have chosen to do this. So we're hiking all around this mountain, as are many other botanists and scientists, looking for the famed Mariposa Lily. And then we run into this other group of hikers, and this woman's like, "We found it! We found it! We found that Mariposa Lily!" And she's trying to tell us where it is. It's just one flower, okay? This whole mountain, this is one. It's not like there's ten of these blooming. This is one. And so she tells us where it is, and it's kind of hard to describe where something is on a mountain. And so we're still wandering around for like an hour and a half, two hours. And then finally, I just get kind of bored and I'm like, "I'm just gonna hike over here and get away from all these people." And, you know, I wasn't gonna meditate, but I just want to be by myself. And so I took this trail that looked really nice. And I'm walking along for like five minutes, and I'm looking down, and what do I see? The flower. I started screaming and yelling and waving my hands and saying, "Oh my God, it's! I found it! I found it!" And all these people are running from all around. "I found the one Mariposa Lily!" Now, how did I do that? I don't know. I was listening to the botany people. I knew it only existed at a certain altitude. Had to be near craggy rocks. It had a certain kind of soil content. The plant looked like something like this. I was storing all that information in the back of my head somewhere, apparently, because when I went walking, I went right to the lily, that one lily on that whole mountain.

So what I'm talking about with with this lab test here is exactly that. I want you guys to start to develop over, I'm, you know, this ability to go, "Okay, I think this is the Mariposa Lily for this patient." Okay? I'm not sure exactly why, but I'm listening to the patient history, I'm looking at what they look like, I'm thinking about their sensitivity to supplements, I'm thinking about where they grew up, I'm looking in their mouth at all the dental work they've had and all the mercury in their mouth. I'm seeing their methylation marker. I get that they have GI infections too, but I really think this is a toxicity patient. Okay? So the labs can guide you there. The information, just like with the botany story I just told, kind of filters through your brain. But at the same time, whether it's intuition or the accumulation of all this data that you're processing, what you'll often pick up with these labs is that one nugget that the person really needs to get better. Now, in this case, they did have a yeast overgrowth and we treated that, but the really big problem was right here in black and white, okay, with the detox markers.

All right, so let me show you how that plays out with an example, and then we're going to wrap things up and maybe have a minute for some questions. So I don't want to call it intuition because that sounds too flaky, but it's somehow the sorting through of lab information to come to a conclusion which may not be the most obvious. Okay? So this person did have some GI problems, but the main issue was coming from detox. We saw the glucuronate marker, we saw the methylation marker. What do those signify? Well, if you go back to our diagram here, a little bit of physiology involved, which is kind of the fun part. Always like the physiology. I usually take him in physiology classes just for fun in college. Methylation, okay, super important, right? We know for phase 1, phase 2 detox. And then we have the phase 2 processes here, right? Sulfation, glucuronidation, glutathione conjugation, and methylation. Here's methylation right here, right? So you have to have all the B vitamins present that are required, B12, folate, etc. And you have to have these nutrients over here, glycine, taurine, glutamine, and N-acetylcysteine, methionine, etc., in order to open these paths to run, okay? Now, in this particular patient's case, this was the key. Identifying these pathways, the folate and the phase 2 support, completely changed the whole picture.

Now, if you haven't been doing this for a million years, don't panic because look at the lab. I mean, there weren't that many things to potentially work on anyhow, right? And we're always going to work on the gut, and they had a yeast overgrowth. But this marker and this marker were really the drivers of the case. Now, if you follow my basic schematic and you're treating things in a body system order, it doesn't matter if you have a huge intuitive blast of information and find the Mariposa Lily on that patient or not, all right? Because we're just gonna march through this model on everybody. I'm gonna treat the neuroendocrine, the GI, and detox. I would have figured this out later anyways because I would have done my neuroendocrine treatments for the adrenal, the thyroid, brain, etc., fixed all that stuff. I would have marched through and treated the GI tract, gotten rid of the GI infections that were present, the Blasto and all that, and then I would have worked on the detox pathways and methylation issues towards the end. Okay? So if you follow a clear clinical model, you're going to hit on all these important things. And then over time, as the years roll by, you'll start to develop more and more of a sense of how an individual test reading can really change someone's life, okay? And this is a little bit of a segue for our next session too. We're going to talk exclusively about detox indicators. But you've had many cases where this one marker here combined with this one marker here, or what changed that person's life. Is that worth three or four hundred bucks for a test? Absolutely. Absolutely worth it.

All right, so I'm going to wrap things up. Let me see here, what we have. Oh, the next class, again, apropos of detox pathways, is going to talk about. Our next mentorship program starts May 25th, which is next week. We have all kinds of amazing resources. If you guys are interested, call us, set up a time to talk with me. We're signing up people this next week. And let's see, we will, yes, we will have a recording of this available, so you're welcome to listen to it, send it to a friend, etc. And I think I'm going to wrap up now because we're right on the hour. Okay, everyone. If you have other questions, feel free to email them in. Otherwise, I look forward to connecting with you next month for our next talk. All right, bye for now.