Transcription
Acids and fatty acids, kind of my passion project for their time being. And we'll talk a little bit about the work that I do and the things that we have upcoming. Also, an additional course work for somebody that might be interested in taking additional classes with us as well.
All right, so, um, a couple of sort of a big picture items to discuss. Um, the first being that, um, it's not even a misconception. I think we have an industry-wide delusional understanding of amino acids. And I know I have participated in this delusion. I have participated in it personally with my patients. I participated by teaching amino acids, and maybe not the best way. And I'm trying to rectify this whole problem.
Why is this all even happening? Well, I went through a major metamorphosis about four years ago, and I started to work with a very well-known biochemist named Dr. Richard Lord. And Richard's been very gracious to me in his retirement years. And we spend a couple days a week now together, just training on amino acids and fatty acids and how to interpret these labs. And it's like being in, uh, you know, biochemical graduate program for biochemistry and human physiology, basically. And so, what, what I want to talk about is like how our profession works and how easy it is to get these misconceptions about what's happening. And I think that's happened with amino acids in a really extraordinary way.
So the whole role, the primary role, the primary function of amino acids, and we say they're the building blocks of life, is not their non-protein functions. That's a double negative. So their non-protein functions are not the essential foundations of life. It's very important that you make adequate serotonin, but you can live, and many people do, with low serotonin levels. Okay? That's a non-protein function of tryptophan. It's very important that you have bile, but, you know, a lot of people live, they don't even have the gallbladders. A lot of people live without gallbladders at all, right? So glycine, in its role, its non-protein role of helping produce bile, is really important. But, you know, you can live without adequate production of bile. But amino acids and their role in protein synthesis is where amino acids are essential building blocks for life. Okay? And again, this work is just usually not taught that way.
The way that I learned it, and the way that I've taught it all these years, is why use an amino acid? Well, you're low in tryptophan. We give tryptophan. You know, we give tryptophan, that brings up your serotonin and melatonin. You're low in, uh, cysteine or N-acetylcysteine or cystine. We, and we give N-acetylcysteine, and that helps with the production of glutathione. But what really matters more than anything with amino acids is their roles in protein synthesis. And that's the production of all proteins in the body. Okay? So we want to really kind of think about that from a deeper perspective. And then we also want to think about the non-protein functions of amino acids. Of course, they're important. Of course, we want to fix serotonin and fix gallbladder problems, all that stuff.
And then I want to put a fair amount of time today into also talking about essential fatty acids and how essential fatty acids are related to diet. You know, which you don't need to pay a doctor to figure out that you should eat nuts and seeds, you know, or that, you know, maybe cold water fish are good for you. You just pick up a magazine at Whole Foods and you can figure that out. Well, we're not, not really concerned about diet-related issues because that's like, whatever, you know, go eat healthy food, right? You don't pay a doctor to go eat healthy food. You pay a doctor typically when the healthy diet is not working and you just can't figure it out. And that's where you want to learn about fatty acids and endogenous production. That's where the problems are that we can really work with and dig your teeth into. And you can see all this on the labs. You can see blocks in endogenous production of fats on these tests. And that has so profound implications for cardiovascular disease, for energy production problems, for everything. It's so profound, it's hard to even wrap your mind around. Okay?
So those are the big topics we want to talk about. And, and not things that are, you know, run-of-the-mill functional medicine topics. So you guys should know these things. Um, starting in April, which is coming right up, we're going to have these lab interpretation boot camps. It's kind of an opportunity for you to work directly with me, for me to work directly with you for two months. They include four live calls. It includes a beautiful curriculum that Richard Lord and I have recorded in Richard's voice, talking about his work. And then it includes the clinical application stuff that I do and sort of specialized in for 20, 30 years now. And you get a discount if you come to us through Genova. You get 20% off, which makes it a very reasonable price.
We also have another boot camp coming up in early June on combining functional medicine labs like organic acids and fatty acids and amino acids with genetic testing. What a great thing that we can do that now. And again, these bootcamps are coming up. They're around a thousand, two thousand bucks each, depending on which one it is. You get a 20% discount, uh, on the lab, I mean, on the, on the class. So if you guys are interested, make sure you use the Genova discount for your 20% off. If you lose that discount, just email my office and say, "Hey, I heard about you guys through Genova, and I want to get the 20% off."
All right. So today's like a little cross-section of what we'll be talking about in that class. Amino acids and fatty acids play roles across all body systems. So you need adrenal, you need amino acids and fatty acids. Well, you need fats to make steroid hormones like cortisol. You need amino acids to make neurotransmitters. You need both amino acids and fats to make energy. Obviously, you need fats or steroid hormones, fats to make steroid hormones like the female hormones. You need the amino acids and fatty acids to work the gut. Work all the detox pathways and detox systems are dependent on these. You need amino acids to actually run phase two detox pathways. You need fatty acids to make cell membranes to keep toxins out, right? So the list goes on and on. You even need fatty acids, um, to make the brain work properly.
And so I always like to mention that we're looking at an isolated subject today, but there's a bigger picture here of emotional and spiritual crises that most of our patients are in, the chronic inflammation, and the different body system problems. And we're kind of looking at a little narrow spectrum, but we never want to forget that there's a bigger picture. And that the treatment model involves us interacting with a patient, not us just sort of looking at a lab and then making up a program. In fact, I really encourage people that take my more advanced courses to design programs when the patient's in the room. You know, and I used this, uh, example yesterday with a patient, and it seemed to work pretty well. I was like, "Well, you know, if you're planning a vacation and you planned the whole vacation out, right? And then you told your wife that this is what we're going to do on vacation, you know, how would that go?" Not so well.
If you're going to plan a vacation out, you know, you ask your partner, "Where would you like to go?" "I kind of am thinking about Hawaii." "Okay, maybe we could do the Bahamas." You know, whatever. You know, there's a negotiation, there's an interaction here. So when we're designing programs, it's not like I'm going to sit down and design a lab-based program and then tell my patient, "Oh, yeah, this is kind of what you need to do. And if you don't do this, that's like the way it is." You know, it's this interaction. It's this doctor-patient equilibrium. I'm saying, "Hey, patient, here's the underlying cause and the physiological damage." And then, and then I'm asking nicely, "What do you really want to change in your life? What are your goals here? How am I going to make this program work for you?" So I always sit down and design these complex programs with the patient in an interactive way. And that solves so many problems, you wouldn't believe. Um, it's, yeah, that's a huge one. It also means you don't have to go home at night with a stack of labs to interpret. I am paid by the hour to design the program when the patient's sitting across from me during their consultation. When that consultation is over, I put the file away. You know, and it's done until I see them again. There's no extra work outside of patient hours for me because I'm interacting with the person as I'm designing the program. And then I also like to follow these treatment sequences. We talk a lot about that in the, in the various mentorship courses I teach.
Okay, so now, quick review here. You've probably heard this before, but say it again. We need these 20 amino acids in order to make proteins. And this is the, uh, order by per, you know, by percentage, you know, how much of, um, an amino acid, not percentage, but, you know, by amount, by density, how much of an amino acid is in a given protein. They have these ways of measuring these. They're complicated. You can look at the research studies. They're cited back from 2014. But the idea being that we need all these amino acids, right? For every protein. And that there are these really critical non-protein functions of amino acids. Like arginine removes ammonia. If you don't have enough arginine, ammonia builds up, and really bad things will happen to your brain and body. If you don't have enough arginine, you need arginine to make nitric oxide. And if you don't have enough nitric oxide, then your endothelial tissues, your cardiovascular system, is not going to do very well, and you're going to develop hypertension, which is not a good thing, right?
Another example. Oh, lysine. You know, lysine doesn't get a lot of attention, but lysine is how your body makes carnitine. And the last time I checked, carnitine is how you perform fatty acid oxidation, right? Fat. Carnitine is how you burn fat. So if you're low in carnitine, low in lysine, you're going to be low on carnitine. You're not going to burn fat, and then you're going to be overweight, and you'll be tired, and you're not going to feel very good. So these, the list goes on and on about the non-protein functions of amino acids. And again, that's generally what we're taught in the various courses that we all take.
The big questions here, did you think about? And I'm just asking these questions, I'm not claiming I'm going to answer them, okay? Because they're deep. You know, what does that non-protein function even mean? Okay? Well, it means that you're not making proteins, but you're doing all these other hundreds of things or thousands of things that amino acids do. I also want to get a little bit into what's the single carbon pool, because that's another thing that amino acids do that's really important that we don't think about a lot. You probably didn't wake up this morning and think, "I wonder how the single carbon pool is working in Betsy, who's been tired all the time, has this MTHFR problem." Anytime you hear the term MTHFR or folate, you should the first thing you should think about is, "How's her single carbon pool good or not good?" Basic biochemistry. What do amino acids have to do with methylation? That's kind of a trick question, but we'll look at that. And then what does methylation have to do with glutathione?
So if you look at the really great leaders in our field, Mark Hyman comes to mind first because he's the most famous, brilliant scientist, brilliant researcher, brilliant physician, brilliant teacher. If you look at his work on what are the most important processes in the body, and you can Google this later, just Google Mark Hyman glutathione and methylation, and he's got a beautiful blog post. He's talked a lot about this in the past where the two most important body processes are the making of glutathione and the process of methylation. And we'll talk about how these are linked and why they're inextricably connected. Very, very important, directly related to what we're measuring on the tests. When you measure amino acids, well, this is a tough one, and I don't even know if we could probably spend the whole hour on this one slide here. I'm trying to look for a clock, but I don't know what time it is. But anyways, the, um, just think of it this way. The, the test is done fasting. So what you're looking at is what the body's releasing in terms of amino acids from breaking down tissues and what your body's making in the liver, okay, combined with the amount of amino acids that are flowing out of the bloodstream to make stuff, right? To make hemoglobin and enzymes and DNA and RNA and receptors, to make neurotransmitters and insulin and growth hormone and all these different things, right? So as the amino acids are flowing out, they're going to make things, and they're flowing in to the system from their body breaking them down. Now, obviously, if you eat a meal, it's a whole different scenario. We're talking about when you're fasting, which is how this test is done. So this test is looking at a really complex dynamic of what's happening with amino acids, okay? And it picks up a lot of, you know, genetic issues, which you might not be able to see otherwise.
So just a quick review of the things that it tests. Well, amino acids will look at the catecholamine related amino acids, right? Phenylalanine and tyrosine, and see if you're able to have the nutrients that you need to produce these very important chemicals called dopamine, epinephrine, and norepinephrine. Super critical. You also make thyroid hormones and melanin for your skin. It gives you color to the skin there. Amino acids are important for removing toxins. You can see phase two is dominated by amino acids, methionine, cysteine, etc., etc. And then amino acids are important for preventing cardiovascular disease. As I mentioned a minute ago, arginine levels, if they're low, are going to mean you have lower nitric oxide, and the lower nitric oxide is going to cause a problem with your cardiovascular system. Nitric oxide is important for healing and soothing and calming down the lining of blood vessels. And if you don't have enough of it, you can have the beginning of heart disease, and you can have the beginning of hypertension or high blood pressure, as well as arginine being important for other purposes.
And this is worth taking a minute just to take a deep breath and look at here. So, uh, I don't know, I just like reading these things, and I think they kind of open you up to like a new level of understanding. So I'm going to read this. It's a little boring to read a slide, but you see what I mean. I don't think I can say this any better. So let's forget about what it is. You kind of know what nitric oxide is, right? Nitric oxide, or NO, plays an important role in the protection against the onset and progression of cardiovascular disease. Cardiovascular disease is associated with a number of different disorders. The underlying pathology for most cardiovascular diseases is atherosclerosis, which in turn is associated with endothelial. Okay, the cardioprotective roles of nitric oxide include regulation of blood pressure and vascular tone, inhibition of platelet aggregation and leukocyte adhesion, and prevention of smooth muscle cell proliferation. These are all the things that would lead someone to have a heart attack or a blood clot or a stroke, right? And so that's an important role of amino acids. You might not even think about arginine. Yeah, it's important. If you don't have arginine, nitric oxide drops, and the endothelial tissues start to suffer.
Amino acids are critical for making glutathione. That's how you make glutathione. It's from three amino acids: cysteine, glycine, and glutamate or glutamine. If you don't have those amino acids, you can't make glutathione, which is again, arguably one of the more important nutrients in the body. And here are the three nutrients again: glutamine, cysteine, and glycine. That's how you make up your glutathione, which is the master regulator, protector of the body. And then amino acids and methylation. Now you can see the single carbon pool. So I'll explain this, and I got to go back a slide because I skipped an important point. But let me hear, let me go over this real quick. So here's methylation up here. This is the part that we're always seeing where you're taking homocysteine and it's converting to methionine, and then you're taking methionine and converting to homocysteine. Now, obviously, methionine is the amino acid. And if methionine levels are low, you've got a major crisis with methylation. I think we all kind of generally know that, right? That's pretty obvious. But the single carbon pool, that's not so obvious unless you really are thinking big picture in terms of methylation. So in order to make single carbons, to acquire them, we take serine, glycine, histidine, tryptophan, okay, and glutamine. There's five of them. We take these five amino acids and we break them down to pull out carbon. Okay? And that single carbon pool is then what folate works with in order to get methylation going. So you cannot run, run methylation without the single carbons. And the single carbons are coming from single carbon chemistry. It's coming from these amino acids. So if you're low in glycine, serine, histidine, tryptophan, or glutamine, then this process isn't going to go forward, and you're not going to be able to methylate, no matter how much folate you give to somebody, if the single carbon pool is not sufficient, this whole thing falls apart. So again, even for a process like methylation, that we think about as being B vitamin dependent, you've got a role of amino acids in there that's pretty profound. And you need to be able to test and correct the amino acids to get people to methylate properly. And again, you, I'll understand, I think, why methylation matters. Super important for making everything from DNA to detox pathways and all that.
Okay, so there are these non-protein roles of amino acids that we talked about, and I just gave a whole bunch of examples, right? Detox, neurotransmitter production, all this kind of stuff. Now, that's in my mind, kind of classic functional medicine knowledge that most of us, you know, these are familiar with, if not, you know, kind of conversant with. But now, here's, here's the part that's sort of shocking: is that any single amino acid that's low out of the standard 20 amino acids, the scientists argue about which they are, but anyways, most people agree there's 20 of these that are important. Okay? That's going to, any single amino acid that's low is going to limit all protein synthesis, except for collagen. Collagen is a little special. But besides collagen, if you don't have one of these 20 amino acids present enough, you can't assemble proteins properly. And that's every single protein in the human body. This, in my mind, now is the reason why I prescribe tryptophan when I see low tryptophan. Okay? It's going to help the serotonin. I'm glad you're not depressed anymore. However, I'm even more glad that you're able to synthesize proteins throughout your entire body now.
Okay? So again, the primary role of amino acids is in the synthesis of proteins. The secondary role is in their non-protein roles. And the way that I learned this, and the way that, you know, the way that our minds think in our field, is exclusively on the non-protein roles of amino acids. That's it. You know? So if you see glycine low on a test, forget about all the non-protein things it does. You have to give the glycine for protein synthesis to proceed normally. Okay? That's the deeper level of what we're doing. Now, obviously, I've been accidentally doing this my whole career. It's just nice to know that you can do it on purpose, too. In other words, I've given gazillions of people tryptophan, watched them get better miraculously from all kinds of problems, not really understanding that it wasn't just their serotonin that was improving, it was their ability to make all enzymes, all transport molecules like hemoglobin, all structural molecules, all the protein-related hormones like thyroid hormones and insulin, and all immunoglobulins. Every single immunoglobulin relies upon all 20 of those amino acids. So if you're low in tryptophan and you give it to the person thinking you're helping their serotonin, which you are, you're also helping them produce immunoglobulins, hemoglobin, digestive enzymes. All these things are impacted. And, you know, I would like to say I kind of knew this intuitively, but that is not true. I had no idea this was going on. I just knew that people got a lot better, you know, when I gave them amino acids, and I was like, "Oh, well, that's interesting." Like, you know, and you, you hear these reports. You guys have been in practice for a while, you know what I mean? Where they just tell you like 16 million things that are better, you know, and you're like, "Well, that's kind of interesting. I wonder why that happened. Maybe because they're sleeping better." But in fact, it's like this whole other dynamic.
Okay? And then there's, um, some pretty cool stuff that's out there about structural proteins. I don't know that's super important, but it's important if you work with a lot of musculoskeletal injuries, okay? That you need specifically for collagen production, you need glycine, proline, and hydroxyproline. These are all measured on the lab testing that Genova does, okay? There's no mystery here. If they're low, you see it low, and you can supplement accordingly. And if they have frequent soft tissue problems, this can make a really big difference for people. Now, if you have someone who's tired all the time, and maybe their oxygen carrying capacity is not really what it should be, then you would look at things like hemoglobin in relation to all the amino acids that you need to make hemoglobin, right? Which is a protein, which means all of them. Now, heme specifically is made from glycine. So there's a non-protein role there, okay? So your body makes heme from glycine, but the entire hemoglobin as a protein, the protein portion of it, needs all the amino acids, including glycine. Same with insulin, needs all 20. Immunoglobulins need all 20. Done to done. Okay?
So it's very easy to somehow think that conditionally essential or non-essential amino acids are less important. This is another misunderstanding that I was kind of plagued with for a long time because the essential amino acids, you have to get from food. The non-essential ones and the conditionally essential ones, you can make in your body. However, and this is where it gets a little tricky, you got to think about this one for a while. If they're not eating enough protein, or they're not digesting protein, you'll see the essential amino acids, which only come from diet, or low. But what if the ones that we make are low? Well, there's a bunch of reasons why that could be happening. But a common reason that that could be happening is that you don't have the enzymes in place that you need to make these amino acids in your body, okay? And there's a genetic problem going on. So again, if that's going on, and there's a genetic defect in the synthesis of amino acids in the body, then no matter what the diet is like, this just isn't going to work. And there's, of course, a whole series of inborn errors of metabolism, genetic disorders that appear in newborns when they're born, right? And are screened for this. These kinds of problems where they're not able to make a given amino acid. Like with PKU, they can't make the conversion from phenylalanine to tyrosine. You know, that can cause some pretty major health problems in a newborn baby. So we're always also concerned about these adult-onset genetic issues. And single amino acid deficiencies can ruin protein synthesis all across the board. This is a really important thing to start to think about. Now, we also want to be able to do the non-protein functions of amino acids, you know, and that's not, I'm not against doing that. Obviously, that's super important too. Okay?
All right, so anyways, enough fun amino acids. Let's talk for a moment about fatty acids. And again, I try to, um, I guess I'm kind of maturing. I don't know. I'm 56. I act like I'm 20 half the time. I act like a kid more probably more often than not, especially if I get together with my old buddies. I still hang out a lot with the guys I grew up with. We got the Berkeley boys. Well, grew up in Berkeley, California, and went to grade school and high school together. If you get like five or six of the Berkeley boys together, even though we're in our 50s, we act like we're 15 or something. It's pretty funny. But, you know, as I'm getting older, I'm also like looking back on my career and I'm thinking, "Man, like I kind of learned that wrong. I didn't really understand what was going on." And the fatty acids are just another version of that. And so I would really like if, you know, the twilight of my career here, in the next 20 years, you know, I can kind of teach things in a way that's a little more open-minded so you can see the entire picture, all the dynamics of the physiology, and incorporate that with the genomics. You know, that's, and I think if you're a new doctor, new to me, is doing this for less than 10 years, you know, you're new to the field, less than 10 years, then this could really help you shortcut, you know, a lot of the things, a lot of the misconceptions you might have.
So the typical view of amino, a fatty acids, and this has just saturated our entire culture, is that omega-3s are good, and that we don't get enough of them, and that omega-6s are, yeah, they're kind of good, but, you know, they're not that good. And anyways, even if they were good, which they kind of aren't, then we all get too many of the omega-6s. Okay? That's the common view. Omega-3 is good, and because the threes are good, the way the human brain works, the sixes must not be that good. It's very hard for us to hold gray areas in our minds. It's much easier to think, "Ah, threes are good, that means sixes are bad." And then if you really push someone on, like, "Are the sixes bad?" Well, no, they're not bad, but they're often bad, aren't they? Because everybody has high sixes and everybody has low threes. And so what this led, led to over, you know, the last couple decades, I've been watching, is that everybody prescribes omega-3s and nobody ever prescribes omega-6s. And a fatty, and there's a problem inherent in that, which we're going to talk about in a minute. This is kind of like the setup here for you, okay?
So what are the EFA deficiencies that we're even thinking about? Fatigue and depression, cravings for food, cravings for alcohol. I see a lot of people with low EFAs that have anxiety and panic attacks, or they can't sleep, just chronic inflammation, body pain, inflammatory disorders. Anything to do with your brain. Your brain is mostly fat, right? So these fats are super, super important. And then when you start to supplement with the right kinds of threes and sixes, it's amazing. People can see better, people have better mood, people have better triglyceride levels, people have healthier joints. And the brain, it takes a huge, you know, huge benefit from all this. So we're going to kind of revert back to a little of basic physiology here, biochemistry, so you can see how all this works. And I'm going to show you why this is important and why this isn't really important when you analyze labs. And, and we'll have some time at the end here to look at tests for you guys too, so you can see how all this actually works, okay?
So, and again, this is kind of set up, but let us do it here. Let's talk about the threes first because they get a lot more attention. Let's just get them out of the way. So the omega-3 oils, we start off with alpha-linolenic acid (ALA), and then we can make this one, and then this one, and then this one, and then down to some prostaglandins, some of the anti-inflammatory effects, okay? And the sources again, cold water fish, et cetera. And we use, I've got a bunch of diagrams. We're going to go through a whole bunch of these delta-6 desaturates. There's an enzyme that helps makes this, makes this work. You have elongates enzymes that add carbons. So you're changing these fats. You're making them longer. You also have a delta-5 desaturated enzyme. Then on this side, you have the sixes again, going down this pathway to GLA from linoleic, and then again going down to arachidonic, and the prostaglandins. Prostaglandin series 1 and 2 are over here. Prostaglandin series 3 is over here. Is over here. And that's the basic layout. So I find these diagrams really confusing. So I just put a bunch of them in this talk so you guys can see it. The same thing in different ways, you know, and maybe one of them will kind of click. Same exact kind of thing here, but now we're looking at them on opposite sides.
All right, this is like using scissors for left-handed people if you've ever tried to do that, okay? So omega-3s, we're going to start with cold water fish, ALA. There's an enzyme that converts ALA into this fat here. It's a delta-6 desaturates, okay? And that goes on for a few more steps, and then you end up producing EPA. Now, producing, yeah, you're taking this fat and making this fat. You're making this fat and making this fat and making this fat. And then you're thinking, "Well, I thought these were essential fatty acids. Doesn't that mean that we can only get them from diet?" No, some of these you can, okay? But some of these, like EPA, your body can make. And DHA, your body can make. Arachidonic, your body makes, okay? So just because it's a three or six doesn't mean that you can't make it. Some of the threes and sixes are only from diet, but the majority of them, you're actually producing. So anytime that you say that something's being made in the body, it's subject to, to not being made very well by a defective enzyme, okay? And there's a couple of tricks you need to learn about that really will help a lot, okay?
So number one is that the enzymes like delta-6 desaturates have a preferential, uh, converting effect on the threes. So if you're giving omega-3 supplements to somebody without lab testing, you're going to be soaking up this delta-6 desaturates enzyme, and you're going to mess up their sixes. If you give threes for long enough. Let me say that again. There's a preferential utilization, but these enzymes are going to prefer to convert threes. So if you give someone fish oil and you don't test them, and you do it for long enough, you're going to start to interfere with the production of sixes. It's not dietary. We're talking about enzyme enzymatic production. And I see this every day in practice. "How long have you been on those omega-3s for?" "12 years." "How many are you taking?" "2 grams a day." "Well, I wonder why your omega-6s are low. Maybe you've been cramming these enzymes with threes and robbing your body's ability to make the sixes." Now, some people might say, "Well, that's a good thing because the sixes are bad and the threes are good." But the sixes aren't bad, okay? The sixes are just a little different. In fact, the sixes also are responsible, which we saw a second ago, for making prostaglandins. Is a prostaglandin bad? No. Well, they're bad if you're inflamed and something's, you're sick, and something's going on. But these are not good or bad fats. You need both of these. In fact, when people get really low in the omega-6s, their brain starts to go, you know, not so good. It's a bad experience for people when they're low in. It's a very bad experience.
All right, and so, um, I'm not saying don't give threes. I'm just saying do the test. That's it. That's the message here. Just do the test. Because you can't tell. You can't just look at somebody and say, "I think you're low in threes." You can't tell. You really can't tell. And if they've been taking threes for a long time, you better test. And here's arachidonic. So this is a six, right? This is omega-6. It's making prostaglandins, it's making thromboxanes, leukotrienes. These are things that we all had to study when you had to deal with all this immune stuff into this immunology class. You didn't really like, but you had to memorize it anyways. So these are not bad things. It just, it's bad when your body is inflamed. But if you're too low in arachidonic, it's not good either, okay?
And here again, we'll make it the omega fats are how we make series one, two, and three prostaglandins, okay? And it's the balance of these fats that matters. So again, one more of these diagrams. I know I got a million of them here, but let's see. This one's a little different, but kind of the same thing. You will find some people that are low in threes. You will find some people that are actually remarkably low in omega-6s. You'll find some people that are low on both. It's amazing. And why would someone be low in threes? Well, could be a lack of cold water fish. Could be an enzyme defect. Why are people low in sixes? Well, maybe they don't eat enough nuts and seeds, or it could be an enzyme defect. See how it says right here, "compete for the same desaturates enzyme." If that delta-6 desaturates enzyme is not working well, then production, internal endogenous production of these fats is going to suffer. Okay? And that becomes a really catastrophic problem. Bad, bad, bad. And so you can have patients that are low in threes, or low in sixes, or low in both. It's all over the mat in terms of how that plays out. And that is an important thing to think about. And look, people who are low in sixes do not feel very good. I'm just telling you. It's not just that people are low in threes that have problems.
So then how could you be low in a six? Dietary omega-3 excess. That's not that common. I did have this patient, it was a married couple a couple years ago, and they owned a bunch of fish restaurants, like three fish restaurants, and they worked every day and every night in their fish restaurants, and they only ate fish, which is a little weird. Like, how many people only eat fish? But anyways, they were able to eat so much fish for breakfast, lunch, and dinner, and without throwing up somehow, that they had super high omega-3s and their sixes were low. But that's a little weird. Not too many people eat fish every day, all day long. Not too many people own fish restaurants. So people more commonly would be over-supplementing with omega-3s. You can also just have a dietary deficiency of the sixes, obviously. You could have a polymorphism or a snip in the delta-6 desaturates enzyme. That enzyme could have a snip. They're very prone to snips. A lot of people have that. It's common. You could have fat malabsorption. Maybe their gallbladder is not working that well. You could have damage to the mitochondria, and the mitochondria are not making enough fatty acids because the mitochondria make fatty acids as well. And then, this is a little note just to remind me to say delta-6 desaturates activity is really important, right? It's not just, you know, enzyme defects or snips, but also aging can cause a problem.
Here's the same diagram again, just to drive this home. We're talking about the threes and the sixes, okay? And the prostaglandins are super important. So a quick reminder here, and then I want to, uh, if we have time here, we're going to look at some labs and some questions that, um, we have a boot camp coming up on April 12th, lab interpretation boot camp on amino acids and vitamins. We're going to go into depth for a couple months on this subject. If you're really interested in it, come check it out. And we'll have four live calls, a series of lectures that Richard Lord's given, a series of lectures that I'm going to give, and it's a pretty robust class. You get 20% off if you're a Genova client and use that code there. And then we've got in June, a lab interpretation bootcamp on genomics, which is going to look at snip testing and how genes are expressed on functional medicine labs. So we're kind of combining those two areas together for a better clinical outcome for people, okay?
Now I want to show a couple of labs and I want to show on the labs one more little factoid real quick here, okay? And, um, I always like to try to do things that are kind of fresh, fresh and new, not old and stale. And so you can't get much fresher than today. It's like if you're in France and you go to buy some bread, and it's fresh, and you think, "This is really the way to live. People in this country eat fresh bread every day. Do they have gluten problems?" I don't know. Not that often. But anyways, so I want you to see this is fresh from this morning. In fact, if you were in one of the classes, you would have been in this class, and this is my clinical rounds call that we do every Tuesday morning. And these are labs that were just submitted today. So, and in terms of testing, you can run the Genova NutraVal test to get these results, and you can run the Genova ION panel. They're very similar, one would say almost identical tests. So clinical rounds from this morning, okay? Get fresher than this. Do here's David submitting a test, ION panel, how convenient, first one of the morning. Now we're talking about amino acids and fatty acids. So amino acids here, normal, looking pretty good. I don't feel my Ionia is a little low, isn't it? And that's not so great. Pretty good. But we're going to, it's one lab. I'm actually trying to get to that I remember from this morning. Let's just scroll here through here for a minute so we get it. Potassium and magnesium are low. That's really another time. But important. Here we go. Here's the, here's what an actual lab looks like. Omega-3s, beautiful omega-3s. You can see them right? The way you read the, see how it says alpha-linolenic, and then it has an 18. The 18 length of carbon. So that's an 18-carbon long fat. The eicosapentaenoic is a 20. Then of course, you go down to docosahexaenoic, that's a 22. So these fat chains are getting longer and longer. All right? And then we look at the omega-6s, and one of them is borderline low, almost low, but not bad. Don't let that person get by, okay? And then we want to look at some very important fats, palmitic and stearic. Palmitic and stearic are arguably, I don't know, I guess you might say the most important fats in the body. They appear in the largest amount. And in terms of endogenous or internal production, your primary, your body primarily is making palmitic and stearic. Okay? Those are the two most important fats that are made internally. Okay? So that's kind of a setup. So that was the normal test, obviously. So we're going to scroll down and home dedum, and we talk about that case for a while. Get another case for Monica here. Here's an organic acids test that we went over. And then, you know, we talk about that case. And Aaron submits a lab. And I think this is Aaron's first ION panel. She's like, "I don't know what to do. What do you do?" And I'm like, "Hey, I think this is what's going on. And let's talk about it."
So this person is low in phenylalanine and tyrosine. So what is the tyrosine going to help with? If you prescribe the tyrosine, what's it going to do? What's the most important thing it's going to do? The major effect, you know? And if you're, you know, you can type it into the little question box there thing. We'll have like a little quiz here. What's the most important thing that tyrosine can help with with this patient? Yes, you all fell for it. You see? You're falling for it. See, this is the problem. And this is why I'm going to tease you about this until you stop. It's just everyone's saying dopamine, dopamine, dopamine. I'm reading this, you guys can't see this. Dopamine, dopamine, dopamine. Thyroid, thyroid, thyroid. That's how we all got trained. Do you die if you don't have, if you have a thyroid problem? No, you get put on thyroid medication and you're fine. Do you die if your dopamine levels are a little low? No, you just get depressed and mopey and sad and compulsive with your behavior and lose all your friends, but you're still alive, right? It's protein synthesis. Now everyone's saying protein synthesis. Yes.
So I'm not kidding. When Richard Lord, he's been torturing me for four years. And I think two weeks ago, we're talking about, he set me up for this. We're talking about this case, and we're talking about glycine. I'm like, "Oh, damn, you mean the low glycine is why she's not making hemoglobin, and that's the oxygen carrying problem?" And he's like, "Yeah, I'm pretty sure that's it." And so we're all in this non-protein role, I mean, of, of, of glycine because glycine is how you make porphyrin rings. That's how you make heme, right? So I'm like, "Wow, I'm discovering this new thing." It's like, "Ugh, you're right. She can't make heme. She doesn't have enough glycine." And then he snuck it in. He's like, "Well, yeah, Dan, what else could be causing, what else do you think be related to the low glycine?" And I'm thinking, "I don't know, gallbladder problems." And I'm rattling off all these non-protein functions. "You need glycine to make bile." And he's laughing. And I'm like, "Oh, proteins. Oh, proteins. Proteins. Proteins is proteins." Okay? So I'm being overly dramatic here. So you guys try to remember this. The tyrosine being low, it's important and it relates to dopamine and thyroid hormones, but it's life critical for proteins. So when you prescribe that tyrosine, you're looking for an improvement in thyroid or catecholamine production, but you're also looking for an improvement in what? The synthesis of all proteins throughout the human body. That's why this stuff is so important. That's why you got to do amino acid testing. Okay? And the thing is, if they don't have a thyroid problem, who cares? If the main role of tyrosine is in protein synthesis, not in thyroid hormone production. Ah, but look at this, okay?
Omega-3s and omega-6s. If you didn't do this test, I don't know how you'd figure this out. This person is critically low in threes and not doing very well with the sixes either. Okay? Low, low, low, low, low, low, low, low. Okay? So a couple of quick things here. When you're looking at the reference ranges on these tests, like look at the EPA. See EPA, eicosapentaenoic. It's low. The results are a four. The range is 5 to 210. Okay? The range is 505 to 210. This person's at a four. And that is, uh, was it like micromoles per milliliter, I think, is a measurement. It's from a blood test. Now, I just want to cut over here to this other page. Now look at the palmitic. It's also low. It's at 746. The EPA was at 4, remember that? But look at the range for palmitic, 666 to 2500. So in other words, in a world where you make, I don't know, five or ten units of EPA, or have, I shouldn't say make, in a world where your body has five or ten units of EPA, you've got a couple thousand units of palmitic. Do you think palmitic's more important? Absolutely. It's super important. Where does it come from? Your liver. Your liver is making it, okay? And where else is it coming from? Oh, this is a really hard quiz question. If anyone gets this right, I don't know, I'll like mail you a nice gift from Amazon. Where else is that? This is a really hard question. So palmitic is made in your liver by your liver and then dumped out into your bloodstream in, uh, lipoproteins, right? Where else do we get palmitic and these other fats from in the first place? Well, when you eat food, and the food goes into the intestinal cells, and enterocytes, the enterocytes make chylomicrons, remember that from school? They make these fat little things, not fat little things, little things made of fat called chylomicrons. So there's a process in the intestinal cells where we package together fats and then secrete them out into the bloodstream. And there's an enzyme in there, and there's this whole apolipoprotein B48 that does that. And then in your liver, you also grab, you know, stuff, foods, glucose, whatever it is, you're grabbing from your meals, right? It's going into your liver. You're grabbing the, the macronutrient, and then you're packaging that into fat as well, right? And so a lot of the fats we make in our liver, obviously from sugar or glucose, not necessarily from dietary fat. So
Palmitic is made internally, endogenously, primarily. So, if you see low palmitic, what does it mean? It means the liver is not making fats very well. Is that a problem? Yeah, kind of. You know, because it's the major fuel source for the human body. Means that when you're, you know, not eating, you haven't eaten, like in the middle of the night, you're not going to have fat circulating for energy production. Will that interfere with your sleep? Yeah, of course, it would cause all kinds of problems.
Okay, so and again, these fats are super important: palmitic and stearic. And then you'll see this pattern often, and I've seen it, you know, it might be a dozen or two times the last year. Omega-3s and omega-6s are low, and palmitic is also low. And that's kind of a death blow to the brain, right? Because you don't have enough threes and sixes to put into your membranes. And on top of that, you don't have enough of the, um, of the palmitic to get these fats circulating. So enzyme production could be part of this. In other words, the ends, you don't have the delta-six enzymes to turn one fat to the, convert one fat to the other. Some of it could be dietary. Can some could be absorption related? But if you take a patient like we're looking at here, and you just give them the omega-3s, you're not going to get a very good result. You need to also work with the sixes at the same time, okay?
And this again is a fresh, hot off the presses from this morning series of labs. And then there's a whole other set of protocols that we're not going to talk about today. Sometime we can, we do some fatty acid stuff, maybe next year on palmitic and stearic and how you can fix those, okay? Because that's really important too. All right, um, let's see here. Oh, we had this other case. This says, um, I may be pushing my luck here on time. Oh, no, we got a few minutes. I'll do questions. But this was just a really cool case. This has nothing to do with today's class, but just check this out. This is really cool. These are all fresh in my mind this morning. These tests are so important, you guys. Uh, let's see. Yeah, I need to do a class on glycolysis sometimes too, sometime too, because I think that's something we don't talk a lot about, you know. Oh, well, my computer is kind of acting up where it's saying, "Dan, you're at the end of your time. Just better stop talking because it's over now." Okay. Okay, fine. All right, so I'm going to stop now because my computer is telling me to, and because we're out of time. But that means I can open up for some questions. And hang on, let me just get this cleared out there. And reminder, sign up for the bootcamps. You guys want to really do this stuff in a serious way, go for it. And, uh, oh my god, let me find the question thing here.
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You just, I mean, the bottom line to all this is you got to do the testing. You, and the more that you learn how to interpret the tests at a deep level, the more satisfying your life and practice will be. It's, it's just, you know, incredibly satisfying to really understand how all these enzymes convert things, and you can see this playing out in your patients' physiology. I mean, this morning's class, the Tuesday morning class, we had a patient that had just survived breast cancer, and she had the markers to show that. We had this patient with the fatty acids I just showed you with, um, oh, she, I didn't tell you the punchline: multiple sclerosis diagnosis. Okay, these people are sick. One person just got over breast cancer, and her pyruvate lactate are through the roof. That's scary bad. This woman just got diagnosed with MS. She has no fats for her brain, no palmitic, no stearic, no threes, no sixes. What the hell do you think is going to happen to your brain if that's what's going on? You're not going to be able to make the myelin sheath properly. There's no way you're going to feel normal, okay? There's absolutely norm, no way. All right, so anyways, I'm going to stop ranting here. Let me do some questions. Oh, so amino acids. So you can, in terms of the testing, either neutral valves or ion panels, depending on your age. Most of the doctors that are over 50, like me, do ion panels. Most of the doctors under 50 do neutral valves. That's kind of a joke, but not really.
Um, so is too much omega-3 inhibiting six reversible? Absolutely. I've reversed that over and over again. You just stop the threes, give the sixes, they'll get better in 90 days, okay? Takes about 90 days. Um, yeah, low fixing low palmitic, that is a whole another complicated talk. Um, I would, I know, and I wish, you know, you guys just buy one of these classes, and I can have more time. I just don't have time to get into it. I was going to pull the slides up, but I'm going to get yelled at by my staff. Out, did the Genova normal ranges reflect ideal ratios? Well, if, if the person's in the ballpark of the normal range on all the threes and sixes, then the ratios are going to be fine, okay? Um, and I don't think it really matters what supplements you use. Use a good quality company. They all have good omega-3s and sixes out there. I don't think there's a quality difference between those, okay?
Um, who's not getting enough omega-6 fats? A lot of people. Why is it diet? Probably not. What else could it be? Genetics, right? Genetics, genetics, or excessive threes. If you see many single amino acids low, yeah, then you can use combination amino acid formulas, okay? So when replacing threes and sixes, should you start with a baseline combo? Well, if the person is low in both, then I use both together, but in pretty high dosages. So I'll use, like, with that patient we had on the board, six grams a day of the threes and like 1500 a day of the sixes for a short period of time, for like 90 days, and just flood the system. That's the another way that you can start to get palmitic back too, okay? And then I think we have one minute left here, maybe a couple minutes left. Let me just show you this other thing here because it's so cool. And so, you know, I, I've been teaching for a long time. I've had this institute thing running since 2006. But now, as I've mentioned many times in these talks, I'm working with Richard Lord on a regular basis. And that's like going from, you know, a 1983 Honda Civic to a 2021, you know, Ferrari. So my, my teaching ability has skyrocketed because I just hang out with Richard, Dan Knight, now. And he's, he's just determined to turn me into a junior Richard Lord, which is amazing. In fact, we had, you know, we worked together Mondays and Thursdays. Yesterday, on Monday, we did our morning session and all the recording. And like, Richard, you want to talk in the afternoon? He was like, "Yeah, let's talk in the afternoon." So we did two sessions yesterday. Like, I really got to get this fat production thing figured out. He's the most generous and amazing human being. And he, the reason he's spending his whole life energy teaching me is because I do these things for you guys. He, he only wants his work to continue and for you all to have the knowledge that he has, you know, and that I'm that, uh, kind of in-between role player here, okay?
So this is the answer to one person's question here, real quick, one minute on this. Someday we'll do a talk on this too. We'll do the whole talk. Um, see where to go. I got the wrong slideshow here. It is here. It is. This is it. Uh, but just to answer that question that came in, forget who it was now. Here we go. This is the punchline on that one. There we go. Let me see if I can find the image here. So you see the cell membrane? It's fats lined up in that cell membrane. The fluidity and func, of that membrane is dependent on the quality of the fat. If you have enough threes and sixes in there, they're going to be fluid and keep the whole thing moving, right? If you have too many saturated fats in there, then it gets stiff and it doesn't work that well, right? And the threes and sixes are equally important. And I think we have, here we go. Um, here. So when palmitic and stearic are both low, it's a crisis with your internal production of fat. Here's another couple of examples. Palmitic and stearic are both low. It's an endogenous fat production problem. Your liver is not working properly, okay? And that's a straight-up liver problem with enzymes not working right in terms of producing fats, okay? And the way that you can fix that is attempt to get the threes and sixes working with high dosages of the threes and sixes, okay?
All right, you guys, I gotta wrap it up. Thank you, everyone. I hope to see some of you in the bootcamps that were coming up in a couple of weeks. And we'll talk to you again soon. Bye for now. You.