Mentorship Miniseries Organic Acid and Amino Acid Testing In Clinical Practice

Hello everybody and welcome to our mentorship mini-series, which is continuing with organic acids and amino acid testing in clinical practice. This is what we're talking about. So, uh, if someone could raise my hand, raise my hand, if someone could raise their hand to make sure my sound is working, and then I would like to start jumping in.

So, when, thank you, Kim. So, when I had been in, in 2015, I'd been in practice 20, 25 years, I kind of thought I knew what I was doing. And, um, I did. I, I very much thought I knew what I was doing, especially with organic acids, because I've been doing organic acids for 20 or 25 years. So you think you've figured things out. So I had my first conversation with Dr. Richard Lord. Well, that's not true. I knew Richard from years ago, but everybody knew Richard because you would call the lab and ask about organic acids interpretation, and he would get on the phone and tell you what to do. And so he had since retired. He was in his mid-70s at the time, and I emailed him some, just kind of random question, and we got on the phone and started talking. And, um, seven years later, he and I talk, you know, once or twice a week. I've got hundreds and hundreds of hours of him recorded now. He's, you know, reoriented my entire brain and nervous system to really understand organic acids.

So Dr. Lord is the scientist that first thought of using organic acid testing as a way to look at nutrient levels. And when we had our first conversation, um, he told me what his real intentions were with this type of testing with amino acids and organic acids. And my response to that was like, Richard, like, nobody knows that this is what we're supposed to be thinking. And his response to that was to sit down and write a couple hundred page book and to spend the next seven years teaching me what he meant by that comment. And the comment was, Dan, these tests are screening tools to determine both nutrient deficits and genetic disorders. And I was like, well, wait a minute, let's just reverse the tape a minute. Genetic? What? He's like, yeah, that's what organic acids and amino acids testing is for. So that really opened up a whole new world of concepts for me, and I want to pass it on to you as we talk about this test.

So when we say metabolomics and organic acids is measuring metabolomics metabolites, however you want to see it, it's also, you should always be accompanied by the term genomics. So what are these tests about? They're about metabolomics and genomics. That's what they're about. They're not about assessing nutrient levels. They're about metabolomics and genomics. Okay? And try to explain what that means today.

So who am I? If this is the first one of these you've been to, that is super exciting. Glad to have you here. I am Dan Kalish. I have been around for a while. I've been practicing for, this is my 30th year, believe it or not. And, um, I've trained thousands of doctors in it. At the Kalish Institute, we have a one-year mentorship program. We've had these shorter courses that are boot camps, and, uh, I just love teaching. And the last seven years working with Richard has really brought my skill level of teaching to quite a high, uh, higher bar than I had before. You know, um, he's really poured his heart and soul into training me, and it's, it's probably the greatest privilege of my life, really, to be able to do that with him. He's quite a person, and he's meant a lot to our profession, and it's my role now to carry on, uh, generationally, you know, what he has given us to you all.

I've also done research with the Mayo Clinic, and I'm IFM certified. I passed the test. Yes, that's a really hard test. I was sweating it. I wasn't sure if I passed when I walked out of the exam. I remember that thinking, I hope I passed that test. But I did. So I'm IFM certified.

So you can join us for upcoming things. You get 20% off if you use this code, MINI22. And the next big boot camp we have coming up is the Long Haul COVID Syndrome Boot Camp, which I've put a fair amount of work into, and so has Dr. Lord. And you're going to be hearing from both of us if you sign up for that class. We talk a lot about the pathways, talk a lot about the mechanisms, and it's all lab interpretation oriented. So you can start to see what we are all facing now in terms of long-haul syndrome patients. And in this week, yesterday's classes in the mentorship program, each hour-long class had a long-haul COVID patient that was represented. And so this is a very real problem we're seeing in clinics all throughout the country, and it's certainly going to be growing as a problem. So it's something we all want to learn about. Okay, so you can register for that if you're interested in learning a little bit more detail about this stuff.

Now, for organic acids. So they're, so hard to even think what they are. They're looked at in two different ways. In a simplistic way, you can think of organic acids as a nutritional screening test to see if people are deficient in different things, B vitamins, etc. But at a deeper level, you can also see the interaction between the environment, the genes, and the, and, um, that patient's psyche and spiritual life, in a way, you know? So it's that, the depth of this test. It could be as superficial as saying, "Oh, you need B6 because your B6 marker is high." And it can be as deep as saying, "You know, I think you're under a huge amount of emotional stress because your catecholamine markers are high, and you're toxic because of your exposure to environmental toxins, and that's why you can't lose weight." So there's, there's different levels you can approach this at. And at its core, we're looking at metabolic dysfunction. We're not looking at disease processes, but we're looking at metabolic dysfunction that creates cardiovascular disease, that creates higher risk for cancer, that creates higher risk for diabetes. Right? We're seeing the underpinnings in the cell physiology and biochemistry of metabolic disorders, which are what are, you know, kill most people in the first world country. So these are, these are big deals. And if you can find out and learn how to interpret these labs, you can absolutely prevent people from going into these chronic disease states.

It has been accepted in functional medicine that organic acid testing should be reserved for a special class of chronically ill people that aren't responding to the regular testing. I mean, that's how I was taught this stuff. "Oh, don't do organic acids because it's so expensive, and you only want to do it on someone who you can't fix." And that is ridiculous. And I did that for a long time. I did that for 20 years. I only ran organic acids testing if everything else failed. And then I hired an assistant who started to screen all my new patients, and he was smarter than I was at pitching new patients on what to do, and he got every one of my new patients to do an organic acid test. He's like, "Why not do it? It's like, whatever, it's a couple hundred bucks, it's $300, do the test." So then, since Mark worked for me, and that's been a while ago now, my son was a little kid, so it's probably 10 or 15 years, I've had every single one of my new patients, every single one of my new patients, do at least one organic acid test, and often as many as five or six or seven over the course of a few years. And what I've learned from doing that is that you should do an organic acid test on everyone because it really makes a difference, regardless of what the condition is. And if the test comes back and it's clean and it's perfect, that's even more of a reason to have done the test. So, and that won't happen, by the way. You know, very few people who are going to be able to pass this test in a sense and have it all be normal. You will find so many things that are so important for how the cells work in the body that it's, in my mind now, just a required initial assessment for any new patient workup. I would feel like I was committing a negligent act if I tried to design a supplement program for somebody without the organic acids in front of me. I would, I don't think I could physically do it anymore. I would just be like, shaking or something. This is a really important test. It takes a little while, a little while to see that, but you're going to find out inflammatory problems, you're going to see toxin-related issues, you're going to see neural inflammation, you're going to see mitochondrial damage. You'll see if the person's catabolic or not. You'll see the underpinnings of insulin resistance. It's got a whole section of markers on oxidative stress. These are the, the key factors that we're looking at in terms of patients, you know, health problems. So it's an essential test to do, and it's going to help you hone in on the brain issues, the mitochondrial issues, the nurture, the toxin-related issues, even a section on gut-related problems. So you can see what is physically getting damaged here, what's going on. Okay, so it's a very, very, very important test.

So now there's a couple different ways to think about it. You can design simple supplement programs based on one supplement per sec. These and then, you know, on the difference between adept and subarray and ethel melanade, and you don't have to understand, like, in-depth about CoQ10 biosynthesis and stuff like that. You can just figure out, "Oh, okay, there's a mitochondrial problem." That's easy. I'm going to give that person this, you know, general mitochondrial support. Or there's a liver detox problem. Okay, I'm going to give them a general liver detox support. And so the products that are designed by all the companies that we work with, like for mitochondria, for example, they'll have all the nutrients that the mitochondria need to work well crammed into one capsule. So you don't have to figure out exactly which nutrient and what dose the person is going to need. Same with liver detox products. Every company will have a liver detox product that'll have all the pathways of liver detox covered in one supplement. So you don't have to, like, narrow it down to which pathway and which nutrient works for which pathway. So these general broad-spectrum products can be used easily. The first organic acid profile you run, you can use these products very effectively. And then as the years roll by and you learn more about each individual marker and pathway, then you can get more sophisticated with the programs, which makes it, um, easy to get started with, but a rich learning experience as you go on.

And now I spend, you know, this is kind of ironic. I never thought of it, but I spend more time now designing every organic acids related nutritional program than I did five or ten years ago. You think you'd get faster at this, but you don't because it gets more interesting and you want to learn and you get better at it. And it's something that is, it just, it's a joy to do because when you get just the right nutrient for just the right pathway for just the right person, you can change things in a way that other practitioners have not been able to do. You know, and these patients that have gone from person to person to person and just never gotten results, you can help them. And if it's an easier patient who's, you know, first time they've seen an integrative doctor, then even better, you know, you can make a really big difference with people doing this.

So when Dr. Lord first set up these tests 30, 40 years ago, he was thinking about organic acids as a screening tool for inherited metabolic diseases in adults. There is now a book about this subject, which you can buy. I bought a copy of this last year. I would encourage you to buy it. It's a thick book. It's heavy. It's heavy emotionally, heavy, and it's physically heavy, and it's kind of intense. But it's kind of like a reference book if you want to get into the metabolomics and genomics aspect of the work. Turns out that the metabolic diseases that present in early childhood can also present in adults, and we can help screen for these disorders of the mitochondria, of the urea cycle, of all these different things with this test.

So this complex slide is designed to let you know that there's a lot of science behind all this, but that you don't need to understand all this in the very beginning. Okay? You can keep it simple. And for example, if you see a problem with one of the citric acid cycle markers, you can give that generalized mitochondrial product, and it'll work really well. If you see a problem with tryptophan, you can just give tryptophan, and it'll work really well. If you see a problem with fatty acids, you can give fatty acids, and the product, the product, and the program will work really well. So you don't have to understand this level of complexity to get clinical results. You really don't. It's interesting, and over the years, you probably want to learn a lot of these different things, but you don't have to now.

Oh, and I want to queue this up too. So let me show you here. Um, because we're about, we're about to talk about B vitamins for a while, uh, here now. And I'll do questions at the end, okay? So your body takes amino acids, see those? And it breaks them down into keto acids. This is the crux or the core of how we can measure many of these B vitamin markers. Okay? So amino acids and B vitamins, very much tied together.

And then one of the things that has occurred to me in my old age here, I'm 57, almost 58 now, is that the first things I learned in my earliest clinical training were some of the most important, and then I forgot them for like 10, 15, 20 years, got distracted by complicated things, and now I'm coming back and realizing, wow, B vitamins are really important. And you don't really see a lot of conferences on the importance of B vitamins or, you know, like why B5 really matters. Now it's all about the new products of the era that all the supplement companies are trying to sell, which is okay because that's their business model, right? Nobody makes money off of B vitamins. It costs like eight bucks for a bottle. However, when I went back, and I have this personal obsession with the Nobel Prize because I think it's kind of an interesting organization, you know, but look at how many Nobel Prizes were given out for B vitamins. 1929, B1, right? Then B12, then B12 again, and then B12 again. And then in 1938, another one, B2 and B6. That guy was pretty smart, he figured out two of them. Okay? This just goes on and on. In fact, one of Dr. Lord's teachers discovered, uh, two of the B vitamins. He didn't get the Nobel Prize, I don't think. But anyways, the point of this is that in the history of medicine, as we've each year come together and said, "What's the most important thing that our science has brought us?" B vitamins ranked right up there. And it's not like the Nobel Prize committee was spaced out on this one, or they made some mistakes. Look how many, this went on from 1929 until 1964. Okay? And so B vitamins are very, very important to scientists who study human health, and they should be at the absolute top of our list in terms of treatment interventions. It's very, very important.

And then why do they call them B vitamins? I don't know. It's just kind of a funny story because they started off with the first one they found, it was beriberi, was the disease that was associated with it. So they just started with this "B" thing. It's just kind of random. But anyway, so the B, the B vitamins are coenzymes. And so when you say that term "coenzyme," you immediately think, "That's not that important." And my examples I use in class all the time where if you're walking on an airplane, as I just did recently, and you see the pilot, and you're like, "Okay, well, she's going to fly the plane." That's a good thing. And then you see the co-pilot, and then you're thinking, "Oh, okay, that guy's the co-pilot." And you're immediately thinking, "Ah, you know, the co-pilot, it's okay, maybe he has a heart attack. That's okay because the pilot's going to be able to." It's more important. Or a co-star in a movie. You have a star and a co-star. The co-star is always diminutive, right? They're not as important. So when we say the word "coenzyme," it seems like, "Oh, you know what? That's not that important." Look at the Nobel Prize committee. They didn't think that. They thought that this is a really, really important thing. So B vitamins should be at the very top of your list. If someone says, "What are the most essential nutrients for life on this earth?" And Richard has asked me this question before, under pressure, Dr. Lord, who said, "What do you think are the most important nutrients for life on Earth? Not just human life, Dan, but all life." I got it wrong. But the answer was B vitamins. They're essential. They just have to be there. Okay? And if there's any sense of deficiency of B vitamins, people are going to have major metabolic problems, and organic acids will tell you that. It's one of the core parts of this test. Okay?

So that coenzyme is the part of the enzyme that's required to make the enzyme work. It's not like a peripheral thing. It's not the co-pilot. It's not the co-star. It's like the central player in getting that enzyme to be effective. Then on the flip side, the amino acids are used to make the protein to make the enzyme. So you need the amino acids to make the enzyme, you need the B vitamins to make it work. And now, if we think about that relationship, and I'll show you, this is the classic version of it here, right? Where you have, you see, we've all seen this in textbooks when we were in school, where you have, uh, the enzyme, and then it's this kind of lock and key thing, right? In the, and the coenzyme fits in there, and then the enzyme becomes active. That's the typical depiction that we see all the time.

When you think then about the importance of B vitamins, you think about what are the things that B vitamins do? They're required for DNA synthesis. They're required for protein synthesis. Your metabolism is completely dependent in every step on B vitamins. Neurotransmitters are dependent on them. Hormone production is totally dependent on them. I said protein synthesis twice. It's kind of like a joke, but that's like super important. So I said it twice so you don't forget. It was the second one. It's the last one too. You need B vitamins to correct every body system that we work with: neuroendocrine, GI, detox. You need B vitamins to deal with inflammation. You need B vitamins to deal with catabolic physiology. You need them to deal with insulin resistance. You need them to deal with oxidative stress. You really do. At some deep level, you need them for depression and anxiety and digestive problems. They're just everywhere in our field. You need them. If you look at this was a, just this random slide I found, but, you know, you look at every little phase of these are all B vitamins here, right? NAD, NADH, FAD, that's niacin, riboflavin, there's vitamin B5. It's all B's everywhere. Folic acid, B12, B6. It's all B's, B's, B's, B's. One B vitamin deficiency screws the whole thing up. And they're very common. This is back to Richard's concept. The genetic variation between human beings on B vitamin needs is massive. And so you're going to have a large percentage of patients whose needs for B vitamins are quite a bit larger than the average pop person in the population. Okay? Those are the people that tend to get sick because they don't have enough B vitamins. So the genetic variation on an individual's need for B vitamins is huge. Roger Williams wrote about this in a book in the 1950s called Biochemical Individuality. If you haven't read that, you have to read that book, Biochemical Individuality. And it says, scientist Roger Williams, this is one of Dr. Lord's, um, PhD dissertation kind of peoples, where he was a professor where Richard went to graduate school. But Roger Williams, the discoverer of a couple of the B vitamins, realized very early in the 1950s that the genetic variation between patients for B vitamin requirements was behind a lot of the mental health problems that they were seeing in the 1950s: schizophrenia, bipolar disorder, depression. It's all written up in this book in the 1950s, really, you know, pretty far ahead of his time.

B vitamins and amino acids are required for methylation. You probably knew that one already. That one's kind of easy. B vitamins used to supply the energy for the brain, the nervous system. B12 is required for myelin. We need B vitamins all over the stress pathways. Everybody knows that one too. And of course, carbohydrate metabolism. And then you need B vitamins to detox. It just never ends. But just to keep in the, in the front of your mind here, that genetic variation can lead to greater than typical need for B vitamins.

So again, the B vitamins can be measured with these alpha-ketos. And it's all this complicated stuff, but the amino acids break down into these alpha-ketos, and that process is regulated by B vitamins. So when you see, sorry, I got the wrong, sorry, hang on a second. When you see that, uh, I want to show you the lab, and somehow I pulled up the wrong one here. I apologize. When you see on the labs that there's a B vitamin deficiency, what you're seeing for many of these markers is involved with amino acid metabolism. Okay? So amino acids and B vitamins get tied together in a whole wide variety of ways that are, um, pretty almost inextricably linked. Sorry about this. I've got the wrong thing here, and I've got to change real quick. Don't go away and check your email or something. Just give me about 10 more seconds. I'll have this done here. Apologize. There we go. I updated this right before I went on, and I pulled up the old one. So now we can measure all these things. This is the phenomenal part of what we're talking about. Is you can measure all this stuff, and measure it, you should do.

So if you look at the labs here, you're going to see all these markers. And the key point to remember is that when you see a high marker, and just to keep this easy, when you see a high marker, you're going to think that there's a problem with a deficiency of a B vitamin. And this always trips up patients too, right? Because they get confused, they think, "Well, my marker is high, and why does that mean I'm low in B vitamins?" You're going to have to take a minute and explain that to people. So a high B vitamin marker typically means that there's a deficiency of that given B vitamin that they're tracking, right? And a series of low B vitamin markers means that you've got a problem with the mitochondria. There's not enough mitochondria present to make this whole thing work. So those are the two variables that we're kind of juggling back and forth between. And I'm sorry, but there's something happening here with my computer. Oh, I see. I just found it. Alright, let's try this now. It's called having too many windows open. There we go. All right, now we're out. I'm going to pop my screen back up again. You should see this in just one second. Ding ding. Apologize for this. Ding ding. There we go. So, [Music] bingo. You should see that. Yeah, someone can type in if they can see that again. You guys see me again? Yeah, okay, good. So now let's go back here. Oh, sorry, second. Oh, my gosh. Hang on a second. I have too many windows open. I'm sorry. I'm teaching two webinars today, and I'm just a little overwhelmed by my, my own self. You got a sec open? There we go. Bingo. All right, now we're back in action. Okay, so I apologize about that. I had two presentations opened at the same time, and I got them flipped around. Now we're back on track.

So now let's take a look here at, I wanted to talk about beta oxidation just for a few minutes because this is, um, if I look at the things, the things that I didn't know, the things that I wasn't taught, the things that I wasn't taught until it was almost too late, you know, like, I'm, I'm, I've been in practice for 30 years, I'm clearly more than halfway through my career. Like, why am I learning some of the most important things like at the midway point? You know, this just doesn't make any sense. So let's just stop that trend, and let's have you guys all spend the next two to six months really thinking about beta oxidation. Okay? It sounds like an obscure thing. I promise you'll thank me if you spend some time reading about beta oxidation. Go listen to some Khan Academy videos about beta oxidation, and let's get all on the same page here about how important beta oxidation is. Okay?

So it's, you require B2 to make beta oxidation work, and it's the burning of fat in the mitochondria. When we're at rest, like just standing around, like we are now, sitting around, listening to something, working, whatever, 80 to 90% of your cellular energy is coming from burning fatty acids through beta oxidation. When you start to exercise, everything changes. But it's a very important process, and it's a very complicated process, and it's very prone to error. It's very, very prone to error.

So here's the cytosol, here's the mitochondria in green, here's the mitochondrial outer membrane and the mitochondrial inner membrane. And this is what your body has to do. It has to get the fat, the fatty acid, in this case, palmitate, so our example here, that's the main fat that we burn for energy. It has to get the fat from the cytosol across the outer membrane, across the inner membrane, and back into the part of the mitochondria where the energy can be produced. It has to do this at a very rapid rate. And it, it's not possible for these fats to just diffuse across the membrane. If that happened, then every time that I ate ice cream, I'd probably have a heart attack because if the fat in the cytosol could get into your mitochondria just at will, it'd be a disaster. It'll be like horrible. So this highly regulated process. Your body's holding the fat out here so that when you eat ice cream, you just get fat. Your body gets fat. Your mitochondria don't all die, right? So in order to get that palmitate or that fatty acid across these membranes, you have to cram a carnitine molecule onto it. Then it makes it small enough that it can get through these different mechanisms that transport it through the membrane. There's this translocase protein and this transfer protein here. And then once that carnitine-bound fatty acid is in the inner part of the mitochondria, your body tosses the carnitine back outside the cell and it burns the fat up for fuel. So if this process is not working, you've got an interference with 80 to 90% of cellular energy production when the human is at rest. It's a big deal. And you can see here, the palmitoyl CoA molecule is huge. It's a big molecule, and it won't fit through the membrane. It's just too physically large. So your body has to strip off the CoA part and cram on the carnitine, that's small, that gets through membrane one, through membrane two. And then when it gets here, the carnitine gets stripped off again, gets put back out here, and your body takes another CoA and crams it back on the fatty acids so you can burn it up for fuel. You see that? It's, take me like two minutes just to explain it. Can you imagine how complicated it is? How many genes are involved in this? And this can get screwed up in a hundred different ways, and it does often get screwed up. And you can see that on organic acids testing. And when we go over the labs, I'll show you some examples. Okay? And here are the size challenges again with the carnitine that makes it smaller so it can sneak across. All right.

So now I'm gonna, oh, and for those of you that joined us late, there is a webinar, I mean, sorry, a boot camp coming up. You get 20% off if you sign up for it using this code MINI22. Uh, Long Haul Syndrome. And starting in June, this is going to be a two-month deep dive into the lab interpretation information that we're all learning in real time now in treating long-haul COVID patients. We have, as I mentioned earlier, every week in the classes I teach in the mentorship program, patient after patient that has long-haul syndrome or COVID vaccine-related symptoms. And we're seeing the labs and we're learning what this all means and how to help people that are in a very dire situation. Okay?

So now let's look at some tests. And I'm going to pull up a couple of labs, and let's go through organic acids. Now, this, there are many sources for organic acids testing, and there are many fine labs in our industry. There is Genova, which has the Organic Acids Profile, Organix with an X. There's Great Plains, which has its own organic acid profile, or OAT test, as it's known. And then there is a new entrant into the area, to the field, which is Diagnostic Solutions, which many of you know of already, the lab company that does the GI MAP test. They are now offering organic acids as well. And you can't really go wrong. I use a combination of Genova testing and Diagnostic Solutions testing in my own practice. I don't use Great Plains. It's not that I don't like Great Plains, it's just that I don't use them. I, I mean, how can I say it? Like, I have an Audi. I don't have a Mercedes. Do I like Mercedes? Yeah, I think they have a lot of nice cars. I just don't have one. You know, I'm not against Mercedes. I just like the Audi. I'll probably buy a Mercedes someday, you know? So I'm not against any of these labs. But, you know, what happens to most practitioners is you get really familiar with one or two of these companies, and it's kind of hard to learn them all. So I just want to show you a couple of examples here, especially the one that's a little obscure because you're not going to hear about this a lot, and I want to show you clearly what I'm talking about. Yeah.

So let's look at this first. So remember I showed you a couple of images of this alpha-keto thing? I was like, "Oh, it's kind of related to amino acids, but a little confusing." That's how they measure many of the B vitamin markers. If the alpha-keto goes high, it means there's a deficiency of the B vitamin. But it's also important to note that that means that amino acid processing or metabolism isn't working very well either. And there are some really critical B vitamins. If you just want a take-home message, you know, one thing to kind of take home from today, I would say, if I was pressed, if someone really kind of twisted my arm hard enough and said, "What's the most important B vitamin?" I go, "Ah, you'd be like, ah, about B, I'd B6." I would just say B6. Most people probably would say B6. I'm sure there's some B12, folate people out there, but B6 is pretty darn important. Let's put it in the top three, no matter what. Okay? And so there's a couple markers on here. You might see this in different tests as pyruvate or pyruvic acid, or this one is pyridoxic acid, but it's the same basic compound. That marker goes high, that's a deficiency of B6. You can, uh, you can also see xanthuria, xanthurinate, or xanthelic acid go high, and that's another marker of a deficiency of B6. And these are probably, if you miss B6, if the person is deficient in B6, and you don't give them enough B6, your hormone programs won't work, your detox programs won't work, your neurotransmitter programs won't work, your metabolic programs won't work. This is very important, and a lot of times people are underdosed on B6. So I start everybody, if they're deficient in B6, on 100 milligrams of B6 a day, using the five-phosphate form, P5P. If that's not enough, I will, you know, after maybe two weeks or three weeks, unhesitatingly go up to 200 milligrams a day, no questions asked. Do I often go above 200? No, I'd have to have a really good reason because that's a lot. But when somebody has a B6 deficiency, or even worse, a genetic problem which is leading to B6 deficiency, 25 milligrams of it is just not going to touch it. So I would recommend you generally start with either 50 or 100, and then feel confident to double the dose if you need to until you're starting to get a clear result. Okay? So that's one section of this test. I just want to show you one other, like, kind of real-life example here. I think it's back this way.

And I talked a lot about this. There's so many markers on here. I just want to show you. Here it is. The fatty acid oxidation part. So this should not be like a peripheral, peripheral issue. This should be like top, top of your list. Adipic acid, succinic acid, right? There's a whole section of markers here. Ethanolm, ethylmalonate, at the malonic acid. If these are high, like here's an example, one that's high, then that means there's a block in the body's ability to use carnitine. Remember we just saw how important carnitine is because it's the shuttle that grabs that fatty acid and pulls it into the mitochondria. There's no other backup system for that. You know what it's like? It's like a plane. You know, I was recently flying somewhere and I woke up like two hours early because I was worried about missing my plane. When you, when you have a plane reservation and you go to the airport, if you miss that plane, there's no guarantee you're going to get on another plane at all. So carnitine is like that. It's just carnitine or nothing. There's not another shuttle that's around that's, "Oh, if your carnitine is not working, then this will." No, you have to have carnitine, or those fatty acids are just going to stick out in the cytosol, and you won't burn them up for energy. And then what would be the symptomatic expression of that? Well, first of all, people would get fat, right? Because they're not burning fat very well. Then they get tired, exhausted all the time, and they can often seem to have blood sugar related problems because they're going to crave carbohydrates all the time because they need something to keep their energy systems going. So beta oxidation problems will lead to high triglycerides, high cholesterol, metabolic syndrome type stuff, eventually, if it gets bad enough, it'll cause problems with blood sugar fluctuation, and it will mimic or can mimic the symptoms that you would associate with carbohydrate metabolism problems. It's confusing. That's why we do the lab so you can really clearly differentiate, you know, which thing is happening where. All right.

Now, let's see here. I want to leave some time for questions. Uh, let's see here. Oh, I can show you like on it. This is the, again, this is an Omics report from Diagnostic Solutions. This is the newer, or the newest organic acids test, and they have some nice summary information on the front of it. And you can look at metabolic functions, amino acids, nutrition, stress, and mood. It's a nice little summary section there for you. Okay?

Now let's take a look at another test. And then I'll, yeah, we still have like 10 minutes, and then I'll go to questions. Okay? I'm just going to pull up some more labs here. You can see some other examples. Oh, let me find one. So we had some really, so it's like, I don't know, it was probably the saddest day of teaching I've ever had was yesterday. I really generally, as you can tell, enjoy teaching. I find it uplifting and fun. And, but yesterday, it was just grim. I'm just going to show you. So horrible. So this is from yesterday's mentorship class, but this is the reality that we're all facing now. So here's a 12-year-old kid with severe depression. And now this is a Genova Diagnostics Organics test. This is one that Richard designed, um, I guess now it's a little bit old school in a way. And I just want to show you, and you'll find these markers on all these tests. So, you know, once you find out what's your favorite test, you can just use that one.

So when you're looking at these labs, the, um, what I try to do is go not in the lit priority in which the lab is printed out, but in the priority of like, what's the most important stuff? Okay? And so, hang on a second, let me share my screen again. Here we go. Organic acids from Genova. And on this particular, well, on all of these tests, the most important marker, according to Dr. Lord, and I'm just going to trust him on this because he's the guy that invented all this, is a sulfate, or any marker that has to do with glutathione. In this case, it's sulfate, pyroglutamate, and alpha-hydroxybutyrate. These all three are glutathione markers. And the worst thing that can happen to your glutathione is that sulfate is low, pyroglutamate is low, and then alpha-hydroxybutyrate is either high or low. So this person is at the end stage of glutathione collapse. And again, it's a 12-year-old that's severely depressed. That's not a good thing because glutathione does what? It's the master antioxidant that protects your brain. And then if you look at the neurotransmitter markers, you'll see why this kid is so depressed. 12-year-old, you know, 12-year-olds are supposed to be getting in trouble, you know, for like, I don't know, when I was 12, what are we doing? Like, I don't know, you like, I remember the worst thing we did, we, we got caught throwing mud balls at cars when we were 12. And my friend Ricky Taylor's dad, we really yelled at us. We were like, in serious trouble because we were making these big mud balls and not them at cars they were driving by. And these rain storms, so we were hiding in these trees. We didn't think anyone would find us, but someone found us. So you should be doing that. You shouldn't be like depressed and sitting in a functional medicine doctor's office. So this kid has extremely low vanillylmandelate, which means low epinephrine and low norepinephrine, and reasonably high, uh, homovanillate, a little bit on the high side, that's a dopamine marker. And then very low serotonin, okay, along with low glutathione. And this is sort of packaged together. This is the power of organic acids. You can see exactly why this kid's brain is not doing well. Glutathione levels are low, there's no protection for the brain, the neurotransmitter markers are low, and you can absolutely help this kid in a really significant way. And I've had thousands of patients with this exact same lab, exact same lab. I've seen this a couple thousand times. You can help these people a lot. Okay? So again, this is a Genova Organic Acids test, Genova Diagnostics. This is a good one.

And we have time for one or two more examples. Let's see here. Um, let's just scan through. You can see we do a lot of, every, every mentorship class, we just go through lab after lab, and doctors submit all their cases, and we go through them. Um, here's another organic acids profile. Let's see. This is a, uh, fatigue is the main symptom. So we're looking at the organic acids here, okay? The patient's main complaint is fatigue. Here's our fatty acid section. It's perfect. So there's nothing going on there. After all that talk about carnitine, I wish it had been a carnitine marker, but there's not. So you just say, "Okay, well, that's fine." Um, and we're going to kind of cruise through here and see. That doesn't look that bad. Oh, but look. This is, this is the same, this is not the same person. It's a whole different person. But remember how I said I've seen these hundreds or thousands of times? Here we go. Low sulfate, low pyroglutamate, high alpha-hydroxybutyrate. We just learned on that 12-year-old kid, that's the worst thing that can happen on this lab. That means the glutathione has collapsed. With the child that we just looked at, that collapse of glutathione had damaged her neuro, her brain, her neurotransmitter system was all messed up. This person, not so much. The neurotransmitter markers are okay. So what else is left? I'll pose it as a question, and let's see if anyone gets it right. So let's say that you have a case like this one, and you have low glutathione, which is the worst thing that can happen. So now you know that the patient has glutathione collapse. You look at the brain markers, you're like, "Oh, they're okay." What's the other system that this test measures that would be impacted by low glutathione that would have a huge impact on fatigue? Somebody, oh, no, that's wrong. That's wrong. That's wrong. You guys, you're guessing. Come on, fatigue, think, what's the fatigue? Energy, fatigue, energy, fatigue, energy, energy, fatigue. There we go. Thank you. Now everyone's getting it. Oh, guys, there's some sort of gestalt breakthrough. Now everyone got it. Okay, it's mitochondria. So the, the ultimate protector of your mitochondria, which is the ultimate energy source for your brain, is glutathione. So if you see the glutathione markers are screwed up, I would check the brain first. I don't know, just out of habit. But if there's no problem with the brain, then we're going to look at the mitochondria. And I tricked you because I hid you, I hid this from you before so you couldn't see it, which is why you all got it wrong. Energy production markers, one, two, three, four, five, six of the eight markers are high. That is not okay. That's like having a bike chain that has links in it, and it's got eight links, and six of them are broken. That's not, it's not a functioning system. In this person's case, the low glutathione caused oxidative stress and damage to the mitochondria. And our 12-year-old kid, the low glutathione had damaged her neuro, her brain, her neurotransmitter system was all messed up. If you treat the 12-year-old kid for her mitochondria, no change. If you treat the 12-year-old kid for her neurotransmitter problems, big change. If you treat this person for neurotransmitter issues, which they don't have, it's not going to help them at all. If you treat them for the mitochondria, you're going to see a big change. Okay?

Now, um, I should go to questions, but first, let me see here. I'll remind you that we have an upcoming Long Haul webinar. And let's start off with Suzanne's question, which is the obvious one, which is, "Why is glutathione low?" So that's the million-dollar question. You have to figure that out. What are the options? Well, there could be an environmental toxin that's super common. It could be gut dysbiosis and chronic gut infections generating tons of oxidative stress. So in general, when I'm thinking, "Okay, what's driving the glutathione low?" I would think first, environmental toxin exposure, and I would think second, gut-related problems. It could also be other things like mold, Lyme disease, something else like that. But I always go for the obvious first: environmental toxin exposure, heavy metals or chemicals, something wrong with the liver, right? Or something wrong with the gut. I don't know, that stress, emotional stress can cause low glutathione. I don't know, maybe, but I don't think that would be like super common. Um, yeah.

And so Karen was asking about Dr. Lord's book. So his new book is called, his old book is Laboratory Evaluations in Integrative and Functional Medicine. His new book is called Laboratory Guides to Health. Laboratory Guides to Health, Richard Lord. And you can buy it from iBooks, and I think you can buy it from, like, Google Books too. It's a virtual book, right? It's a downloadable, 1400-page monster of a book. If you're going to practice functional medicine, you have to have either the old copy or the new copy of the book. That's like, I would say, it's just kind of a requirement.

So the difference between the various organic acids tests. I still use them both in my practice. I don't use Great Plains because I just don't know that much about them. I think they're a really good lab. I just don't know about them. And they have other fine teachers over there. A very old friend of mine, Kurt Wohler, is one of their main teachers, and they're doing their own thing. They're doing a great job, but I'm just not involved in that group. So I've been heavily involved with Dr. Lord, and he developed the Genova test, and then his co-workers.

Basically, um, from a gazillion years ago, created the OMA test. And their OMA test is newer and more complex. The organic acids from Genova is sort of the classic, tried and true one. Um, I use them both in my practice. I don't know that one of those is better. I think they're, they're kind of uniquely both really good in their own ways.

So the B vitamins present in a multi are rarely enough. If you see these B vitamin markers low, high, which means the B vitamins are low, then you almost always would have to add a B complex or an individual B vitamin to a multivitamin. You're never going to really see a multi that has enough B vitamins to really make a difference for what we're talking about here. Once the markers show up in the lab, the need for the B vitamins is going to be pretty significant.

Yeah, let's see. Uh, yeah, and then for Thalia's question, this is direct Dr. Lord quote. Every nutrient can be a toxicant. Every nutrient can be a toxicant. You can give, you can over-methylate people, you can over-glutathione people, you can over-DHEA people, you can over-anything people. You can give them too much progesterone. I mean, this happens all the time. And so the way that you prevent yourself from giving people the wrong amounts of various products is by learning how to interpret the labs.

If you are doing lab-based programs and you really understand how to interpret organic acids, which takes a couple of years, you're not going to figure out how to interpret organic acids, you know, tonight. I mean, I worked on it for 20 years and then honestly, when I met Richard in 2015, I didn't know beans about it. And then I've spent seven years working with him twice a week and now I have a clue. Okay, so this takes a little while to really get it, but it's well worth your time to, to invest your energy and time in it. Um, but one of the main problems that I see in our industry right now is that people are don't know how to interpret the labs. And so they're scared, rightly so, to recommend products because they don't know what they're doing. And so they underdose everybody on everything and it doesn't really work. So it's up to us, you know, individually to learn how to interpret these tests because there's no university of, you know, how to interpret lab testing. And out there, you can go do like a master's degree in this stuff or something. You just have to figure it out through people like me or other teachers that you, you know, think you know what they're doing.

Let's see. I would never prescribe a B vitamin until I had a lab come back and I knew the patient needed it, unless you're using a multivitamin. That's why the dosage or dosages are so low in multi is because you don't have to worry about it because you're not, you know, it's not much in there. It's not going to cause a problem if you're, if they don't need it, right? It's just a general teeny, teeny little bit.

Um, let's see. If you're having consistent problems getting links from us, there's probably something going on because we have thousands of people that sign up for these and usually the links go right through. So it's probably some, uh, some connection problem in some way. Let's see. I'm gonna, I'm just scanning the questions right now and let me, okay, there's one question that, this is an important one. Let me try to answer it. It is, um, let's look at this. How do you know if the patient has a problem with toxic exposure? Let's see here. Let me show you. Oh, here. And pull up a test. Pull up this one first.

So each of these tests has sections that will show you about environmental toxin exposure. In this case, it's under toxic impacts and it's going to include markers that relate to oxidative damage, detoxification pathways, and very importantly, the urea cycle. The urea cycle is screwed up, you can have ammonia buildup. Okay. And so when we're thinking about, you know, where is this all coming from, let me show you what the other test as well. You can see there's a very special section for that here. Ding ding. This is again, the Genova one. And they have a whole section on detoxification indicators. Now, you can't always tell which chemical or heavy metal it might be, but if you see glutathione depletion, if you see oxidative stress markers very high, then you're kind of coming to the conclusion that there's, you know, something pretty seriously wrong here in terms of environmental toxin exposure or perhaps a really bad gut problem that's causing inflammation and oxidative stress also.

Now, part of the basic workout they do in every patient includes a gut test. So if they have a gut problem, you can see that on the gut test. So I should emphasize that I never do organic acids only. We know we're doing a hormone panel, a GI panel, and then organic acids and amino acids testing on everybody. So if they have a major gut problem, it's going to show up in the gut test. So when you, you're already going to know when you look at organic acids, okay, they have a gut problem, maybe the oxidative stress is coming from there. If they don't have a gut problem on the gut test, then you can surmise, oh, it's probably coming from environmental toxin exposure.

And then there's one other thing here that's an important question. Sorry, I can't get to all the questions. We're just going to run out of time. Oh, so if the glutathione markers are low in general, you can use N-acetylcysteine, NAC, or NAC, anywhere from 3,000 to 5,000, maybe 6,000 milligrams a day. I usually start with 3,000 a day and see how that works. And if you want to boost it up more, you can add in glycine also at 3,000 milligrams a day. So to boost up glutathione, you can use NAC, 3,000 a day or more, up to 6,000. You can, if you want to make it more potent, you can add glycine to that at 3,000 up to 6,000 a day. So I often do 3,000 NAC, 3,000 glycine to really get glutathione levels up. If you're in a rush, you can also use glutathione itself at 100 milligrams twice a day. Some people might use 200 twice a day. That's kind of a lot. But NAC and glycine are kind of the time-tested ways to get glutathione levels up. You can use glutathione itself if you want, obviously, too. But it, you know, it doesn't taste that great, although there's some brands that maybe, you know, are better. And glutathione has a very checkered past in terms of absorption.

So when I started my clinic 30 years ago, we would order glutathione. This is not a joke. This is a true story. We ordered glutathione from Dr. Abershemian in New Jersey. And my secretary would call him on the phone and say, "Hey, Dan wants some glutathione." And he would ship us out these boxes that were packed with, uh, with dry ice. Then in the boxes were these little bottles that were amber colored. And he didn't put labels on anything. It totally looked like a cocaine deal or a heroin deal or something like that. Then I would sell these to patients. I can't believe I did this. I'd say, "Here's your glutathione." Because it was heat-sensitive and it would be expired or useless in like a couple of weeks. So we had to do these crazy things because glutathione doesn't stay stable very long. It's also really hard to absorb when it's in a powder form. So everybody pretty much uses liposomal glutathione because that got around this whole problem of shipping dry ice boxes across the country and unlabeled bottles of stuff, you know, because Aberchemian would make it in his lab, cram it in the bottle, and then overnight it to us. And then we'd have, we would call patients and say, "Your glutathione's in, you got to come in right now." Okay. So it doesn't work very well in a powdered form. Liposomal form is kind of key. And a lot of the liposomal forms taste really bad. So the patient compliance can be kind of weak sometimes on that.

Okay. Um, let's see here. Yeah, in the long-haul COVID class, it's going to be very clinically oriented. So I'm going to cover all the different pathways with short lectures and then we're going to review case after case after case after case after case and show you guys what we're seeing in terms of long-haul patients and also patients that have these vaccine reactions as well.

Um, oh, there's one more question I want to answer and then I'll wrap up. Okay. Let me just show you on this one because I have it up. So we talked a lot about B vitamins. The most important, again, if someone comes up to you on the street next week, you're on the subway, you're in New York, and some guy comes up to you and he says, "What's the most important nutrient for life?" Not human life, for all life on Earth. What's the most important nutrient? You should just unhesitatingly say thiamin or B vitamins. Okay. You can be one, you can aim any of the B's. B vitamins, most essential.

So when we look at this section, if we see these markers are high, we know that the person needs a given B vitamin. And you can memorize later on, one of these is biotin, one is B6, one is B12. When it's folate, you can just look that up. You can figure that out. Okay. If you see a large, a preponderance of these markers low, let's say the entire section is undetectable or very low, that should get you extremely suspicious. You should think, "Hmm, why are they all so low?" This one is not like that, but imagine every one of these B vitamin markers was low. Then what you should do in your suspicious moment is you should come up here and look at the mitochondrial portion of the test for under energy production. If you see all those markers also suspiciously low, then you've got a hypometabolic patient on your hands. And that means that they don't have enough mitochondria present to make these chemical reactions go forward. So if you see energy production markers all low, B vitamin markers all low, that's your worst-case chronic fatigue patient, depression patient, mitochondrial collapse patient. Right? The mitochondria are no longer present. They're not collapsed, they're just physically not there. Dr. Lord calls that mitochondrial retraction because they've cut back or mitochondrial or a hypometabolic state. And those are treated in really specific protocols with high dosages of amino acids and B vitamins and CoQ10 and magnesium. So high markers show that the enzyme systems aren't working very well and the person needs help. Low markers across the board for B vitamins and for mitochondrial, uh, energy production show a hypometabolic state. Okay.

All right, we're going to wrap it up for now. Thank you guys for attending. I hope some of you will join us for our long-haul COVID boot camp. We also have a mentorship class starting this month. So if you're interested, contact the office and we'll talk to you about it. Okay, take care everyone. I'll see ya.