Transcription
Hello and happy whatever day it is. I think it's a Thursday right now. So I am Dr. Dan Kish, and I see a lot of new names logging into this class. So many of you, this may have been your first experience at the Kish Institute. So I want to welcome you.
I will tell you what the general format for this class will be. It's a little different, and so I'm going to talk a little bit about what the class is about so you can make sure you're in the right place. I'm going to describe my background so you can see where I'm coming from and why I'm even up here talking about this stuff. And then we're going to get into an abstract but very important subject area, which is treatment sequencing.
I'm going to show you a series of real cases that we have reviewed this week in my mentorship class. Real patients, real problems. And then show you how you could work through two different major issues that we all face. One, one is you get a big fat lab back and it's complex, and you have to sequence out the various aspects of that one test so that you prioritize things and do it in the right order. And then two, when you get multiple labs back that have a huge amount of data, and you have to not only sequence within a lab but sequence between multiple labs.
I have not ever seen a class like this given. I learned how to do all this at the feet of two masters. First, Dr. Glenn Fredericks, who I worked with for at least six or seven years. Glenn is still alive, he's still kicking, he's still practicing. And what did I do? I just followed him around. He gave me a clipboard. I bought a white shirt and a tie because I was still in school, and I just followed him from room to room and watched him work on patients. And he would, I really wasn't writing anything down because he was taking his own notes, but it was like I was taking notes. It was like a fake-out thing. So patients would have an understanding of why I was in the room. I was just like writing down everything he was saying. And over the years of just following Glenn around, I realized after, and I knew how to sequence things. He never said, "Oh, this is how you sequence things." He just did it over and over and over again, and then I learned how to do it.
And then around five, six years into that experience, I met Dr. Bill Timmons. Same exact thing. I would just drive down to Bill's office every Thursday afternoon in my little Honda Civic, and I would just watch him work on patients. Watch him work on patients. I had the clipboard, he gave me a clipboard too. I would take notes for myself, and I just watched how he did it. And then when I had my own patients, I just copied what they did. That's why I don't know if this even exists as a course.
But the problem, if you're relatively new to functional medicine, relatively new to me, is in your first 10 years of doing this work, unless you're following around a Glenn or a Bill for four or five years, how are you going to figure this stuff out? You're going to figure it out by making mistakes, and that's like a painful way to learn this. And so the point of today's class is to teach you everything that I learned from Dr. Bill, Dr. Glenn, and all the things that I've learned from my patients in the last 31 years. And every single mistake that I've ever made is reflected in these sequences. These aren't sequences that are brilliant because I figured them out. They're sequences that are brilliant because I did it wrong a million times, even copying Glenn and Bill. And then I'm just trying to summarize all that for you guys so you don't make any of the same mistakes. That's the goal of tonight's class.
Okay, it's a little different. Usually, these classes are more clinically oriented in terms of like specific topics. This is sort of a global topic. So, who am I? That's a good question. That's the name of a book, I think. But anyways, um, I'm the founder of the Kish Institute. We've trained over 7,000 practitioners. I started this training program in 2006, started online teaching back then. I've worked with the Mayo Clinic, which was really one of the kind of academic highlights, probably the academic highlight of my career, a year, a full year of research with the Mayo Clinic on the Kish method, where we looked at adrenal and GI testing. We used the same exact protocols and sequencing that we're going to talk about tonight in the Mayo Clinic study. Um, it was published in 2016. If you ever want a copy of that, I'm sure we can get you a copy of that. You could just probably find it online somewhere.
And then, uh, in the last 10 or 12 years, I worked with Richard Lord, who is a chief scientist that developed much of the testing that we do. He developed organic acids, amino acids, fatty acid testing. He was the originator of the GI Effects test, which many of you know from Genova Lab. So Richard's long been retired, but he and I work together on a regular basis and lab interpretation skills development, basically. Um, so I'm still a student as well as teaching. And, um, I'm IFM certified, believe it or not. I passed that exam, which is a miracle. And I've been practicing forever.
So we have a couple of special classes coming up. This one, we rarely offer. I think it's been at least a year since we offered our cardiometabolic Health Bootcamp. If you're interested, scan that code, that QR code. It'll take you right to the place you need to be to register. And just remember MiniMe23, which seems to rhyme, MiniMe23, um, which is the code that gets you 20% off. And if you can't remember any of this stuff, you can email the office. But use your phone, take a little scan of that. You should be, or just click a picture of this so you can remember all the details. Okay. And that is starting in November, and it's three months, and it's intense. There's a lot of material in there. There's a lot of biochemistry. There's a lot of clinical stuff that you're just going to get amazing at if you take this class. Uh, this class is based on Richard Lord's work. There's also a whole series of Richard Lord lectures in this class as well. The cardiometabolic Health Bootcamp has maybe 10, 15 hours of Richard Lord lectures, as well as all my lectures. And it's very clinically oriented. It's all about interpreting fatty acids, amino acids, beta-oxidation, mitochondrial markers, all the functional medicine cardiometabolic markers that are, um, kind of challenging to learn how to interpret. And it's a great skill set to have. Okay.
And then we have our partner that we've been working with for several years now, Rupa Health. When you look at the labs from the mentorship class that I'm about to show you, I was looking at them a few hours ago. Every single one of them is ordered from Rupa. Okay. So everyone's using Rupa. If you're not using Rupa, you're behind. So you should use Rupa. What is it, if you haven't heard of it? It's a lab distribution company. They did to the lab industry what Uber did to the taxi industry. They just created an app for it. They created an online platform. You can order all the labs in the industry. They take care of all the administration. They collect all the, they process all the, you know, reports, and they just throw it all into one simple portal that you look at. This eliminates like, almost a full-time job in most busy clinics. This is a lot of work, that money and hassle and time that you save using Rupa. So basically, everyone's using them. And you get $100 off your first order with Rupa. Just scan that code and order a test. I mean, order a cheap test if you don't want to spend a lot of money. Order like an adrenal panel, and it'll pay for most of it. The $100 will cover most of it. You can see how well the platform works. It's a little hard to describe how effortless it is once you try it on yourself. Order a test, you'll, you'll see what I mean. You probably never go back because you can order any lab from any company, and it all comes to one place, and it's super simple. It doesn't cost you anything either. Okay.
Okay, so that's the Rupa, the Rupa game. So now for the goal of today's class is we want to start thinking about a body systems approach, a systems-oriented approach. Systems medicine, functional medicine, lifestyle medicine, whatever you want to call this, precision medicine, personalized medicine. There's many different names, but it's systems-oriented. That's the key. I am going to present my model of body systems. It makes no difference if you use my model or if you make up your own model. And in fact, I would say probably half of the students in the mentorship class that I teach have their own model that they developed. That's fine. The whole point is that you have a model. If you don't have a model of what you're doing, then what are you really doing? You're just randomly ordering labs and randomly giving people supplements, and there's no cohesion to it. That's one of the biggest problems in our industry is a lack of cohesion. And that's why when you get back a whole bunch of complex lab work, you don't know what to do because you don't have a model to put it in. Nobody can handle that much data and make a rational decision. It's not just you, it's all of us are faced by the same, facing the same problem.
So you need to learn how to construct these complex lab-based patient programs with lifestyle changes, all kinds of supplements, and many of these people may even either need medications or need to come off medications, right? There's a lot of variables here. But you've got to make it easy for the patient to implement, and you've got to make it, design it in such a way that the patient's actually going to keep on it. It's easy to design a great program that nobody does. I've designed a lot of great programs that the patients did for like a month and then stopped. Okay. I had a couple years of my practice where I designed amazing programs that people did for like a month and then stopped. That is not really the goal here. We want people on long-term programs so they can actually start to get well. All right, that's the bigger picture goal.
So if you don't like my body system model, modify it and make up your own, and that is totally fine. But you want a cohesive model that you can absolutely use with every single patient. That's your philosophy. It states what you think makes people sick and what you think will make people what you think will make people better. That's what the model is, right? It's a construct of how people get sick and how they can get better.
There's a couple of, I don't know, fallacy is the right word, that's kind of a strong word, but there's a couple of misperceptions in our industry. One of which is that we should always start with the most important thing. That's absolutely not true. So most functional medicine doctors agree that one of the most important things is the gut. Um, some people might push for environmental toxin exposure or genomics or, you know, diet or lifestyle. I don't know. But pretty much everybody agrees that the gut's in the top three, let's say. And mo, many people would say that the gut is the most important thing to fix. But that doesn't mean you start there. And so it's hard to start somewhere other than what you think is the most important place. However, if that's really the most important thing, which it is for a lot of patients, then you want to set the person up for success so that when you get to the gut treatments, you're more likely to have those programs work. And if you jump right in and treat H. pylori on the first day that you get the lab back, it's very likely that it's not going to go as well as if you waited for a few months to prepare and strengthen the immune system for getting rid of the H. pylori and then did it sequentially later on when the person's ready for that treatment.
Many times, you might have a toxicity case where the main problem is mercury toxicity. That's a really serious health problem that might be that patient's most important thing. But if on day one, you aggressively try to remove the mercury, it's very likely you're going to make the person more sick, which is against the rules, right? This is this whole "do no harm" motto that we all adhere to. You're not allowed to make people worse. That's against the rules. So don't do that, right? You've got to prepare the body so that you can get the mercury out, even though that may be the most important thing. Big mistake to start there.
And, uh, there are moments when everything I'm saying is reversed, when you really do need to start with the gut and start with the liver. We can try to get into those instances. So none of these rules is hard and fast. But I think the, the, the single most important concept to try to take home from this talk is that you want to have a model and a way that you proceed with every new patient. So that when you don't do that, you're breaking a rule that you have. Not so you don't want to recreate a brand new model with every patient. It's just not realistic if you have a busy practice.
When, and let's see, I can remember, I think because my son was like five, so like around 2002, 2003, I got the opportunity to work with this osteopath. You may have heard of him. His name is Dr. Joe Mola. And Joe and I were friends from previous stuff that we'd done together. And he had just launched this website, which was like this new thing back in the early 2000s. And he was like, "Hey Dan, you know, I know you have a private practice. I wonder, you know, would you be able to handle patients coming in through this website?" I'm like, "What's a website?" So he's like, "Sure." And so in those years when I worked with Dr. Mola, we had a minimum of, uh, 10 new patients a week, 40 new patients a month, four, five, 600 new patients a year. So when you get to high volume like that, this is when I developed the model, right? When you get to high volume like that, you can't make a completely different model for every new patient because you don't have time because you're running from room to room. So that forced me to develop the model that we teach today at the Kish Institute. And that was one of the best things that ever happened to me because now in my current practice, I don't know, we're lucky to do a hundred people a year. You know, it's a really small practice. We do like maybe 10 patients a month max. And at that volume, having the model really helps still because I know exactly what I'm going to start with and what I'm going to progress to next. And I have a flow that I go through with every single patient. And then what changes the model is the interaction of the patient with the model. So in other words, I'll bet you 85% of the time, I don't follow the exact model that I'm teaching tonight. But the reason why I veer from the model is because there's something about that patient that forces the change. So that way, I always have the same model. I always try to do the same model. And then as that model interacts with that individual patient, it's modified. But there's a core structure to this thing that has stood the test of well over 20 years of time. I've also taught this model to thousands of doctors. It really works well. And again, a lot of them modify it. That's totally fine. A lot of them will put thyroid in there, I don't know, instead of adrenals or whatever they want to do. It's totally fine. But having this model is what creates the sequence that we're going to talk about.
Okay. And we'll have time for questions at the end today too. I'm not going to do too many slides because today is really theoretical. And then I want to show some examples. So here's the model. This is the whole thing. This is everything that I do in my practice in one slide. And you should be able to reduce everything you do in your practice to one slide. Again, it's going to look different than this one. That's fine.
So adrenals. Adrenals is code word for hormones. That includes thyroid. So adrenals and thyroid, neurotransmitters, female hormones, male hormones too. Okay, just have to have female hormones. Mitochondria is what energy stands for. On the GI side, GI pathogens, foods, you, that's the gluten problems, all that stuff. The microbiome itself, the good bacteria. And then leaky gut, repair, detoxification, oxidative stress, and methylation, inflammation. And then this last category in the lower right hand of the very last body system is a tricky one. It's a sneak. It's not really very fair. Nutrient replacement because that's like everything that's really broad. So, okay, my model is a little bit, you know, again, that, that could be vitamin D, that could be omega-3s, that could be magnesium. Nutrient replacement is like really broad, and it's in the lower right hand corner for a reason because you don't want to replace a ton of nutrients in someone that has a leaky gut that's not absorbing them, right? So stuff like that. That's what, there's a, there's a secret, there's a rational to this.
So we start with the neuroendocrine for two important reasons. From the patient management perspective, we start with that because you want people feeling better in the very beginning so that they want to keep doing this stuff. And if you design a perfect program and six months later the person's feeling worse, the motivation to keep going with the program is going to be minimal, and they're going to drop out. So neuroendocrine, might as well be, let's get them feeling better first. From the patient perspective. From the practitioner perspective, it's really all about strengthening the immune system, reducing the stress, getting the diet and lifestyle dialed in in that first couple of months, getting the mitochondria working, getting the hormones working, getting the brain working. When you get all that stuff working, you're reducing inflammation, strengthening the immune response, all that stuff is happening. Then that allows you to go on a much more effective deal with the GI and detox issues later on. So from a clinical standpoint, you're preparing the body for what's going to come next, which is going to be the GI treatments, whether that might be leaky gut treatments, microbiome treatments, GI pathogen treatments, uh, or, you know, dealing with food allergies and food intolerances and that kind of stuff.
Once the gut's working reasonably well and the person can bind up and remove toxins in their gut, then you, you can aggressively go for detox. You can work with oxidative stress and methylation defects, can knock the remaining inflammation out of their body, start to flood the system with the nutrients that are missing now that they're absorbing nutrients properly. That's a general sequence. If you try to detox people in the early stages of treatment and their GI tract is screwed up, the toxins aren't going to have a very great exit route in terms of the GI tract, and they may reabsorb the toxins and get worse. And generally, you don't want to do that. The GI system is also generating many of the toxins that are impacting the liver. So clearing out the gut takes a huge load of stress off the liver, as well as allowing you to then work with liver detox pathways so that, you know, they can start to get better. So detox, I would say in some ways is probably the most important. So we put it last. It's also the most likely to cause side effects and symptoms, so we put it last.
Now, Dr. Timmons ran a series of clinics in Mexico and West Virginia where they detoxed people first. This was back in the '70s and early '80s, and people crashed constantly. Dr. Libowitz, another one of my early teachers, detoxed his mercury too aggressively, too early in his program, and this is again, probably the '80s, and he became extremely ill for many years from doing that. So aggressive detox too early in the program makes people worse. So we don't want to do that. The GI tract, again, we're pacing ourselves because we want to upregulate the immune system before we go after anything that's going wrong with the gut. You want to strengthen the immune system before you kill any GI pathogens. And neuro, neuroendocrine, again, makes people feel better. So that, this is a model, you know, that I have. Again, this kind of fits into these systems, but this explains why we treat in this order.
So I believe that when people are eating poorly, they're stressed out of their mind, they're not exercising, they're not sleeping well, all these problems are happening that we want to correct the lifestyle, correct the neuroendocrine, work on the GI as soon as the neuroendocrine is improving, get all the leaky gut stuff cleared out, and then clear out all the environmental toxin junk that everyone has. Okay. So that's again, a model for treatment sequencing, correcting the body systems in the order in which the problems occurred. And why do I think that? Because I think that this is what makes people sick. People are under stress, that screws up their neuroendocrine thing, right? That weakens their immune response. Their gut starts to develop problems. Foods make it worse. Toxins start to build up. So we get sick in this direction of neuroendocrine, GI, and detox. And that's one way that we can treat as well. So that's the basic model. But again, you can develop your own model for sure. Most of you probably should do that.
So I want to, there's a lot of slides here which we're not going to review. I just threw them in here so I have them to poke around with. But I want to just jump right into an actual program in a minute. Okay? But first, I thought this is important because I learned all these things separately, and I don't know that, I don't know what you guys, if you guys know the things you need to know. So I'm just going to talk about that. These are the, the design components that you just need to have. One is product understanding. So what does that mean? That means you really need to know a lot about magnesium, B6, calcium. You need to know a lot about potassium. You need to know the ins and outs of folate. There's a lot of, B12. I mean, there's a lot of nutrients that you just have to nail the understanding of. And then once you understand the basics of clinical nutrition, then you can look at these formulas that these companies develop for us, the professional brands, and see the combination formulas, what's in them. So then you understand those products. So you need to understand single ingredients first. And then you need to put together a picture for why these combination products are developed and how they work. Then when you have a program that you need to design, you can flip through any supplement company catalog and pick out the right stuff. It's kind of impossible to do that without this understanding. And I think, I don't know, I didn't really understand the basics of clinical nutrition for at least four or five years. So I had to study it pretty intensively for four or five years till I really felt like I had at least a beginning understanding. So supplement ingredient knowledge, individual nutrients, and then why these combinations are put together and then product knowledge. It's not infinite though. I have it down to like 50 products. If you really understand the use of these 50 products, you'll have a very, very solid foundation to expand upon. Okay.
And then once you get all that figured out, then you need to be able to apply this information to specific lab values and to specific patients because everybody's different. The labs could look the same, you may treat the person completely differently depending on what's going on. And then you should learn, just like the "this for that" stuff. They call it, that's kind of a disparaging term, "this for that." But you have heartburn, take a probiotic. You got migraines, you should try some magnesium. You know, you kind of need to know the "this for that" treatment things too. Those are not lab-based. Those are just general things that you're supposed to know. You got the white marks on your fingernails, take zinc. That kind of stuff. So those are the fundamentals of clinical nutrition that we should be all familiar with. Okay.
So now, oh, this is so complicated, you guys. Program design, addressing multivariable complex systems breakdown. Then you need to be able to use combinations of products that are combinations to address entire body systems. Adrenals program, mitochondria program, leaky gut program. And then you have to take multiple variables that have multiple products. So in other words, you need to be able to take, um, a series of different problems with different body systems and put all that together. So it goes from like single ingredients to combination products to how products are put together into a program to then how programs are stacked together. When you start to think about it, it's a little overwhelming. And then you need to sequence it all in the right order. And then you need to combine it with lifestyle changes, otherwise it doesn't work. You can't just give people supplements. Nobody gets better if they just take supplements. That doesn't work at all.
And then there's other things that I wish I had known this in the beginning. I remember my first adrenal program, I was like, "How long am I supposed to do this for?" Because I got on the phone with Timmons and he told me what to do, and then I, click, phone is over, phone call is over, you know. And then I thought, "Oh shoot, I forgot to ask him for how long." And like, "How long is it going to take for the patient to get better?" And "How long should they do this for?" Those are important questions. And that's different for each protocol. Totally different for each protocol. What are you going to do first? Can you overlap programs? Can you run multiple programs together? Yes. Which ones? You know, which ones are sort of synergistic? And then what do you do to update things? What if you set up this beautiful program, it's not working? How are you going to change it? Or what if they have side effects and they're getting worse? How are you going to change it? It's a lot to think about.
So this is my default sequence. I don't think it's a bad place to start if you don't have a sequence yet. I think this is a good one, you know. And then as you use it, modify it over time. So the order would be neuroendocrine, GI, and detox. Neuroendocrine, GI, and detox. Neuroendocrine, GI, and detox. And it's a safe program too because it puts the things that are most likely to cause side effects last, which is the detox part. In other words, it allows you to get the person healthier and healthier and healthier before you do the most challenging thing, which is to get all the environmental toxins out. So adrenals first. I know that's like, really. Yeah, because there's, there's two, there's two reasons why. Because really, what we're setting the person up for is a GI program for the most part, often, the most often. So cortisol regulates secretory IgA, that's the immune response in the gut lining. So as you're improving in cortisol, you're improving the immune response in the gut. That is very, very, very, very important. The immune response in the gut weakening is the whole reason they have a gut problem in the first place. So you're addressing the underlying cause of the gut problem when you start to correct cortisol. Absolutely. Similarly, when we have an adrenal situation, an HPA axis situation, you're in a catabolic state, which means you're breaking down your tissues. You're going to be breaking down muscle tissue and breaking down gut lining. So abnormal cortisol, adrenal problems mean you're having a leaky gut develop because of the catabolic balance of the hormones. So correcting adrenal problems in the beginning improves and upregulates the immune response in the gut and stops this catabolic state. So the damage to the gut lining that's creating leaky gut starts to go away. That's why if you do that for a few months and then you go after the gut problem, much easier to fix the leaky gut, fix the microbiome, fix the, uh, immune problems, infections, whatnot, that are happening in the gut. If you've got a month or two of the adrenals under your belt, you can do supportive things for the gut in the meantime, for sure. But you don't want to do anything too aggressive with gut treatment too early on.
So let's see. I want to just do a little bit more lecturing and then we'll, we'll look at some cases. Okay. Now, there's definitely times when you start with the GI tract. Sometimes you have to. I don't know. We had this patient a few years ago, she was having diarrhea like 15 times a day. She couldn't, she couldn't even drive to work without planning out where she was going to stop to use the bathroom on the way to work. I mean, that's obviously, if I told her, "We're going to do this adrenal program for two months," she probably would have just slapped me, and understandably so. Sometimes you have to do the GI stuff. Or we had a patient today, she wants to get pregnant like now, right away. Two months of doing an adrenal program, that's not going to work for her. So we're jumping right into the GI treatment. So absolutely, you can start with GI if you need to. But most of the time, it's going to be to your advantage to take that first two months working on the adrenals. And remember, an adrenal program is code word for not only just hormone balancing, but for addressing stress, diet, exercise, sleep patterns, and meditation. So an adrenal program means they're cleaning up their diet, starting to exercise properly, um, working on sleep improvement, and working on meditation. So they're doing all these lifestyle changes in that first couple months before you get to the gut treatment. They're doing all the diet changes in the very beginning. That's part of an adrenal program. So there's times when you need to do that.
And then there's times when you might have to start with detox. Let's see, what are examples of that? Well, we had one this week in class where the patient was, uh, reacting to every single supplement. You know, the, every, in, in the adrenal program. So pregnenolone, can't do it. DHEA, can't do it. Licorice, can't take it. Highly reactive. Clearly a liver is not working really well. So we can't even do the adrenal program. So we're going to go and shift gears and start with detox. But remember what I said a minute ago, that's an example of having a model, using it, and then it doesn't work, so you modify the model based on what the patient feedback is. So we didn't start with detox right away. We started with the adrenal program, that didn't work. So then we segue over to doing liver support first, so that we can do the adrenal program later. But that's the patient guiding you through this model. That's really the best way to do it. And the same with the GI stuff. The patient's guiding you through the change. She wants to get pregnant, they're having diarrhea at 15 times a day, whatever it is, that forces you to change and veer away from the model. But you still have the model. You're just making an exception for that particular patient. You might have a patient that's reactive based on the past. You may know right away, just from talking to them, they tell you, "Hey, every supplement I've ever taken makes me really sick." You probably don't want to start with an adrenal program. Probably have to start with the liver.
We had, I used to work at one of the neurotransmitter labs a long time ago. And, um, we had a map. I don't know if this is legal or not. I probably was legal. Yeah, anyways, we had a map, and we had patient labs by zip code. How cool is that? Okay. We didn't share this with anybody. This was like internal, just for the lab. And when you do that, you have thousands and thousands of patients. We started to see neurotransmitter programs that were different in different zip codes. Okay. And this kind of bleeds over to my Cincinnati story, which is that we had a doctor in the mentorship class a long time ago, like 15 years ago, and he was from Cincinnati. And his patients were all from Cincinnati. And the toxicity level of the patients in his practice was just like something I'd never seen before. It was just like the neurotransmitter thing. That zip code, that little zone of Cincinnati was just full of heavy metals. And his whole practice, every single patient, 10, 20, 30 people in a row, highly reactive to every adrenal product. So in that guy's practice, based on his patient base, he had to flip the model backwards, and everyone started with liver detoxification just to catch them up so that then he could do the GI and adrenal program. So he did our exact model, but backwards, based on his, uh, patient population. And I don't know if that was just Cincinnati or if it's Cincinnati plus the fact that, you know, he had really sick people coming in.
And then I'm going to do one more slide, then I promise I'm going to stop and go and do, um, some program design. But this, this question comes up 100% of the time with every case and every mentorship class I always, ever teach, which is, "What about when you get a GI program back? What, what's the sequence with which you should do all this stuff?" And so there's a bunch of classes I've taught on this where I talk about the three different stages, which is one is microbiome, two would be GI organs, and then three would be, um, killing pathogens. So the easiest way to do this, in a lot of ways, is to just go one, and then two, then three. So it's to correct the microbiome first, either along with or leading up to GI organ corrections, and then once that's all in place and doing pretty well, deal with the pathogens if you need to. That's the easiest way to do it. You can reverse that and do pathogens first, and then work with the organs, and then do the microbiome. A lot of people do it that way too. So really, you can do it either way.
So what do we mean by that? And I'll design some programs here to show you, but I'll just talk you through it first. So a microbiome program would be prebiotics and probiotics and, uh, prebiotics and probiotics and, uh. An organ problem? Well, the organs are pancreas, so that would be digestive enzymes. Stomach, that would be hydrochloric acid. Gallbladder, so that would be all the gallbladder support products. And leaky gut, the gut lining is damaged, so leaky gut repair. And then the gut lining can also have an immune compromise. So immune building, you know, building up of the IGG stuff in the gut lining. That would be on the organ side. And then on the pathogen side, it's your garden variety Giardia, dysbiosis, yeast overgrowth, all that stuff. Okay. So you can start with the microbiome, integrate in the organ treatments, and then later on do the pathogens. Or you can flip that and do it the opposite direction. Really can go either way. And then this question comes up a lot too. I would always do all these other treatments before you get into SIBO. I would put SIBO as last. Not that it's not important. Again, we're talking about a lot of important things go last. But many times, by the time you get to SIBO, if you've corrected the microbiome, the GI organs, and other pathogens that are going on, you know, you, we won't have to deal with this H. pylori. Okay? You'll have it resolved. Okay.
So let's look at some tests. I pulled up a whole bunch of them already. But then, of course, now that I'm thinking about it, I think I forgot to pull up one that I want to start with. Sorry. Let's, let's see here. Hang on a second. Let me pull this up. Uh, all right. Hang on. Let's see. All right, let's start with this one. Uh, well, sample one. All right. Okay. This is a horrible one. It's a good one to start with. So this is a test that came in this week. I think it's like a 53-year-old female with all kinds of chronic problems. And look at that. So, oh, and what kind of test is it? Sorry, it's a Neutra, it's a Neutra from Genova. Neutra with plasma amino acids. All right. So this person has oxidative stress, mitochondrial dysfunction, omega imbalances, toxin exposure, and methylation. It has, this person has every single thing that can go wrong, every single thing that can go wrong, all at the same time. That's kind of overwhelming, right? So now, this is getting back to within one test, how do you possibly prioritize this? Well, you look at the top three symptoms that the person has and just address those first. Why not with some underlying support for what you think is the root cause of the problem? So if this person is depressed and has a lot of body aches and pain, then let's look at the neurotransmitters first and see what we can do there. How do I turn the pen off? That's a good question, isn't it? I don't want the pen on there. There we did that. Turn off. Oh, there we go. Okay.
And this is a great diagram, but it's easier to see it in some ways right here. So with this kind of a test, let's just say this, just work on the depression side of this. Okay. And so there's four main areas. It would be liver detoxification, brain, mitochondria, and gut. All within this one test, which is kind of phenomenal when you think about it. So let's look at the gut first, just for fun. No, no, no. Let's do it in the right order. So neurotransmitters would come first. So neuroendocrine, neurotransmitters. So is there a neurotransmitter problem? Well, a little bit. There's a problem. Let me find my right pen here. I got the wrong pen. There's a problem here that means there's a dopamine issue. Homovanillic acid. It's a problem here that means there's a serotonin issue. 5-HIAA is high. And there's a whole bunch of problems here, which means there's a mitochondrial issue. So under neuroendocrine, we have mitochondrial and brain problems, both. So that's one thing to think about. And we'll add all these up and then we'll do some program design. Is there a gut problem? Kind of like every single gut marker is elevated except for one, okay, or two or three. So big problem with the gut. So we've got to deal with the yeast overgrowth and dysbiosis also. So that's another issue. And then mitochondria was a yes. Oh, there's a methylation defect. Okay, that's another thing. This is a good example because there's so much stuff going on, right? Uh, let's see. And let's look further down here. And I'm not even, oh, glutathione is low. 8-OHDG is high. All the oxidative stress markers are, are problematic. And let's not even talk about this because that's going to get too complicated. So I think we got plenty to work on there.
All right. So let me grab a protocol. So now here's the problem is we've got how many things going on? Let's just write them out. So again, this is problem-solving for one test. We had, let's do it by body system. Neuroendocrine: we had, uh, mitochondrial issues. We have brain. Is that it? Yeah, there's no hormone panel here. So with, um, gut, we had dysbiosis and yeast overgrowth. And then with the third body system, do we had detox problems? Yeah, pyroglutamic acid was high. I didn't point that out, but we had, uh, glutathione, glutathione, 8-OHDG, lipid peroxides, all pyroglutamic acid. What's up? Um, so what do we, in detox, oh, methylation defect. Remember, methylation defect was there. So oxidative stress, methylation, nutrient replacement. Um, there's a glycine deficiency. It's kind of subtle, but that's worth noting.
Um, let's see. Did I miss anything? That's not that's not enough, but let's just look back up here one more time. Uh, yeah, that's plenty. Okay. So then how are we going to sequence that? Well, we're going to do neuroendocrine for the first month or two, getting the person feeling better into the lifestyle. So that's say, neuroendocrine with lifestyle. As soon as they're a month or two into the program and starting to feel better, we're going to go after the dysbiosis and yeast overgrowth, clear all that out. As soon as that's better, we're going to do a massive input here with glutathione and antioxidants and fat-soluble antioxidants and niacin and glycine and methylation support. Soon as the gut is starting to work better and absorb, go, go, boom, boom, boom, like that, one, two, three. How long does each program last? Neuroendocrine programs are typically six to 12 months. You would run them the whole six to 12 months. The gut programs, hopefully, are going to be short, let's say two to four months. As the gut programs winding down, you're going to do, uh, this third body system, detox and oxidative stress and methylation. And that program is going to last, let's say, six months. But it's going to start towards the end of the gut program. Okay. So you've got a year here to do all this. You've got at least a year to clean out everything that we just saw in these labs. And this is just a garden variety test that we just got, I mean, this week. This is not anything unusual. I didn't have to hunt around. I just went to the folder for labs that were submitted this week and grabbed the first one I could find. Literally, it's like the first one I could find. So this is like a common thing that we see all the time. I mean, anybody with this much going on in their body would be depressed. There's no way you could be like happy-go-lucky if every single oxidative stress marker is screwed up, you know, it's just not possible.
Okay. So now let's look at the next part of this. Then is we got like a guideline here. We're going to start here, neuroendocrine. Then in a few months, we're going to do GI. As soon as the GI is winding down, we're going to do, uh, the gut treatment. I mean, the, um, third body system treatment, which is again, this is, this includes, let me just show you on the diagram. You can see it on here. Um, here, go back here. I'll show you. This will make more sense now because this, we're now, we're like doing this, right? We don't have an adrenal thing, so we don't really care about that. But we're doing neurotransmitters and mitochondria first. After a month or two, we're going to go after the dysbiosis. When that's winding down, we're going to do detox, oxidative stress, and methylation. And some nutrient replacement with things like glycine. Okay. So one, two, three, just like that. This is a whole year program. This is six to 12 months of neuroendocrine. The GI stuff, two to four months. As the GI stuff's winding down, that's going to be around month five or six. Do all the detox, oxidative stress support, methylation support, nutrient replacement, and boom, boom, boom, just got a whole series of programs there.
Okay. So now, I don't know, you guys could vote on this. I don't know if you want me to actually write out every single supplement or if you want to look at some more labs. I don't know how detailed you want to get. I don't know, raise your hand if you want individual supplement recommendations. And if a lot of people raise their hand, I'll do that. And if you don't, I'm going to just look at some other labs so you can get more of this bigger picture stuff. All right. Everyone's saying subs, right? I'm, let me do that. So homovanillic acid was screwed up. Give them tyrosine. That always works. They will feel better. A gram of tyrosine three times a day. Just knock that dopamine back up or back in, back in place. Their serotonin marker was screwed up. So give him some 5-HTP, 100 milligrams. What the heck, give it with the tyrosine. Get all that out of the way. So now that's your neuroendocrine program right there. Tyrosine and 5-HTP. Is it that easy? Yeah, it is. So the mitochondria had a problem, but we've got a lot of complexity going on here. So you can use some combination products. And I like to use combination products because it's kind of like cheating.
because it's like a whole bunch of stuff all at one time. And so the ones, and every company has one of these. I happen to use the one from Pure, but every brand will have a mitochondrial product. Mitochondrial ATP is what they call theirs. And that's a little bit of everything that you need for the mitochondria to work properly. So again, this is something that, this, you know, it's many years of study just to learn about this one product here. It's got the antioxidants, it's got the Magnesium, it's got the creatine, nicotinamide mononucleotide, carnitine, Resveratrol. It's just who's who of all the stuff for your mitochondria. It's a little bit of everything. It's like a multivitamin for your mitochondria. So just stick that in there because that covers all your bases from Pure. And don't be skimpy with it. It's kind of expensive, but what the heck, you're worth it.
And then you have to give some extra CoQ10 because there's not enough of it in that other stuff. And you have to give a little bit of extra magnesium. I like the glycinate form. You may have your favorite forms, but but that's a really great mitochondrial support program, okay, right there, those three products. So now we got the MIT. This is our neuroendocrine program here. And then you just want to polish it off with some kind of a multi-energize pack. I do the men's pack from Pure, depending. You could do the athletes pack. There's a bunch of options. The energized one is specifically for mitochondria. So let's just say we do that one. That's just like one pack a day.
Okay, so now we got the neuroendocrine program. That's going to run in the background for like six months. Once. And you're going to start with lifestyle. So all that's going on for the first couple months. Then around month three, you're going to be like, "H, it's time to get rid of the yeast." So AC Formula 2 from Pure, just knock the yeast out. But that's only for a couple months, okay? And you can make them clean up their diet too. If you're in a bad mood and you want to just do that, you know.
Now Cindy is asking a question, "Why don't you start with detox?" Totally, you could do that. That could be your model. But just do it all the time unless you have a reason not to. You know, one of the things that I learned in the, we can call them the Merola years, when you're doing 40, 50 new patients a month, you just see a lot of cases. And if you're doing the same model over and over again, guess what? You get really, really, really good at it. Like, really good at it. And so you understand exactly how people should get better, what timeframe, what all the potential side effects are, what all the benefits are. So in those years when I had super high patient volume, um, I just learned so much from it. And I could have done any model. You could put the liver support stuff first if you want, and then you'll learn that model inside and out. But you got to stick with a model long enough that you really learn what all the impact of it is. You know?
So make up your own model if you want. My favorite student, I haven't talked to him in so many years now, it's Sam. I don't know, he's not here anymore on this call, I don't think. No. But Sam Shay is a great guy. He was in our classes for many years and just one of the best clinicians, wonderful human being too. I love Sam. And, um, he had like an 11 body point model that he had, or something like that. I forget what it was now. It was like a lot. I was like, "Dude, that's like crazy." He's like, "I know, I love it." He loved that model because he loved the complexity. You could totally do that too. Just got to have a model, though. If you don't have a model, you're lost. You are lost in a sea of confusion. And patients will sense that.
So once this six to TW, how long is this program for? Six to 12 months. You're going to modify it based on how the person responds. Then around month three, you're going to jump. You're going to keep that whole neuroendocrine thing running. And you're going to do, oh, I already wrote it down here. Around month three, you're going to add in the AC Formula 2, just for a couple months to clean out the yeast. Maybe put in some enzymes too, if you want. But that's only going to be for a couple months. If you're lucky and they're eating clean enough by that point, that's going to be it. That's going to then go away. Okay, these are going to go away. I'll put them in italic so they're still there, but they're gone now.
Now we're like in month five or six. The gut program is done now. Now you can get down to the good part. Now you can do the methylation, oxidative stress correction, and all that. So these are the products I use a lot. Methyl Assist, which is just what it sounds like. It's all the methylation stuff in one pill. And then they need a bunch of antioxidants. Right? Oh, what would you do? I don't know. Let's see here. Hang on a second. Um, let me show you what Methyl Assist even is. You don't go too fast here. And again, every company has something like this. Um, it's a combination product to make sure the person can methylate well. And you generally don't want to use a single ingredient thing. You want to fix all of methylation. So it's got B6, B12, and folate, and the thiamine, fancy B vitamin stuff there. Okay? So you give one of these three times a day. Maybe even one twice a day might be enough.
And then for antioxidants, you have a lot of choices. Um, sometimes I use like the plant-based ones, like a curcumin type thing that could work really well. Um, but other cases, you may want to use a more traditional antioxidant formula. Something like this. Again, every company will have one of these. You can look up whatever brand you're using. And it's, you know, they're all kind of the same, right? NAC, M.E.K., Thistle, some carotenoids, lutein, lycopene, zeaxanthin, Vitamin E, A. I mean, how many antioxidants are there, right? People are using the same kind. Um, so you can use something like that or a curcumin-based product. I like curcumin a lot. So now we're handling the oxidative stress. Let's make that Methyl Assist not such a crazy dose. How about we just do two a day? That antioxidants. Um, what else did we have? Well, let's go back up and look. Did I forget something? Oh, glutathione. Duh. Yeah, yeah, yeah. So I, and and glycine. So it's really, I think it's great to use NAC. I just use it all the time. What a great product. And use a lot of it. You know, 3,000 a day, 4,000 a day, no problem. Oh, that's we could, if we want to make it a little simpler for the person. Um, and then glycine. Remember there's a glycine deficiency that also supports glutathione. So these are massive antioxidant support. Glutathione, NAC, and glycine are the precursors to glutathione itself. So you're going to cover a whole bunch of. Is there NAC? It's a biofilm disruptor. It's good for your gut. I mean, it's good for everything. Okay.
So this would be phase three. This would be, let's say months 6 through 12. Okay. So let's review. You start off with neuroendocrine, mitochondria, and brain with lifestyle changes. All that runs for six to 12 months. But around the third month, you're two months into it now. You're going to wipe out the gut problem. In this case, it's a yeast overgrowth. You wipe out the gut problem. That stops. Maybe you keep them on some probiotics or something if you want. You could do a maintenance thing for the gut. That's fine. And then you go into the antioxidant, methylation, detoxification part of the protocol.
Okay, so now I'm going to pause for those of you that joined us late, of which there are many. Um, I'm going to just catch you up on the goings-on at Kish Institute. Two things are going on. Well, there's a lot going on. We're starting a mentorship class in November. We still have spots open. So anybody who wants to jump in and spend a year doing this kind of stuff, sign up for that. But if you don't, you're not really ready for that, you want to do a boot camp. These are shorter. This is a three-month boot camp on cardiometabolic health where we just review lab after lab after lab after lab. It's pretty intense. You get 20% off with that discount code. Kind of cute code, mini me23. I love QR codes. I don't like to remember mini me23. So you can just scan the QR code there. Take a picture of this, whatever you want to do, because you're going to save a bunch of money if you have this discount code. You decide to do this. It starts in November. And then we have a discount code for Rupa. You get $100 off your first Rupa order. Also, you can scan that QR code. Uh, and we, I'm sure my office is an amazing group of people. They will send you reminders about all this stuff in the next day or two. I'm sure. Okay.
So I'm going to pause for a moment and I'm going to look at questions. And we have some time for questions here. So let's get to that part. Uh, oh, I just screwed up. Sorry. I don't know what I did here. Hang on a second. Somehow I consolidated the questions. I don't know. Uh, questions. Well, I hit a button that I didn't even know was there. I don't know how I did that. Okay, now we're back to normal. Sorry about that. Uh, oh, May DOD MD's always asking the hard questions. Could you rank these systems? What's the most important? So I, for sure, this is straight out of the Richard Lord playbook. This is not my personal opinion. This is, according to the leading scientist in our profession. He's in his 80s now. He's been doing studying nutritional science since the 1960s. He was at University of Texas at Austin in the late 1960s getting his PhD when there was like a, um, Renaissance of nutritional medicine. And he worked with all kinds of super famous scientists that developed, discovered things like the B vitamins. It's pretty profound. So this is Richard's opinion on it. Most important ranking for what? Out of all the stuff that I've talked about tonight, there's two things that are absolutely the most critical for what? For life? For us to sustain life? One time, Richard asked me, "What's the most important vitamin?" I was like, "I don't know, for what?" He's like, "For life. What's the most single most important vitamin for life?" And he, he made me squirm for a long time. And then he answered the question himself. But so for May's question of the body systems, 12 body systems, for sure the most important thing is glutathione. That would be in the antioxidant section. And then the second most important thing is methylation. Because if you don't have enough glutathione, cells die. If you can't methylate, nothing happens. DNA doesn't happen. Hormones don't happen. Your brain doesn't happen. Just everything's over. So in terms of life-sustaining prioritization, glutathione and methylation are the most important.
Okay. Uh, uh, how to sequence if the stress is stemming from chronic H. pylori and candida? You still want to do the adrenal programs first for a month or two, get things under control, and then go after the killing. Okay. So a month or two of adrenals, and then GI. If you have H. pylori and yeast, always do H. pylori first. There's a lot of reasons for that, but it's pretty important. Okay. We talked about why not start with detox. You can. You totally can if you want with neuroendocrine. Usually we use, I mean, I have a preference for using the natural products. I kind of feel like that's it's my job. But, you know, and this is not a joke. A lot of my best friends are medical doctors. And I'm not kidding. They really are. I mean, I was just talking to, you know, Bill yesterday for a long time. And they use medicines for everything. This, they doctors, and they practice medicine. So they use medicines for everything. They use prescriptions for hormones. They use prescriptions for yeast overgrowth. They use prescriptions for all kinds of stuff. So I have a strong preference for natural products. But plenty of functional medicine docs use prescriptions all the time. There's nothing wrong with that. I've absolutely no judgment against that at all. There's nothing wrong with it at all. Um, I think sometimes in natural medicine, people think that natural medicine's better per se, but not necessarily. You know, you can use taurine with NAC, but usually we use glycine with NAC. If you want to really get the glutathione back up, you can use glutathione by itself. And if somebody reacts to glutathione, you got a pretty big problem on your hands. Okay.
Carina is at Car, KMA is asking that. Um, that's a complicated big problem. If someone's reacting to glutathione, I would try them on glycine and N-acetylcysteine and see if you can get away with that. Otherwise, you may need to come up with a much different strategy. Um, do you still need to use Methyl Assist if someone's using a multi-pack? Absolutely yes, because there's not that many B vitamins in the multi-packs, the energy packs. Okay. And the energy pack is in addition to the mitochondrial supplements. So these are high dosages of products that we're talking about. You're only going to do them for three to six months, and then you're going to retest. So each of these protocols I'm laying out, they're typically going to be around six months. Then you're going to stop, do the other programs, finish things up, and then retest. So you're not on any of these programs for very long, six months max, typically. Okay. The same system, you could absolutely follow with athletes. We get great results working with athletes doing these programs. Absolutely great results. Um, so glutathione and methylation happen last. Yeah, a lot of times the most important stuff happens, happens towards the end.
So, comment on giving glutathione directly instead of precursors. Um, you can do either. I prefer using the precursors personally. That's just a total personal preference kind of thing. So NAC and glycine, because they do so many other things. A lot of doctors prefer to use glutathione itself. And in some cases, you can use both. If a person's really in bad shape, or you can try to use one and see how well it works. How do, how do you know? You just retest, basically. So all, all the success of everything that we're talking about tonight is based on predicate on testing. Okay. Oh, which glutathione product? So I use the liposomal glutathione. What my students tell me, because I've never tasted this one, is the one from Quicksilver Lab. Apparently, Quicksilver's glutathione tastes, tastes the least bad. Um, so, you know, that's a little tip there. I've never actually tasted it, but apparently it's the least bad tasting one.
All right. Now, if someone's reacting to multiple supplements, NAC, glutathione, you got a complicated case on your hands. And there's going to usually be a lot of infections and toxicity. You just have to kind of problem-solve and work your way through that. Those are, those are a struggle. Okay. All right, you guys, this is a miniseries. It means we have more of them coming up. Just keep an eye on your email inbox. And I hope to see some of you in some of these classes, like the cardiometabolic health one or the mentorship that's starting in a couple weeks. Okay. Bye for now.