Mentorship Miniseries - How to Combine Supplement Programs with Lifestyle Changes

Hi, Dr. Dan Kalish here, and welcome to our summer mentorship mini-series. Doesn't everybody love anything with the word "summer" in it? I know when I was a kid, that was a summer Shakespeare Festival. My dad used to try against you all the time. Anyways, we're doing some fun summer stuff here, and, um, we are combining supplement programs with lifestyle changes. So, for those of you that are new, I will introduce myself. And we had a lot of new people sign up for this particular series of classes, so I'm really excited about that. It seems to be an extremely popular, uh, idea. It's the first time I've ever taught any of these courses in this particular mini-series is to just talk about the the basic stuff, the case management, practice management. Do you never hear anybody talk about? You're supposed to just figure all this out on your own. So anyways, today is a free webinar to introduce you to the concepts that I try to espouse in terms of specifically supplement program design. And so, just to start with a philosophy for a moment, the whole point of functional medicine is to get people to make lifestyle changes, right? Diet, exercise, sleep, spiritual work. And in order to do that, we get people to do these fancy lab tests, and we figure out all these biochemical pathways that are disrupted and disturbed, and then we fix them, and then they feel better. And then, as they feel better, based on the supplement programs, they can start to make all the lifestyle changes we want them to make. And so, if you're not doing the lifestyle coaching, you're not doing functional medicine, I guess is what I'm trying to say, right?

So, let me introduce myself. A little bit about my background. I started the Kalish Institute in 2006. We've trained thousands and thousands of doctors at this point in how to start successful functional management practices. So I try to focus on both business skills development and practical application, things like tonight's talk, as well as, uh, pretty intense levels of lab interpretation. I really, really enjoyed it. Um, benefit of watching practitioners learn how to interpret adrenal labs, female hormone labs, organic acids testing, GI testing, and really understand the depth of the work that you can get to with the labs. I've been involved in research with the Mayo Clinic. I've been involved for a decade now, working with the top scientists in our field, Dr. Richard Lord, to develop curriculum on lab interpretation. I'm in practice, have been for, I can now say over 30 years, I think, because I started in 1992. Over 30 years. I don't think I'm going to count anymore. Let's just say over 30 years in clinical experience. And 10% of what I've learned, I've learned from other practitioners and scientists and schools and all the training programs I've done. 90% of what I've learned, I've learned from working with patients. And that's just the reality of the practice of functional medicine. Okay.

So, we have a whole bunch of special things coming up here. We have, uh, Advanced Mentorship. This is the one-year program. People really jump in and want to do the work at the deepest level. At the end of this year, you will know how to interpret labs better than just about anyone else in your community. So it'll make you stand out as being a top-notch, tippy-top practitioner. In fact, I was just at the IFM conference in Florida for several days, and at least three or four people came up to me and said, "Oh, you know, Dan, we hired one of your graduates, and they're so great." And several of the graduates came up to me and said, "You know, I've been able to get jobs easily because I've been trained in functional medicine by you. And when I mention your name, that I did the Kalish Institute training program, people listen and hire me." And that's because this training program works. We get people to understand how to interpret labs, and very few people in our industry know how to interpret labs at a super high level. So that's really the goal here. And that class is starting in June. So if you guys are interested, you will get a discount code in your email tomorrow, and you can sign up tomorrow when you get that discount code.

And we also have a Long-Haul Syndrome Bootcamp that's coming up, and that is also in the month of June. And that is a couple months of exploration about how we can use lab interpretation for, basically, like cardio-metabolic profiles to understand long-haul syndrome and how to correct a lot of symptoms associated with long-haul COVID, right? And you'll get a discount on that, too. Again, you'll be getting an email on that. And for those of you that have not used Rupa yet, I'm a very strong proponent of Rupa. I've been using them for a while now. Everybody that I know uses Rupa because it's a great service, and you get $100 off your first Rupa order if you use our special discount code. And again, you'll be getting that with an email tomorrow. So hold off if you're not a Rupa user yet. Sign up with them tomorrow. And they're basically a lab distribution company where you can order all the different labs that you use in your practice all at one place, and they're super convenient. As a matter of fact, we just met with them at IFM2. They're kind of the best thing that's happened to the industry from a financial standpoint for practices, probably since online scheduling. You know, when back in the day, we used to have a pen, a paper, and a pencil and schedule people that way, and we did. I did that for a decade, you know. And then online scheduling came around, and everybody was like, "Wow, this is really kind of a cool thing." And now you don't even think about it. You would never hire somebody full-time to answer your phone and schedule people. This is the same thing, but it's for lab ordering. It's even more impactful. You can save maybe 15-plus hours a week of employee time just using Rupa. Okay, so check them out.

All right, so now let's get to the content at hand here. So we've got to think about, if functional medicine is 80% lifestyle, how do we as practitioners inspire people to eat better, exercise more, stop drinking alcohol, sugar, and caffeine? You know, stop consuming alcohol, sugar, and caffeine. So I think of this now as this labs-to-lifestyle thing. Meaning that if you just tell somebody to eat more vegetables, that is not a new concept. In fact, if any of you are parents, and the parents out there can raise your hand, like, how many times did you tell your kids when they were growing up to eat their broccoli? I mean, every parent, every parent has said, "Eat your broccoli," I don't know, thousands of times, at least hundreds of times. And so we're all conditioned. We've all heard somebody telling us to eat our vegetables. And it's the same thing as going to bed on time. You know, how many times you have to tell your kids to go to bed because it's 9 or 10 or 11 or whatever their bedtime is, you know, depending on how old they are. And so just saying things to people doesn't really work. Everybody knows, every morning, every day of their life when they wake up, that they should go to bed earlier and that they should eat more vegetables that coming day, right? But nobody ever does it. So if you're just, you don't want to just be another person telling this person to do something, and you remind them of their mom or their dad or whatever, and then they just don't do it. But if you have a lab, I'm telling you, this works 98% of the time. If you have a lab that shows the person is deficient in a certain kind of vegetables or fruit, and you can say, "Look, your polyphenol markers are really low. Poly, and this is a little scary. Polyphenol markers, a lot. You tell my polyphenols are for, and how they work." You show them the lab markers, and we'll go over some of those in a minute towards the end of the class. We'll review some labs, okay? Um, you say, "Gosh, I don't know what's happening here, but your polyphenol markers are low, and you're going to have to eat more polyphenols based on this test, and I'm going to retest you in six months and make sure these levels come up. Let's go through the foods that are high in polyphenols that you're going to start buying tonight so you can start eating them tomorrow on your new program." And then you write out all the high polyphenol-containing foods. Similarly, what else? Another, uh, your liver detox pathways are not working very well. That's like a death knell in functional medicine. You're not detoxifying. You want to be full of chemicals and heavy metals. You want to walk around with a bunch of arsenic and lead in your brain? I don't think so. You know, it's not a good thing. You want to get Alzheimer's or die from cancer. Bad things happen to people that have environmental toxins stored in their brain. You don't want that to happen. So, gosh, what are we going to do about that? Well, what does your liver do? Let's think about it. Your liver processes alcohol, sugar, and caffeine. So I guess we got to give your liver a break. When we get these chemicals and heavy metals out, and while you take these liver support supplements, we're going to put you on a 90-day no alcohol, no sugar, and no caffeine program. Give you the liver support supplements to get your liver working properly. We can talk later on about whether you want to consume alcohol, sugar, and caffeine again, but let's just give that a break. It does not make sense to spend all this money on these labs and these supplements to clean out your liver and to retoxify your liver as you're detoxifying it. It just doesn't make any sense at all. You know, if you want to retoxify your liver, wait until your vacation next spring when you go to, like, Bermuda or whatever, and you can drink and smoke cigarettes and drink coffee and drink alcohol that you want. But that's just for now. Have a 90-day period where your liver is just completely cleaned out. So if you get leverage from the lab test results, then people will, the vast majority of the time, make the lifestyle change, at least they'll start to. And you can, you know, kind of coach them on how to make that happen. I'm not saying you can't just say this once and it magically happens, but this gives you the leverage to make it happen over time.

So I want to show you some actual cases, and I want to talk about some real-life stuff. I pulled up some labs here so we can actually design a lab-based supplement program and then show you how the lifestyle can be incorporated around that. And I'll also show you, um, some common ones that you're going to want to use all the time that you probably want to memorize, uh, and, um, we can start doing this with your patients like tomorrow if you want. So the skills are also, I mean, a part of this is also, you know, you understanding exercise physiology, some of the basics about clinical nutrition, um, having your own meditation or spiritual practice, making sure that you're exercising every day, um, you know, so there is like a self-care component to this. And, um, that's pretty important. I was at a conference 25 years ago, uh, in the mid-90s, late 90s, and then I remember it very clearly because it was the first time that I was ever on stage where I was actually speaking. And I got in front, I stood up in front of this audience, I said, like, 100 people there was in San Diego. And I was looking at everyone in the audience. I thought, "Wow, that's a really strange group of doctors. They're all really sitting up straight, like, like their backs were like super straight." And I was like, "Wow, there's like 100 people in this room, and half of them have back pain. Why are they all sitting up straight?" Because usually when you hear conferences and there's doctors, you know, it's like two in the afternoon, they're slumped over their chair and they're kind of hunched over. And I went on stage and I did my little talk, and at the end of it, I went to Dr. Timmons, I was like, "What is going on here? What is, are all these people in pain, or why is everybody sitting up straight?" He's like, "Oh, no, no, no. You have the people at this conference are these exercise and physiology specialist people." So what happened was, it was like the room was half doctors, and the room was this other half where these physical therapy people and exercise people and personal trainer people. And you could literally tell who was who just by how they were sitting. So if you have the musculature to sit straight for eight hours in a chair, if you have, you know, the strength to deadlift your body weight, to do a dead hang for a minute, if you have the strength to do, you know, 10 pull-ups and 100 push-ups and that kind of thing, it really, really makes a big difference. And we need to get our patients to that point. And you can only do that if you're actually doing it yourself. I'm very proud to say last week on Friday, I deadlifted my body weight five times, which I haven't done in a while, in like a long time. And so you got to have a certain amount of core strength yourself to make all this work. And you have to do the diet, exercise, sleep, and meditation, spiritual work on your own. So if you're not doing all those things, then you want to start to initiate this work with yourself because then, as you do, you can explain it to your patients. You can say, "Gosh, I've been gluten-free for two months now. Let me tell you all the benefits. Let's get you gluten-free." Or, "I'm starting to do strength training three times a week now for the last 90 days. Let me tell you all the benefits. Let's get you to strength training." You absolutely cannot get people to do these things unless you're doing them. So if you're not doing all these things, you want to do them yourself or study them until you get, um, you know, up to the point where it's starting to make more sense.

Okay, so let's go, um, I want to start with here, yeah, okay. So I'm skipping around the slides a little bit because this is sort of a little bit of a free-form class, um, but let me show you the labs first, and then, um, we can take it from there because I think this will start to make more sense if you see that, uh, so I have a series of labs that I pulled up. Let me just find them here. And bingo. So this is a 54-year-old male, high stress job, bloating, no pain, uh, uh, major symptoms are sugar addiction and digestive problems, and he's got a problem with ringing in his ears, okay? So here are the labs. So here's an adrenal lab, okay? And this one happens to be from Genova. It's their, you know, standard salivary adrenal test. And there's three different things you want to look at here to determine if there's a problem or not, uh, and this guy has all three, which is why I chose this one. So, um, DHEA is low, not good. The cortisol awakening response is way off, and his cortisol rhythm is off. He's either low or high on cortisol, cattywampus, as they would say in Texas, right? Almost all the time. And so that's not good. And you can say, "What's clearly a problem with your adrenal glands? We're going to do the supplement program, and we're going to bring your DHEA levels up. We're going to use pregnenolone to help both bring up and bring down your cortisols. It has a stabilizing effect. We're going to work on blood sugar control because when you see these high cortisols during the day, at the noon and afternoon, that's a key sign that your blood sugar is not being regulated. So you're heading into this land of insulin resistance. So we don't want you going into insulin resistance land. We want to stop that. So, and then you can talk about the exercise and whatnot that's appropriate for someone in a, what this would be called a stage two or something like, like that, for the adrenals, okay?

So let's go then to a program. Let me just review that. Maybe I went to that too, a little too fast. Let me slow it down one here, a second. So DHEA levels are low, so we're going to put them on DHEA. The cortisol levels are irregular, so we're going to use pregnenolone. And when you see these high cortisols at the noon and afternoon time, that's a key indicator of blood sugar instability. Blood sugar is starting to fluctuate. You may or may not see it yet on the glucose levels, but it's starting because cortisol is a glucocorticosteroid. And when those levels are up like that during the day, there's cortisol imbalances. When you see an abnormal cortisol in the morning, what's the first thing that you think of? I was going to say a latte or a cup of coffee, but that's not very funny. Does anybody want to type in this response to that question? What's the first treatment that you think of when you see abnormal cortisol in the morning? Somebody type in something. Just type in anything. Come on, you guys. You can come up with some thought here. Oh, here we go. Thank you, Barbara, saving us here. Uh, yes, thank you. Yes, Guyana got it right. Barbara got it right. You guys are, oh, I'm so happy. Thank you. The most important treatment for what? What is this rhythm? Let's just take a big step back. What is this? This is the circadian rhythm. When you wake up in the morning, you make huge amounts of cortisol. At night, when you're watching Netflix, I strongly recommend "Drive to Survive," which is about Formula One racing. You're watching "Drive to Survive" season five at night, but your cortisol is down because you're about to go to sleep. You surge from highs of cortisol by, it has like 10 times higher when you wake up in the morning to what it is at night when you're watching Netflix. And the way that this is controlled, the master controller of all of this is light. It's your exposure to light. So one of the most impactful lifestyle treatments is getting the person to get exposed to light when they first wake up in the morning, as soon as they wake up, and as soon as the sun is out, to go outside. You're not supposed to look at the sun directly. That's a bad idea. Everybody learned that in like second grade. Don't look at the sun. But you can't sit near a window. You can't be driving in your car. Glass screws this up. You have to be physically outside. If it's bright outside, um, like I don't know, it was this morning. I got up at like six, and it was bright. It would seem really bright to me. The sun was out. It was bright, you know. Five or 10 minutes is plenty. If it's cloudy, it still works because the infrared stuff's still coming through the clouds. But you have to stay out more like 10 or 20 minutes. I usually don't tell patients that level of detail. I just say, "Five minutes every morning, physically get outside as soon as you wake up and the sun is up." If you wake up and it's still dark out, don't go. It's not going to help, okay? But as soon as you wake up and the sun comes up, go outside for five minutes. That has the most profound change in human physiology of anything you could imagine because all of a sudden there's light, and your entire HPA axis goes, "Oh, I get it. This is what I'm supposed to be doing." So low cortisol in the morning, it could be high cortisol, any kind of cortisol problem in the morning, get them outside for five minutes first thing in the morning. Now, this is one of those examples of labs, the lifestyle, where you could just say that and give them all their research that shows how important this is. And there's like entire neuroscientists who have developed their careers to studying how the human eye and brain react to light. This is not like an abstract thing that we're making up because we're like natural medicine people. This is like documented, real science stuff, right? And it's in the literature if you want to read about it. You should. But the reason to do it now is because of the lab. You're like, "Whoa, Jane, I don't know. This cortisol in the morning is really low." Well, we're going to give you a supplement to fix that, and we'll design the supplement program. This is something called licorice root. Um, if you don't want to have to buy this licorice root forever, put my kid through college, spending your money on supplements, you know, let's get you outside for five minutes every morning. The licorice root will do a quick start on this. Going outside for a few months every day will seal the deal. You can get off the supplement once you've got that lifestyle change in place. And then eventually, you'll be like me, and you can tell them because you're all going to be doing this now, right? You can say, "Gosh, ever since I went to Dr. Kalish's car, you know, free webinar, and I started doing this myself, I can't believe how much better I feel." And in fact, you know, for myself, like this morning when I woke up, once you do this for a while, you will wake up and you will look at the light outside and you will run to the light. You will think, "I can't really start my day." It's probably how people feel about coffee. I don't personally drink coffee, but I, that's how I feel. The morning you wake up and you look outside, I can't start my day until I get outside for five minutes. I combine being outside on our porch or deck that's off the bedroom. It fortunately faces the sun, so I'm getting full sun. I'm outside and I do all my exercises for, you know, 20 or 30 minutes, my like kind of Tai Chi stretching exercise type stuff, horse stance, and I do like the kind of crunch thing. We have to hold your stomach for like a minute and all that stuff. So, um, it's very efficient because I get my light, I get a warm, you know, kind of warm-up exercise workout in every day, and poof, off to run. Running now. You don't have to get that deep into it with patients. Two to five minutes of outdoor light at day when you wake up. Remember, this is a rhythm or a pattern. If they're having trouble going to sleep at night, getting the cortisol up in the morning will improve their sleep at night. It's a rhythm. It's a pattern. And if you're off in the morning, you, the major symptom of low morning cortisol might be, "I can't get to sleep at night." As soon as you bring up that cortisol, they're going to sleep better. I know it sounds a little strange, but it's a rhythm or a pattern. And if you get the light exposure, then it puts a hard, you know, stop on things and says, "Okay, this is the sun coming up," which then lets the body know, "Oh, now it's nighttime. Now I'm going to let down and go to sleep." So, labs, the lifestyle, that's number one. And on a supplement side, you can use licorice root to make that happen.

Part number two for the adrenals is high cortisol at noon and afternoon. That's the key sign in an adrenal lab of a blood sugar instability problem. Blood sugars are fluctuating up and down too quickly. Your cortisol is stepping in to deal with this problem. Okay? It doesn't mean that they're diabetic or pre-diabetic necessarily, but it means they're not handling blood sugar well, and cortisol's role as a glucocorticosteroid is now, you know, not working right either. And so if you get their diet corrected, and you have them eating a little bit of protein and healthy food with breakfast, and a little bit of protein, that you don't have to be a carnivore and just eat meat, but, you know, healthy food, whatever, either vegan or meat eater, however you're doing it, healthy protein with breakfast and lunch. The healthy breakfast will knock this lunchtime level down. The healthy lunch will knock this level down. And then you're going to also give them blood sugar support supplements to speed up the process. And typically within two weeks, this should be a really big shift in their blood sugar regulation, and they should feel tremendously better. So we just did this adrenal lab. We're going to get the person waking up in the morning, going outside for five minutes, rain or shine, just being outside. We're going to get them on a blood sugar regulation diet to lower these cortisols. And then we're going to put them on a massive supplement program that I'm about to show you to, uh, to just make this whole thing accelerate. Okay? So again, with the lab in front of you, you can have a discussion about the importance of setting the HPA axis by getting outside and the importance of blood sugar regulation. When a person's healthier and their adrenals are working really well, then you can advance them to intermittent fasting. And I ate today. My first meal today was at, uh, 2:30 PM. So I ate dinner last night around 6:30, and I didn't eat until today around 2:30 PM. I'm a very strong proponent of intermittent fasting. I think it's great. However, in the beginning, when you're working with people, if their cortisol levels are wonky like this, it may not be the best idea to have them, you know, starve themselves with breakfast and lunch. So in the beginning, you want them to eat breakfast and lunch, get enough protein with each meal, get these things stabilized. Once you start to see normal cortisol tests come back, then you can move them up to intermittent fasting. Okay? So let's save the exercise thing for later because I have a special thing I want to show you. You could talk about exercise now, but let's just wait if you don't mind.

All right, so now let me pull up a protocol. Let me kind of make this a little more real. So here it is here. I got it down here. Let's look at this one. So we've got someone on with the adrenal issue. We've got their DHEA drops, their pregnenolone drops. It's a male, so we're giving them a men's pack from Pure Encapsulations, giving them some additional adrenal support here. And then, uh, let's see. This one thing has got to change here. This would be Metabolic Extra, that's for the blood sugar control. It's also from Pure. And then some Vitamin C with flavonoids. And usually that's a 500 milligram. You want to give about three to five thousand a day. So here would be the adrenal program. Oh, and the licorice root. They need licorice root first thing when they first wake up. So now we've got the DHEA, why? Because they're low in DHEA. We've got the pregnenolone, helps stabilize cortisol. The Managed Pure Packs, so they get all the multivitamin mineral stuff in there. ADR, which is an adrenal support. Metabolic Extract, which is blood sugar support. Some extra Vitamin C. And then the licorice for their low cortisol. The Metabolic Extra is going to help with their high cortisol at noon and afternoon because a lot of that is blood sugar handling issues. And then if you get them eating properly, this all comes together. So now, just based on what we've covered so far, you've got the person waking up early, and that's going to improve their sleep cycle and their whole HPA axis. And you've got them on the blood sugar control diet with blood sugar control supplements and the adrenal supplements. That's a lot right there. And for most patients, this is enough for the first six months. I mean, that's a lot to deal with. You can have tremendous potential benefits, more energy, better weight loss, losing weight, um, sleeping better, you know, GI problems getting better, all kinds of things will get better if you just do a program like this by itself.

Okay, now let's see here. Here's the same patient here. This is a real patient. This is from, um, I don't know. This is supposed to say this is from yesterday's class, I think, or Tuesday's class. These are a couple days old. So when patients, when doctors are in the mentorship program, they submit labs, and this is Tina, is one of our doctors, and she submitted this guy's labs. Or 54-year-old. Hers adrenal, GI, and organic acids. And then we reviewed them on Wednesday and designed programs. That's what the mentorship is. If you guys sign up for the mentorship, you can send in your patients every week, and we'll go over these every week until you get really good at this, and then you'll all be happy. So this particular patient had H. pylori, so that's an issue. Some dysbiosis, that's not good. And like, extraordinarily high secretory IgA. Look at that. That's kind of cool. Super high sIgA. All right. Now, on the organic acids, we don't have time to get into all these probably because we're trying to do program design here. But let me just show you, let's say a section of it, uh, here. This is good. So this is organic acids from Great Plains, now called Mosaic. It's kind of like when Prince changed his name. Do you remember? I love Prince. Who sort of said, very sad when he died. But when he changed his name, he wasn't Prince anymore, you know? But anyways, so Great Plains is not Great Plains anymore. They're they're Mosaic Lab, if you can believe that. They changed their name. I'm upset by that. I liked Great Plains. I think it's a cool name. Anyways, not my decision. Uh, homovanillic and vanillylmandelic are both low. See those? Okay. Homovanillic and vanillylmandelic are both low. Most you probably noticed, but those are markers for dopamine and epinephrine and norepinephrine, okay? They're catecholamine markers. So when they're low, the system is burned out or deficient. It's, it's been depleted in those chemicals, okay? And so that's a concern. And we're going back to our program here because of that. We're going to add in tyrosine. And this is adrenaline, right? Epinephrine, adrenaline, they're the same thing. So we're adding in this supplement. And then we're saying, "Hey, you know, your adrenaline levels are kind of exhausted." And he's like, "Well, yeah, that's a big surprise. That's why I'm seeing you. You know, I already knew that." Well, let's talk about how you could rejuvenate your brain. Gosh, I wonder, has anyone ever in the history of human beings thought about this before? I don't know. Maybe maybe that's what we call meditation, cleaning of the mind, cleansing of the mind, clearing, you know? Yeah. So we would want to get this person into a meditation practice so they can control all the chemicals being produced in their brain. You give the tyrosine and the instructions. Now, we want you to meditate 10 minutes every morning, 20 minutes every morning, whatever it may be. Now, you can't stack all these lifestyle changes up at the same time. You got to do one at a time. But this is like a class. This isn't really, but let me lay out what they are. So if we had number one, we had morning wake and outside for five minutes. Remember I said five to ten minutes is better if there's the full sun light, 10 to 20 minutes is better if it's cloudy out, but I usually just ask people for five because that seems a little more reasonable. And that's life. So I'll change one. And there's a cardinal rule to this: you only give one lifestyle change per session. So first session, start with a light exposure. They come back in two weeks or whatever your cadence is for retail, you know, reevaluating, you know, how's it going? Are you waking up every morning? Like, "No, I forgot about that." Okay. Once they get that first lifestyle change going, and that may take a little while, it could take weeks or months. Once they get that going, then you're going to work on the next lifestyle change. In this case, it's blood sugar regulation, and that's going to be a blood sugar control diet. If they're an advanced patient, you put them on the wake up in the morning thing. They come back in a week. You're like, "You ready for blood sugar? Let's do that now." You know, when you can make this go quickly. But circle control diet, I start with all the supplements right away. But the lifestyle changes, usually you want to do one per session. If you're seeing people once a week, you can make this go fast. Uh, and then what did we say was the third one? Oh, meditation, based on exhausted catecholamines. So this may be a couple months of lifestyle changes. I'm just trying to lay them all out for you so you guys can see them all at the same time, right? And then that's the supplement program. Yeah.

Okay, so hopefully that kind of wraps up that particular example. Now I want to show you one other thing here because I, this is sort of a general sample, and, you know, what I just listed out, you probably could be used, um, honestly, by most of the patients that you see. You could probably do what we just went through, um, pretty much everybody needs to get outside if they're living on the earth, they're living on this planet, in the human body, they have to get outside when the sun comes up. There's not a lot of negotiating there. So that's like a lifestyle change for every single patient. Okay. Blood sugar regulation, kind of essential. Now, you can get to the point where you can keep your blood sugar stable with intermittent fasting, but in the beginning, for someone who's got a lot of health complaints, that's a little taxing. So I would save your intermittent fasting for once you've got their adrenals stabilized. Okay? We're not against that. I do it. I recommend it. But that's a later step. So for the beginning, with every patient, you're going to want to also focus on blood sugar regulation. Again, that's a kind of like a given that you're going to want to use almost all the time. And then let me just show you this one other thing here. And then meditation, I pretty universal too, isn't it? Like you want every human being, every one of your patients to meditate. When I look back on the teachers that trained me, Dr. Timmons, Dr. Leibowitz, Dr. Frieder, all of them, all of them were intensely spiritual people. None of them really talked about that a lot. It was sort of unspoken. It's a little old school, but they were in essence spiritual healers that were practicing lab-based functional medicine and naturopathic medicine. And that's kind of what, what I think all healers for all of human history have primarily been spiritual healers. So anyways, just want to keep that in the back of your mind as we get into these labs because it can get kind of technical. You just don't want to forget that there's this, you know, spiritual thing happening too.

Okay, so here's a, this is a metabolomics lab. If you're not familiar with these from Genova, could just rush out and order one of these from Rupa tomorrow when you get your discount code, right? So a couple things on here that I just want to point out. Now, we went broad with our first example, adrenal stress problem. We're going to get them to get exposed to daylight, get their blood sugar regulated, and get them meditating. Okay? When I skipped there because there's four things: diet, exercise, sleep, and meditation. Was the exercise part. So there's lots of ways you can control for exercise and make exercise recommendations. But there's a couple that I think are particularly helpful to know if you guys haven't learned these already. I think this will help because I use this one like literally every day. Uh, here, let me show you on here. So, and it's a little, kind of a stealthy thing. So under carbohydrate, sorry, under fatty acid metabolism, did these two markers, adipic acid and suberic acid. And if you're using the Great Plains test, let me show you on that one. Uh, so this is the Great Plains, now Mosaic test. If you look at that, you see adipic and suberic acid and ethylmalonic acid. These three in particular kind of stand out. These others are important also, but just to make these the most important: ethylmalonic, adipic, and suberic. And again, if you're doing the metabolomics test, it appear in this test. They put it in the ketone and fatty acid oxidation section because some of these markers are for ketones and some are for fatty acid oxidation. I think they should keep them separate personally because I think it's kind of confusing to do it that way. But again, no one's asking me here. They do separate it out, which I like more on the Genova test, a fatty acid metabolism. Okay, they don't confuse it with the ketone part. And that's adipic acid and suberic acid, the same exact markers, right? So now you see this marker high there. So suberic acid is high. And you'll also see that contextually in the other part of the lab. Let me show you that. Oh, here's a sec. I use this one all the time. In fact, I think this is one of the more interesting lifestyle changes to help people with. Uh, here, up here. So now, if the person is overweight, or has any kind of fatigue problems, or has any history of cardiovascular problems or concerns about that, high triglycerides, high cholesterol, high blood pressure, family history of heart disease, weight gain, they can't lose the weight they want to lose, weight gain, fatigue, uh, you can throw long-haul COVID in there if you want. Anything that has to do with vasculature, blood vessels not working well, or a metabolic problem that has to do with fatigue and not being able to lose weight, you have to be able to burn fatty acids in order to be healthy, in order for your cardiovascular system to work. Because this is a major source of energy for the heart. And depending on who you read, 50, 60, 70% of the energy in the human body when you're at rest is coming from beta oxidation of fatty acids. So what your body does is it takes the fat, it, uh, runs it through beta oxidation through a kind of complex process, I can show you in a minute, and then that fat gets turned into acetyl-CoA and it enters into the energy-producing cycle, the citric acid cycle. So if you can't burn fat, you're going to be tired, you're going to be overweight, and you're going to end up having high cholesterol, high triglycerides, high blood pressure, high risk of heart disease, pre-diabetes, diabetes, metabolic syndrome, insulin resistance, all those kinds of things are going to happen. And if you eat too many carbs, obviously that's going to interfere with your body's ability to burn fat, and you're going to store fat, and this whole thing gets worse. So it's, you know, there's a lot of reasons why this happens. But you can see on the lab here, if suberic acid or adipic acid are high, it means there's a block right here, and that beta oxidation isn't working very well. And that is crippling for your mitochondria because your mitochondria want to have the ability to make energy from fat. All right.

So now that's kind of part one of this. And then part two of this, let me just show you. There's one, one image here I just need to pull up real quick. Uh, uh, here, where is it? Sorry. Oh, hang on a second. Give me 10 more seconds. I thought I had this pulled up and I didn't do it right. Uh, here we go. So in order for beta oxidation to work properly, you have to have, I think we can just use this one here. In order for beta oxidation to work properly, you have to have sufficient carnitine in order to transport that fat. Yeah, this is perfect. So the way it works is you have your fatty acid. You take carnitine to bring that fatty acid into the mitochondria. You run beta oxidation, and then you make energy. This is the fat burning process right here. If you don't have enough carnitine, there's a block right here, and the fatty acid cannot get into the mitochondria, and you can't burn fats outside the mitochondria. It just doesn't work like that. If you could burn fat outside the mitochondria, I don't know, behold, nobody would be fat, right? Like the BCD probably wouldn't exist. I don't think we'd be alive either. I mean, it's pretty important that you don't do that. Anyways, you can't do that. So carnitine is this shuttle that pulls the fat into the mitochondria. This is the mitochondria, right? The, remember, has that double layer. This is the two, the two layers there. So the explanation for this with the patient is, "Gosh, your adipic acid is, suberic acid, or ethylmalonic acid is high. You're not doing this beta oxidation process very well. Okay? We want to get that corrected. I'm going to give you the supplement carnitine, which is kind of like a miracle because it's going to all of a sudden make it so you can burn fat." That's like step one. However, if we just use the carnitine, that would be like if you were, let's say, you went to the gas station. Did anybody see Zoolander? There's a movie called Zoolander. It's kind of embarrassing that I've seen that movie. I've only seen it once, maybe I saw it twice, but only twice. But there's a scene in Zoolander, um, with, uh, where, um, it's two of my favorite comedians. Anyways, they're, they're in a gas station, and they're, they're playing with the gas pumps, and they're spraying gas all around, and they're blasting like really cool music, and they're dancing, and they're not that smart. And then of course, the whole thing blows up, which is kind of funny. But if you went up to a gas, if you pulled your car into a gas station and you started to put gas into the tank, and then the tank filled up, and you just kept holding the thing down, there's gas spilling everywhere like they did in Zoolander. Is that going to give you more gas in your car? Is it going to get more energy out of that gas tank? No, it's not. So you can't just give the person carnitine and then have those fatty acids magically go somewhere. You have to actually get them to burn up. You have to have a reason for your body to burn the fat, and that's called exercise. So carnitine by itself, in the absence of exercise, isn't going to do that much. I mean, it'll fix it. It'll fix a lot. I shouldn't say that. It'll fix a lot, but it's not going to get someone to lose a lot of weight, and it'll give them limited improvement in terms of energy. But if you get the carnitine in their system so they can burn the fat, and you can pull the fat into the mitochondria, and then you stimulate beta oxidation, that's where things are at. And that happens inside the mitochondria. Okay.

So here's your second quiz question for the day. How do you stimulate mitochondria in such a way that you improve beta oxidation? And there's a couple ways you could look at it. How do you get more mitochondria that will burn fat? How do you get the mitochondria that you have to burn fat better? Basically, what kind of treatment can you do? Well, Barbara is all over this. Zone 2 exercise is the answer. Zone 2 exercise. Zone 2 exercise. Now, the carnitine puts all the, you know, fuel into the gas tank. The Zone 2 exercise forces your body to produce more slow-twitch muscle fibers. So in the muscle tissue, there's slow-twitch and fast-twitch. And they've got a name for what they do. Fast-twitch is your sprinting muscle fiber. Sprinting muscle fiber. So if I say, "Okay, all of us, get off our chairs. We're going to run as fast as we can for 30 seconds." You're going to be using fast-twitch muscle fibers. And if you've ever been to a playground and watched kids, have you ever seen like a five-year-old walk across the playground? No, they run. Human beings are designed to run. And we do that, you know, all throughout our childhood. Just run places. You want to go over there, you run over there. Adults tend to stop doing that. And so that running, that 30-second sprint, that's a glycolysis process. That's using glucose. You're using the glycogen stores in the muscle, in your creatine in the muscle, she's just, you know, making it happen, right? That's not beta oxidation. That's fast-twitch. So if you haven't done a sprint in a long time, it takes them a minute tomorrow and just sprint for 30 seconds, rest for a couple minutes, sprint for three. Do that like three or four times and see how sore you are the next day. You'll feel those fast-twitch fibers that you haven't used in a while. Okay? That's for glycolysis. That's for blood sugar burning. That's for, you know, glucose, glycogen, all that stuff. You know, I just want

To point out there's separate fibers. The slow-twitch muscle fibers are slow. They burn fat, and they are produced and stimulated and encouraged to be healthier. And you'll grow more mitochondria that have these slow-twitch ones, and there'll be more slow-twitch muscle fibers in general if you do what's called zone two exercise.

And so, if you've never heard that term before, zone two, it's cardiovascular exercise that's relatively low intensity. As an example, I do zone two three or four times a week. I always do it on my bicycle because I love to ride bikes, and I have maybe five or six bikes, so I have to take them all out every week, you know. And, um, the rule of thumb for zone two is that there's, you can measure your heart rate. There's complicated ways to do it, but I think the easiest way is just it's, it's nose breathing only. So you're on your bike, or you're doing a jog, or whatever, or you're rowing on a rowing machine, whatever you're doing, but you have to be sure that you can breathe through your nose the whole time if you're working out. So hard that you have to start breathing through your mouth, you're leaving zone two and you're going into higher heart rates. So zone two is relatively low heart rate.

Okay, again, it's defined as it's faster than walking, but it's not so fast that you have to breathe through your mouth. The other rule of thumb, and this works really well too with zone two, is if you're on a jog and you're doing zone two, you should be able to sing a line of a song or have a conversation with the person next to you. So when I'm jogging and I'm trying to make sure I do my zone two, I'll just say something, you know, because I'm always jogging by myself. I don't do jogging groups. But if you're with a person, you could, you know, can you say a sentence? If you can't get a sentence out without breathing, you know, irregularly, then, uh, then you're, you're beyond zone two. Okay, so either talking test or singing test or the nose breathing test to keep you in the zone two.

So zone two stimulates the mitochondrial, the mitochondria that specializes in this beta oxidation thing. Now, what that means is if you get a lot of mitochondria like that, it means that when you're sitting around, when you're sleeping, when you're listening to free webinars like you're right now, you have more muscle fibers, more muscle tissue devoted to beta oxidation. So guess what? You're burning fat all the time. It's not the effect of weight loss while you're exercising that matters because you don't burn that many calories when you're out for an hour-long bike ride. I mean, you could undermine a whole week of bike rides with one bowl of ice cream if you're looking at it from a calorie to calorie perspective, right? So you burn a couple hundred, 500 calories, you eat one big bowl of ice cream with, I know, chocolate sauce on it, and it's all of a sudden, you know, you've made up for that. It's the calories that you're burning 24 hours a day because you now physically have more mitochondria, more muscle cells, more muscle tissue that's engaged in beta oxidation.

Okay, so this is the, my, I think one of my favorite labs to lifestyle combo packs here because you've got the subaric acid or adipic acid or ethylonic acid that are high, which shows the need for carnitine. You give the patient some carnitine, so now they're transporting the fat across the mitochondrial membrane into the mitochondria. But it's just sitting there. Remember, it's like gas just sitting in the gas tank. The car is not moving yet. You have to get beta oxidation engaged. You have to have a reason to burn the fat, and that's your zone two exercise. If they're doing super high-intensity exercise, you're going to be more in the glycolytic pathways. That's good too for other reasons. I'm not, that's not a bad thing. That's just not fat burning. You will still burn up a lot of calories and you can lose weight that way. But what we're talking about here now is trying to rehab the mitochondria based on the labs so that you get better beta oxidation. And this is one of the most important things you could do for your cardiovascular health. It's one of the most important things you could do to lower cholesterol, lower triglycerides, lower blood pressure, lower your risk of a heart attack, improve your metabolic, you know, situation in the world, your metabolic stance, your metabolic status, is to get beta oxidation working.

Okay, so again, let's go look back on the labs and show you how to tie this in. Sorry, that's the wrong thing here. Bingo, bingo, here we go. Okay, so again, on the metabolomics, you'll see fatty acids, adipic acid, sebaric acid, and beta oxidation. If subaric or adipic or high, then there's a block there. So you give the nutrient carnitine, and then you get the person to start to do zone two exercise to stimulate beta oxidation. So just giving the carnitine is great and will help a lot of people. Just doing the exercise component is great. It will help a lot of people. But it's very frustrating if you're a patient. Let's say that you're a well-intended patient and you're, I was trying to think of who my ideal patient is, but let's not go there. So you're just a good patient, okay? And you give them carnitine because their fatty acid markers are off, but you don't tell them about the zone two part. I don't know, it's going to help a little bit, but they're going to get frustrated after a while because it's not going to really help that much.

Similarly, let's say that you're an exercise person, you know, you're a personal trainer or something, and you're like, well, we're going to do the zone two thing, and you get their beta oxidation really cranked up, but they don't have the nutrient status to make that work. They don't have the carnitine in their system to burn the fat. Then they're going to get pissed off because the exercise. They're going to come in, they would say the same thing every single time. They'll come in, "I don't know, I've been doing seven hours of cardio every day, all day, and haven't lost any weight. How could that be?" Well, let's do this lab, and you'll see more often than not, there's a block right here in your ability to burn fat. That's why you're not losing weight. Okay, so the combination of a lab-based supplement protocol with the lifestyle change for exercise makes all the difference in the world.

All right, so let's go back. We got a couple more minutes, and then I'll try to get to a few questions. Let's see. Health Plan. Okay, so we're back to our same person here, and now we're adding to this, uh, what do we want to call it? Zone two exercise, 45 to 60 minutes, three to four times a week with carnitine because of those markers that we just showed. So then you would add to the program here, L-Carnitine. Let's just say get into 500 milligrams, and usually you want to do about a gram in the morning and a gram at night. You can go a little higher, but that's kind of usually enough. Two thousand to three thousand a day, somewhere in that range. And again, imagine the frustration of just doing the carnitine without improving the mitochondria. You're putting the gas in the car, but it's, there's nowhere for it to go. It's not moving. It's just as silly as those Zoolander guys spraying gas everywhere. And imagine how pissed off you would be if you've been exercising for a couple years and just couldn't lose weight because you had a carnitine deficiency. That's why everybody needs to do the labs. And I've done these labs with a lot of professional athletes. If you find a professional or semi-professional athlete who's low in carnitine, they will just not believe their performance improvements when you give them the carnitine. This really, really matters. This is not like an abstract kind of side pathway that, you know, some people. This is like central. This is the main way that human beings burn energy, especially in endurance activities. Now, if they're a 100-meter sprinter, they may not notice it, right? But anyone else is going to notice a pre-profound difference in terms of how they feel. And not in a subtle way. It's not going to take like a really long time, okay? It's going to happen pretty fast.

All right, so let me do something here. Let me make sure we've got through this. Yeah. Okay, so quick announcements in case you joined us late. Number one, we have a mentorship class starting now. If you guys are interested, we'll be sending out a discount code tomorrow. You can talk to my staff about the class. You can schedule a call with myself so I can go over what the class is all about. So one year deep training into the labs, into organic acids, and all the gut-related things and the hormone-related programs, and how to tie that together like we are tonight with the lab impacting the entire program and the lifestyle changes. We also talk a lot about business models and the structure of the practice and what labs you should order on everybody, exactly what supplements you should use, what brands you should use. There's a live call every week where we get to review your labs. There's a huge curriculum I've built over the years, so you learn how to interpret the labs, and at the end of this year, you'll be like one of the best people in your area in interpreting labs, and I'm very proud to see our mentorship students doing so well with their jobs out there.

We also have a long-haul syndrome boot camp coming up, which is a two-month exploration of how these labs can be applied to long-haul COVID cases. We're seeing great results with that, a lot of symptomatic relief and overall improvement in people that are suffering from long haul. If you get their glutathione normalized and their vitamin D normalized and all these things that we can do with the lab tests. Okay, and so that's been going well. And again, you'll get an email with a discount code on this tomorrow. And if you haven't joined with Rupa yet, you can check out Rupa Health, and we have a hundred dollar discount going with them. Again, you're going to email on that tomorrow too.

Okay, so now let me glance at questions. We got a couple minutes here, and let's see what we can do on questions. I'm not going to be able to get to them all, I'm sorry, but, uh, see what we can do. Uh, oh yeah, textbook for organic acids interpretation. Laboratory Guides to Health by Richard Lord. Laboratory Guides to Health by Richard Lord. That is the really only significant text on organic acids interpretation, and it should be something that we all have just on our desk all the time. I mean, that metaphorically, because it's an online book. But, uh, let me show you here. So this is my teacher's book. I take full responsibility for this book because a lot of the writing in this book is Richard's response to my nagging him over the years, me basically telling him, hey, you know, none of these doctors understand bloody blah, and then him going out and adding another chapter in his book about the various topics. And there's, there's a completely updated and revised, um, version of this for, uh, organic acids only. So let me show you here. Here we go. Let's pull up the page. Laboratory Guides to Health, Richard Lord. Okay, you can buy that from Apple Books or from Google Books. It's an online thing. And that's, uh, the other questions here.

Carnitine supplementation. Any supplement can be a toxicant. So if you have a patient that has kidney disease or some other kind of condition, thyroid problem, you have to make sure that the supplement that I'm recommending here, like carnitine, is safe for that individual. And just to remember, every nutrient, every nutrient can be a toxicant. Every nutrient can be potentially dangerous. So you have to keep that in mind that you have to kind of research that. Let's see. So it doesn't, how about mold clearing? Usually mold is done towards the end of a protocol. Turn when you're getting ready to do detoxification towards the end. Okay. If the GI map, this is from Joseph, the GI map shows dysbiosis, H pylori, and high CIGA, would the client be able to absorb these nutrients? And couldn't the GI issue be stressed on the adrenals, brain, etcetera? So yeah, so the, we're always assuming that people have poor absorption of nutrients. That's sort of fixed into these programs. So you have to kind of take that into account. And there's some complex, you know, GI adrenal decisions you need to make about which one's going to go first. So that's going to vary depending on the case.

Uh, then Carrie's asking about, uh, the difference between Epi Integrity powder, one to two times a day. I would always start low and then go up, you know, when you're working with a new patient, start low for the first week or two, and then go up if you can. And so for women, there's a women's pure pack, pretty straightforward. And if you want to be gender neutral, there's the energize pack. Oh, those are all from Pure. Energize pack is sort of sex neutral, gender neutral. This is women's pack and men's pack. Uh, why pregnant alone? You have to come to the adrenal classes for that. Pregnant alone is probably one of the most important supplements that I've ever used. If you don't use pregnant alone, you're not living. Okay? So, but that's a whole other subject for another day. We'll do some adrenal classes at some point. Right, I've got to wrap it up for now. Thank you guys so much for your attention and your time. Take care. We'll be in touch soon.