Transcription
Hello and welcome. If someone could raise their hand just to make sure my sound is working, that'd be great. So, I battle these computers. Oh, thank you. All right, we are, yes, yes, yes, sound is on. So, all right, who am I? What are we doing here? Dan Kalish. For those of you that are brand new, um, I teach functional medicine classes. I've been working with IFM for the last two or three years, doing these practice implementation programs. I've done a little bit of research, enough research to know that I don't want to do any more research. But I did achieve a research study with the Mayo Clinic, which is pretty cool. They studied my practice for six months. Whew, man, talk about under, like, under, under scrutiny. Like, every patient had to return every supplement bottle to verify that they had taken all their stuff. Anyways, I was a research study, and we showed that, hey, functional medicine works. I'm working with Richard Lord. We're talking about a lot of his work tonight on advanced interpretation of labs. And I've been in practice for longer than I want to tell people at this point. You know, the whole first part of your career, you're like, "Oh, I've been in practice," where you kind of exaggerate. Now I'm just like, whatever, I've been doing this for a really long time, and I'm kind of old.
So, we have, for those of you that want to get really into this, the Case Method 101 class. We're selling it for cheap. You can go to, uh, bit.ly backslash Kalish Method 101. We will also send out a link to this if that's a little too much to remember. Um, and that'll take you right into the class. It's kind of secret. We don't post it on the website, so you need the link. And, um, I think it's $99 now instead of like $400 bucks. So, if you're interested in this K-lite method thing that I do and you want to learn more about the work, you can check out that class if you're interested.
And I'm going to talk today about mitochondria and cellular energy. These are the underpinnings for chronic fatigue, for a lot of the depression that we worked with, for everyone that can't lose weight, and how insulin and blood sugar control are, you know, part of this. And now, we all know the basics. So let's just talk about the basics for a minute, and then I'll talk about what really upsets me, and I'll talk about what the potential solutions are.
The basics are, we know patients have to follow diets that control their blood sugar really well. One of the more important things that you can do to reduce inflammation and reduce risk of cardiovascular disease, cancer, diabetes, chronic pain syndromes, depression, you know, is to reduce inflammation by balancing insulin. Because insulin, when it's out of control, causes out of control inflammation, and that causes every chronic disease known to mankind, from arthritis to anxiety, right? So we know that, right? We're kind of assuming that we all know that, and that, um, you know, insulin's super important, and you guys have thought about blood sugar for a bunch of years, and, and, you know, you kind of grappled with it, and you put patients on diets that control their blood sugar and watch them get better. Okay? So we're just kind of assuming that basic knowledge. And, um, and then kind of assuming that we know that metabolism is really important, but then we kind of throw that word around without really thinking about what it means. So today, I want to talk about that, and how this can show up on labs, and how you can sort through this in a way which will really help you help a lot of different patients.
And so now I'm going to complain about things for a little while. So, like, when, when I, when we all first learned how to do this stuff, you learn about B vitamins. It's like the first thing you learn. You know, maybe, maybe the book that you read had vitamin A first because it was alphabetical, but, you know, B vitamins are really important. And we learn about B1, and we learned about B3, and we learned about, you know, all these kinds of things. And then, uh, we kind of move on to other stuff. And, you know, in our industry, a lot of educational programs are led by supplement companies, or they're created by lab companies, or, you know, somebody's selling something. And so you can't just keep talking about vitamin B1 every year because who cares? You could buy vitamin B1 from any company, and they're all kind of about the same, and it's like eight bucks for a bottle. No one is making any money off of vitamin B sales, and so there's not a lot of interest in promoting it. So no one ever talks about it, but it's like the most important thing to human health.
When I was quizzed by my teacher, Dr. Lord, Richard Lord, the other day, and he was, he basically, he had this question. He'd ask me questions every time he worked together. He asked me questions. He knows I don't know the answer to sometimes. If he's in a good mood, he'll ask me a question that he knows I know an answer to. And here's this, this is Richard's book. You know, he wrote the, the only real text that we have for, uh, lab interpretation. Our whole industry is written by Richard. And so he's like, "What's the most essential thing to human life?" And I'm like, "I don't really know. Water? I don't know. Uh, fast cars?" I didn't have a good answer. And he launched into this two and a half hour discussion about thiamin, or vitamin B1. And he's right. If you look at it carefully, if you don't, if you stripped all the B1 out of your body instantly, you'd be dead instantly. It's a very important nutrient. So is B3. I don't know. B2 is important too, but we're not talking about B2 right now. B1, B3, B5. These are not like, kind of optional things that you can have, and some people need and some people don't. These are really, really, really, really important things. And if you don't have them, you're gonna have some serious metabolic problems.
Now, that being said, you know, in my mind, I'm thinking, you know, until recently, okay, well, you don't have enough B vitamins. So what's going to happen? What's the worst that could happen? You're going to be tired, or maybe if it's B6, you're going to have neurological problems, or, you know, there'll be some kind of things like that that, in, in a way, to be honest, seem a little bit minor to me. You know, not like front and center stuff that we see all the time. But when you really start to study the B vitamins and you really start to see how they work, you're going to realize that this is really a super big deal. Okay? And it's not something that's just kind of, uh, you throw the B vitamins in the program and keep your fingers crossed. This is, like, central energy metabolism. This is the basis of human life. And that's what I want to talk about.
And, you know, to, to realize how our industry works. And I, I am supported by supplement companies, and I support supplement companies. I am very good friends with the leadership at Pure Encapsulations and Designs for Health and Ortho Molecular and Metagenics. And I seriously love these people. They are good friends. I believe in the mission that they are accomplishing, and I support them. And when we see each other at conferences, we have hugs, and we go out for drinks. And these are people that I really consider to be close to me. So, not to attack them at all, but in order to run a supplement company, B vitamins has just fallen off the radar screen a long, long time ago. You know, and the supplement companies are competing over exotic and newer products. And this stuff that we're talking about today is just not taught often enough because, you know, we don't have enough, you know, education in our industry that's just being done from a clinical perspective. Uh, and that's just the reality of the business that, you know, being a capitalist culture, right? So you gotta kind of elevate these to absolute top number one importance, not as, you know, "I'll deal with this when their microbiome is better," or "I'll deal with this when I get the brain working," or "I'll deal with this when they're progesterone levels are good." This is like front and center, number one, top priority kind of stuff.
All right, so let's start with that. And some of you are struggling to get this link. Let me see if I can just copy it into the, now, I'll put it into a little folder here. Someone just texted me, so they couldn't get into, here's the Case Method 101 master class. I'm not sure why that link wasn't working, but let me put it into the download folder, then you guys can just download it. And let's see how clever I am. I'm going to copy the link, and this kind of secret, you can't get to this just going to the website, I don't think. I think it's kind of on a on a hidden page. So I'll just call this link, and I'll put it in there. Now, again, this is the Kalish Method 101 class. Um, I'll just call the file link, or Kalish Method 101 blank. This is for Christine, so she can get into there. Check it out. Save, save. There we go. All right. Now I'm going to drag it in. This should work. Um, so the other thing about B vitamins is that when you learn about them early in your career, forget about the whole marketing part of, in terms of the problem here, but you learn about them early in your career, and this, this has been my experience at least. And Christine, I just put that file in there, should be able to download it now. Okay, with the link, when you learn about this earlier in your career, you know, so much other information comes in every year that you kind of push this stuff to the back a little bit, you know what I mean? And you're not really thinking about it, you know, as a front and center kind of thing.
So let's talk basic, basic nutrition, cellular metabolism. Catabolism is the breaking down and using of food for energy. Anabolic states are using food to repair cells. Catabolism comes from the word "cata" in the Greek, it means down. Okay? It's a process consisting of all the reactions during which larger molecules are broken down into tiny ones, and what happens when you do that? They release energy. It's like taking a piece of wood and burning it. You're releasing all this fire as energy, right? All this heat as energy. And what we're really want to focus on now is the digest. Here's a quote here. An example of this process is the digestion of protein. The digestion of protein, which is broken down into amino acids, and then later the breakdown of amino acids so that we can utilize them. And on the opposite end of this is an anabolic state where we're using amino acids and building them up. So you have to break down protein, break down amino acids. One of the major roles of B vitamins is to metabolize or catabolize amino acids. Okay? Strangely enough, they're also involved in building them up. It's kind of weird, but that's how it grows. Okay? Catabolic pathways involved in the breakdown. What we're thinking about primarily for today's class is a breakdown of glucose so you can turn it into energy. Anabolism, "ana" from the Greek, "ana" means up. It's the opposite. Catabolic is down. Catabolic states. The classic catabolic state is a patient is stressed out of their mind. They're going through a divorce, they're in a war zone, they're, you know, just found out they lost all the money they ever made. Something horrible is happening emotionally. They become catabolic. Cortisol is surging. They're in a catabolic breakdown state. And most of the patients that we work with are in a catabolic state by definition. That's why they're sick, right? Anabolic means a building up state where we're starting to assemble amino acids into larger proteins. And this again, assembly process is building up. That's what we want to do. We want to get people into an anabolic state so they can repair. That's the whole thing. And what are the examples of synthesis of proteins from amino acids? Making DNA, making RNA, making mitochondria, making brain chemicals, making heart tissue, right? Super, super important that we can build up. And so again, anabolic is taking small molecules and building them up into large things, especially amino acids being built up into proteins. Catabolic is taking a big molecule and then breaking it down. Okay?
Now, thyroid is super, super important because thyroid is regulating this whole metabolic activity that we're talking about. The thyroid hormones reach out and they tell the mitochondria what to do. When we say, "What does thyroid do?" you say, "It regulates basal metabolic rate." Okay? What does that really mean? It means that the thyroid hormones are regulating the mitochondria, and the mitochondria is burning of energy. I had a patient today, classic example. Put on thyroid medication. They got the dosages just right. Over the course of two years, she didn't get any better. She's still fat, she was still tired. And she finally stopped taking the thyroid because it wasn't working. We ran her tests, we found out she had a massive mitochondrial problem, right? And that problem was overriding the ability of the thyroid medications to work. So as you're thinking about thyroid and metabolism, you got to think about the mitochondria. You got to think about the B vitamins. As you're thinking about patients that have anything as diverse as neuropathies, or depression, or anxiety, could even be bipolar disorder, you got to think about B vitamins and their role, and think about how all this works in terms of energy production, and how thyroid is overlooking all of this. So you always have to check thyroid as part of one of these programs. And again, here's a little quote about the thyroid hormones. T3 acts as a transcription factor within the cell, literally turning on genes within the nucleus of each cell that contribute to the function of that cell. T3 and T2 hormone work in a similar manner within the mitochondria. Within the mitochondria, they turn on mitochondrial genes that code for proteins with the electron transport chain, which is exactly what we're talking about. So thyroid's got to be balanced for this to all work.
Now, we're talking, we're going to get a little more granular now. We're thinking about cellular respiration. That's like how cells breathe, right? They're using oxygen and they're making energy. They're using oxygen and they're making energy. And this is the diagram that Dr. Lord put together, but I want to blow this up a little bit so you can see exactly what we're talking about here. I've copied this so many times, it's a little fuzzy. I gotta go get the original one. But today, we're gonna focus on pyruvate and lactate. So energy, energy production. We take carbohydrate or glucose, other sugars too, but primarily glucose. We convert them. We convert the glucose into pyruvate, lactate, and eventually down here into acetyl-CoA. Separately, we could talk some other day about fats and proteins and how all this works. But primarily today, we're talking about pyruvate and lactate. And can your patient take glucose, run it through this step, get acetyl-CoA, and then make energy? If they can't, they're going to have some really major energy deficits, brain fog, numbness and tingling in the periphery of their limbs, you know, pre-diabetic states, blood sugar fluctuations all over the map, chronic inflammation because they're insulin resistant, right? All these problems are going to happen if they can't control that mechanism.
Okay, another way of looking at it here. We just do a bunch of visuals, then we're going to look on some labs. A lot of what we're talking about today, today is based on genetic problems. Glucose converting down here. Here's our pyruvate, and here's our lactate. Okay? So glucose comes into the cell. This is the cell membrane here. Converts into pyruvate and lactate. Pyruvate coming down, acetyl-CoA, and now we're making energy, right? If you can't do this properly, you're going to have some pretty major problems. And on this testing, we measure many of these things that you see here. We're about to look at labs that measure pyruvate and lactate. It's pretty profound. Measure acetyl-CoA, that's even more profound. That measure alpha-ketoglutarate and isocitrate and citrate. We're literally measuring every little aspect of how energy metabolism works, and you can see exactly where things are broken, and then how to fix them.
So another kind of schematic here, just to show you again, because we all learned this in college, but that was a long time ago. We take lactate. There's an enzyme called lactate dehydrogenase that converts it to pyruvate. There's an enzyme called pyruvate dehydrogenase that converts the pyruvate to acetyl-CoA, and then the acetyl-CoA enters the Krebs cycle, and we get energy. Now, wherever you see an enzyme, lactate dehydrogenase, pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, wherever you see the enzyme, what is right next to that enzyme is a snip. Anywhere you see an enzyme, you have the potential to have a genetic defect or a single nucleotide polymorphism, right? Or snip. Polymorphism means that there's a structural defect with how that protein has been assembled. And we talked about anabolic. So in anabolic states, we build up protein. If your body is messed up in how it builds up a protein because of a genetic defect, then these proteins aren't going to work well, okay? And you can just imagine if the lactate dehydrogenase enzyme was busted up, not working real well, then what would happen? It's not too complicated to see. Lactate would build up, it would go high, and pyruvate would not be high, right? Because it's not going through this next step. If the pyruvate dehydrogenase enzyme was screwed up, and this happens all the time, if you learn how to diagnosis, you're going to see this every week the rest of your career. That enzyme gets screwed up by a snip. Guess what? Pyruvate is going to go sky high, and then what doesn't happen is energy production. What if down in here, this enzyme's messed up? Alpha-ketoglutarate dehydrogenase is messed up. Guess what? Alpha-ketoglutarate is gonna build up to astronomically high levels, and it's gonna mess that person's brain up more than anything you've ever seen.
So these are largely genetic defects. The cells are breathing, right? Cellular respiration. They need oxygen, CoQ10, magnesium, B vitamins. B1 with the high pyruvate. We just talked about CoQ10 with the high lactate. So, in other words, when you look at this here, if lactates build up because this enzyme is messed up, lactate dehydrogenase is messed up, they got a genetic defect, lactate's high, you give CoQ10, it makes the whole system work. Pyruvate is high because this enzyme is messed up, you give vitamin B3 and B1, usually also, and it'll start to work. You can restore normal function to these energy producing pathways. Okay? And once you memorize a few of these pathways, then you'll see them over and over again. You also need a bunch of other nutrients like carnitine and other stuff. Okay? The key is all these enzymes. So I'll read this quote again. "One important note: the chemical reactions in metabolic pathways don't take place automatically. So lactate doesn't just go to pyruvate like through some diffusion process or just because it's a sunny day out, okay? Each reaction, each step is created, facilitated, catalyzed by a protein, protein, protein made from amino acids. And these proteins assembled into amino acid, these amino acids assembled into proteins, we call enzymes. But it's a protein. Let's just call it what it is. It's a protein. And if it's not folded properly because of a snip, it's got a structural defect, it's not going to work." And in case you're wondering how important all the are the B vitamins in this diagram? It circles everywhere where the B vitamins are going to either allow or disallow this whole process to go forward. So let me zoom in a little bit. You can see here's pyruvate at the top. Okay? So many potential ways this can get messed up. You don't have B vitamins.
And here's another thing. I'm just showing the same thing over and over, kind of in different views. So here's actually the mechanisms of direct actions of T3 and T2 on mitochondria. That's kind of cool. So we talked about this earlier. Here's the thyroid hormones telling the mitochondria what to do, directing and controlling cellular respiration, right? And this is complex one and two and three. Remember all that stuff you have to memorize all that for your biochemistry exams? Same thing again. Just want to keep giving you some visuals. Then we're going to look at some labs in a moment. Pyruvate converts to lactate, remember? And ultimately, it's glucose getting into the energy, uh, production pathways that we're looking for. But what's a concern, and we're going to see this in a second here, is if there's a genetic defect in this process, then the, the whole process is going to start to fall apart.
There's another way to look at the same thing. This is kind of a close-in view. Pyruvate dehydrogenase complex. This is pyruvate going to acetyl-CoA. You see what requires the process requires vitamin B1, vitamin B5, vitamin B3, right? All these are required for production of energy. If you're missing, like, and this is why Richard asked me this question the other day, if you don't have vitamin B1, you cannot make cellular energy from glucose. And one would reason, one wouldn't be on this planet for a whole lot longer if that was the case.
Okay, so now with that in the back of your mind, let us pause. I was going to get a drink of water, but I forgot my water. So I'm just going to pause and take a mental drink of water. Now we're back. Now we're going to review some labs. So here is a case. This is an organics profile from Genova Lab, and we are looking at energy production markers, and we're focusing for today primarily on carbohydrate metabolism. So here you have this relatively innocent looking pyruvate marker and lactate right next to it. And this person's markers are quite high. In fact, they're astronomically high. So the way you assess this, pyruvate is abnormal if it's above a 3.9. The 95th percentile level is 6.4. So that means nobody's above a six, and this person's at a 32. So they're five times greater than the 95 reference range, the 95th percentile. So that would be like, this is what I tell patients, you know, because everyone has heard of this straightforward. Let's say you're at a PTA meeting, and you know your kid's in fifth grade, and you're with all the fifth grade parents, and some obnoxious parent comes up to you and says, "Well, you know, my kid's in the 95th percentile, uh, on her IQ test." And you look at me like, rolling your eyes, and then you say, "Well, you know, my child's five times the 95th percentile." You couldn't say that because it's statistically impossible, right? So when you have a 95th percentile number that's a six at the high end, it can't be a 32. That's statistically impossible. This couldn't be a nutritional deficit. This could not be, you couldn't eat enough Burger King hamburgers to make this happen. This could not be a lack of B vitamins in the diet, okay? It has to be a genetic issue or a snip or an enzyme problem or a protein folding problem, whatever you want to call it. So once these numbers get more than double the reference range, it's very unlikely that it's just a straight up nutritional deficit due to bad diet. It's most likely going to be a defect in the enzyme, and that's what these tests are designed to detect, both nutrient deficits because of bad diet, as well as genetic disorders. L-lactate, 47. Again, it's double, almost triple the reference range. Now, you got to think through these things. You can't just assume it's genetic just because it's high. So lactate, it could be high because a person just ran a marathon the day before, and they have a boatload of lactic acid in their body. Lactate can be high because they're on Metformin. I mean, you got to think through these things. I'm not saying these are blanket assumptions, but suspicious, say, none the least. You see these markers this high, and they have peripheral neuropathy, and they're pre-diabetic, and everyone in their family is diabetic, that's probably a genetic issue. That was a patient I had earlier today.
Okay, um, okay, and then what's the treatment? Well, how hard is this? They put it in. It's right in the lab report. You don't even have to ask me. B1, B3, chromium, lipoic acid, and CoQ10. If you're not sure which one, just give them all. You know, you can kind of narrow it down if you want. Um, and lactate requires, I think, a lot of extra CoQ10. Pyruvate, for sure, a lot of, you know, B1 and B3. But if you just give B complex, you know, hefty dosages, and all these other nutrients, these problems start to resolve pretty dramatically.
Let's see. Let's look at a few others. Now, this is this morning's class. So when I teach the mentorship, we review labs every week for a couple of hours for each group, hour, hour and a half, whatever it is, depending on how many labs come in. And this was from this morning. Yeah, hot off the presses. So let's even look at this whole case, and I can show you. So here's one of our doctors, Montserrat. Her patient, 52-year-old male, boat yard manager, environmental health and safety director, blah, blah, blah. Silver weight, high blood pressure, and is overweight. Here's his adrenal lab that doesn't look that great. Has an adrenal problem. DHEA is low, cortisol is high. So I want to work on that. And then under his carbohydrate metabolism markers, pyruvate is undetectable. DL means like, we couldn't even find it. DL means, hey, I'm the lab guy, I looked, we just couldn't find this thing beneath the detected limit. That's super low. And yet, a lactate is high. See that? Well, how could that happen? I thought one converted to the other, but clearly that is not happening in this instance. So we go back and we look at all our charts and graphs and woo-ha stuff here. Let's see. Let me get this hooked up again here. What did we just say? Lactate was high, but pyruvate wasn't even detectable. So something's building up right here and not going to here. Is that good? Not really. Okay? Because remember, they go back and forth. See, pyruvate can go to lactate, and lactate can go to pyruvate. Pyruvate can go to lactate, and lactate can go to pyruvate. So what's happening in this particular patient is pyruvate is going to lactate, absolutely, but lactate ain't going to pyruvate. And is that going to lead to a happy energy production world? No, absolutely not. It's a disaster because this person is going to have all kinds of energy problems. So what do you do for that? You give them the nutrients that are going to make this system, make this enzyme work a little better. What are they? CoQ10, B1, B3, right? But you don't do it like, you don't give like a little bit. This is where the problem comes. You can't give 50 milligrams of CoQ10 and change anything like that. That's gonna be like, I don't know, it'd be like if my car ran out of gas and I went to the gas station and I got like, you know, one cup of gasoline, and then I went back to my car five miles away, I walked, and I put the one cup of gasoline in the, in the gas tank, and I tried to start up. It probably wouldn't even work. Now, you could put it under the hood directly into the carburetor thing, it might start up for a minute, but, you know, a cup of gasoline is not going to get you anywhere. 50 milligrams of CoQ10 is not going to fix anything that we're talking about. You got to start with at least 200 milligrams of CoQ10 and go up from there until you hit a therapeutic dose. And it's the same thing with vitamin B1. You know, 50 milligrams of B1, honestly, you know, if that was the going to solve the problem, they probably would have just had it fixed when they took their first multivitamin, you know, 10 years before they saw you. So you're starting at 100 milligrams of B1 and going up from there. Maybe they need 200 or 300. 100 milligrams of B3 and going up from there. So start conservatively, but start at least at 100 milligrams of things like B1 and B3 and go up from there every few weeks if you're not getting a clinical response. You don't want to make people toxic or sick in any way, but at the same time, what I see in my practice in the last two or three years, I have seen many of my new patients on another program where they were underdosed. I have yet to see in the last two or three years anybody that was taking too much of anything. So most practitioners out there are underdosing from what I can tell, and it just doesn't work, and then they end up coming to see me.
Here's another example. Now, this one is kind of opposite day. The lactate is okay, and that pyruvate is a little high. Is it dramatically high? No, it's a little bit, but still, that could really, you know, cause some serious problems. So again, B complex or B1 and B3, maybe a little extra CoQ10. But for pyruvate being high, most important thing would be the B vitamins. And you can start. A lot of doctors will start with, and this is probably the best way to do it, they'll start with a B complex, breakfast and lunch, B complex, and then whatever extra B you want to give, extra B3, add that on top, extra B6, add that on top. So you always start with the basic B complex so they're getting all their B's, and then add the basic, they add the specific nutrient on top. And a lot of this stuff you can look up online, so you don't necessarily have to memorize everything. But after a while, you start to remember. Like, for example, here, I just wrote some cheat sheets on this slide that I showed you a minute ago. Here are the basic nutrients we're talking about to use. Vitamin B1, especially with high pyruvate. B3 is important too. And then CoQ10 with the high lactate. So the programs vary a little bit depending on which one is high. You really want to crank up the CoQ10 with high lactate to get a response. You're gonna really want to crank up B1 with high pyruvate to get a response, and also use some B3.
So when we're looking here at these systems, okay? And if you're going to all of a sudden, here's a better example, maybe this one. If you're going to give, like, a bunch of B1 and B3 to get this whole pyruvate and lactate thing to work better, then think about what the ramifications of that are. That means you're going to get acetyl-CoA to be better. That means you're going to be making more cis, connote, you're going to be more making more succinate, you're going to be making more fumarate. All the needs for B vitamins all throughout here. Remember, every red circle here is a B vitamin. As you feed more acetyl-CoA in here, you're going to need more of all these B vitamins. So when you get somebody working properly and you release one of these blocks, let's say their pyruvate is really high, and you get that released and working right, they're going to need more B5 for acetyl-CoA conversion into or movement into the citric acid cycle. They're going to need more of all these B vitamins, especially B5 here. They're also going to be more, uh, B2. All these B vitamins are going to the need is going to increase because they're going to be making more energy. They're going to have the potential to make more energy. So that's why as you fix pyruvate, give the B complex so you're covering all the next steps that are going to happen in cellular energy, energy production. If you just give B1 or B3 by itself, you're just going to hit the next roadblock. It's just going to get stuck here. So B complex, all the B's together, potent B complex, and then adding on top of it whatever individual B vitamin you want. And we're talking about pre-profound changes. People with neuropathies, people with chronic depression and anxiety problems, you know, these programs, you know, are pretty, pretty amazing in how they work.
Here's another example. This one looks kind of easy, doesn't it? High L-lactate and normal pyruvate. Okay, that's not too hard. Now, I want to end on one more thought, and then I'll open it up for a few questions, which is that this really matters to the energy production part because we're talking about getting to the end of the road here. This last step, hydroxymethylglutarate push, then you're making ATP, okay? So we want to get people all the way through that process. And in order to get all these working, if you see high levels here, you also need to think about the citric acid cycle too. And again, that's going to be B vitamins, CoQ10, magnesium is extremely important for that. So magnesium is one thing you may consider adding for some of these people.
And I'll show you, there are also on these labs, these sections that say, a section that says B complex vitamin markers. Now, what we're learning today is that if pyruvate and lactate are messed up, the person needs B vitamins, whether or not these B vitamin complex markers are positive. Okay? We're showing you a deeper, not deeper, but a different way to look and see if the person needs B vitamins or not. And you'll see some people, like here, like this person who has high lactate doesn't have any of the B complex vitamin markers, but they still need B vitamins. That's a little confusing, isn't it? Or this person, we started off with high pyruvate, high lactate. Let's see what their B vitamin markers say. Oh, if you just were going by these markers, let's say B complex vitamin markers, you would go, "Oh, they don't need any B vitamins." Oh, here they need this one, they need biotin. Okay, that's a marker for biotin, but they don't need any of the other B vitamins. Wrong, wrong, wrong. Okay? These markers are not showing you the dynamic we're talking about. We're talking about B vitamins specifically used for energy metabolism, for cellular energy production, pyruvate, lactate driven stuff. Okay? So this person has a massive need for B vitamins based on pyruvate and lactate. It's not showing up here, okay? Because these markers look at B vitamins from a completely different perspective. And in this particular case, these B vitamin complex markers missed it completely, and you can pick it up here with these.
So we're going to end on this last concept. Carbohydrate metabolism is super important. Depression, anxiety, don't forget about any kind of cognitive problems, brain fog, anything nervous system related, peripheral neuropathies, pain, chronic pain syndromes, hormone imbalances, delicious, oh, toxicity issues, anything to do with food or blood sugar, anyone who's overweight, anyone who has body fat that they think is not supposed to be there, anyone who craves sweets. I mean, there's a huge car, you know, category of people who are going to benefit. Of course, anyone who's pre-diabetic or diabetic, you would have to fix this on and expect this to be really messed up.
So let's see where we're at here. Just as a reminder, we have this Kalish Method 101 class. Here is the link for it. bit.ly backslash Kalish Method 101. I also put the link in the handout things you can download, the link. And if you can't, if the link's not working for you for some weird reason, just email my office. Let's see, it worked really nicely for me, but sometimes, you know, you things maybe get copied wrong, or maybe your browser is, you know, on a holiday. But if you type that in here, it should pop up, take you right to the Case Method 101 class. You can buy it for $99 bucks and see how deeply you want to get into this. We're also starting a mentorship program in September. If you've been on the fence for a while, jump in, jump in. Okay? And, uh, let's look at a couple questions, then we'll wrap it up. So type in questions, we'll see what we have time for.
Um, can we find some of the causes of energy and dysfunction from the amino acid part of the ion? That's a good question, J.E. Ah, let's go here. So let's look at, let me answer that. But here's a quote. We just did this this morning, like, this is one of their students in class that submitted four organic acids on one patient. We were comparing them. That is pretty cool. But I'm trying to find, here we go. So Jay's question is, "Can we find the causes of mitochondrial and energy production problems on the amino acid part of the test?" And the answer to that is yes, absolutely. Because amino acids are essential for this energy production process, absolutely essential. Why? Because we're using amino acids to build up, remember the anabolic part, to build up and produce mitochondria. You take amino acids, you slam them together into proteins, they get folded up, and those proteins are how we build these very mitochondria that we're talking about. So if you're, like this patient here, if you're missing a single amino acid, a single, if you're missing a single essential amino acid, that means you're not able to completely build proteins as you should because you're missing a single amino acid that's essential, right? And so you're going to have problems right off the bat with building mitochondria. Because lysine is low, one of the biggest, no, that's not mistakes, but misunderstandings. One of my biggest misunderstandings. Let's take tryptophan as an example. Uh, no, that's too easy. Let's take a harder one. Um, I don't know. Let's just say tryptophan. Why make it hard, right? Okay. So if your tryptophan levels are really low, if your tryptophan levels are really low, your tryptophan levels are low, you're thinking, "Oh man, this person has a serotonin problem. I bet they're depressed or anxious or have a sleep disorder." Okay? And all that may be true. But tryptophan is an essential amino acid. That means if your tryptophan levels are low, forget about the brain, they can't assemble proteins anywhere in the body because you have to have every essential amino acid to assemble proteins. So like with this patient, if lysine is low, okay, forget about lysine's relationship to cold sores and immune function, all that stuff you think about with lysine. Lysine is an essential amino acid. Without lysine, you can't assemble proteins anywhere in the whole human body, anywhere. And that's what we've been talking about this whole evening, right? Enzymes and proteins. So if you don't have enough lysine, every single enzyme we've been talking about tonight is going to be compromised. If you don't have enough methionine, every single enzyme we've been talking about is going to be compromised. So J.E.'s question is pretty deep. The answer to that is absolutely yes.
Um, if lactate is normal and pyruvate is low, then it depends. Then you have, that could just be a normal lab, or it may be, what we call a hypometabolic state. You have to see the rest of the test to know. So that's either normal or a big problem. Could go either way. With snips, should you give activated B's? Yeah, with snips, you should give, you know, the best quality B vitamins you can get, absolutely. Okay.
All right, Christine's asked, this is a hard one. Uh, how do you manage MTHFR mutation and subclinical hypothyroidism with normal T4 but low T3? Yeah, so in terms of the snips testing, I use, uh, Pure Genomics. They take the 23andMe data and crank it through a program, which is free, which is nice. Free is good. So I like Pure Genomics a lot. I use them with patients on a regular basis. And then if someone has a problem with T3 and a little bit of hypothyroidism is not enough to show up on a conventional test, but there's still a problem, then I mean, I may pose it as a question. See who gets this right. So what, think about it like a matching game. So like insulin regulates blood sugar. Estrogen regulates, you know, female reproductive stuff, like the uterus and the ovaries. When we say thyroid, what does it regulate? Someone should type in an answer. We'll just be here all night. Thank you, J.E. It regulates the mitochondria. It regulates basal metabolic rate. You guys, I had a slide on this like a minute ago. You should all got that one. All right, just, I don't know. So you guys are checking your phones or something? But here, I have a slide on it. Basal metabolic rate. But how does it do that? Here's my slide. How does it do it? Remember all that? All I said on this slide was, think about it. How do the thyroid hormones act on mitochondria? I mean, what are the thyroid hormones act on? They act on mitochondria. So if you're having thyroid problems, you have to check the mitochondria and make sure that they're working or not, because you can fix the thyroid, and if the mitochondria are busted up, it's not going to help as much as you would want it to, okay? And of course, inflammation is involved in all this. That's kind of the theme, right? Is that if you're lactating and pyruvate or off, you're inflamed. And we started off saying that insulin is very inflammogenic. That's not a word, but insulin is pro-inflammatory.
Oh, and then do I have a preferred nutrient mitochondria nutrient combo supplement? You know, honestly, I think they're all about the same. You know, um, there's Mitochondrial Boost, Mitochondrial Energy, MitoVite, MitoTone. If you look at the labels, they're all kind of similar. I would just go with whoever you, whatever company it's like your favorite company. Um, I even designed my own mitochondrial product. It's the one that Douglas Lab sells. If you want me to earn like 55 cents, you could buy a bottle of that. I get a little commission every time someone buys it. All that. We've probably sold like 100 bottles of it. Wasn't exactly a bestseller, but I did kind of get into it and design it. It's kind of a fun project. But yeah, honestly, I think they're all about the same, you know, because we look at the formulas carefully, everyone's doing about the same thing. Um, I don't think you're gonna have a huge difference there. But you know, you're not going to get to therapeutic levels. So think about those combination formulas as being like the multivitamin for the mitochondria. Then you need to stack on top of that some extra CoQ10, magnesium, B vitamins, perhaps, depending on what the labs say, right?
Okay, gang. I'm going to wrap it up. And again, if you're interested, you can check out the Kalish Method 101 on class. We'll send out links to it. bit.ly backslash Kalish Method 101. And otherwise, we'll see you again. We'll be doing another, it's a series. We'll be keeping going for a while. Okay, take care, everyone. See you soon. You.