Roadblocks to Burning Body Fat: Lab-Based Warning Signs of Insulin Resistance and Metabolic Syndrome

Hey Dan, Kayla's here and we are going to talk about roadblocks to burning body fat, lab-based early warning signs of insulin resistance and metabolic syndrome. I don't think it could get more important in this topic. You know, it seems like a basic and fundamental problem that we see. The last series of studies everyone was talking about, you know, last year, 88% of Americans have a disturbed metabolism. Almost every patient that we're working with has something wrong with their metabolism. It's not always what we're talking about today, but oftentimes it is. And if there's a problem with this aspect of human metabolism, you know, you're just looking at a catastrophic event down the road. And so we want to be able to prevent that, which is the whole point of preventive medicine and functional medicine, right?

And so, who am I? If this is the first one of these you've been to, I'm Dan Kalish. I founded the Kalish Institute. Okay, not every creative name was the best I could come up with at the time under pressure. We've trained thousands of doctors. Like, we counted actually, my whole staff counted the other day, and we kind of like, how many was it? In that 19, ladder, 80, whatever. But anyways, there's been 5,000 people minimum over all these years, which is a lot of practitioners that I've worked with. I've done some research. I'm working now with Dr. Richard Lord quite a bit, and I'm still in practice. I still see patients, and I still use everything we're talking about today. I use in my practice on a regular basis.

So, you know, it's interesting to me. This is just kind of an aside, but it's interesting to me that cardiovascular disease kind of peaked and then way, you know, sort of waxed, it's dropping down a little bit. Who knows why that's happening? But metabolic problems are on the upswing, right? Everyone's overweight, everyone's got diabetes or pre-diabetes. Those numbers are just skyrocketing. So we're not doing well protecting people's overall metabolism, even though perhaps death from heart attack is down. You know, the population is not doing well. And we're eating more sugar, it's out of control, and we're getting fatter and fatter and fatter, and that's out of control too. So this is a super important consideration to understand that we want to be able to reverse these problems or prevent them from when they start, okay? From before they even start.

And so we, um, oh, just a little advertising moment here. We have two boot camps coming up in the next couple of months. In August, we have our Business Essentials Boot Camp, and that's for those of you that, um, have just been thinking, wow, maybe I should work on my business. Maybe I should take two months out of my life and just focus on financial planning, business planning, strategy, operations. Maybe you need to look at sales and marketing. I don't know what you need, but this class has it all. And it's been super popular over the last few years that we've been running it. And so that's two months, starts in August. If you want to spend a deep dive, just jumping into business structure, business planning, it's almost like a business coaching class, you know, but it's in a group. 20% off if you enter that code.

And then in September, we're going to have the full-blown version of what we're talking about today, Cardiometabolic Boot Camp. That really gets a, you know, much deeper into it. There, we are now, similar two-month format, looking at, you know, this topic in an intensive way. And again, you get 20% off of that, you know, that discount code.

Okay, so now, um, we have, if you guys make it to the boot camp level and you do this Cardio Metabolic Boot Camp, you'll get exposed to Dr. Richard Lord. And I have a whole series of recordings that he and I have done. And some of them are him lecturing, some of them are him reading from his books, and some of the talks are just in conversation, he and I in conversation. That, you know, very well curated and edited to make them interesting. But just to give you an idea of how Dr. Lord's brain works, this is a quote directly out of his book. And this is a 1300-page book, right? 1300 pages of this, where every word in every sentence has been carefully selected.

So for our topic today, carbohydrate metabolism, deficiencies of B1, B3, chromium, lipoate, or lipoic acid, we usually call it, or CoQ10. So let's say that again. Carbohydrate metabolism. This is what we're talking about today. What are the nutrients that you should be thinking about? Thiamine or B1, niacin also known as B3, chromium, lipoic acid, and or CoQ10. Those the key nutrients. The operation of the central energy pathways of glycolysis, the catabolism of glucose, generates large dynamic pools of L-lactate and pyruvate. Think about like a swimming pool, like an Olympic-sized swimming pool in your body, full of lactate and pyruvate. Oxidation of fatty acids and ketone body body, similarly generates pools of beta-hydroxybutyrate and acetoacetate. We're not talking about that today. When these pathways are perturbed, excretion of their intermediates can shift in response to the metabolic acidosis. Okay, now the patient's acidic, that's a bad thing. We all know that. Yeah. Although some patterns of abnormalities for these compounds may be indicative of a specific micronutrient insufficiency, they usually require further evidence to specify the origin of the metabolic impairment.

And here's the punchline: that evidence is frequently supplied by reading the rest of the laboratory report where organic acid profiles are found. So, in other words, what, what Dr. Lord is saying there, that these huge pools, large pools of lactate and pyruvate, they're sloshing around in your cells. They're moving in mitochondria, they're making energy, they're making you tired, they're making you energetic. You get too much of one, you get neurological symptoms. You get too little of one, this other thing happens. It's just, it's a dynamic system that's in flux based on how physically active you are, what you eat, how stressed out you are. But that the context in which we're looking at this today is not in an isolated context that pyruvate and lactate are going to respond to these micronutrient problems, but then they're also going to respond to other things, right? And so there's this bigger world. We're like getting really narrow now because these two markers are super important. You should know them inside and out. But then he's also saying in those sentences that there's a larger world that you want to look at as well.

So here they are: L-lactate, um, if it's high, and right off the bat, this is right out of his book. CoQ10, how much? 100 to 400 milligrams a day. Relieve hypoxia. That means get the person breathing, right? If they're low, that's a whole other can of worms. We're not going to talk about today. Pyruvate, if it's high, relieve the hypoxia, get the person breathing, do some deep breathing exercises, get them out for a walk, whatever you have to do. And then thiamine or B1, how much? 25 to 100 milligrams a day, at least, okay? So go higher sometimes. Or B complex vitamins. Nice little quick summary there.

So we just want to recognize that there are enzymes that make all this happen, and there's two of them: pyruvate dehydrogenase and lactate dehydrogenase. And that these enzymes, if you want to study them in more depth, I encourage you to do that. They're quite interesting. But the enzymes need cofactors or coenzymes to work. And you can see how this diagram nicely lays out the nutrients that are required to make the pyruvate dehydrogenase complex work. And they are B1 for this part of the enzyme, lipoic acid for this part of the enzyme called E2, and then pantothenic acid or B5 plays a role. And then we have B3, right? And B2. Okay, so all these B vitamins playing a role in the pyruvate dehydrogenase complex. And the job of this complex is to take pyruvate and convert it into acetyl-CoA. The job of this complex is to take pyruvate and convert it to acetyl-CoA. And that turns out to be an incredibly important process. If it's not happening really successfully, you've got a major problem, right? Because it means you can't get your glucose or your carbs into the citric acid cycle.

So I have this beef about the terminology. And, you know, one of the things, I don't know if it's just because I'm getting so old now, I just turned 57 the other day, you know, but like the way that I learned this work, you know, over the last 30 years, the words really have mattered. And so like a lot of things I misinterpreted because of terminology. And so coenzyme, it's not like a co-star in a movie where you have the star of the movie and then a co-star that's, you know, or like a co-pilot. That's my best example of this. Like, you get on the plane, you see the pilot, you see there's a co-pilot. You're clearly thinking if the co-pilot, you know, has a heart attack or she, you know, starts throwing up or something because he's sick, we'll be okay because we got this pilot over there, right? And the pilot will fly the plane. But then you're thinking, I don't know if the pilot gets sick, I'm trusting this co-pilot is okay. But if she was really the better pilot, why isn't she the pilot and why is she the co-pilot, right? So the woman that's the pilot, you're thinking, I'm quite interested in her, excuse me, to fly the plane. And I'm trusting her, the pilot, to fly the plane. And I'm thinking the co-pilot seems like a nice person, but I'm really hoping it doesn't come down to the fact that she has to pick up the thing and fly it, right? So when we say coenzyme, immediately you're thinking co-pilot, costar. It's like lesser importance. The coenzyme, in some ways, it's at least as equally important as the actual enzyme, okay? And you, the enzyme is useless without it, completely useless without it. All that construction you've put into building this enzyme, it's not going to work if you don't have the coenzyme, okay? So just want to keep that in mind.

And we have this other term called cofactors, right? The cofactor is the non-protein portion of the enzyme. When the cofactor can be a mineral like magnesium, but if the cofactor is an organic compound with a bunch of carbon in it, then we call them coenzymes. And then we're right off to where the B vitamins are, okay? And just a little bit about protein. So we take amino acids, we string them together, we put them into these structures called proteins, and those proteins are these enzymes that we're talking about, okay? And you can see that in order to make this whole situation work here, where we're taking carbohydrate and turning it into acetyl-CoA so we can make energy in the citric acid cycle, you need to have pyruvate getting converted into acetyl-CoA, okay? And then going back and forth with lactate depending on how much you exercise and other variables like that, okay? But the key point being that you really have to have these enzymes working properly, the pyruvate dehydrogenase enzyme to convert pyruvate and the lactate dehydrogenase enzyme to convert lactate. And if one or more of those enzymes is not working, what do you see on the testing? You see really high or, in certain cases, really low levels of those markers. Again, we have amino acids strung together here. It's a complicated thing that your body has to do. It takes individual amino acids. It's amazing you can even find them in all the mess of your body, right? String them together, turn them into these structures like an alpha helix or a beta sheet, then those fold themselves up into an actual protein.

And this, here's what pyruvate dehydrogenase actually looks like from a computer view of all these amino acids thrown together. The first thing that you can see is there's hundreds of amino acids, right? There's a lot of these things that are all gathered together. And so it's really likely because it's such a large structure that one amino acid is going to be out of sequence. If you have one amino acid out of sequence, what happens? So we call a SNP, it means that the single nucleotide polymorphism, right? The amino acid, one amino acid out of sequence means that this enzyme's not at 100%, okay? So if it's not at 100%, it needs more of the coenzyme to work. So if there's a SNP because this, uh, string of amino acids wasn't, uh, lined up properly and one is out of sequence, then the actual mechanics, not mechanical, but actual structure of the enzyme is a little bit off, just a tiny little bit. I don't remember when you were a little kid and you'd make paper airplanes, if you didn't fold the wings quite right and you threw them, they didn't fly at all, right? There's a little bit of something off with an enzyme, it's not going to work right, right? And so you need to have more B vitamins, then more coenzymes in order to get an enzyme that's not quite structured right to work. It's not straightforward, okay?

And now pyruvate dehydrogenase again, the enzyme, it converts pyruvate into acetyl-CoA. And where does that happen? In the cytosol. We take the pyruvate, what is glucose over here, right? Then that gets converted into pyruvate, and then that pyruvate goes into the mitochondria where it's broken down and enters into the citric acid cycle. But ultimately, your body is trying to get that glucose molecule converted into acetyl-CoA. And if that's not happening really well, then pyruvate is going to go high, and you will see that on the lab test. We'll see that on an organic acid test. So high pyruvate means this whole mechanism is not working, and that this patient has a major problem with carbohydrate metabolism, which either means that they're heading towards some metabolic disorder or they're in one, right? Pyruvate going to lactate again. We have glucose or carbohydrate at the top. It's converting into pyruvate. What's supposed to happen is it goes into acetyl-CoA and we make energy. You know, and if for some reason this enzyme, pyruvate dehydrogenase, isn't working and there's a block right here, and then the pyruvate converts into lactate, and you'll see high lactate on the lab. And then, you know, this is bad. This person has a lot of lactic acid in their body. Maybe they're achy and stiff, maybe they're having some neurological symptoms, maybe they're just kind of a little cranky. It doesn't feel good to have a whole bunch of lactic acid. Now, if you go and work out really hard tomorrow and do a, you know, 100-mile bike ride and then lift weights for two hours, and you're going to get really sore, stiff the next day. But that's kind of like a good sore, stiff, right? That means you're like, oh, I worked out hard, now I feel good. But people who have this particular problem have more lactic acid in their bodies even though they didn't exercise. So how do they feel? They complain about being achy and stiff all the time, not because they're working out, because the lactate is building up, okay? So again, if pyruvate cannot go to acetyl-CoA as a block here, either pyruvate or lactate, or both, are going to go high. And there's many different patterns to this you can see. But the general gist of it is, if you see high pyruvate or high lactate, there's a problem.

What's the solution? Oh, we started with a solution. You remember? Vitamins, B vitamins, B1, B3, lipoic acid, CoQ10. Maybe if it's really bad, pantothenic acid, remember B2, B3, all those things. Oh, again, in case you didn't, in case you started late, you missed the beginning of this. We are having, uh, telehealth Business Essentials Boot Camp in August, which is one of our most popular classes of the year. I really enjoy it too. It's fun to talk about business. And, you know, it's good for you guys to make comfortable income. And certainly, if you're not making a comfortable income, or if you want to scale your practice up, or you want to start to think about retirement, or whatever you need to do, some business planning. It's a great class. And then in September, we're going to have the Cardio Metabolic Boot Camp, all new material, hot off the press after me working with Richard Lord for the last four or five years. Okay, it's gonna be really good.

All right, so now lactate dehydrogenase is the other enzyme. That's what it looks like, kind of ribbony, isn't it? And again, here we go. We're just showing these pathways in different ways so they can start to sink in. We take the glucose, convert it into pyruvate. That's supposed to go into the mitochondria so we can make all this ATP. It can also go down to lactic acid if there's a block here, right? And it's unable to enter. Other bad things happen when pyruvate is blocked, right? In that the extra goes over to, uh, become fat, right? Body fat. And I think everybody pretty much knows that if you eat too many carbs for too long, you start to get a little fat, right? Another image of the same exact thing, but with an expansive view. Now we're seeing glucose going to pyruvate. Here's this lactate thing going back and forth here. If pyruvate dehydrogenase, as the complex, is screwed up, then there's a block here. If the lactate dehydrogenase thing is screwed up, then there's a block here. And either way, you can see either high or low pyruvate, lactate in different combinations. What we're trying to do is get the pyruvate into acetyl-CoA so we can make energy. And that is the main goal of all of this stuff, right? So we can have a normal metabolism again. The B vitamins, we talked about B5, B3, B1, B2. You need all these B vitamins, or this system won't work.

So now we just talked briefly about lipid metabolism and beta oxidation, okay? So now we're thinking about, we're talking about carb burning. Now we're thinking about fat burning and fat production. And want to think a little bit about the mechanisms involved here and how this can lead to all kinds of problems for your patients, right? They're overweight, they're tired, they can't sleep. So at the center of all this, we have acetyl-CoA. We can take glucose to pyruvate to acetyl-CoA. That's what we just talked about. You can also make acetyl-CoA from amino acids. You can also make acetyl-CoA from fatty acids. So you can take fat, carbs, or amino acids, or protein, right? And make acetyl-CoA. So then the question is, what happens to the acetyl-CoA? Right? We already talked about if this is, if the pyruvate's screwed up here, then the pyruvate builds up and it starts to turn into fat. The glucose starts into to turn into fat, right? But let's say that you do get to acetyl-CoA, what do you do with it? You can make triglycerides, phospholipids, eicosanoids, you can make ATP, you can make steroid hormones. You can make a lot of things with acetyl-CoA. It's a very interesting compound. It's something that we should all study a lot because it's important, you know, and it's the center of lipid metabolism, it's the center of fat metabolism. Acetyl-CoA, everything's going there or coming from there, you know? And how strange is this? You even really ever think about it this way? Like acetyl-CoA, if you eat too many carbs, you're going to get too much acetyl-CoA, and you're going to get too much fat, right? You're going to make too much fat, triglycerides, fatty acids. Oh, that's going to go high. Cholesterol can go high, right? But what's really strange, and you know, it's a miracle that this all works at all, is that you can make acetyl-CoA from fatty acids as well as make fatty acids from acetyl-CoA, right? Goes both ways. The major source of energy for the human body is actually coming from fatty acids into acetyl-CoA, which is what we're talking about now, beta oxidation. But strangely enough, you get too much acetyl-CoA, you can convert it, you can convert it back into fat. It's a two-way street. Um, I don't know why that's so interesting, but it is because it's complicated because you learn them separately and it's kind of hard to tie together. But we're right now, just for clarity, we're talking about beta oxidation or the burning of fat. That is the main point, right? And so when you're at rest and you're just sitting around, 80 to 90% of your energy is coming from fat. And lots of people have problems burning fat.

Here's where it gets a little tricky. You also are synthesizing fatty acids, right? You're synthesizing fatty acids. Most of the fat in the body, like two-thirds of the fat, is made by your body. It's not from your diet. And if you have too many carbs, too much sugar, you're going to have too much fat. Your liver is going to make too much fat. And of course, your cholesterol will go up too. And then the other misunderstanding, we just want to think through, is that cholesterol is always bad. It's only bad when it's toxic at high levels, okay? And the other thing is that your misunderstanding is eating fat makes you fat, you know, kind of. But most people don't overeat fat that much. You mean, how many potato chips can you really eat before you want to throw up, right? People tend to overeat carbs more, leading to the excess fat. And certainly, the excess fat that's accumulating from carbs is tricky to deal with, right? Extra tricky to deal with.

And then again, what are the points of, on the good side of fats, right? This is all this sort of misalignment of fats. They're the main energy supply. You have to have them to make cell membranes. You got to have them to make the myelin sheath. Your brain is 60% fat. You need fats to make prostaglandins. You need fats to make steroid hormones. It would be a bad world without lipids, okay? And then there's the mechanisms of action here. The point of this list is that I'm not going to read it, but it's like us, you need fat for like five different critical reasons here, for everything from just energy production to gene expression, okay? And then we break it up into fatty acids, cell membranes, and triglycerides in terms of categories. Here's what they look like, if you remember, kind of cute-looking little thing. And then just don't want to forget that cholesterol is super important too, and in a positive way. It helps support the functioning of the cell membrane. It's not a bad thing. Too much cholesterol is bad. Too much anything is bad. I put this up just because this one looks interesting. It's try, it's what triglyceride looks like. Look at all those carbons, hydrogens. It's huge. It's huge, huge molecule, right? It's a lot of potential energy stored in there, right? And then another thing on fats, eicosanoids, membrane flexibility. They're just super important. They're good for you, okay? But we want to talk mostly now about fat burning because you want the patient to be able to burn fats so they can have normal energy. And you can have some patients that have, um, excess fat that they're producing, right? This is sometimes called the greater than sign, you'll see why in a minute. And then you can have some people that don't make enough fat in their bodies.

But here's a nice quote again. This is from Dr. Lord's book. Increase in serum triglycerides and cholesterol is one of the earliest manifestations of elevated insulin. So let's say that again. Increases in triglycerides and cholesterol is a sign of elevated insulin. Why is it insulin elevated? Because of the carbohydrate problem. What do fats do to insulin? They don't really screw up insulin that bad. So most of the problems with serum cholesterol and serum triglycerides going up is generated by high insulin, which is generated by excess carbohydrate. That makes sense, okay? And then you'll be able to see this in the lab in a second here, okay?

And just as a, you know, reality check here, we're making two-thirds of the body's fat in the liver. And the major fat that your body produces is called palmitic, palmitic acid or palmitate, okay? We also make cholesterol and CoQ10. So if your insulin levels are high, you're going to have an increased fatty acid production. Just said that. And if your insulin levels are high, you're going to have a pattern in the lab that looks a little bit like this, where you're going to see that again, this is highlighted with a greater than sign. So you're going to see certain fats that your body makes at really high levels. So if you're doing organic, organic acids, fatty acids, amino acids testing, these labs are either called, you can see them in the form of an ion panel through Genova or a Nutri-Eval. What we're looking for in this case is palmitic and stearic, okay? These are the two main fats that your liver makes, especially palmitic. And you can see palmitic is high, that's steric is high, and palmitic is right behind it. That's a sign of your liver making too much fat. This is production by the liver. This is your body making all these fats. You see these other fatty acids are not so bad. Your body doesn't make those as efficiently, okay? But if you're overeating carbohydrate, what's going to go up are palmitic and stearic.

Now you can also have this lesser than sign, whole different discussion, just pointing it out because one of the things that frustrated me, as I said, in the beginning of the talk, is that I learned something one way and then I was thinking all black and white about it. So just because high palmitic and stearic are bad, and just because high palmitic and stearic mean you're insulin resistant, you have metabolic syndrome, you have pre-diabetes or diabetes, right? Those are all bad things. Your body's making too much fat. What's it making it from? From carbohydrate, okay? Just because that high story is bad doesn't mean the low story is good. So just because high palmitic and stearic are bad, does it mean that low palmitic and stearic are okay? Okay, normal palmitic and stearic are great, but high is bad, low is bad for a whole other set of reasons. I just want to point that out so you don't, you know, miss that.

Now we're right back to acetyl-CoA. I know this is a little tedious, but let's look at acetyl-CoA. Remember where does that come from? Everything, right? If you eat fat, if you eat carbs, if you eat protein, everything gets converted into acetyl-CoA. Remember that? And then what do you do with acetyl-CoA? You make CoQ10, you make cholesterol, and you go through this process called protein prenylation, which is kind of complicated but interesting. So a lot of things happen with acetyl-CoA. If you get too much acetyl-CoA, what happens? Well, you can make too much cholesterol, and you can make too much body fat as well, right? Triglycerides, right? Those can go up. So just the right amount of acetyl-CoA, you have great energy. Too much, not a good thing. And we just want to be a little cognizant of it. Is there's never a black and white here, right? It's never a one-size-fits-all black and white kind of story.

I'm going to skip some of these. Let's see here. We go. I'm going to look at this. So quick summary here, right? When you eat glucose or you have glucose in the system, you should convert it into pyruvate. That pyruvate then goes to acetyl-CoA, and we turn that into energy. That's the ideal story. There also, when you consume fatty acids, you convert those through beta oxidation into acetyl-CoA, and then you make energy out of those. And ultimately, all of this fuels the electron transport chain, which is shown up here for some reason. Usually, they put that at the bottom, but at the top of this diagram. Okay, the idea being that once you've gone through the citric acid cycle, then you have CoQ10 carrying electrons along to the electron transport chain, ultimately depositing everything with oxygen, you make a little water, and you get a ton of ATP from all this. So that's kind of the goal of this whole process. Now we're going to look at some lab examples in a moment and get to some questions in a moment too. And in the lab examples, we're going to look at where's the pyruvate? It's not on this diagram, but where's the lactate? And then what about the nutrients that help with beta oxidation? Glance at that as well.

All right, so let's look at some labs. All right, so now here's a lab. This is an organic profile from Genova, and you will see on the page pyruvate and lactate being measured, okay? This is what we've been talking about the whole time. These two innocent-looking markers here reveal a massive amount of information about all those pathways we just looked at. Now, what we've talked about for this whole session is high pyruvate. I just want you to show it can be low also. See, it can be low also. What does that mean? I don't know. That's for a whole another day. That's a complicated thing. It could mean that the enzymes are working really well. It could mean there's a huge problem going on, okay? But, and the point is that, you know, yet just because high pyruvate is bad doesn't mean low pyruvate is good. So I'm trying to say, some other day we can talk about what low pyruvate means because you see low pyruvate, low lactate, C L D is low here. That's a whole different set of problems. I just want to free your mind of thinking everything's black and white. And the lactate on this one is normal. So this person doesn't have that specific problem that we've been talking about this whole time, okay?

Let's look at another lab here. And these are from the, uh, mentorship class that I teach, year-long class. Some of you may sign up for, as a matter of fact, statistically speaking, I can say for sure, a few of you, some day, are gonna sign up for the mentorship. I don't know which ones, but anyways, hopefully a whole bunch of you will. And what happens is doctors submit labs, we get to see, you know, these cases coming in. This is from Elky, one of our students. Mentorship. One of the top complaints, joint pain, body aches, fatigue. And then we get to look at the lab. And here's Elky's question, actually, would appreciate help with interpretation of organics as it relates to complaints of body aches. All right, let's check it out. Do you see high L-lactate? I do. Do you now know that lactic acid when it's built up makes people have body aches? Absolutely. Does that make sense? Yes, it does. Would you give some treatment? Absolutely. Well, if you can't, if you didn't memorize that slide, you can see right here, B1, B3, chromium, and lipoic acid. Some combination of those products will lower the lactate and will very likely eliminate the body aches. How happy is this person going to be that they're taking some B vitamins and their body aches went away? Pretty cool stuff.

Let's look at another example. I think we have one more. Um, here. I'm going to skip that one. Let's go forward here. Oh, my gosh, so many examples. I just want, let's see this one. I think it's gonna be better. Yeah. Oh, it's okay. Again, 43-year-old patient, nurse manager, top complaint, fatigue. Now, what do we see? Pyruvate high, lactate extremely high. This person has exactly what we've been talking about. She can't get her pyruvate into the citric acid cycle, so she's going to have carbohydrate cravings. She's going to eat carbs all the time, but it's not working, and they're not getting in for energy production. Her lactate is building up, it's building up, it's building up. She's achy, she's tired, she might have some neurological problems. Not a good feeling. How do you fix it? It's right there. One or two comp, you know, B complex a day, anywhere from 600 to 1200 milligrams of lipoic acid, and dump in 100, 200 milligrams of CoQ10.

Let's just look at one or two more. Uh, Jyoti sent this one in. 57-year-old nutritionist, major complaint, uh, clean eating, but has interstitial, I can't say it, interstitial cystitis symptoms. That's a brain twister, tongue twister. Interstitial cystitis symptoms and skin rashes. That's like if you had a lisp with the S, that would be like your biggest nightmare. Anyways, bunch of problems. Oh, and just so you know, we're not just talking about this, you know, it also has Blastocystis hominis, so that's a whole other thing, but we're not going. Okay, now, holy moly, look at this. That's a problem. Lactate extremely high, 33. The cutoff is like anything over an 8 is a problem. Pyruvate not so bad. And then up here, you can see some fatty acid metabolism problems too. So this section right here looks at beta oxidation, the burning of fat. If adipate, subarate, or ethyl malonate are high, means a person is not burning fat well. That's going to make someone tired and not so great feeling. So remember, with two separate issues, we're talking about primarily talking about glucose metabolism and the burning of glucose through pyruvate and lactate and all those conversions, but we're also just giving a nod to beta oxidation, which occurs right there, right? So again, any of these markers are high, person can't burn body fat. Either these two high, person can't burn glucose.

All right, so just a quick reality check on what we just covered. We looked at the pyruvate dehydrogenase complex. Pyruvate is high, this thing's not working well. What do you supplement with? B1, lipoic acid, B2, B3, B5, right? All the B vitamins. Why is that a problem? Because means pyruvate is not getting into acetyl-CoA. The glucose is not getting into the mitochondria properly. You're going to have an excess of body fat building up. You're going to be tired all the time. You're going to crave carbohydrates all the time. Ironically, you're going to be craving and eating tons of carbohydrate. Your insulin is going to get higher and higher. You're going to make more and more fat. It's not like people crave healthy food when they're having this problem. And then the other quick reality check, there's what the pyruvate enzyme looks like is with lactate. We saw a couple lab examples where lactate was high. So if pyruvate, the dehydrogenase enzyme there, is not working, that's blocked. Pyruvate can go up. You can see how that could dump a whole bunch of pyruvate into lactate. Sometimes lactate goes up, sometimes one or both of them is high, sometimes they're both high, sometimes one's low, sometimes they're both low. They all mean different things. But once you start to think about it, you can figure it out. And what you want is for the pyruvate and lactate to be normal. And that means that you're getting carbohydrate into the citric acid cycle for energy production. If that's not happening, then you're starting to see the early warning signs of insulin resistance, metabolic syndrome, etc., and the person is heading down a rocky road. And you can reverse that with the various B vitamins and CoQ10, lipoic acid that we talked about, okay? So hopefully that's going to help you next time you see those markers show up in your clinic and be like, hey, wait a minute, I know what to do about that.

And we have coming up again in August, the Telehealth Business Essentials Boot Camp. In September, our big one is going to be the Cardio Metabolic Health Boot Camp. If you guys are interested in that, you get some discounts. And look forward to seeing you and talking to you at the next one of these. Thanks.