Transcription
Hello everyone, and welcome to a talk about case reports on long-haul COVID syndrome patients. I'm Dan Kalish. Welcome you. If this is your first time, um, well, well, I want to welcome you extra. You know, we've got, um, so much to talk about and so little time. So I'm going to do a brief introduction to who I am and what I'm doing and my perspective on this. And then we're going to look at some scientific facts combined with some cases. And we can talk about some of the great functional medicine practitioners out there that are resources for you guys.
So this is me, a founder of the Kalish Institute. Um, kind of dropped my creative, uh, I didn't have a creative, uh, moment when I was naming the institute. I was like, "What are we gonna call it?" "I don't know, how about the Kalish Institute?" That's kind of been almost 20 years now. We've trained thousands of practitioners in this work. And, um, I'm very gratified when I go to conferences all throughout the world, I meet people who have taken my course and they're like, "Hey Kalish," or "Hey Dan, you know, so glad to meet you in person." Because, um, my whole class is online, right? And, uh, you know, "Thanks for helping me get my practice started." And that's really what we do is we help people get through that first couple of awkward years of functional medicine training.
And I've also done some work with Mayo Clinic. We had the whole Mayo Clinic Integrative Medicine department, five or six of those doctors took my training program a while back. And then we did a research study together on adrenals and GI, which I'll talk about in a moment. Uh, the next slide here. And I'm working right now with Dr. Lord, Richard Lord, who, for those of you that are older, you will all know him. Those of you that are younger, Richard was the main scientist that developed much of the work that is functional medicine lab testing today. So he was a scientist that first did organic acids testing. He developed all the parameters and set up all the machines for amino acids and fatty acids. And it really was the brainstorm fellow behind the microbiome testing that we now do on the GI Effects. We take a lot of these things for granted, but, you know, somebody had to be the first guy that bought a machine and set it up. And that was Dr. Lord. I just spent four hours this morning talking to him. We talk a couple times a week. And we've been training with him since 2015, which is one of the great privileges of my life right now, uh, to work with Richard. He's quite amazing. And we'll talk a little bit about his work today as well.
I am still in practice. I see patients two days a week. Not that much, maybe four or five hours a couple times a week. But I still do struggle with a patient practice and all the challenges that present. So I haven't forgotten about that part of it. For those of you that are in practice, and that's part of why we're talking about this topic today because obviously this is hitting my clinic just like it's hitting your clinics as well. Um, and then a little bit about what we've got coming up around the Kalish Institute. This is the first time we've ever done this. So last year, my staff had this great idea. Had nothing to do with me. They're like, "Why don't we send out a survey and ask the people on our list what they want?" And I was like, "That's a good idea." I never thought of that. I've been doing this for 20 years. I thought I knew what you guys wanted. But hey, we asked. And it turned out that what everybody wanted was a lab interpretation workshop. So I was like, "Great, let's take a Saturday and I'll just hammer it out from 8 in the morning to 5 in the afternoon, like the good old days with Dr. Timmons." And they're like, "Well, I don't know if that's really still what people want these days, Dan. Like an all-day thing." That's kind of cool. And so we asked you guys what do you want? And you didn't want like an all-day Saturday thing. You guys wanted one hour of things. So we created a basically a program for you, which is Adrenal and GI Lab Interpretation Workshop. There's no chit-chat. There's no like, "Here's a slide, let me tell you about the HPA axis" kind of stuff. It's more like, "Here's a lab, here's what you do, here's the supplements, here's the dose. Here's another lab, here's what you do, here's the supplements, here's the dose. Here's a GI lab, combine it with that lab, which one do you do first? The adrenals." And then the, you know, that just like straight up like you're in the clinic and we're just sitting like in the old days when I was sitting next to Dr. Timmons. And they were there. There wasn't any chit-chat. There's a patient there, I'm sitting there, he's sitting there, "Here's a lab, here's what you do." And you just, how I learned this work too, right? At the feet of a master, Dr. Timmons. And that's what we're trying to replicate here. That just watch exactly what I would do in, you know, in a real patient situation. So anyways, that is starting next week. If you guys are interested, you should check it out and register. And you get $100 off of it if you use that little code at the bottom there. And, um, it's running for eight weeks and it's starting in a week. And we've never done it before. And I'm kind of excited about it. And you can, um, talk to my staff about it more if you're interested as well.
Okay, and then we have our usual mentorship thing that we'll be doing towards the end of the month. And I'll talk about that a little bit later. That's the big year-long class for those of you that really want to devote yourselves to the work for a little while. That's what we have in store.
Okay, now there is a lot of interesting information coming out. So maybe let me back pedal a little bit and talk about, uh, here. I've got all these studies that I pulled up for you guys, um, and talk a little bit about the bigger picture. So, um, when, when COVID first hit a couple years ago now, right? I'm out on a hike with my buddy Dr. Morgan Camp. He's been a good friend of mine for 12 years. Morgan and I always get together, take a hike, uh, you know, go out for a beer, whatever. And obviously, we weren't going out for beer because no one was going anywhere because everything was shut down. But we decided it was safe to go for a hike. And he's on one side of the fire trail, I'm on the other side of the fire trail. We're staying away from each other, wearing our bandanas because nobody even had masks yet. And we're walking on our little hike. And I'm saying, "Morgan, this is not good. There's a new virus. I don't know what to do." I was just losing it, seriously losing it. And Morgan is looking at me going, "What are you talking about, Dan? You've been doing this your whole career." I'm like, "What do you mean?" He's like, "It's just a virus. You've been treating infections your whole life." And I started to think, "Oh." And he started to rattle off all the antiviral testing and treatments. I was like, "Oh, okay." Because he's a medical doctor and he's a little more grounded in his, you know, urgent care, emergency room kind of background. So he's not losing it like I am. He's just thinking logically. And then he kind of grounded me on that talk, to be honest. And, um, on that hike. And I'm thinking, "Okay, well, we maybe we got this one. Maybe we know what to do." And so what we've seen in 30 years that I've been doing functional medicine is the majority of the patients that I work with have some kind of history of some kind of infection, right? It's Cryptosporidium, Blastocystis, Entamoeba histolytica. It's some horrible Lyme disease thing. Maybe it's not really an infection, but it's a mold exposure. You know, something really bad happened to their immune system at some point in their life. Almost everybody that we work with. And then it's years and years later, and now we're working with them to try to help them recover. And so when I saw these news reports coming out about long COVID and long-haul COVID, I'm like, "Okay, game on, Morgan." You know, "You're right, dude. This is happening now. This is the next phase of the pandemic where we're not dealing with the acute infections and the hospitals not being overrun and no one's trying to ship ventilators from Minnesota to New York or anything like that, right? We're now dealing with the millions and millions of people that are going to be having the long-term effects of this horrific and violent and disastrous virus that has struck humanity." And so, um, it's hitting all the students in the mentorship class. We talk every week and review labs. Everyone has long COVID, long-haul COVID patients in their practice. I do. It's just going to become, you know, what you have to learn how to handle. And so I thought I would share a couple of cases today and a little bit of the research and information that I've been looking at so you guys can get a sense of all that.
All right, let's see. Yeah, and if you can't see the discount codes on here because your screen won't show it, then, uh, yeah, for sure, just contact the office and I can try to make this easier to see. That might make it easier there for somebody too. Okay, then, um, let's take a look. There's the ones for there, but you can just email the office and they'll give them to you. And there's the ones for the other workshop.
Okay, so let's start off with, like, again, sort of a grounding exercise, which is, um, because we're about to get into, like, a journey through science, right? And I just don't want to forget that the, because I always do, because I like the labs, that, you know, there are some really simple solutions as well, you know? Um, and, and there's a study that came out. I don't know if you guys have already seen this, but check this out. God bless the Brits, you know, British Medical Journal. That just thinking over there have been for the last thousand years, haven't they? Scientists. I lived in Cambridge, uh, England for a while in this very academic environment. And I, uh, that's why I did my senior thesis, um, was this a professor at Cambridge University. Anyways, it was some of the best six months of my life. Love the Brits. And here they are studying. They're like, "Why don't we look at the risk factor for how you eat and how that compares with what the heck's going on with your risk for COVID?" And so the short version of this study, and you guys should read this later because it's really quite interesting. They took all these healthcare workers from France, Germany, Italy, and Spain, all over the world. They took thousands of them, right? And then they looked at a whole bunch of them. And they had like 500 of them had COVID. And what they found was very interesting was that though diet didn't control for whether the person got COVID or not, however, people that did get COVID that were on a plant-based diet, out of these thousands of people, right? Had a 73% less lower risk of getting moderate or severe COVID than people that were eating regular crappy food. Okay? And people that were on a low-carb, high-protein diet, low-carb, high-animal protein diet, let's just say it how it is, high-animal protein diet, had a four times greater risk of moderate or severe COVID. Four times greater risk if you're eating a ton of meat. 73% protection if you're eating a bunch of plants. Very interesting. So lifestyle matters. That's the whole point of me starting with that slide or this study. Okay? Really matters a lot. Am I vegan? No. I had carnitas last night. But, you know, you should mostly be eating plants, um, if you don't want to, uh, you know, have this thing wipe you out. Okay?
So then I also want to, uh, just set the stage for a few of these kind of bigger picture things. So I have a few slides here, but not that many, just really a couple. Okay? Because we're going to talk about this in a minute when we look at the labs. I just want to show you some visuals so when we look at the testing, you'll have some references. All right? And these are just old slide shows, but I'm just going to zip through them so you can see what we're talking about. So we're going to talk a lot about mitochondria and oxidative stress because the processes that they're seeing in all these long-haul COVID patients, or that they have damage to the vasculature, the lining of the blood vessels are nicked and scarred and irritated and damaged and injured, one might say. And they, this is one of the common characteristics of all these folks. And they have an, uh, excessive amount of inflammation. 41% of them or something like that, a little bit less than half of them, have some kind of nervous system related problems, some neuropathy or a brain related issue. And they all have experienced, you know, oxidative stress. And so we've got endothelial cell damage, we've got inflammation, oxidative stress. And then this sort of repercussion is pretty severe in terms of how it hits the brain. In fact, there's another study, and you can look this up. I'll show you Leo Galland's website at the end here, where they actually can measure. Have they took again, thousands, and I think it's like 40,000 people or something like that in, in, it's the Brits again, in the UK. And they, um, took out a small segment of this group that had MRIs right before COVID hit. And then they brought them in and they redid their MRIs. And they divided them into the COVID group and the didn't get COVID group. And they could clearly see in the "I got COVID" group that the gray matter on the MRIs had been damaged or decreased in the time of COVID, right? So COVID actually causes what we hope are maybe not permanent changes, but significant changes in the brain, cognitive functioning, motor functioning, all these kinds of things. And obviously, along with that, the sense of smell and taste is impacted as well.
So, um, this is like important stuff, you know? And so I think for, if you get into the literature, and I've been reading a lot about this, you will have dozens and dozens, maybe a couple hundred, of different conditions you could read about. Those patients that are getting, um, diabetes. There's a big study. The, the Veterans Administration in the United States did. And there were, I think it was like a, the, the group of the veterans that had had COVID, this versus the group that didn't, had a 35 times greater risk of developing diabetes right after their COVID diagnosis. 35 times more likely to get diabetes immediately after their COVID diagnosis. So clearly, COVID is affecting metabolism. And that's why we're talking about mitochondria. Um, neuropsychiatric disorders, depression, you know, it's a pretty long list. There's a group, a study I just read from France. And amongst their osteoarthritis, and again, it was just like a pain center in a part of a pain treatment center, but it was part of a large hospital group. And they had, again, it was like in the tens of thousands of patients that they're looking at. But they had a small subset that I was interested in personally for a lot of personal reasons, that had a history of chronic degenerative joint disease. And 49 out of the 50 people in that subset that got COVID had increased pain, right? Radiculopathies, neuropathies, increased pain after COVID that they had never experienced pre-COVID. And the, the 40, the, the 50th person in that group that was in the COVID group died. So they weren't able to talk to that person about it. But they probably would have said, "Yeah, I have some more pain now too." Okay? So this is like affecting people with chronic, chronic degenerative joint diseases. This is affecting the brain. This is affecting metabolism. And, and that's just a short list, you know? Autoimmunity. It just goes on and on. So for the sake of brevity, because we're trying to get through this talk in a short period of time so you guys can go back and have your dinner, we're just going to talk about two things. But I want you to know this is a small subset of a much greater world of what this virus is causing. So I thought it was worth talking about mitochondria because of the dramatic results in that veteran study showing that the rate of diabetes just skyrocketed after COVID. Seems like a no-brainer. And also to look at neuroinflammation because of the severity of the symptoms that cause that are caused by, uh, destruction of brain tissue from this virus. Okay? So we're just concentrating, concentrating those two things. And we're ignoring all these other diseases and conditions that are spiraling out of control due to COVID. Okay? Um, someday it'd be really cool to just have a class that was like a couple year long or a two year long class about all this stuff.
Okay, so now let's take a look first here. And I want to show you a couple cases in a moment, but I just want to do the setup so you can see what we're looking at on the labs. So on the labs, well, here we go. Let's just take a step back so you, you get COVID, you're getting through the acute phase, that's over. And now you have what? You have damage to the lining of the blood vessels. So that's a problem. You have inflammation and oxidative stress, and those are problems. And the microcirculation is not that great because of all these things. And so on a lab, there's some really obvious things that you would think about trying to do. Well, the my short list would be, why don't we repair those blood vessels, the endothelium? Because that's the one thing that all these experts agree that all the long-haul people have is a damaged endothelium. How do we do that? I don't know anything better than with nitric oxide, right? I mean, that's classic. They gave out the Nobel Prize to the guys that discovered the gas nitric oxide and its effects on vasculature. It has the most healing, soothing, reparative effect on the blood vessels that one could imagine. And you can easily buy a supplement from any of the supplement companies that we work with that's got arginine and citrulline and ornithine in it, the amino acids that will just crank up nitric oxide levels. So that seems like an easy one to me for us to do on all these folks. And we'll look at labs again where you can measure arginine and citrulline and ornithine, see if that's, you know, an appropriate avenue. But you might consider it with all these folks. And then there's other simple things like, you know, in terms of oxidative stress, you want to measure the oxidative stress and then replace the antioxidants that are missing so that their oxidative stress goes back to normal. With the mitochondrial function, you want to test the various functions of the mitochondria, the various steps in these pathways, and target those and correct what has gone wrong with the mitochondria, whether it's low magnesium or low CoQ10 or low B vitamins or whatever it may be. And then you want to look at the neurotransmitters and neuroinflammatory markers and get that inflammation out of the brain and get those neurotransmitter levels restored back to where they should be. Okay? So that's my short list. And that's why I wanted to kind of focus on these sort of, uh, what do you call it, you know, top couple of topics that I think you'll be dealing with with the majority of these people.
Okay, so this slide encompasses all that we would want to think about with the mitochondria. And let's see if I can, can I make it a little bigger? That doesn't really let me do that, does it? Okay, well, hopefully, I don't know, I'm old, I can't see that very clearly. But if you're under 50, hopefully you can see this slide. If you're over 50, you can get out your reading glasses like I am, right? All right, here we go. I've given up now. I just carry my reading glasses with me. I just started doing this maybe six months or a year ago. For a long time, I pretended like I didn't need them. But then I think my tolerance for asking other people to read things kind of faded out.
Okay, so here we have oxidative stress. And when there's a lot of oxidative stress, it damages the mitochondria. And so when you're measuring for this, you want to measure the oxidative, look at the oxidative stress markers. And so you can see on these tests if there's oxidative stress present, are things being damaged? Then you can also measure the individual antioxidants like vitamin E, vitamin A, CoQ10. You can measure them, okay? And then you can also measure glutathione, the master antioxidant. And you can measure the amino acids that you make glutathione with, including cysteine, glycine, and glutamine, okay? You can test all these things. If they're low in glutathione, you give it. If they're low in cysteine, glutamine, glycine, the amino acids you need to make glutathione, you give those. If they're low in antioxidants, you give the antioxidant that they're low in. Not healthy skeletal, you know, all over the place, but they're low in E, you give E. Low in A, you give A. If they have a lot of oxidative stress, you give them a lot of antioxidants. And then you stop, you retest, and you see if things are better. And you're going to restore mitochondrial function this way. Okay? So that's one big picture one. And then I think this is like a two-slide day. Okay? So I'm just going to show you one more slide here for my brain inflammation talk. Bingo.
Okay, so when we look at the, the brain, um, the brain stuff, this is brutal, people. So you get the virus, the virus is mostly gone, maybe it's completely gone now. But you've got this brain inflammation that just won't stop. And in, in the process of making this massive inflammatory response, this inflammatory cascade that the virus is sort of tripped into place, but your body can't stop it, right? You would think about anti-inflammatories like curcumin, like fish oils, all this good stuff. But we're going to show you on the testing what you can do. Interferon goes crazy. We start to then deal with converting tryptophan into something called kynurenine, which you can measure. You can measure tryptophan, you can measure kynurenine, you can measure inflammation in a million different ways, right? And if the kynurenine is high, then it'll spill over and the quinolinate will go high. When quinolinate is high, it goes over this away and it impacts the NMDA receptors that have to do with glutamate. And when the neurons get super excited and they're jiggling and jiggling and jiggling because of all this inflammatory input, then thing starts to blow up, basically. Brain cells die. And you want to calm that system down with things like magnesium, anti-inflammatories like curcumin, fish oils, you know, depending on what the tests show. So neuroinflammation is bad. Quinolinate is neurotoxic. And a lot of these patients are having this cytokine storm. This is, this is part of that cytokine storm, right? These are cytokines that we're looking at, talking about here.
Okay, so now with that in mind, we've got that slide, we got this slide, right? And now we're going to look at some actual labs. So let's do this one first. Okay, well, that's a bad idea. This is, let's end with that one, sorry. Let's do this one first. I always want to do the most interesting thing first, but that it's probably not the best teaching experience for you guys. Okay? So, oh, and then there's another thing. There's these ACE2 receptors, right? So when that spike protein goes out, everyone knows the spike protein, the whole world, right? It hits a receptor on a cell and then that allows the virus to get into the cell. The receptor that it hits is called an ACE2 receptor. And there's a lot to say about ACE2 receptors. And I'll direct you again to some educational resources at the end of the talk, okay? You can learn more about this. But those ACE2 receptors exist in the gut. And so for some people, this COVID problem can be very impactful on the gut. And if that occurs and ACE2 receptors are impacted by COVID in the gut, and the ACE2 receptors can't do their normal job in the gut, their normal job in the gut is to help with the transportation of amino acids. The normal job of the ACE2 receptors in the gut is to help with the transportation of amino acids. And so if you have COVID and it's hit your gut, and remember, this could be a whole variety of people. A lot of these people that we're, I'm working with now, they had COVID and they don't even know if they had it. They had a little bit, you know, it was a minor infection. They had a positive test, but they're asymptomatic. You don't have to be super sick for this to all happen at all. So you have COVID, it somehow it hits your intestines, right? And then all of a sudden your body's not transporting amino acids well. What are you going to see on a test? Low amino acids. And what is the result of that? We need amino acids for the synthesis of all proteins in the body. So this could be catastrophic if this thing hits your gut. The other thing that's interesting about the gut related stuff is that there's a bacteria, *Faecalibacterium prausnitzii*. If we have time, you could look at a stool test maybe for this all over here tonight. But *Faecalibacterium prausnitzii*, you should make a note of that one somewhere in the back of your brain. That is one that's very, uh, strongly implicated in relation to COVID. Okay? And, um, you, you need it. It's the good one that helps prevent bad things from happening with COVID. *Faecalibacterium prausnitzii*. If you do a lot of stool testing, you'll be seeing those on stool tests.
Okay, so we're kind of cruising through amino acids relevant for what I, for the reason I just mentioned. And of course, if you want the person to recover and for their immune system to recover, you're going to want them to be able to make proteins. Antibodies are proteins, hemoglobin is a protein, lots of things in your body are proteins. And so if you're missing an amino acid or two or three, this person's missing threonine and glycine and serine, you're not going to be able to synthesize proteins very well. So you're going to want to give the person free-form amino acids, which are always also very helpful for, um, for your mitochondria. And then we'll just make a special shout out here for all these labs. And again, you may be using different lab testing companies, that's fine. It's the same amino acids, right? Everyone's testing. So remember, we said that the one commonality for all these long COVID cases is that they have damage to the endothelium, right? The endothelial cells are scarred, nicked, chopped up, scratched, irritated, not functioning very well. And so nitric oxide, the gas, is a simple, easy, safe, time-tested, you know, scientifically studied beyond belief mechanism. And all you have to do to get nitric oxide up is to give the person these amino acids that are right in front of you, arginine and citrulline. Okay? And most of the companies that we work with will have a powder form. Some people do it in capsules. Powders are easier. That'll have the arginine and citrulline in it. And it'll have a name like Nitric Oxide Plus or NOX Synergy or something like that. Because everyone knows, okay, we're using these formulas to improve nitric oxide. But that's like step one in blood vessel repair. Now, if the patient's low in arginine or citrulline, it's an even more extreme situation. But even if they're not low in those amino acids and they're experiencing symptoms of long COVID, you can still use the nitric oxide boost as a solution. And it's usually around 3,000 milligrams of, uh, arginine plus or minus a little bit, and 3,000 milligrams of citrulline, sometimes a little bit less, once or twice a day on an empty stomach to get that nitric oxide up. And again, the one I use is from Pure Encapsulations, is called Nitric Oxide. And then Designs for Health has one also called NOX Synergy. Okay? So that's an easy way to get the blood vessel repair going and help with the microcirculation.
So whenever we think about mitochondria, we're scanning this first lab, looking for mitochondrial problems and looking for neuroinflammatory problems. We're limiting it to these two issues, right? When you think about mitochondria, I should think about three nutrients: CoQ10, magnesium, and oxygen. If you're deprived of any of those nutrients, mitochondria don't work very well. Or if you have a lot of oxidative stress, mitochondria are damaged. So you can have mitochondria faltering because they don't have the nutrients they need, CoQ10, magnesium, and oxygen. Or you could have mitochondrial faltering because you're getting damaged by oxidative stress. That's what this virus does, right? It generates this massive cytokine storm with all this inflammation and oxidative stress. So much oxidative stress that it can literally kill you. That's kind of a lot of oxidative stress, like hard to even imagine that your body could fail at that point, you know? That's why the plant-based diet people survive this and the meat eaters don't, because their bodies are just chock full of antioxidants. And so that cytokine storm thing is just, poof, just hits a wall and gets put out. It's like a fire that's just getting put out. Okay? So anyways, if they're low in magnesium, that's the top of the list. Supplementally, 200 milligrams twice a day. You can go up from there. I always start with that, 200 milligrams in the morning, 200 milligrams at night. I like the magnesium glycinate. Why? Because it's kind of cool that it's bound to glycine. And everybody seems to benefit from glycine. Don't have to use that one, but if patients ask, "Which ones are you?" "Is it magnesium glycinate?" You can use a multi-chelated one too. But that's like ground central, you know, right in the middle of all this stuff for cardiovascular function and for mitochondrial function. And minerals, of course, are also have sort of a sort of alkalizing effect or, you know, they help sort of bounce out all that acidity that comes about with all that oxidative stress.
Okay, and then here's an important section. We talked about antioxidants to stop the oxidative stress. And you can measure them: CoQ10, alpha-tocopherol, gamma-tocopherol, vitamin A, and beta-carotene. So in this case, I would probably give alpha-tocopherol because that's the one that's the lowest. It's borderline, though, depending on what these other markers show. And these are markers here, lipid peroxides and 8-OHdG for oxidative stress. So again, you can measure the antioxidants and you can measure for oxidative stress. You're looking to see about the nutrients that are protective. And then you're looking to see, is there an excess amount of oxidative stress? In this case, the antioxidant levels were okay. The oxidative stress markers are not bad. We're skipping over vitamin D, that one's obviously super important, as are the omega-3s. One of the major characteristics of omega-3s is that they're anti-inflammatory. And the whole thing that we're worried about here is inflammation, inflammation of the blood vessels, inflammation and oxidative stress that's hitting the mitochondria. So you would want to load the person up on omega-3 fatty acids. If it, with this lab, with all of them being low, I would probably give at least 4,000 milligrams a day. That's a lot. 2,000 in the morning, 2,000 at night for around 90 days, then cut the dose in half and then retest after about six months, three to six months. So I'd retest. So I usually give double the typical dose if the numbers are this low with the requirements, shall we say, that they're going to retest. And again, we're just looking for mitochondrial problems. We're skipping through a lot of stuff. And here's the actual mitochondrial section, right? We look at fat metabolism, carb metabolism, neither of which look very good here. And then the mitochondrial energy production itself, which is not that great. And then of course, B vitamins. Okay? So this person has aspects of each one of those problems. Carb metabolism is not working that great, fat metabolism not working that great, and mitochondrial energy production. Okay? And need some B vitamins. And then the last section here, look at, uh, the neural inflammatory markers here are the ones that we mentioned before, kynurenine and quinolinate. And kynurenine is high. Okay? It's complicated, but that can mean that there's neuroinflammation. It can mean a lot of other things too. It's a little complicated. And so, let me show you quickly, and then we'll move on to the other case. Uh, sorry, here. That didn't work. Hang on a second. Here we go. What a program would look like. So I design every program when I'm talking to the patient. I don't do anything ahead of time, even though I end up doing the same thing over and over again, most of the time. I don't know why. I just find it refreshing to just always have a blank canvas and always be starting from scratch, kind of, you know? And so here's what they look like here. So, and this is just a quick rundown, right? So if I was using the, um, I would use the nitric oxide powder from Pure. And that comes with a scooper thing. So it's like one scoop. I mean, gosh, if they're like this sick, you're going to want to do it at least two times a day on an empty stomach. And remember, that's the one that has the arginine, citrulline, a few other things. It's the nitric oxide booster. You can boost that gas up. You're going to next, you want to use magnesium. I like the glycinate form. You can choose other forms. It stands in 100 milligram capsules like that. Start off with at least 400 a day. You could go up from there. This person had a fat metabolism problem. So that's L-carnitine. Usually comes in like a five or six hundred milligram capsules like that. You'd want to give a couple. It's kind of expensive carnitine. I don't know why it's a little expensive yet. People just have to deal with that. And that's going to get beta oxidation or fat metabolism going a little bit better. And then we're thinking about, oh, omega-3s. Remember? So those are usually in a thousand milligram capsule, something like that. So we'd want to, you know, quadruple, give like at least four a day. Cut that in half after 90 days, you know? And then, um, oh, there were some carb markers. So for carbohydrate, I usually gonna do B complex. I'm putting asterisks by this. I'm going to try to fill the box with asterisks and then I'm going to highlight it. I spent two and a half hours today talking with Richard Lord about B1. He's really into B1 right now. What did he call it? He called it the, uh, archetypal nutrient, ancestral nutrient. Like, I guess, I guess all animal forms are, all life forms, not animals, all life forms need need thiamine. Who would have known that B complex is is so important? You can't really even wrap your mind around it. Okay? It's so important that all I can do is just put asterisks here and just say it's so important. It's the most important thing. And it's not very expensive. It's not a big deal. Give people B complex. This person tested low in the B's anyway, so you kind of have to do it with them. But it's incredibly important to get thiamine and riboflavin and niacin and all those things. Your body just ceases to work without them. Okay? I'm probably forgetting something here. Let me go back. Oxidative stress. Oh, vitamin E. They need a little E. You could do individual aminos and you could do a lot of other things too, you know? Um, I'd probably do the free-form amino acid powder, one to two teaspoons daily. We can mix it with the other powder between meals. And then this is super important. You gotta do some kind of comprehensive multi. I've been using the women's pack for women, the men's pack for men from Pure. And I'm telling you, you could get tripped up if you don't use the multis. You know, you don't have like stupid little stuff like zinc, molybdenum. Molybdenum. I'm telling you, man, sometimes cases will either go or not go based on molybdenum. You got to have all the little micronutrients. So you can't skip the multis. If people look at you like a little bit like, "Do I need this?" You're like, "Yeah, you have to take the multi." Otherwise, you end up giving them little bottles of so many different things that drives people crazy. Anyways, this is a, a nice, you know, let's get you better mitochondrially, reduce your inflammation, get your vasculature working better. And then we need the anti-inflammatories because remember the kynurenine was high. So you could use some kind of curcumin product. We know whatever the dosing is on those, you know, one or two, three times a day. So like that. And Leo Galland's really into the resveratrol too. You could use that as bear, uh, troll. I'm gonna spell it wrong. I don't know how you spell resveratrol or something like that. Let's call it res. That would be another potent anti-inflammatory antioxidant. So you could end up with a program like this. This is a reasonable thing. Most people could do this. It's not too, too much stuff. And a lot of these things are powders, right? So they're not super overwhelming.
Okay, oh yeah, and thank you. Um, you should always include CoQ10. I knew I was forgetting something. Ubiquinol, ubiquinone, ubiquitol, or whatever. One to two. That's really expensive. One to two, something like that. Okay? So that'd be like program number one. That's a lot of stuff, but, you know, if someone's really that sick, they're gonna do it.
Okay, let's look at one more lab. Let me just do a quick little refresher here for you guys so you can see. Well, you don't need to see that. Let's just, let's just look at the test. Um, let's go backwards this time. Oh, gosh, look at that. Wow, what a wipeout. So for those of you that have a younger, you know, so I'm 57, so younger to me is like in your 30s and 40s. For those of you that are younger, I think the next 10 years of your career, starting from around now and increasing every year, at least for the next five years, is going to be oriented around treating these long COVID patients. I would say, just guesstimate, 50% or more of your practice, five years from now, is going to be dealing with this, you know? And it's not going to change that much. They're all going to have damage to the endothelium. They're all going to have oxidative stress and inflammation. 40% of them are like that are going to have neurological problems. A whole bunch of them are going to have brain matter that's been discombobulated. Years ago now, they're stumbling into your office. There's going to be this massive increase in diabetes that that VA research project showed. Incomprehensible increase in diabetes due to this, the metabolic disorders from this virus. And, um, you guys are going to be dealing with this. I'm going to be running a bicycle shop on the Big Island of Hawaii. And you can drop by and rent a bike for me if you want and say, "Hey, Dan, I took your classes way back when that pandemic first happened. You were right." And I'll just laugh and smile and say, "You want to ride a bike? I know you must be stressed. I'm glad you're on the island for a week to relax before you go back to your clinic." I'll be one of those wise old guys that you see in Hawaii that's just like nodding a lot. And you're like, "I know he's running a bicycle shop, but he looks like maybe he did something before this."
Amino acids, if B vitamins get all those asterisks, or ask for whatever the plural of an asterisk is, estrous or whatever. Then, um, the amino acids would be a little more important than the B vitamins because you need these amino acids to make all proteins. So you'd have to replace the amino acids. And remember, I told you that the research now showing these ACE2 receptors in the gut, damage from COVID, not to everybody, but a significant portion of these people are going to have amino acid transport problems as a result of COVID. So you can be seeing low amino acid levels like crazy. Stuff is just going to accelerate, but you're going to have the solution in a bottle. Just give them amino acids and get their gut working and get their, you know, microbiome in better shape and all that. Um, so again, this case, we would just use all the free-form amino acids. You can give individual amino acids, obviously also. And the ones you're going to be on a, on the lookout for are ones that are sulfur-containing, especially. Let me see here again. Magnesium low, replace it. Zinc low, you want to replace that. Usually, I get somewhere between 30 and 50 milligrams of zinc. Now, this case, look at this. So this one has a bunch of the antioxidants low: alpha and gamma tocopherol along with vitamin A. So I usually give 400 units of E, vitamin E, twice a day with alpha-gamma tocopherol, vitamin A. I usually use it in a liquid. I'll give three to five drops of vitamin A once or twice a day. You have to be careful with vitamin A because people can get toxic in it. The oxidative stress markers are not that bad. Vitamin D is pretty good. Omega-3s are a little bad, but not horrible. Omega-6s, I don't know what to say. They're all low, basically. That's amazing how sick people get. So obviously, you'd want to give this person omega-6s. Probably a typical dose of omega-6 would be 500 milligrams a day. If someone's in this bad shape, I'd feel pretty bad for them. I'd probably give them a thousand or 1500 milligrams a day for six months, then cut the dose in half and retest. Yeah. And look at this. So we're seeing this a lot with these long-haul cases. And I don't know exactly why this is happening, but I'm seeing this over and over again. And, um, maybe one of you guys will figure this out in the next few years. You see these fatty acids? Look at this. These are the, these are the saturated fats and palmitic and stearic. Palmitic in particular, that's made by your liver. Okay? Of course, you eat some food with palmitic in it too. But when palmitic drops this low, it's a problem with your liver being able to make fatty acids. It's a problem with your liver being able to make fatty acids. Why that's happening to all these people? Not entirely sure. This two and a half hour talk with Richard today about thiamine, about B1, the end of the, maybe the last three minutes of the talk that he was basically privately lecturing me on was the, the punchline to this whole thing was that you need vitamin B1 to synthesize fatty acids. Go figure. I don't know. There's more of a mystery here than we, you know, can make sense of. And let's look at the neurotransmitter markers. That one's not that bad.
Okay, there's one more test here. Let's just see. This was a, a pre and post. And let me see if there is, I think there is something interesting in here because I asked my staff to pull this one. This is a patient from earlier in the week. I just can't remember why. I think it was at the end here, though. Let me see. Uh, oh, yeah, yeah. This is, okay, yeah, this is a good one. Yeah, look at this. So here, check this out. So let's start. That we can't look at the whole thing, we don't have time. But let's just look at some of it. So this is a pre and post test, okay? On a, on a long-haul COVID patient. And look at her kynurenine on the first test was a 1.9. Remember, that's the cytokine marker. That's the neuroinflammatory marker. That when that thing goes up, it means your body's cranking out cytokines and the brain is inflaming. And that gets out of control, completely out of control. It causes this cascade that your body can't recover from. So her kynurenine went from a 1.9 to a 1.1. I mean, almost cut it in half. That's got to feel better for that person's brain, right? And look at her antioxidant levels here. These are the antioxidant markers, 28 and 29. Uh, marker number 20, oh, sorry, I'm all hitting the wrong buttons here. Hey, a second. Oh my gosh, Dan, what are you doing there? Okay, I'm trying to get this other thing going here. Um, can we make that stop? These people, is that not there? You go. Okay, so her, and this is exactly what you want to see. This is meant to give you some.
Sense of hope. Okay. Her this is a marker for oxidative stress. It was at a 0.5, now it's at 0.26. We cut that oxidative stress in half. Her 80htg, which is one of the most important markers of oxidative stress, this is like what kills people from COVID, right? Oxidative stress was a 5.8, now it's a three. Almost cut it in half. We reduced her oxidative stress by half. We reduced the inflammation, one of the inflammatory markers in her brain, by almost half. You know, that's a big deal in terms of how people feel.
Um, let me show you what else happened to her. Let's look at her. This stuff really does work. So let's say that, um, if you're ever wondering, I don't know if this is really going to work or not. Yeah, look at this. Let me show you here. Um, yeah. So her threes were okay before. Her threes are okay now. But look at her omega sixes. They were quite low. Gamma linolenic was a one, now it's a 21. Can I say that again? Gamma linolenic was a one, now it's a twenty-one. Okay. Um, all of the omega sixes came up. Look, all of them did, except for arachidonic being a little stubborn there. Okay. But look, anyways, it's moving in the right direction. She's not fixed. We're not saying that she's like completely better, but, you know, moving in the right direction.
Vitamin D went from a 30 to a 50. Um, here's another oxidative stress marker, lipid peroxides. That's a measure of oxidation of lipids or fats. Went from a 2.5 to a 2. So that dropped. Her CoQ10 went from a 0.3 to a 2.1 and went up by seven times. Okay. That's because I gave her CoQ10. But I was just showing you this stuff really works. Okay. Like if someone's CoQ10 is low, you give them CoQ10, it's gonna come up.
Her vitamin E dropped. Okay. That's my fault. I probably should have given her E, but I didn't know that. Her vitamin A, which I gave her, went from a 0.3 to 0.7. It doubled. Magnesium was quite low. Went up and two quintiles. And by the way, this translates into people feeling better, right? It's not just an abstract lab thing. Magnesium was quite low. Is it below the low end of the first quintile? Now it's in the third quintile. Potassium was extremely low. Now it's just normal. Low, low, low. Copper, very important nutrient. Most people don't walk around thinking that copper is important, but look it up. Copper's essential for your electron transport chain, essential for the carrying of oxygen, hemoglobin, all that stuff. You got to have copper. Copper went up two quintiles. How did I do that? Voodoo magic? My golden personality? No, I prescribed her copper picolinate, two milligrams for six months. All these programs I do run for six months, then we retest.
If you look at her amino acids, and she's, I'm not saying she's perfect now because she's not. She still needs to do another round of stuff. Oh, this, this got worse. So, you know, I just have to deal with this. You know, her amino acids dropped. That's not supposed to happen. So there's some things that got worse with her. In fact, she became a lot more physically active. There's kind of a whole backstory to this case. There's reasons why some of those things look worse.
But let me just show you what the actual program for her was. So I always do a lab, give a person a program, run it for six months, stop, and retest. So what did I give that woman that we just saw? GLA, 240 milligrams. I loaded her up on it because she was so low. And then after 90 days, cut those in half. And then magnesium glycinate, because I like the glycinate, that's 100 milligrams. And two and two. Now, the multi that I use also has magnesium. So people are ending up on more magnesium. I should put that in here. Um, women's pack from Pure. So that's going to have extra magnesium in there too. Okay. Just, you know, it's not just that one source.
And then we didn't use amino acids. Kind of that was my fault. We used the CoQ10, remember that came way, way up. I usually cheese. I don't know, sometimes I only get 200 milligrams. I always want to give more, but I always look at the price of anything. Oh my god, it's like 80 bucks for a bottle. That stuff. It's kind of a little crazy town to try to get people to take too, too much of it, you know. And then, um, oh, vitamin A. I use it in the vitamin A drops and I'll usually give three to five drops twice a day. That really works. So these are some good antioxidants, right? CoQ10, vitamin A. I give just about anybody I can get away with. Lipoic acid. It's a really good antioxidant. There's so many other things. There's all this stuff about it preventing COVID too. So that comes in at 300 milligrams and give a couple of those a day.
A second. Let me pull this up here. Let me get rid of this one so you have some more room. You can see it there. There we go. Uh, I think she was okay with the threes. I'm trying to think of the other things we used. Well, I can't, maybe I'm missing something, but that's the bulk of it, you know.
So in a perfect world, we test people every six months. By the time you get to the second or third lab, you're going to start to have a sense of what's happening. The first test is just like a brand new introduction to what's going on, you know. You really have to see a second and third lab and see what your interventions were before you can get a sense of how things are moving around. Like with that case I just showed you, all these things got better, she's feeling better, but now her amino acids fell apart. I didn't know that was going to happen. There's no way to predict that. So now we're going to do an amino acid programming. So it's, you know, it's a work in progress. But when you've done two or three tests, people are consistently getting better every month that you're doing this, right? Then you know, you start to build momentum and you start to understand the dynamics of that case. But one individual lab, you really have no idea what's going on because you have to see how the patient interacts with actual products that you're using, right?
Oh, and then I forgot the whole most important thing for this whole talk. Sorry, that this should be with everybody's program is N-acetylcysteine. Sorry, sorry about that. Sorry, my bad. Because that's the way you boost glutathione, right? At least 3,000 milligrams a day. You can go up from there. So let's just say anywhere from 3,000 milligrams to six thousand. I'm talking about these more exotic things, and this is, um, just almost assumed, right? For any of these long-haul COVID people. I don't even care if their glutathione tests low or if their cysteine is high or low. You should just include NAC or NCL16 just as a matter of course, okay? For all these people.
All right, now let me see here. Where did all my stuff go? Uh, here? No. Uh, too many windows open, huh? That's what I think. All right, let me grab this here. So let me see if there's a few questions that have come in. Try to handle those and then we can wrap it up. You guys are in for the time of your lives, man. This, no one could have predicted this was going to happen. Nobody. You guys who are starting your practices now, I'm telling you, this is going to hit so hard. It's really going to be something. You're all going to be so busy. Just, you know, drink a lot of water or drink a lot of wine, whatever you need to do to take care of yourselves for the next little while because you're all going to be busy.
All right, so reminder before we look at questions, join us January 10th. That is next week. Adrenals and GI. The first time we've done this. It's just straight up lab interpretation workshop. It's like cramming an all-day Saturday thing, except where we broke it up into separate hours. We're going to look at a bunch of the stuff I did with the Mayo Clinic study, so you can see the adrenal and GI protocols that we use for that group of patients, what the outcomes were. Then I've got a whole bunch of other things planned for this where we're just reviewing labs, reviewing labs, and you get 100 discount on it if you use that code MINIWSJN2. Good luck remembering that. If you can't remember that, just email the office and say, "Hey, I listened to the talk, could you give me the code?" And they'll say, "Okay, sure." That's coming up next week. Pretty excited about that because I've never done that one before. Eight weeks long.
And then the one-year class for those of you that have been considering this, you should seriously consider it. What the heck code there for a discount as well? And, um, we're picking up some momentum now. It's a really great group of doctors we got going, and you just jump right into this high level of lab interpretation, and it's a pretty cool class. So we'll be starting our first group of the year with the mentorship, uh, January 26th. If you're ready for a whole year of doing this, hours and hours and hours a day, then sign up and you'll have the time of your life and you'll learn at the end of the year how to interpret labs at a high level. Okay. All right.
So now let me take a look at these questions. So there's like a hundred questions that came in, and we only have like four minutes. So let me just see what I can do here. Hopefully, you guys can see the discount code. Someone couldn't. Um, yeah. Oh, there's, and for those of you that are asking questions about the vaccines and some of these other things, let me show you a resource here in a second on that that'll, um, answer that. And then, oh yeah, for the, um, arginine product, it's nitric oxide from Pure Encapsulations. That's when I just ordered some for myself, to be honest. Um, I won't bore you with my COVID story, but anyways, I'm buying this stuff because I think I need it. You really don't want to get this disease. I did, and I lived in the tropics for a long time, you know, I lived in Thailand and Malaysia, Indonesia for several three years, and it just reminded me of these horrible tropical diseases. Here's the product that someone was asking about, nitric oxide support. Everybody should just be doing a couple scoops of this every day until all of our blood vessels are back to our pre-COVID status. Okay.
Um, all right, let's see here. Yeah, now there's a bunch of questions that are coming in that I'm not going to have time to answer, but that you will answer if you, there's a question about POTS, there's a question about loss of taste and smell, there's a bunch of other ones. So I think the easy way to answer that is I can direct you to a resource because, wow, you guys, there's a ton of questions here. Sorry, it's like five or six times more questions than we ever usually get. All right, but let me show you the resource that I would recommend for you guys. Those are there asking questions. I think most of the questions that I'm looking at here will be answered by this website. So obviously, we're all reading the research studies, but if you want like a quick, like, how to get started on this subject, then Leo Galland. Um, I'm sure most of you are familiar with him and his work. When I was in my mid-20s, I picked up one of his books and I thought, wow, this is what I want to do. Guys still alive, you know, he's healthier than anyone that I know. He's in his late 70s, I think, early 80s, like that, still practicing all day long, still saving the world. Dr. Galland, God bless you. He's really one of the inspirations and one of the reasons why I became a functional medicine doctor. They didn't even have the word functional medicine back then, but I read his book and I read about dysbiosis, I was like, wow, this is really, really cool, right? When I came back from the monastery. Anyways, Leo is still around. He is better than ever, and he has spent the last two years applying his brilliant scientific mind to understanding COVID and to long-haul COVID, and he has not only understands the science behind it, but is also treating patients every day. So you go to drgalland.com, you can click on the Coronavirus Guidebook, that will take you to a link here. You can read the guidebook, you can listen to his video about healing long COVID, his video about understanding long COVID, and this will answer probably 85% of the questions that you guys, um, sent in. Well, will be answered in these videos, okay? I'm sorry I don't have time to cover them all, but I think this will get you guys started. And then if you're, um, curious about what he's really saying, then, you know, you can certainly look at all his, if you look at the end of this here, um, he's got all the studies cited here, so you can start to poke around the literature like I have been. But this is a really great starting point, and then you can go to the original source materials and and read about what he's reading, you know, in the scientific literature. It's a good way, good to have a resource like this to get started with because once you get into this, you're going to want to, you know, really make it all work. And he talks about fecal bacterium protein. It's, I even, it's a lot of cool stuff on the GI that we didn't have time to get into.
Okay, I'm going to wrap it up for tonight. By thank you guys for coming. I hope to see some of you either in our mentorship class starting or in our, uh, Adrenals and GI class that will be coming up in a week. Okay, take care everyone. We'll talk to you soon. Bye for now. You.