Transcription
You're welcome to our evening presentation or talk about depression, anxiety, and overeating. Three common problems that we see all the time, and the things that you can do with neurotransmitters to help support patients. So I'm pretty excited about that.
I thought I would just take the first couple minutes to give you all a little orientation, maybe a little update to the things going on around the Kalos Institute. Some of you may be new to us, some of you I know have been listening to these for several years, and just give you a little refresh on where we're at and all the happenings right now. And let us take a look here and give you a quick update.
So, um, some big news happened, you know, in my life, and we entered into a collaboration with the Institute for Functional Medicine. And it's the best thing that's ever happened to me professionally. Number one, it's the best group of human beings I've ever met professionally. I have him faculty and staff are just like incredible. They're like the top-notch doctors clinically and the most mission-oriented, compassionate, great group of human beings I could ever imagine to work with. So really excited about that.
And what we're doing is we're launching this "My Practice Plan" course, which is oriented around developing business skills, things like strategy, operations, communication, sales, marketing, legal strategy, and so on. And, you know, some of the things that came out of the IFM. I was at the IFM conference in in December last week, and, you know, I think this really spills over to what I've been trying to do with the Kalos Institute.
So I want to spend just a couple minutes talking about it. That, you know, I see functional medicine and I see my entire life, really, as oriented around a movement for social change. And this started off in the Kalish family. It's those four generations of us that are really doing this. So my, my grandfather, Max Kalish, was an artist. He was a sculptor. He made bronze sculptures, primarily of American laborers. He was very famous in the 1930s. And, you know, Max made a good living. He had an amazing office and studio, which fit West 57th Street in New York City, or in the heart of Manhattan. He employed a dozen or two people. And, you know, but what he did and when he was passionate about was social change through the labor movement. And that's a big deal, right?
And then I realized my dad, Richard Kalish, again, a pioneer, late '50s, early 1960s. My father was researching and writing about the death and dying process. He even did the original grant writing for an organization called Shanti. And I was reading their website, you know, a couple weeks ago, I was putting this together. One of the first organizations in the world to train lay volunteers to treat what mainstream medicine does not and cannot treat: isolation and loneliness. And that's for people who are dying. So my dad's whole career is oriented towards helping people who were dying have a better quality of life. And I've never really thought about him as an advocate for social change, but it was radical in the late '50s to say we need to look at dying and the dying process in a different way.
Then I come to my own history now. I grew up in Berkeley, California, one of the most liberal cities in America. I then attended Antioch College in Yellow Springs, Ohio. Some of you may have heard of. In fact, this is a symbol for Antioch College. You know, you like some colleges are like the Washington Huskies and the Cal Bears. Antioch, where we were the radicals, right? That's a symbol for anarchy. They're so very sort of left-wing orientation. I then wasn't enough for me again, you know, to just be a liberal college. And when I graduated, I spent two years in this hut in a monastery in southern Thailand where the monks, you know, couldn't even touch money. So this was this was an orientation that was not about success in practice and not about making money, but really about helping people.
And I realize now, even my son, Asa, has carried on this tradition. You know, and again, it's just putting together this talk for IFM made me realize all these things about my family that were so profound. In my son, I'm so proud of him. When he was 16 years old, he created "Tutors for Opportunity." And there's my little guy right there, Asa Kalish. So I sent him off to Columbia for a summer program in high school. He comes back with his nonprofit. He created with other kids, you know, and what do they do? They tutor kids. They take all the money they make from the tutoring and then they invest it in microloans that they give out to people all over the world, whether it's like Nigeria and there's some water plant thing that they funded, or whether it's Armenia, or Cambodia, or Pakistan, right?
And so there's four generations now in the Kalish family who are really oriented around this idea of social change movements. And that's how I want to frame functional medicine. This isn't about, you know, us being super successful as doctors. This is about, you know, there's a revolution going on in medicine now, and we want to be able to help participate and lead this revolution in a sensible way. And it is very much a revolution back, as all revolutions are, to where we started, right? Which is the idea of small private practices, lifestyle medicine doctors looking after patients and talking about things like their emotional health and their physical health, exercise, and diet. You know, this is nothing new. We're really going back to where things were, you know, in the doctoring world 100, 200 years ago.
So anyways, that's I want to sort of frame that sort of revelation for me in my terms of my family history and where I'm at in my career now and being able to go out and say, you know, this is really what my whole life has been about. I want to share that with people. All right. So that's the the new direction that Kalos Institute. And we're super excited to be working with IFM, like I said, the kindest, smartest, you know, most well-intentioned group of people. And they're getting a lot done. And so I'm glad to be onboard with them. And if you guys are interested into my "Practice Plan" program, you can check it out too. We'll be starting those groups up soon.
Okay, so that's where to get into the clinical now. And I wanted to talk about, you know, it's basically the use of amino acids in these kinds of treatments. And we have a bunch of slides here. I'm going to go through them kind of quickly so you can have them as reference, but I want to focus on the bigger picture theories and then how we can start to, you know, work with neurotransmitters effectively. And it's something I had a personal personal passion about. And I spent about a 12-year period of my career just focused on this one subject. And so I learned a lot about it and I'd like to share what I know.
Quick introduction to me. Obviously, I've been in practice for a while. I've trained a lot of people. The Kalish Institute, happy to work with you. And if you're interested in functional medicine training, I'll talk about some of the upcoming class opportunities in a moment. And this gets cut right over here to some of the key factors in terms of organic acids and why did you keep this in a really big picture kind of way so that we don't get too overwhelmed when we're looking at these labs. And in fact, you can even do non-lab-based programs.
But quickly, review of organic acids. There's a really great section on organic acids that looks at cell energetics, mitochondrial function, very important. There's a section that looks at the GI markers. And there's an amazing section that looks at detoxification, oxidative stress, methylation. We're not talking about any of those tonight, but you should just know that they're there. What we're going to focus on are these markers here for the neuroendocrine system and how you can design effective programs to help people and the supplements that are associated with all this, right?
And so let's look at what we're going to focus on tonight. Again, down in here, lower left-hand corner, we want to learn how to use tyrosine, mucuna, 5-HTP, or tryptophan, either one, 5-HTP or tryptophan, and vitamin B6, primarily, a little bit of a mix of magnesium in there. Tyrosine, mucuna, 5-HTP, or tyrosine and B6. If you master the use of those and different combinations, you can be able to help fix all these broken brains that are out there. So it's not too many products. And, you know, that's like overwhelming when you look at these labs. And I want to try to just boil it down so we're just kind of focusing and concentrating on just the neurotransmitter section alone. You know, because honestly, in so many of my difficult cases, knowing how to work with that system has just made the biggest, you know, impact on the patient. And it's a hard-to-learn skillset. And I certainly suffered for 12 years trying to figure this out. I want to try to share all of it with you.
And so we're not ignoring inflammation and insulin resistance and all these other things. I have a slide on it, but we're, you know, going to skip through that rather gingerly and just focus on this one targeted area. I can't treat this in isolation, but we want to focus tonight just what can we do for neurotransmitter metabolism correction, understanding that you have to address detox, GI, all these other issues as well, right?
So when I think about it, there's the difficulty here, in some ways, is determining where the original problem came from. And for tonight's lecture, we're not really going to get into that. We're just going to look at brain problems as how you fix brain problems. And assuming that you're going to spend some other time, some other place, you know, figuring out the source of the neurotransmitter dysfunction, we're just talking about how to fix things. The different types of sources that you may just want to float around and think about would be a deficiency type, right? That's someone who just doesn't have the nutrients they need to make these brain chemicals. A damage type, someone who's got either chemical, heavy metal, or some kind of physical trauma that's affected the brain. Or then, of course, there are some people who are just born with brain-related issues, and it's just their bad luck that they have that.
So a deficiency type means the person could have burned through or used up these particular chemicals. Damage type means something happened to them, chemical or heavy metal exposure, or physical trauma like a car accident, your head against the windshield. Or the genetic folks, which are a small percentage of my practice, but people who tend to be suffering dramatically who were born with, you know, inherited, unfortunately, defects in dopamine production, serotonin production, and so on. We can look a little bit about the labs and how that can work in terms of determining whether it's genetic or not, too.
Okay, and then again, deficiency, damage, or genetics that triggers this neuroendocrine system collapse, which is obviously going to drag in the GI and the detox systems, which we're kind of skipping over for tonight. And then another one, you know, another subject area which we can determine with the testing is to what extent is an inflammatory process part of the brain-related problem. And when we look at the labs, I can show you how to differentiate. Is it a stress condition? Is it an inflammatory condition? And of course, there's almost always a stress component.
But, you know, my favorite example this, I use in class all the time, is Bradley Cooper. One of my favorite actors. Love the guy. He's funny, he's serious, he's handsome, he's great. You know, he's just like, "dude." And he can play a silly role and begin a really serious role. But the role that I'm thinking of in terms of tonight is, you know, "American Sniper." If you didn't see that film, and he plays the American sniper and the American military who's killed the most human beings of all time. I've heard it's like 300 people or some like that. But, you know, you see in the movie, you see him just degenerating into this ball of intense stress as he goes to Iraq and shoots people in the head and then comes back to, you know, to Texas where he lives with his wife and kids. And the sort of, you know, pure stress-induced brain-related problem is very real with a lot of the patients that we work with. Maybe not as dramatic as, you know, if you're a sniper or something. But, you know, we see this.
And the mechanisms by which we see this played out are through the production of catecholamines, right? So here you have dopamine, norepinephrine, and epinephrine. And when the brain is stressed enough, like if you're a sniper, or, you know, I don't know, I was pretty stressed in my second marriage, you know, just being married to the wrong person. I don't know. She wasn't the sniper, she never killed anybody, but boy, she wasn't very nice to me a lot of the time, you know? So just even in an unhealthy marriage, or what do I see in my practice? Like, um, you know, a parent who has a kid that has a drug problem, someone who has a spouse that's an alcoholic, someone who's in a really tense work situation that they can't get out of. You know, that level of constant stress is going to drive the catecholamine production through the roof. And we'll see this on the tests by measuring homovanillate and vanillylmandelate levels. So really helpful to understand the stress component of all this, okay? The stress markers. And stress can be enough to throw off a human being's brain. And something that we can restore, you know, if we understand where it's coming from.
And then you have these inflammatory pathways down over here with picolinate and 4-hydroxy-3-methoxyphenylacetic acid. Again, strong levels of inflammation, neuroinflammation can trigger depletion of brain chemicals because we make these cytokines. These inflammatory cytokines are produced by the same amino acids from which we make dopamine, norepinephrine, and epinephrine, serotonin. Serotonin is not on this picture, but it's in the mix as well. So you can have an inflammatory condition, neuro-inflammatory condition, that would deplete brain chemicals. And you can have a stress-related condition. Some people are both. And the labs will tell you which way to go. In fact, you could argue for the sake of tonight's class, and maybe it doesn't matter so much because you're going to treat these conditions in the same way. But when you're trying to find the underlying cause, the problem, of course, it's very helpful to know whether it's related to a bad marriage or if it's related to, you know, a bunch of inflammation and the person's got something like that. It's for the deeper level dive.
All right. So here are the markers again. Vanillylmandelate, homovanillate, and 5-hydroxyindoleacetic acid. Okay? And these are for serotonin, dopamine, epinephrine, and norepinephrine. And then we have these other markers, kynurenate, 4-hydroxy-3-methoxyphenylacetic acid, and picolinate, that are the inflammation markers. Inflammation-related markers. So you can see again, is it stress-related? Is it inflammation? Based on the test, sometimes just talking to the person, you may be able to figure that out as well.
And the organic acids testing is a foundation for how I work on this. You know, I can't imagine doing this without the test. Although you could, if you really wanted to, I'm sure, you know, just do some general guessing. I wouldn't recommend that. I think the test, even though it is a little expensive, it's like three or four hundred bucks, it's going to yield so much helpful information and shortcut any of your programs so much that from the patient's expense standpoint, the money that they spend on the test will be more than, you know, rewarded or saved as they go through and and start to do various programs with you.
Okay. So again, we have these two urinary byproducts of the catecholamines, vanillylmandelate and homovanillate. You see the dopamine breaking down to homovanillate. The norepinephrine and epinephrine breaking down to vanillylmandelate. And we're measuring these urinary byproducts. Now, you can measure dopamine, epinephrine, and norepinephrine in the urine directly. You can measure dopamine, epinephrine, and norepinephrine in the urine directly. However, that's a highly unreliable way of tracking what's going on in the brain because of some complicated things that go on in your kidneys and whatnot. So these metabolites are much more stable and were easy to track. It's a much more accurate way to assess. And any measurement of dopamine, epinephrine, and norepinephrine in the urine itself is going to be somewhat suspect. And I don't think those tests are very accurate.
Okay. So we talked about this. Now, what's interesting about these markers is that when we're first stressed, they shoot up. And then when things get really bad, they go low. And this could be tied in to adrenal exhaustion. Well, of course, because another word for epinephrine is adrenaline. Right? Another word for norepinephrine is noradrenaline. So these chemical compounds are produced in the adrenal glands as well as in the brain. And in a sense, the catecholamine markers like vanillylmandelate and the dopamine marker like homovanillate can give you a pretty accurate sense of what's going on with the adrenals as well. I also, in my practice, measure adrenal hormones directly on everybody. And I think one of the biggest decisions that I make with every patient is what direction are we going to go? And in my mind, when we're looking at, you know, the kind of classic cases of fatigue and exhaustion and weight gain and these kind of problems that we we see pretty much every day in our practice, there's going to be three directions that I'm trying to assess. And am I going to go down one or two or all three of these different pathways?
And the one, obviously, is neurotransmitter function, like we're talking about tonight. The other would be to wonder, you know, how much am I going to really work on cortisol in the adrenals, or the thyroid, the hormonal component to all this? And then the third would be cell energetics. So let me just show those to you real quick here. So the Kō method, the neuroendocrine system. We're always, I'm always wondering, am I going to do an adrenal or thyroid program? Okay? Am I going to work with the brain or the neurotransmitters? Or am I going to work with cell energetics, mitochondrial health? Which one of these areas, adrenal, thyroid, brain, or mitochondria, is going to get this patient the most, really, from their fatigue? And so I use the labs to differentiate. And whenever I see these brain markers, I'm always in my mind comparing them to the adrenal markers and thyroid markers and markers for mitochondria to see where the biggest problem is. So definitely don't just treat the brain with everyone.
You can also have high homovanillate, high vanillylmandelate, right? That would be the initial stages of stress. And here's some more detail on some of the products that we're going to use. So we can use tyrosine to improve. We can use L-dopa to improve dopamine, norepinephrine, and epinephrine. So now I'll say that one more time, I guess. You can use phenylalanine, but I don't. It seems inconvenient. You can use tyrosine or L-dopa along with some vitamin B6 to improve production and function of dopamine-related neurons, norepinephrine-related neurons, and epinephrine or adrenaline-related neurons. So these three ingredients, tyrosine, L-dopa, and B6, very, very effective.
And I'm just showing you on a quick wellness plan here how that translates. So tyrosine, obviously, is tyrosine, right? And most companies sell it in a 500-milligram capsule. Typical, if you're wondering what a starting dose is, you know, somewhere around 2,000, 3,000 milligrams a day, something like that. The L-dopa is sold as an herb called Mucuna pruriens. And that is an herbal form of L-dopa. And it's all standardized, so certain potency. You can see on the labels of the various products. And that product, depending on what company you're using, it's typically quite a potent little thing. Usually, you give people just a few of these a day. Okay? And this would be like a first level. And then if that's not sufficient after a few weeks, this would be a second level kind of program. And then remember, you need B6 always. So in order to get around the B6 problem, I just give everybody a multi that has a ton of B6 in it. So multi with B6. You can give them separate B6 if you want.
So these are the kinds of supplements that we're talking about. And again, here are the pathways. Here's your tyrosine. Here's your Mucuna or L-dopa. And then here's your B6. And those three ingredients in different combinations are going to yield you increases in dopamine, norepinephrine, and epinephrine. So in a way, it's a way to help the adrenal glands, the adrenal medulla. It's a way to help, you know, the brain. It's a way to help a lot of different things.
So same exact scenario here. Now we're talking about homovanillate, it's the dopamine marker. Or the solution is the same, right? Because this pathway is all the same. High homovanillate, low homovanillate, all that complication doesn't really matter because, look, you're going to be using L-dopa and tyrosine to fix all these things. So the solution is exactly the same, regardless of which one of these brain chemicals is off. And that makes it pretty easy.
Now, there is a second stage to this, which is going to be the markers that are related to serotonin. And that's 5-HIAA. And as everyone probably knows already, tryptophan and 5-HTP are the precursors to serotonin. And what's that sneaky little thing right in there that to me looks like vitamin B6? So remember, we saw B6 being essential for catecholamines. Turns out if you don't have the B6, this is not going to happen. You could give someone a truckload of tryptophan and a jet load of 5-HTP, and if they don't have the B6, it ain't going to make it over to serotonin. So B6 is super mission-critical. And how many programs have failed because of lack of B6? I hate to even think about how common a problem that is.
And then another, like, question I've had for about 20 years is, which is better? Is tryptophan better, or is 5-HTP better? And it depends. So let me try to describe the depending part to you, because this is super important. And you should know how to use each of them. And remember, there's only, like, we're not talking about an infinite number of ingredients here, right? We're talking about just a few. And so learning how to use the dopamine catecholamine side properly, and then learning how to use the serotonin side properly, it doesn't involve that, that many supplements, okay? It's not a totally overwhelming thing. So I want to try to present the whole detail tonight so you guys can kind of get a general sense of of familiarity with the products and and, you know, also maybe some comfort around starting to mess with this stuff so you can help people.
So let's talk a little bit about this. So tryptophan is right here. Tryptophan converts into 5-HTP. 5-HTP, with the help of B6, converts into serotonin. Now, there is an enzyme that sits on, I'll draw it in red so you can see real obvious. How do I know this? Because I spent 12 years obsessively studying this. There's a, there's an enzyme that sits right here, all right, in the red zone. We'll call it, even it's this hydroxylase thing, right? And so when tryptophan levels get up to a certain point, this enzyme increases. And guess what it does? It shuts down the conversion of tryptophan over to serotonin. There's like a block to that pathway. So if you get tryptophan up to a certain level, you're going to max out the boost of serotonin. So tryptophan is an amazing and essential part of this whole thing. But if someone's extraordinarily low, you're only going to get the serotonin up to a certain point before that enzyme kicks in and stops the conversion.
5-HTP is sitting right here. Remember, the enzyme is here. The red line is the enzyme. It's past that pathway. So 5-HTP, the more of it you give, as long as they have B6, the more serotonin they're going to make. So for people who are extraordinarily deficient, the 5-HTP will be able to get this serotonin up as high as you need. For people in general, especially people with sleep-related problems or protein synthesis-related problems, the tryptophan is actually better. So I use both. And as long as you understand tryptophan has its limits, it'll get you to a certain place, you know, and that 5-HTP in some cases can be more helpful. You can kind of, you know, segue between the two and have familiarity with both of them. And there's only two products, okay? 5-HTP and tryptophan. So it's not a lot to stock in your clinic. And getting from, you know, comfortable with each of them is is super important to do these protocols right. All right. It's a little bit of a pain, but to have to carry both, but nothing in the world.
And so again, 5-hydroxyindoleacetic acid. There's some details about, you know, how this all happens. And here's some more on the pathways. So let me just reiterate. Tryptophan is essential for boosting serotonin. And you can use it very effectively up to a certain point. Tryptophan also helps with people who have mitochondrial problems, people who have the need to produce more protein, the need to make more stuff from their amino acids. So tryptophan has a lot of repair properties to it that 5-HTP doesn't. So in some ways, that makes tryptophan superior. However, because there's this enzyme blocking system thing here where the red line is, tryptophan can only get your serotonin up to a certain point. So for people with extraordinarily low serotonin levels, 5-HTP can be better, even though it doesn't have all these magical properties of repair that tryptophan does. For the really low serotonin people, 5-HTP can work more effectively.
And then we mentioned this earlier. You also have this kynurenate pathway, right? So when you're inflamed and you've got a lot going on in that regard, got inflammation and emotional stress, information, whatever it is, tryptophan and 5-HTP can become depleted, ie, serotonin can become depleted because you're diverting your amino acids over to this other pathway. There's only a certain amount of them to go around. And of course, if you're, if that's going on, it's bad enough, you can even have a problem with melatonin and end up with a sleep problem and depression and all sorts of stuff. So again, I've learned over the years just to trust the labs completely. Just put my belief in science, and it all works out somehow.
Okay, kynurenate, inflammation, something going on with your immune system getting messed up with. Okay? And then there's especially the B6 marker too, which is extra-special. 4-hydroxy-3-methoxyphenylacetic acid, when it's elevated, that's a B6 deficiency. Remember, we just said B6 is critical for catecholamine production, dopamine production, serotonin production. So you've got to really keep an eye on B6 all the time. In fact, if you just don't want to even worry about it, just give everybody that ever comes into your clinic B6. When I was a very young doctor, I was like 29 years old. I was working with this senior clinical wiz, amazing naturopath that was training me in clinical nutrition. And I must have seen him pull off like a dozen miracle cures using B6. And then at some point in my career, I was just like, "Screw it, I'm just going to give everybody B6." Why not? It's in the multi, right? I mean, it's just like, give everybody a multi that has B6 in it. If not, then they just make sure that you get B6 into the right people if you're not going to do it with everyone.
So here's a more complicated pathway, just to show you again. Tryptophan sitting here. Remember, there's a block, so you can only get up to a certain level. You've got your 5-HTP right here, that also converts to serotonin. And then what we don't want to have happen, which is happening to most of our patients, is have that tryptophan be diverted toward the kynurenate pathway. Well, there's all this inflammation going on, right? And then we have this sort of collapse of the brain due to chronic inflammation. And we're trying to reverse that. Now, the funny thing is, you don't have to fix the inflammation to fix the brain. You can fix the brain right away, get them thinking and feeling well, and then chase down inflammation and the gut problems and all that other stuff. In fact, that's why the Kalos method is set up like this: neuroendocrine is first. Why not? I get people feeling better first. As you're doing that, track down the pathogens and the toxins and the oxidative stress problems, ignoring that. But we want to relieve the human suffering up front first, and then move into these other more complicated areas.
Okay, and let's see here. Again, 4-hydroxy-3-methoxyphenylacetic acid, high inflammation makes high 4-hydroxy-3-methoxyphenylacetic acid. That's a problem. Picolinate, similar, high inflammation makes high picolinate. That's a problem. And kynurenate, as you mentioned, those are the three inflammatory markers, right? Kynurenate, picolinate, and 4-hydroxy-3-methoxyphenylacetic acid. And I'll just show you one other kind of cool diagram here. Well, we'll give you this. Let's do a quick break. Let's just do something like relaxing. It's because we're all kind of like working too hard anyways.
So this is the hometown where my family's from in Hawaii, Honoka'a. Can you believe that? And my Uncle Mike, I'm not making this up. We were just visiting him this summer. He owns a 500-acre ranch. And it's right there. And it goes from the beach all the way up the mountain, like six miles or something like that. Can you believe that? Oh my gosh, it's like paradise. Anyways, not a really great summer. My mom turned 80. I took her back to her hometown for the summer. And we had a really wonderful time there. There's the kynurenate pathway. There's my new car. I bought an Alfa Romeo 4C. I know it's a little extravagant, but it's them, it's the love of my life. I don't know what to say about my Alfa other than I just love it more than anything. There's my old Alfa, case you're wondering. There's my son in my old Alfa. And there's back in Hawaii again.
Okay, now we got ourselves refreshed. I have a car problem. I know that. The only good thing about my car problem is I'm limited now because I've got four cars and how many more parking spaces. So I'm going to have to stop for a little while. I've got the two Alfas, I got a vintage Mercedes, and then my regular little Mini that I run around in. Okay? So that's, um, just a moment here.
When I talk about the mentorship, this is why teaches free webinars. Because I want you guys to come and take my training program because I believe it's super helpful. I watch doctors transform their practices all the time. I'm interested in finding the right doctors to take the class, ones that really want a clinical model, people that want to have a more efficient business, people that want to transition and kind of get into this functional medicine thing for real. We're starting a functional medicine mentorship class next week. It's happening. And this is the one of the year. We're not going to be doing one for a while because I have all these other commitments now. And so if you're interested in doing it, this is the time. You get six months of mentoring with me, of the live weekly calls that we do. We have this amazing community of doctors. We have a couple thousand case studies. We have assignments and reading and testing and more resources than you could possibly imagine. It's a really great group of doctors. It's a really great experience for doctors. And I spent over a decade building this thing.
I'm going to show you real quick what the community looks like just so you can understand what we actually do. And here you are. You log in. It's a whole massive software world. My meditation teacher calls it "Dan's Worlds." But it's got interactions with other doctors, right? So I kind of like a Facebook format here. You can look at other, what other doctors are saying and talk to other practitioners. We've got the content and resources here that just go on. Here's some new doctors that are coming into the class that go on and on. We have a case study library. So like, for example, for tonight, you could type in, you know, dopamine into the case study library. And there's like literally a couple thousand cases in here. Restless leg, OCD, throat cancer and dopamine, Bacteroides fragilis and dopamine. So it just goes on and on with case studies. And all these case studies are transcribed. And there's also a video behind them. Migraines, anything that you can imagine is in here. There's thousands of these case studies that we've put in here that are from the various classes that we've taught in the past. And then I've got a discussion forum. We've got the actual content and how the class rolls out, the live calls. It's a very robust system that we've created. Pretty proud of it. And we're starting a new group. And it'll be till the middle of next year, perhaps, that we start another class. So if you've been thinking about it for a while, jump in and get in touch with us in the next week or so, and we can get you started. Right? There's the community. We have the lecture hall. Is it a great amazing amount of oh. And we have a, let's get back to the talk here. And we have a discount if you sign up by a certain date. I think save like $500 or something.
So now let's take a look at supplements that we're going to use to fix this stuff. Tyrosine, number one. Talked a lot about that. L-dopa, or you could call that Mucuna, if you want, but it's really L-dopa. 5-HTP or tryptophan. We mentioned that a little bit about that, right? And vitamin B6. So it's not that many things that you need to learn about. And I want to show you some basic protocols about how you can set all this stuff up. So we got a bunch of other things here. There we go. But let's take a look at a typical lab. And then I'll show you what a typical protocol can look like.
Well, here's an easy one. My staff kind of stacked the deck here. That was pretty easy, right? See the big L? So low vanillylmandelate, low homovanillate, low 5-HIAA. So all these markers are low. So you can't really go wrong with someone like this in terms of what your potential treatment would be. So let's talk about the different levels and the dosing schedules that you can follow.
Now, number one, let's talk about like the first level. Now, in this case that we're looking at now, this person has both serotonin and dopamine problems and the catecholamine problems. You can't really go wrong, right? So the first level, the first opening move for most people is to use tyrosine around 500 milligrams once or twice a day. And if the patient's super-sensitive, don't give them too much. But and that is just like to test the waters and see what happens as you bring their dopamine, epinephrine, and norepinephrine levels up. If that's not sufficient, you can add in a Mucuna-related product. And many of the companies that we work with have these. Okay? And that's typically dosed pretty high. You have to do a little bit of math on the numbers depending on the company that you're working with. You can check with them. But most of the Mucuna products, remember this is L-dopa, but this would be like the second level if you're really trying to boost the tyrosine-related brain chemicals. Second level up. Okay? First level, second level, meaning that you keep the first level going. So you've done a week or two of the tyrosine, two weeks at the most, nothing's really happened. You can add into that the Mucuna and really start to bring up the dopamine, epinephrine, and norepinephrine more significantly. Yeah, and oftentimes this is enough.
If that's not enough, and you want to go down another pathway, then you can look at the 5-HTP or tryptophan pathway, right? So that would be something like this. 5-HTP, I use it in a 100-milligram capsule. And that first level would be two to three of these before sleep. Not 30, two to two to three, there we go. So that would be the first level, let's call that first level for serotonin. And again, give that like a week or two and see what the 5-HTP does. If that's not sufficient to make a big difference, then I would go up to three a day at bedtime for sure. And then you can add in more 5-HTP during the day. And again, now if you give 5-HTP during the day, you guys probably know people can get kind of drowsy. So in order to offset that, give them a little tyrosine. Something like that would work really well for most people. If they're super deficient in serotonin, this would be an effective program.
If the 5-HTP doesn't work, or for some gut feeling you think tryptophan is going to be better, then you could just swap out tryptophan for the 5-HTP. So this would be tryptophan, except for, of course, those are usually sold in a 500-milligram capsule. So you do, you know, that would be your first level, right? Let me get rid of this for a moment here. So you'll be tryptophan, 500 milligrams, first level, serotonin boosting, two or three of these before bed. If that wasn't enough after a week or two, then you could bring up the tryptophan. But remember, if they're super deficient, the 5-HTP works a little better. You could bring up to two tryptophan. And some people are really so deficient with these brain chemicals, they need as much of the stuff as we're talking at here. Okay? I know the dosage just seemed really high, but some people need that much.
So that's one simple protocol for boosting dopamine in two different tiers. A separate protocol for boosting up serotonin. Just those two protocols alone, it's probably 80, 90% of what I do with these brain cases. Sometimes it gets more complicated, you need to vary things around. Oh, and did I forget something? Mmm-hmm. B6. B6. We write that three times. B6 with three exclamation points. So don't forget the B6, right? Because without the B6, this thing won't work.
So a super basic protocol in this patient's case, you could have done both, right? Because they had problems on both sides. Let me show you some more labs. And again, in my practice, I run the salivary cortisol, so I look at adrenals. We run a stool test, we look at the gut. And then we run also the brain cases, the brain testing here with organic acids. So we're going to cut right over to the organic acids. And here are two markers that are high: kynurenate and picolinate. Remember, these are the inflammatory markers that indicate that there's a brain-related problem. It doesn't change the treatment at all. You can still use the 5-HTP and tryptophan and tyrosine quite effectively. But you mean then obviously, if you see this, you want to investigate and find out why that person is so inflamed and and what kind of things that you might do to, you know, start to correct that. But protocols can be the same.
And I'll just show you one other quick slide here because it's kind of cool how this stuff works. So here's your, so let me blow that up for you so you can see here. Yeah, there we go. So when you have this kynurenate, 4-hydroxy-3-methoxyphenylacetic acid problem, right? Here's your pathway here. You've got your inflammation driving all this stuff. You've got your kynurenate heading over this way, and it affects glutamate levels. And remember all this from school. And I guess I totally remember that classes when I was learning all this. You got this calcium, magnesium, and you got the NMDA receptors and all this stuff. And when this system is screwed up and kynurenate is out of control, you get this neuroexcitatory explosion thing. And cells start to blow up. And anyways, it doesn't do well for your brain. And people get depressed, anxious, fired up, unable to slow down, all kinds of different problems. When it's kynurenate/4-hydroxy-3-methoxyphenylacetic acid problem kicks into gear, it really messes up your brain. But again, you don't have to fix this to help the person's brain. You can just get them on the right amino acids and come back a little later and deal with the other things that are going on. Okay? That's me. It's surprising, but true. You can you can work on these things sequentially. You know, you can get the brain working properly and then come back around and start to deal with the underlying issues.
And I just want to show you one other thing that I use a lot with my patient education information here. Not really part of tonight's talk, but it's it's relevant, I think, because it's important, which is that in general, and this is something that tripped me up about functional medicine. So here I am, I'm like Dr. Dan. I'm in my first three or four years of practice, just like learning clinical nutrition, just handing out supplements by the truckload. And everybody's getting better and healing. And I'm pretty excited about my life. And then I stumble into this whole functional medicine group. And they're like, "Oh, well, kid," you know, he used to call me Danny Boy, Dr. Timmons. He's like, "Danny Boy, you know, the funny thing is that Tim has never met my father. My dad died when I was 22." Right? So I'm kind of constantly in search of older male model role models. People. So anyways, I'm working with Dr. Timmons. He's like, you know, about my dad's age. And he started calling me Danny Boy. And having never met my father, and the only other person in the history of the world that ever called me Danny Boy was my dad. So anyways, he's Danny Boy, you know, it's great that you can do all these things, but don't you want to know what the underlying cause of that person's brain problem is? I'm like, "I guess so." And is that worthwhile? He's like, "Yeah, you better figure this out. Is it a gluten problem?" Wow, I don't know. We got to change your diet. Is it a GI infection? Is it a toxin? Yeah, you better investigate and find the underlying cause. Because he's wonderful in programs that you run, and, you know, aren't doing people that much good if you're letting the underlying cause percolate and get worse and worse and worse. And so that was a real revelation for me in my early years of practice.
And then I, because I'm a little bit of an extremist, I just thought, "Oh, screw this, I'm not supposed to treat symptoms." So I'm going to forget all the clinical nutrition I learned to help treat symptoms. And I'm just going to spend the next ten years of my life finding the underlying cause. And then around year 12 to 15 in my practice, I was like, "Oh, maybe I could do them both. Maybe I could get some symptomatic relief up front with these brain programs for depression and anxiety and so on, and buy myself some time to find out what's really driving it." And that's how I run my practice now. Since hematocrit front, buy myself some time to get the diet figured out, to get the GI infections cleared up, you know, all these other things regulated. Well, and, you know, I guess the take-home message for me is that our most important mission in functional medicine is to find the underlying cause of this particular patient's problem. However, you rarely need to treat that first. Let's say that again. The main job is to find the underlying cause of a patient's problem. However, you rarely need to treat that first. In fact, it's usually to your advantage, and the patient's advantage, to get some symptomatic control and set them up for success when you're dealing with the underlying cause.
For example, a patient I have right now in a, I don't know how you'd say, a dramatic situation. She's taking care of her son's baby. The son is in prison. The young woman that the son had the baby with is a drug addict. It is just not a very good scene. It is not realistic for me to tell this woman, you know, "You should resolve all your, you know, emotional issues around your son right now," because she's just trying to figure out, is she going to raise this, you know, six-month-old baby or not? Can she even raise it? You know, what's going to happen? So a lot of times, the underlying cause, if it's a massive stress like that, we can't make it go away. But we can do a lot of symptomatic control to help people handle the situation they're in. You might have another situation where you have someone who has a major toxin overload and they're full of mercury and lead and arsenic. And you know that, but they're pregnant. And you're not going to.
To do a detox program on a woman who's pregnant, because that would just make everything worse. So you may have to wait to deal with the underlying cause and work on short-term symptoms in the beginning.
So there's many, many times when we can identify the underlying cause, but we don't have to jump in and start with that. And so the brain programs are a really great opening act because you can get control over obsessive-compulsive disorders, over anxiety, over depression. You can help people sleep better, really improve brain fog and mood. You can eliminate sugar cravings. I didn't really talk much about that yet, but these protocols, if anything, they're very effective at eliminating food cravings and really getting people to lose weight. So there's so many benefits of working with the brain that I think it's a legitimate thing to do that upfront as you're just getting started. Hang with a patient as long as you have your eye on this bigger picture.
There's our mentorship starting. I'm going to show you some more lab examples, okay? And then I'll try to go through a few questions. I don't think I can handle all the questions, we're going to run out of time, but I'll try to answer a few your questions. And if you have a lot of questions, you should take the class because it means you're interested and engaged. Okay, so let's take a look here. Just some more examples. I think part of this is repetition helps. And adrenal panel, we're not ignoring the adrenals. Thyroid should be included in this as well. So there's really low cortisol, low DHEA. We see some gut issues. There's an H. pylori infection. Okay, we're going to need to treat that to reduce the inflammation. And then we look at neurotransmitter markers and detox. And let's see where those sit.
Now here's a good example of someone who's not that messed up. Okay, these markers are all okay. This one's a little low, so a little bit on the dopamine side. These two are okay. And so while people are in pretty good shape, you know, as a miracle as it is. And sometimes when you've been doing this job for too long, you start to wonder like, you know, does everyone have this problem? I'm going to show off now. It's just because I think it's kind of funny. And anyone who knows me well realizes that this is just being me being a wiseass, basically. But check out my lab. This is really me for real. Let's see. Patient Daniel Kalish is not some fake, fake out thing. This was really my birthday, 7/23/64. All right, I'm 53 years old now. This is a few years old, but still. Let's check out my brain markers. Look at this. I swear this is not a fake lab. Look at this. Look at this, you guys. Just first of all, it's right in the middle. Okay? And second of all, they're just lined up. Like, man, that is a brain on fire. That is just a brain that is just designed to work properly. I'm not going to take any personal credit for this. This isn't because, you know, I'm a better person than anyone else. I attribute 100% of this to the fact that I wake up every morning around 4:00 in the morning and I meditate for three or four hours. I swear, if you meditate for three or four hours a day, your brain will just flip to like this. And then forget the supplements. I know this is an unsub, and this is zero supplements. This is just pure Taoist meditation group.
Now, most of the patients that I work with are not going to wake up at four in the morning and meditate for three or four hours. So it's unrealistic to even talk about that with them. However, I just want to point out that you can do all of this with your mind in a really elegant and wonderful way. Let's see here. Yeah, actually, I got out this morning at like 3:20. I don't recommend it for a really robust social life, but it's great for your brain. And you ever talk to my staff at my office? They know, like, by the time it's like six or seven o'clock at night, they're not even going to bother asking me a question because they know my brain is just pretty much turned off by that point.
So here, part of part of these labs, part of interpreting these labs is pattern recognition. I think that's one of the harder parts. So now look at this. Here's our three stress markers. There's no red here, nothing got flagged by the computer. But can you see the pattern? And sometimes having three markers borderline elevated is even more impactful in the negative way to a person's brain than having a single marker up. So always remember you're looking for patterns as well as for individual markers. So if you see three that are clustering in the high end like this, then you can suspect there's some pretty significant going on with that particular patient.
All right, I've got some more examples here. I want to show you. Let's pull this one in here. And again, a lot of this is pattern recognition. Hopefully, the protocols I showed you guys can use right away. Honestly, if you wanted to, you could use those protocols I showed even without the labs. I wouldn't recommend that. Everything I do is lab-based, but you could if you just wanted to experiment with this stuff and not actually get into having to let me get out of here now. I have to get into doing all the complicated testing. There we go. I was having trouble playing that over there. There we go.
All right, so let's look at a few more. King. There's a good one, man. I see ones like this all the time. This is really good. Okay, so I see these all the time. Look at the dopamine marker. And again, I mean, if someone walks in and they have OCD or that restless leg, or I don't know, they've been depressed their whole life and their parent, you know, their dad had Parkinson's. I mean, if they have an obvious dopamine problem, you can just do the protocol without the lab. I never do that in my own practice at all. But I also understand that some of you guys are not really super gung-ho when doing the testing. And, you know, my first three or four years, I did all these programs without labs. The reason why I do lab testing now, so, you know, for syphilis or regularly, you know, is because it, it just saves me from making a lot of mistakes and it makes things really clear. So I'm a strong advocate of the testing. But if there's no, if you're just not going to do the labs, you can still try protocols without labs. All right, no, I don't recommend that as a great strategy.
Anyways, this marker here, homovanillate, being this low, I see this every day of the week in my practice. And that is a low dopamine person. There is almost 100% guarantee you're going to help someone if you can catch a level like that that's that low. You're really going to make a difference in that person's life. And I actually had a patient like this yesterday. She had one of those stacks of a file with like 15 to 20 labs from four to five different integrative doctors over the last seven or eight years. And, you know, I'm always still thinking like, guys, this is really going to help. And we did. We did this test. She had a super low homovanillate. No one had ever messed with her dopamine before. Dad had Parkinson's. She's been depressed and anxious since she was like five years old. It's a lifetime of suffering. And I'm pretty convinced she'll get better, you know, in the next couple months. Lying would be that hard. So it's super important to have this in your toolbox because you'll get a lot of patients where this is their main problem.
You know, oh, and by the way, when we do the live Q&A calls, I actually didn't do this on purpose, but this is, um, this is from class in the last month or so. So the doctor submits their case. This is what we do in the, in the live calls in the training program. Doctor submits their case, you know, the top complaints, and then they send in the labs. And then we go over the labs together as a group. That's what the class is about, the live calls.
So here's a really good one, right? We've got panel, man, delay problems, homovanillate problems, hydroxyindoleacetate, and quinolinate. This is like an example of everything that could go wrong with your brain going wrong at the same time. So we should be able to dissect this pretty well now. So let's look at it. This will be our last case, and we'll wrap up. Okay, let's see here. Oh, wow. Look at that. Homovanillate, 11.1. You know, that's so low, they had trouble getting the dot on the thing there, right? That's extraordinarily low. So that's low dopamine. Hydroxyindoleacetate is high, and quinolinate is high. Remember that. That's this person burning through serotonin, stressed and inflamed. Two reasons why their serotonin is just going down the toilet, right? They're just burning up serotonin through stress and inflammation and completely have already depleted their dopamine. If you look at that protocol that I set up earlier, you could run both of those protocols with this person. Like, literally, you could run the dopamine program and a serotonin program simultaneously, and they would probably think that you were some kind of saint that had come on this planet just to save them. Okay, so you can't go wrong. Two markers for serotonin, an outrageously low dopamine level. It's a really straightforward process to go through. And as I showed you guys earlier, the protocols are not even that complicated. Just learn how to use. And we write these down again. Learn how to use tryptophan and 5-HTP. Let me write all this out. 5-HTP, the tyrosine that we talked about, and the Mucuna. And then either stress about it or just give everybody B6. But just make sure the B6 is in the picture. Some of these companies will actually cram the B6 in with the 5-HTP or whatever, so you don't have to worry about it. And how much B6? At least 100 milligrams a day if they're really messed up. Okay, at least 100 milligrams a day. If you got a big problem with B6, I would say maybe a minimum of 50, but 50 to 100. And remember, you can get these dosages. We went through the dosages already. Let's see, let me make clean this up a little bit so it's easier to see. These are the ingredients that you need to learn how to mess with. It's really even not that many things, right? Tryptophan, tyrosine, 5-HTP, Mucuna. And then everyone needs B6. In different combinations of these, you'll just have stellar, stellar results.
So I'm going to wrap it up for tonight. If you need to take off, please do. I understand. I'm going to go stay for an extra few minutes and go through questions. If you can hang out, great. Otherwise, go hang out with your kids. If you want, like a personal recommendation, I strongly recommend, and I know I'm late to the party here because it's the second season already, but best TV show I've watched in a long time, Stranger Things. Have you seen this yet? So good. Netflix. So, you know, if you need to go rest, go your Netflix, check out Stranger Things. If you've already seen the first season, then, you know, I'm a little behind. Sorry, I might get your behind on that one. My office manager is making fun of me. She's like, you just heard about that.
All right, so let's go through some questions here. Oh, Patrick, love the question on the brain inflammation markers that show up as DL. Is that a good thing? Haha. Oh, man. All right, Patrick, thank you for asking that. So can I, man, we're going to go late now because that was a really provocative question. So what Patrick is asking is a profound question. He's saying, okay, these markers are low, is that a good thing? No, no, no, no, no, no, no. Each one of these 46 markers on this test means something different when it's low than when it's high. Many of these markers when they're low means something extra bad is happening. As an example for what Patrick just asked, quinolinate is low, kynurenine is high. Let's go back. I swear I didn't set up that question. Patrick just asked that randomly. But he's sort of, this is something I'm very, very concerned about nowadays. I'm going to show you guys all this stuff real quick. This is, we're totally off topic now, but, um, I'm going to show you one example here. Okay, so remember now, we have a hangout. Second, the sarong diagram. Here we go. So remember now, we had this, we just looked at this lab, and we had a high kynurenine and a low quinolinate. So look at what kynurenine. One of the things that kynurenine does, complicated, but it's an NMDA receptor antagonist. Antagonist being the operative word. Let's quinolinate, a brain NMDA receptor agonist. Meaning that when kynurenine goes up, quinolinate is supposed to go up to balance things out. That was that diagram I showed you guys earlier, and it really explained it in this context. But this guy here, so if kynurenine goes up and quinolinate is low, that is extra big disaster zone. Okay, that means that the ratio of those two is off, and that's an extra big problem. Now, just to provoke your thinking in even more, I want to show you some mind-blowing stuff here for one second, real quick, because Patrick's set in motion this whole thing I've been obsessed with. All right, this is going to blow your minds. Ready for this? So you, I hope you're all sitting down. Sit down. Take a deep breath. Ready? What about oxidative damage? Is it better? Well, we know oxidative stress markers being high is bad. Cancer, diabetes, heart disease, bad. Can oxidative stress markers be too low? And what does it mean if they're too low? Absolutely. You need a certain amount of oxidative stress just to function, right? Excessively low oxidative load is a problem, which in some ways may be as significant in some weird ways as having a high level. And this is going to, this is going to go on for like the next hour. Know that Patrick asked that question. What about, what about these markers? What about this whole page right here? Okay, we know the high markers are bad. What does it mean when there's a pattern of low markers that's extra bad? So for many of the organic acids markers, and this varies from marker to marker, a high level is bad, and a pattern, not an individual marker, but a pattern of low markers is extra bad. And look at this pattern here. Low, low, low, undetected, undetected, low, low, undetected, low, low, undetected, undetected. This person, the predominant pattern here is that they're undetected or low. That can oftentimes, as a pattern, reflect an even bigger problem than if the markers are high. All right, sorry, Patch. It was probably more of an answer than you wanted to get on that one.
But what if someone's on an SSRI? So I think the number one thing is that they don't change their medications. You obviously, they stay on the drugs. We just had somebody yesterday in class, and it was one of the doctors in the training program, and she had this patient that took herself off of Lexapro. That's never a good thing, right? So we don't want to suddenly change the medication. But we can support neurotransmitter function while the person's taking an SSRI. And once their brain is in great shape, six months or a year or two goes by, then they can taper off the medication. Okay? And you can absolutely do these programs with people who are on the medications.
Can a nutritionist join the program? Is it only for medical practitioners? Yeah, we take nutritionists. Kind of like, you should talk to me first and make sure that it's appropriate for you. So I guess nutritionists can take the class as long as we have a conversation, you and I directly. That's for Karen. And some of the best practitioners that we work with are nutritionists. But I just always want to make sure that, you know, you're in a good position, they have a doctor you can work with and whatnot. Okay.
What have you seen too often work with restless leg syndrome? Absolutely. These dopamine-related products, programs, very effective. Maggie said B6 or P5P? I use the B, P5P for those of you that don't know that's Pyridoxal 5-Phosphate. That's the coenzyme. And P5P is kind of like the fancy form. It's a little better absorbed. So you guys have got a lot of questions. Hang on. Let me just keep going here. Sorry, you see there's some earlier questions that I missed. So let me see if I can get to some of these. At least I think we're going to run out of time before I go. Mom, but, um, nausea. Yeah, you can get nausea with these programs if you're really off on the dosing. Okay.
Should tyrosine be in the form of N-acetyl tyrosine? I just use straight tyrosine. I don't know. I'm not against the N-acetyl tyrosine. I know it has some advantages. You need adequate zinc, magnesium, and B2 to make B6. Yeah, absolutely. That's why I put everybody on a multi. Right? A multi is just kind of takes care of all that kind of cofactor stuff. So if someone gets nauseated and shaky when they're on 5-HTP, half of those people are well, well, many of those people were resolved if you put a little tyrosine in the program. Okay, many of them, not all of them.
Let's see here. Let's see. I've got a few more questions I can get through. So see, there's a couple questions. He forgot him. Is an audio problem? Now, I don't think so. So maybe someone's sound cut out. Do you prefer that, you know of a test over Great Plains? I'm a real Genova fan primarily because my teacher is Richard Lord, who's the man that developed the Genova test. So I have a very strong bias toward Genova. But it's entirely because of Richard. And he's the man that set up and built these machines, you know, 30, 35 years ago. And he's my main teacher. So I'm just 100% on the Genova side. Yeah, we'll have this recorded. You can listen to it over and over if you want. And I get my Mucuna from Designs for Health. The product is called Dopa-Boost. Designs for Health or Dopa-Boost product. Can you combine tryptophan with 5-HTP? I never do, but I don't think there's a problem doing that. Um, what if someone's taking a dopamine drug? That one I'd have to check with the pharmacist about. I've never been in that situation before. I'm not sure. P5P again, like B, 50 milligrams range as a minimum. And I think I got through most of the questions. Gonna wrap it up now. We're a little bit over time. Super glad you guys attended. We're going to be doing a free webinar like this once a month. I told my staff today until I retire, which is going to be a long time from now. So if you guys are interested in this stuff, join us next month. If you're interested in a mentorship program, give us a call or send us an email, and we'll tell you about the class that's starting next week. And have a great rest of your November. And I hope all you come back and join us next month in December. We'll have another talk before the year's out. Okay, have a good evening, everyone.