Transcription
So I'm Dr. Dan Kish. I am excited about our new year. We have our, we, my team has completely rebuilt the Kish Institute mentorship program. It is now a one-year program, starting, uh, next week. January 27th is our first new class. If you guys are interested in it, it's better than ever. Um, I spent the last year, year and a half, completely rebuilding the curriculum. Added organic acids testing to the already existing adrenal and GI and female hormone protocols. We've got research studies coming out. We've got all kinds of things happening. And it's a, I, if I wish you guys could just join the class because it's just a, a great group of human beings. We have medical doctors, chiropractors, acupuncturists, physical therapists. We have, um, naturopaths all mixing it up in class, also supporting each other and learning how to build their functional medicine practices. We had in this morning's class, one of our, uh, students, Justin, gave an amazing presentation about practice building and private labeling supplements, how we doubled a supplement income this year. And I was taking notes. Every student in the class was taking notes because it's a community that we're building here. You know, it's not just me, you know, dictating and talking like we do on the easy evenings. When you're in my classes, you're in a group of a couple hundred doctors and in a small pod of 10 or 15 doctors who are all sharing information and really helping build each other's practices. And it's a powerful thing to have a community behind you when you can ask the community a question like, "What's the best EMR system?" and you get six really great responses and you can dialogue with people about it. You can ask a community, you know, "What do I do with a patient who's breastfeeding? Can I give this supplement?" and you have three OBGYNs that answer that question. You know, it's, um, it's just wonderful. Um, I'm just honored to be a part of the community. I guess I started the community, you know, but it's, um, come to a point where it's about a lot more than me. So anyways, classes are great. The Institute is rolling. I'll talk about that more a little bit later. We're starting a new training program, year-long course. We also have, uh, created a practice management module as part of the class. So we talk now as much about business as we do about clinical. And we have some really excellent business coaches that are, um, in the group. Okay, so can't say enough good things about what we're doing here. I'm pretty excited about what we've created.
Now, what we're going to do tonight is look at organic acids testing. And, you know, I think this test has been left over somehow in the dustbin of functional medicine. So, you know, people use organic acids testing with their chronically ill patients and nothing else is working. People use organic acids testing as a fallback option with the super sick patients and they're not sure what else to do. In my practice now, and for the last several years, I run an organic acids test on every single new patient. I don't care if you have toenail fungus, want to get pregnant, you're tired all the time, or you're anxious or depressed. I run organic acids testing on every single new patient. It is now 50 to 60% of my practice oriented around this single test. What I have found in my own studies is that most doctors don't order this test because they order it a few times and then they're not sure what to do because it's complicated. You know, it's really complicated and nothing is as it seems within an organic acids panel. It's complicated and things are hidden from us. So my mission this year, throughout these various free webinars and all the different public talks I'm going to do as I travel and speak, as well, is to sort of unveil the profound nature of this test and what we can do with this lab because it's just sitting there. The technology is available and we should be utilizing it. And like, literally with every patient, not just your chronically ill patients, not just the ones that you can't figure out what to do with, but literally every new patient. You can run this test and get a benefit from it. Um, we just tested my entire staff with an organic acids test and they're all healthy young folks, you know, who were fit and doing well with their lives and still we found issues to work on that can really improve their health. So organic acids testing, can't say enough good stuff about it. I just ran my own test. I'll, I'll show it to you later if we have time if you're curious. I just tested my son, 17-year-old son. Um, so anyways, test, test, test.
So tonight's talk is more about, uh, fatigue related issues. Okay? And we're going to look at, um, complex patients, yes, but also simple patients. Um, we're going to look at fat loss and how that ties into mitochondrial functions. We're going to explore the link between oxidative stress, energy production, and body fat burning. So that means that when you have a lot of oxidative stress, that can destroy your energy production and make you overweight. Is that crazy and wild? Oxidative stress can make you overweight. Toxins, basically, can make you overweight. When we look at those mechanisms, it's all revealed on the test. We're going to talk about how a broken mitochondria equates to a tired, toxic, and overweight patient. I would say the vast majority of our tired, toxic, and overweight patients have some kind of mitochondrial issue or some kind of oxidative stress or fat burning issue. Clearly. And I want to talk about simple supplement recommendations that you can use now that are clinically impactful. Like, I'm actually still in practice. I saw patients all day today. You know, and what a bummer is it to have a patient come back, you ran $1,000 worth of lab work and they're looking at you like, "Yeah, why don't I feel any better?" That is not an acceptable thing to happen in an allopathic practice. People have to feel like they're getting better. We have to get results. It's not enough to just fix things on a lab and make the labs look better and have the patient not feel better, right? We have to move the needle with the patient so that they're understanding that not only are we fixing what we want to in terms of underlying causes, but that we're actually making them a healthier, happier patient. Okay? And I also think a lot about program design and I want to show you a little bit about the things that I do with program design. And then we're going to look at some basics on the mitochondria. And then we're going to look at some case studies. But I, I find it hard to talk about, um, how to kind of move forward with these kind of cases if we don't have a context. So just give me a minute here. Indulge me. And I just want to show you, like, the basic context that I look at this in. So we have three body systems. You can see on the board here. And they are, simply put, neuroendocrine, GI, and detox. And each body system has these component parts. Neuroendocrine, obviously, adrenals, brain, female hormones. Also, what we're talking about tonight, energy production and the mitochondria. The GI system, the detox systems, they all have their, you know, little seg, uh, sort of sub-segments. But whenever we're looking at program design, I'm always thinking about, okay, where does this fit in? What we're talking about tonight is energy, mitochondrial energy, and a little bit also about oxidation. Okay? So those fit within the neuroendocrine and the detox systems. Energy, oxidative stress, those are kind of the key components for tonight. So in the bigger picture, that's what we're looking at.
Now, if we're again thinking about program design and, you know, I think the elegance and beauty of functional medicine really comes about, uh, from how well we can design a program and how well we can communicate the design of that program to a patient. So when we're looking at program design issues, I just want to show you a couple things here because I think of it as there are, um, a couple categories within program design. So there's the underlying cause. What is that underlying cause? There's the physiological damage that is triggered by that underlying cause. There's the body systems that are impacted by all that damage. And then eventually, the patient. They're the symptoms, okay? Are they fat? Are they tired? Are they depressed? Are they anxious? What are those symptoms? But how do those track back and relate to the underlying cause, the physiological damage, and the body systems? And what we're talking about tonight primarily is in the physiological damage category. And by that category, I mean these are body-wide problems. Like, you don't just get inflamed in your liver or your gut. The inflammation affects the whole body. You don't just get catabolic in one area or one cell. Your whole system becomes catabolic. Insulin resistance affects every cell of the body. And oxidative stress, which we're going to talk a lot about tonight, impacts every body system and every cell in the body. Whether it's triggering, it could be triggering a problem like in basically any organ, tissue, system, anything. Right now, what's interesting to me about functional medicine is that, you know, I was first trained in clinical nutrition and then I got trained in functional medicine. And so I was kind of late in my career, maybe year four or five, I started learning about functional medicine and realizing, "Oh, I'm supposed to be finding the underlying cause of all my patients' problems." And lo and behold, I've been treating symptoms all this time. And that was a real shocker to me. And so I spent a good 10 years obsessively treating underlying causes and, you know, in a kind of arrogant way, ignoring patients' symptoms. And then I woke up one morning and I realized, "Wait a minute, I can treat the underlying cause and if I don't make their symptoms better, I feel good about myself, but the patient's not feeling better." And it's not really going to help. Another thing that kind of flipped my switch a couple years into this understanding about functional medicine was I realized that, "Wait a minute, sometimes the underlying cause is not treated first." And this to me is like revolutionary. Sometimes we find the underlying cause, let's say it's a toxin, but we don't treat that first. Why? Because if we try to detox that person aggressively in the beginning, it could make them sicker. Another classic example, what if we find, like I had a patient today, she had Entamoeba histolytica and H. pylori. If I treat those infections first, she's probably going to get a lot worse. And it's doubtful that the infection treatment will even be successful because her immune system is in such bad shape. I have to work on her body systems and strengthen her immune system before I treat the underlying cause of the problem. So just because you find the underlying cause of the problem doesn't mean that that's where you want to start your treatment. And it took me a long time to understand that. I just want to share that with you. The other big understanding that I have now is that, you know, 25 years into this, is that I can get everything I want done. I can treat the underlying cause and treat patient symptoms at the same time in the right balance so that we're getting the work done that we need to as functional medicine doctors and we're getting patients feeling better all together. But that I don't want to obsessively focus on underlying causes to the exclusion of relieving human suffering. I want to do both together.
Now, what we're going to talk a lot about tonight are various reasons why the mitochondrial energy system would be damaged. Oxidative stress, inflammation. It could be anything from GI infections to toxins. It could be over-exercise. Overdoing cardiovascular exercise to damage your M, your mitochondria as fast as anything else. It could be dietary. It could even be potentially emotional stress related, although I don't think that's that common that emotional stress damages mitochondria. Probably more common that people do it with exercise. So we're going to look at the physiological damage that's sustained by the mitochondria. And we're not talking about underlying causes tonight, okay? But it's good to know how to fix these problems because you can relieve a lot of symptoms. Like, I had a new patient today. I put her on a mitochondrial energy program because I know that's going to make her feel better in a couple weeks. And we're going to deal with her chronic GI issues that she picked up in Guatemala in a couple months. When she's feeling better, she's got a young child. It would be inappropriate to make her feel worse with a sudden GI treatment program. So I want to boost her up symptomatically and then we're going to get around to fixing the underlying problem a little bit later, okay? So when it comes to program design, I'm always thinking about these four issues. Where am I? Which one of these issues am I treating? And in what order? You know, to make sense for the patient. Underlying cause, the damage that that causes, the body systems that are impacted, and then the symptoms. And we're mostly going to talk tonight about mitochondria and energy production and how that works. Okay?
Another way to look at the same thing here is we need to understand our patients' perspective. I just read a book by the Amazon founder, Jeff Bezos. And, you know, and they say the joke in real estate is, "What's the three most important things in real estate?" Location, location, location. And his thing is, "What's the most important thing in business?" Customers, customers, customers. So it's our patients' perception of what's happening that matters. If I detox, detox someone, pull the mercury out of their body, and they don't feel any better, then I didn't really do my job. So understanding the pains of the patient, what they're going through, the gains, the things that we want them to gain by doing a program, and then ultimately what their life goals are, that has to play into our whole concept of program design.
Okay, so now let's look at the actual details of what we're talking about tonight. But we have this context, three body systems. We have a context of program design, alleviating symptoms as kind of a theme. So now, and it's, it's a miracle that we can measure all these things. All right? It really is. And this is all in the labs. I get every new patient to do this, okay? And, um, regardless of finances, I'm like, you know, it's three or $400. It's, it's less than a set of, you know, brakes on a normal car. So most people, if their car goes bad and the brakes aren't working, they can afford the $300. This is something people can definitely afford. So mitochondria, the powerhouse of the cell. They consume oxy, this is all from school, you guys remember this, right? They're consuming oxygen, they're doing all this kind of thing. The most important part is that they're making energy. That's what we really care about. The mitochondria are making energy. You remember from school again, this is what they look like. They're kind of cool structures. They have this inner and outer membrane doing all these important things. But the main thing that we're concerned about is the rate at which they're producing ATP, cellular energy. If ATP levels are low, we got tired patients. You bring ATP levels back up, you got a happy, energized patient. And the mitochondria does a lot of other things, but we're kind of oversimplifying it for the sake of tonight.
So now, where, where does, you're wondering, where does oxidation play this? Well, it's interesting that you asked. So oxidation, you all know what oxidation is, right? You cut an apple in half, it starts to turn brown. You don't have enough free radical protection. So free radicals are damaging your tissues. Where one of the most important structures that could be damaged from the oxidative stress that we're all under would be your mitochondria. And I don't know, I mean, I didn't really think of it this way until relatively recently, but this seems a pretty important issue here. We have a healthy mitochondria. Mitochondrion is a single, mitochondria is plural. But anyways, healthy mitochondria over here. We have a damaged mitochondria in a distressed old cell. Not to be ageist here, but healthy mitochondria, young, young cell. Damaged mitochondria, distressed old cell. It's not just that it's old, it's distressed. You don't have to, you know, I'm old, but I'm not distressed. My kind, my mitochondria are beautiful, even though I'm old. So just because your mitochondria are old and you're over 50 like I am, doesn't mean they have to be distressed. I'm going to stick up for, uh, for the age theory here. So over here, you can see free radicals. And the key here is there's not a whole lot of them. Over on this, you can see a lot of free radicals on the left-hand side. Let me pick a different color. I'll pick red. How's that? So it sort of stands out on the left-hand side. In addition to the free radicals, you can see abundant ATP is powering cellular activity. So the more of these little green bubbles you have, the more energy you have. Over here on the distressed cell, the ATP supply has shrunk. So in a good, good situation, we have very few free radicals and lots of ATP. That's what you want. In a bad situation, you have a lot of free radical damage, which decreases the ATP supply.
So the way that I talk about this to patients, I know this is a little silly, but it seems topical, is if you've ever seen Star Wars or Star Trek or any of those shows, you know, in the movies, they always have a scene where there's like the Death Star or there's the Klingon ship or whatever it is. There's like something that has to be destroyed or something that has to be protected. You know? So if you're a Star Trek fan, it could be like the Starship Enterprise. And what does it have around the Enterprise? It has a shield. It's "Shields up!" You know? And what's happening is the shield is there because the Klingons are launching missiles and trying to get at the Starship Enterprise, which is bad. We don't want the Klingons destroying it. So the shields up means that things are okay. Hey, Klingons, you can fire away as much as you want. It's not going to really cause a problem. Antioxidants protect us from free radicals. So your mitochondria sitting there like a spaceship, but there's things coming at it all the time in the form of free radicals. And we have this shield that we put up that is basically our antioxidant protection that prevents these free radicals from getting in. Now, at a certain point in the film, the shields are always down because the photon pump thing broke and Scotty hasn't fixed it yet or whatever. So what's happening is the missiles are getting in and they're hitting the Starship. And that's what's happening. I'm sorry, I actually should draw it on this lower one here. That's what's happening down here. The shields are gone. Now, that free radical protection that antioxidants provide us is gone. And so the mitochondria is now just an absolute target. And it's taking every hit you can imagine from what? From oxidative stress, right? Generating free radicals that are now destroying the mitochondria. And what's happening in that mitochondria? We're making cellular energy. If the mitochondria is oxidized or hit by the little torpedo photon thingies, then it's going to get dysfunctional. It's going to blow up. It's not going to work. And in all the Star Wars movies, you get, you know, you hit the Starship enough times and the whole thing blows up. That's what's happening to our patients. They don't have enough antioxidant protection. The mitochondria are being damaged.
So then the next question you would ask logically, patients always ask me this, is well, well, why would my shields be down? Like, you know, why would that even happen in the first place, Dr. Kish? Okay? And because I live in a very simple world where I like to actually communicate with other human beings and not confuse them, I will say, "Well, it's interesting you ask that, Jane. There's really only a couple of options here." And again, keeping this simple saves you and the patient so much stress. If you're quote unquote shield down, right? If you're getting oxidized and your mitochondria are being damaged, your energy levels are low, you're tired. There's really only two major issues that could be causing that. You could be having inflammation and tissue damage from your gut that's damaging your energy system. You could have toxins, chemicals, and heavy metals that are damaging your energy system. So again, I always tie it back into the three body systems. Why is this happening? Why are my mitochondria broken? Why am I tired? Could be gut-related. And within the gut, it could be either pathogens or foods that are causing inflammation. Inflammation generates free radicals, makes us tired. Or it could be coming from toxins. There's two types in general: chemicals or heavy metals. Again, that would be generating free radicals and destroying your mitochondria. This is a really important step because now, what did we do? We just tied in the energy problem with the GI tract and with detox. So as you progress and you do more functional medicine, now what's the patient going to want to do? Well, they want to get their energy back with a mitochondrial boosting program. But guess what? They're going to want to check their GI and detox systems as well because that's where these free radicals are coming from. So again, a simple integrated system. We're tying things together. Energy is low either because of pathogens or inflammatory foods, or because of toxins. Want to figure all this out. We're talking more about the effect of inflammation and oxidative stress on the energy cycles, but we always also want to understand where it's coming from, okay? So that's my explanation. I'll go through it one more time because that's a little complicated. Number one, healthy cell, shields up, protected, free radicals bounce off, they can't penetrate, they can't damage it. So what happens is we have a lot of ATP, a lot of energy. Damage cell, shields down, free radicals getting in easily, and there's a lot of them. Where are they coming from? They're coming because patients are under oxidative stress, which we measure on this test, by the way. We measure oxidative stress. Where does oxidative stress come from? Either the gut or the liver. If it's the gut, it's from foods or infections. If it's the liver, it's from chemicals or heavy metals. So that's a really simple, accurate explanation. You got a lot of free radicals making you tired. We want to, in the bigger picture, figure out your gut and detox pathway problems. In the shorter run, let's fix your mitochondria. And there's some other notes in here you can look at later, um, if you want, but basically I just covered all this, okay? Um, you know, you can, all kinds of things can cause this, but we're trying to keep it simple.
Now, there's another aspect to this which is really important. And I know this is something that we all have tried to block out. Um, I did. It was called biochemistry class. And I know when I was in biochemistry, I didn't ever think I would need biochemistry. And it wasn't until later that I realized what an important class that was. And, well, I wish I'd paid more attention. But do you remember glycolysis? I'm sorry to bring back all these painful memories. But basically, within glycolysis, we're breaking down glucose. Glycolysis, right? Cutting down glucose. And we're turning it into something called pyruvate. And then we're eventually taking that and making energy within the Krebs cycle. And if you do all the math here and you figure all this out, and this was an exam question that I'm sure we all answered 100 times, you end up with 36 molecules of ATP at the end of the day per molecule of glucose. That's the important number to remember. So in other words, you cram a molecule of glucose through this system, you end up with 36 ATP, which, it turns out, is not a bad number, okay? And that is when, when people are taking a molecule of glucose, converting into 36 ATP, they have great energy. It's 36 to 38 depending on what's happening. But if they're not doing that, then they're going to be really tired. So we're counting on this Krebs cycle working. In a lot of situations, it's not. There's some basic biochemistry we can kind of skip for now. But beta oxidation, oxidative phosphorylation, all that stuff. But there is some important aspects of this I want to talk about that is important to remember, which is that the Krebs cycle has all these intermediary steps. And this is what we're measuring with this test. We're measuring, can the person convert each one of these chemical compounds to the next compound? Do you have the cofactors that are necessary to make all this happen or not? And if you don't, you have a serious problem with energy.
Now, there's another thing, and I don't honestly remember this from biochemistry. I'm sure I had to memorize it. It's called the Cori cycle. The Cori cycle turns out to be incredibly important for all this. I want to try to keep the physiology short so we can get to the fun part, treating patients. But I think it's important to remember this stuff. The Cori cycle occurs when we're stressed. The Krebs cycle occurs during normal physiology. And let's just look to what that really means. The Cori cycle, let's say that the patient's stressed. It could be their mother-in-law's visiting. It could be that they just lost their job. It could be because they have a Candida overgrowth. It could be because they're depressed, you know, they're depressed and anxious. When you're, when you're stressed, the body needs immediate energy. And to get immediate energy, we use the Cori cycle. So in this situation, we take glucose, we do this whole glycolysis thing, we end up with two ATP and two lactate. We then take that lactate, goes to your liver, of all places, where we then reform through gluconeogenesis more glucose. So if you're sitting on a beach and a pack of wild elephants runs at you and you just have to grab your blanket, your sunglasses, your book, and run away, then the Cori cycle is absolutely fine for that short-term fuel. You need to run to your Jeep and drive away from the wild pack of elephants chasing you. So short-term energy produced through the Cori cycle is fine. But in the long term, it's very detrimental because in order to make this energy, we burn up or use six ATP, but we only gain two back. So every time you run the Cori cycle, you're at a net loss of four ATP. So if you're running away on the beach from a bunch of elephants chasing you down, about to stampede you, the fact that you're losing -4 ATP every moment you make a molecule of glucose is okay. But most of our patients are stuck in the Cori cycle. So they're burning up ATP at a negative rate to make energy. In other words, when they walk up the stairs and they complain about being so tired when they walk up the stairs, it's because to get that energy to walk up their stairs, they're losing four ATP. Can you realize that? So the Krebs cycle gives us a plus 36 or 38. When I ate breakfast this morning, I got 36 or 38 units of ATP out of each molecule of glucose. But my patients who are chronically fatigued, who are in the Cori cycle because they're stressed, are getting a net -4 on the ATP. It's no wonder they're complaining about being so tired. So this is why we need to get the mitochondria working because everyone that we're working with is stressed. They're in stress physiology and they're using up, they're going into debt. It's like a negative to make energy. So we have to get the energy production back in order to restore normal function, normal physiology for our chronically ill patients. Again, the Cori cycle shifts the metabolic burden from muscles to the liver. It's not good. You're making energy in the liver now, okay? And that makes us acidic. It causes all kinds of other health problems.
Oh, this is time for an ad. I'm going to talk about the class for a moment. And then I think we're going to look at a bunch of cases. We're going to try to apply this. And I'll show you a bunch of labs, okay? Now, I mentioned this earlier, some of you weren't on the phone yet. So we, I just redesigned with my team, a really large team of people, the Kish mentorship. It is now a one-year training program instead of six months. We added a practice management section to it. And I have an expert business consultant that's leading the practice management section, which is wonderful because she is incredible at business building, practice building, financial management, understanding how to build your practice through planning your business, working the numbers, and all this good stuff. In fact, she last year ripped apart my personal practice and rebuilt it. And it's better than ever. I can say all kinds of things about the numbers there. But basically, we're making fairly large amounts more money now thanks to all the sort of efficiencies that she created. The year-long course includes what we've always had, which is live weekly Q&A calls. So we have small groups of doctors, you know, maybe 15, 17 doctors on a call, going through every one of the cases that they have had that week. So the classes are different than what I teach on these free webinars. The classes are actually doctors submitting labs. We're going over the labs and talking about their patients. And then we also do, in addition to lab interpretation, business building, practice building, all that kind of stuff. Sometimes a doctor might have a question about, "I want to relocate my practice. What's a good location?" And another day it might be, "You know, how do I interpret this organic acids profile?" Um, in the online community, now we have a couple thousand research studies, a couple thousand case studies that have all been videotaped, transcribed. So you have just an endless amount of information on the clinical topics, on discussion groups that we've had within the course. Everything's cataloged and saved within the community. Um, it's a beautiful, beautiful piece of software that we have that runs all this. It's quite complex. Um, and then you get to have connections with all the other people in the class. I'm in the community every day, literally answering questions, making sure that your labs are all interpreted, that you're ready to go the next morning with your patients. We have the weekly calls. We have the regular banter that's going back and forth within the community. And then, of course, you have access to all the other folks as well. So we have a two-semester program now. We start off with the basics, get into adrenals, GI, food, female hormones. Everyone takes a deep breath, come back for semester two where we talk about organic acids, toxins, the brain, which is probably my favorite subject these days. Can do so many things with the brain. Anyways, and then energy metabolism, which is what we're talking about tonight. So it's nine different modules or sections that roll out throughout the year. The community looks something like this. You can poke around and ask questions. People post information. There's basically these couple thousand case studies in here. It's a huge amount of information. So any kind of case that pops up, you type into the search engine and it'll pop up, um, uh, more information than you could read at this point, I think. I don't think anyone could get through 2,000 cases. And they're all real cases of real doctors that were in the class. So this is, you know, you know, one of the things I think that's a limiting factor in functional medicine education is the volume of new cases that you get. And I was talking with another doctor about this earlier today. And he, he warned me about, you know, doing his work. He's like, "Dan, you know, till you do at least 50 of these, it's not going to make sense." And in the live calls that we do now, in the Q&A sessions, in the mentorship, you're going to be exposed to three or 400, maybe more cases, just from the other doctors in your class. And so what that does is it accelerates your learning curve. So if you have maybe 10, 20, 30, 50 new patients a year that you're testing, my practice, I have a couple hundred a year. Most people don't have that many. But they say you have 50 new patients, 100 new patients a year, you're running all these labs on it. It would take you five years to get 500 cases under your belt, right? That could all happen in a really short period of time in a training program. So you can learn from other doctors. It's a really wonderful experience. Um, we are starting a new class January 27th. It's this whole upgraded thing. So it includes the mentorship that I've always done, plus the advanced work on on all the functional medicine, uh, organic acids testing, etc., the brain. Basically, we about double the course content. And then we also added in a whole practice management section. Okay? And that's why it's a lot more expensive than you guys are used to, because it's a year-long class. There's about double the clinical content. And, uh, there's a practice management course, which is very robust in there as well, okay? And some people just want the practice management course. That's a, you know, typically around a $5,000 thing of itself that we're just including in the basic tuition for this next year. We're going to do that. So that's it on that. Sign up if you want. And if you want to just talk to me about the class, um, give me a call. You can set up times. You can talk to, uh, Leslie at the Kish Institute dot com, see if it's the right program for you. And we don't, uh, you know, I would say we carefully screen people to make sure that it's a good fit because we only want people in the community who are going to be excited and have fun and learn a lot. And so that's part of my job is just to screen people and make sure that it's going to be the right experience for you at the right time. I'll try to give you my honest opinion on that.
All right, so now let's look back at organic acids testing. Now, here's the actual format of what we're about to look at. We're going to look at a test that's going to show us about fat burning, carb burning, and this one here, hydroxybutyrate, that has to do with protein. We're going to look at each one of these steps here, citrate, alpha-ketoglutarate, see all these steps going around here, fumarate, etc. And then ultimately, we're going to look at, is that person able to make enough ATP? So the way that I explain this to patients is just like a chain. Imagine you're going to lock your bike up and you had a chain, not like a U-lock, but like a chain. And if one of the links in that chain was broken and you locked your bike, that would be kind of dumb because everybody knows that a chain doesn't work if one of the links is broken. So when we're looking at the citric acid cycle, if you have, for example, a really big problem here with alpha-ketoglutarate, that link in the chain is broken. The Krebs cycle is not going to work properly. If you have, like I had earlier today, and this, I'm not even making this up, this is true, I just had this patient this afternoon, she had 11 breaks in her Krebs cycle. 11, count them. She had one there, she had three here, and she had another eight down here. She had 11 reasons why her Krebs cycle wasn't working. 11. There's only 14 things that they check. So imagine her trying to make cellular energy with 11 of the 14 steps broken. It's just not going to happen. This is why people get really tired. Why would this happen? Why do these links get broken? Remember, free radicals are getting in because of oxidative stress and damaging the energy production. Free radicals make us tired. Antioxidants protect the mitochondria. Why would you have a lot of free radicals? Either it's because of gut problems or toxins. In the gut, we see infections and foods. In the terms of toxins, we're talking about chemicals and heavy metals. What that means is that the wrong food or gut infections, heavy medical, heavy metals, heavy medical, heavy metals and chemicals damage the citric acid cycle and people get tired. And we can see that on this test. And the test tells you how to fix it. That's the even better part.
Okay, so now let's look at this. Everything that we've just been talking about. Here's the 14 steps, the 14 links in the chain. We want to make sure each one of these is intact. And if one is not intact, you want to jump on it and fix it until everything's working properly. So now take a look at this and you can see how the lab categorizes these things. And, you know, they, you know, you got to appreciate the people who put this together, Dr. Lord and Dr. Bralley. I mean, talk about geniuses that they came up with this. They turned it into a clinical tool. I mean, I think it's just, you know, upon us to to utilize these things because it's so potent and so powerful a technique here. So I want to show you a few things here, but let's start simple. Now, this particular patient, these are all real patients of mine, by the way. My staff pulled these for us. Now, this patient has one marker that's positive, pyruvate, which is under carbohydrate metabolism. And remember, we talked about pyruvate a little while ago. So why is pyruvate so important? And why would we even care about pyruvate? Well, let's go back up to this diagram here and you can see where pyruvate sits in all these pathways, sitting right here. So if pyruvate is elevating, it means you are not successfully getting glucose down to acetyl-CoA where you can burn it up for energy. So can you see how that would work? If pyruvate is going up, it means you are not converting glucose into acetyl-CoA. And that is a major problem for someone. They're not able to utilize carbohydrate fully as a fuel source. And what do we call that when it gets bad? It would be insulin resistance, syndrome X, metabolic syndrome, lots of different names for it. So in this particular patient, your solution to getting their energy levels back is to pounce on and improve their ability to take pyruvate and burn it up for energy. Now, that comes down to, and I even tell you here right on the little form thing, lipoic acid, B vitamins. What's not on here that's also necessary? Obviously would be chromium, maybe taurine, maybe biotin. So this person needs not only dietary coaching about how to eat and make sure they're balancing out all their meals and they're not going low, low, low blood sugar, but they need a heavy-duty supplement program to stabilize their pyruvate to knock that number down so they can start to pull energy from carbohydrate into the citric acid cycle. And I use, you know, in terms of specific products, um, I have, there's, there's so many good ones. But the two that I think are the standout best for this, 'cause they involve so few pills, um, Designs for Health has, uh, and there's, there's a dozen of these I can think of off the top of my head. I'm just giving you a couple because people always want to know specific products. These are the ones that I actually use in my clinic. And I should say a note about things that I use in my clinic. So I use things in my clinic, um, for a lot of different reasons. You know, there are certain companies that I prefer personally, that I just like the people there and I know that the quality is really good. And it's nice that you can pick up the phone and call the owner of the company if you have a problem, you know, and they're, um, you know, that they're inspecting things carefully, you know, the quality is as good as it could be. So there's a couple companies in that category that, and you guys maybe have your favorites as well. You don't have to use these guys, but, um, I like Designs for Health a lot. So Designs for Health has a product called Lipoic Acid Synergy, which works perfectly, perfectly for this purpose. Perfect Lipoic Acid Synergy. And if you don't like them for some reason, there's Diaxinol from Ortho-Molecular. What's unique about each one of those products is you only have to do two pills a day. So boom, boom, done. One pill twice a day of Lipoic Acid. One pill twice a day of Diaxinol. And you got a basic blood sugar program off and running. Now, the efficiency and beauty of only needing two capsules to get something really important done, to me, is exciting. Why? Because I know this person is going to be on another half a dozen different things. And if I can knock out this one super important issue with a single product and some diet changes, then I'm feeling like really good about myself. Because if you use a product that involves six pills, three times a day, just to fix this pyruvate problem, it's going to be limiting in terms of what you can do to correct other issues. So to me, program design elegance is the fewest products to push that person as hard as you can in just the right direction. That to me is is like perfection in a supplement protocol. Whereas if you had asked me perfection 20 years ago, I would have said, uh, the product that works the best without any regard to the number of pills or the feasibility of the patient actually executing the program. So in other words, my first five or 10 years were just wrapped up in myself because my top three things were not customer, customer, customer. My top three things were Dr. Dan, Dr. Dan, Dr. Dan. I was thinking about myself, my training, and what I thought they should do. And never, never occurred to me that I had to communicate with this other human being and make sure that everything that I was doing was going to work for them. And when you do communicate with other human beings a lot, you'll find that they don't want to take a ton of pills. And if I can give them one pill twice a day, like those two products I just showed you, to knock out one of their major problems, that leaves me room to do five or six other things. And if I was using a more complicated protocol, it would fall apart. That's just been my basic experience. People get frustrated with to take all these things. Okay, so that's number one. Let's take a look at the next test.
All right, now we have two markers positive, citrate and succinate. And let me show you how the lab represents these and then show you how I think about them. Maybe that'll help a little bit. So the lab reports display this information as sort of a micronutrient replacement test. Here's, here's an example right here. So they'll give you, you know, this is the actual real lab report. So they'll give you these energy production markers, citrate, succinate, or off. Patient needs Arginine and CoQ10. And for years and years and years, for almost 20 years, I would dutifully give this patient Arginine and CoQ10 for six months or longer and then have them retest and see if the numbers look better. What I have now come to realize is that despite my great efforts and wonderful intentions, that never really worked. And I, I tried many times to make this a micronutrient test. What I understand now when I see these markers, what's the first thing that I think about? Well, I think, okay, well, their mitochondria is messed up. That's a problem. And then I think, well, why? Why is it messed up? Isn't that what we're supposed to be thinking is functional medicine? What's the cause? Okay, well, I'm thinking, okay, well, it's, it's not because they don't have enough Arginine and CoQ10. That's for sure. The mitochondria is messed up. Why? Well, remember Death Star, Star Trek, Star Wars, the mitochondria is messed up because it's getting damaged. And what damages the mitochondria? Oxidative stress. Oxidative stress from what? From gut problems or toxins. Okay, so then the next thing I would look at is, wait a minute here, the detox indicators. Oh my God, that doesn't look very good. This person is incredibly toxic. They have chemicals or heavy metals or both that have overwhelmed their detox systems completely, meaning that they have a lot of oxidative stress from the toxins. Okay, now I understand why their energy production markers are off. All right, so now what do I think? Um, I still going to treat energy production markers, of course, because we want this person to feel better. But now I'm doing it in a context. Remember, I'm always thinking in a context. Program design context, program design context. I'm telling you this is how Dr. Timmons drilled it into me, you know, I, when I was first learning functional medicine, uh, I picked up the phone one night, it was like 7 at night at the end of a long.
Day of patience. Call tech support at this lab, and this guy picked up the phone. I was like, "Wow, this is kind of weird. Why is he picking up the phone? It's like 7 at night." I was going to leave a message, and, um, it was Dr. Timmons, Dr. Bill Timmons. And, and we talked from 7 at night until like 11, 11:30 at night. I had so many questions for this guy.
I later moved into the basement of his house. I spent a long time training with him, and one of the things he just instilled in me, always, always, always. I would bring him a lab, like I just showed you, and I would say, "Oh, these energy productions, markers are off, Tim. Look, this is so messed up. I want to give him Arginine and CoQ10." And he would, you know, in a paternalistic but kind way, because he kind of treated me like I was his son, you know, um, he would go, "Oh, well, why?" You know, he would force me to figure out what was going on. And that's what I want to kind of instill in all of us is an understanding of, "Well, why?" Okay? Because if we know why something's wrong, we can treat it. Now, and what are we treating? We're treating the symptoms of the oxidative stress or the symptoms of the toxin buildup by getting the energy production back. But we're not going to forget that this person needs to detoxify desperately, and that's the real problem.
Now, if we go back to, I'm a man of many PowerPoint slides, sorry about that guys, but it's hard for me to think unless I have a PowerPoint in front of me. Now, if we go back to this model here, and this is what I started off talking about earlier on, where we see that this person has mitochondrial energy problems. Okay, yeah, we can buy that. Neuroendocrine problem, you know, mitochondrial energy, that's a problem. They're tired, they're fatigued. We're going to treat that mitochondrial energy now with these protocols, but we realize that the deeper problem are the toxins that are creating the damage to the mitochondria. This is why the person is tired. We're going to treat the symptoms now, but we're no, we're not going to forget the underlying cause is going to have to be reckoned at some point. We're going to treat the underlying cause immediately? Maybe, maybe not. That's a decision you can make. So again, energy production markers are high. Giving a bottle of Arginine or CoQ10 to this person is not really going to help in the bigger picture in an isolated way. And if you've had frustrations with Organic Acids testing in the past, this is why.
So now we know, okay, big picture, this person needs to detox. We, we're going to deal with that. Short term though, what are we going to do to get the energy production levels back? What can we do to make this person no longer be tired, so that they come back in a couple weeks and say, "Dr. Kish, I don't know what's in that stuff you gave me, but my energy levels are back to okay." And then guess what that does? Then that allows me, that gives me the time that I need to put together their detox program and to flush all these toxins out and to solve it at that level. Okay? And so this is a multifaceted kind of thing here we're talking about now.
I'm going to show you one more thing here because you're there. We're, we're heading in a direction now. Remember, in the gist of this is that an individual micronutrient is not going to really help. What helps is if we get the whole mitochondria going. Each one of the companies that we work with now, each one of the companies that we work with now, or did I lose my? Sorry, I did. I think my phone might cut out for a second. I, hopefully I came back. Can someone raise their hand if they can hear me? Oh, thank you. Okay, good. I think my phone, I don't know what happened there. Anyways, my computer gave me a funny noise. Um, rather than doing this as a micronutrient replacement test, we want to repair the whole system. Okay? Okay. So every company has one of these products. You don't have to use Designs for Health. Has this product. Everybody has a mitochondrial energy product. Just make sure it's got all the basics in it, but it should, because someone smarter than us figured this out. So what does that mean? It means that this product has each one of the co-factors that's needed to make this whole system work. And what are they? Well, they're right here. Magnesium, carnitine, folic acid, some anti-inflammatory support, curcumin, all important. CoQ10, of course, is in here. Alpha-lipoic acid. It's everything, including the B vitamins, right? B12. It's everything that the mitochondria need to make energy. So now, all we need to do as clinicians is figure out how many of these am I going to give the person? You're going to give them four once a day. That's typical starting dose. My clinic, I have some patients on as many as four twice a day of these. That's a large dose, but some people have that much problem, you know, that many problems going on with their Krebs cycle. So again, rather than breaking out as a micronutrient individual test where we're just giving some CoQ10, we're giving the CoQ10 in a context with all the co-factors that the body needs to make energy. And this actually works incredibly well, and people feel it, and you'll notice differences clinically.
Let's look at a couple other examples. Here's another test. Now, this person has alpha-glutarate elevated, fumerate elevated, hydroxymethylglutarate elevated. Three of the markers are positive on this person. Now, in the old days, I would have gone back and I would have ordered separate products for each one of these different patients. And not only is this expensive because you end up having to order a lot of things, and then people don't necessarily always buy them all, and you end up with shelves and shelves of Arginine and CoQ10 lying around, but it also doesn't work very well, very well on a clinical standpoint. So now, the more markers that you see positive, the more aggressive you want to be in your dosing schedule with this product, and the more you want to investigate why this person's mitochondria is damaged in the first place. Now, you can look at each one of these cases, and you'll see, wow, this is a person now who has even more problems. This is someone who's even more fatigued. They have one, two, three, four, five, six more markers positive there. They have the pyruvate marker as well. So this system is completely shut down. They're going to need a bigger detective hunt to find the sources of the energy production problem again, either in the gut or with toxins. Could be emotional stress, but probably not. And you're going to want to give them a higher dose of the supplement that I just mentioned, or something similar to it.
Here's another example. This is exactly the one that I had today, actually. It's not, yeah, this is almost exactly the a patient. It's not the exact lab, but this is almost exactly what I just had today a few hours ago. Two markers positive here. So she's not burning fat for fuel. And this woman was a, used to be a marathon runner. Now she's 43 years old, she has a three-year-old kid, tired all the time. She's an attorney. Lactate, hydroxybutyrate also off, and the whole entire Krebs cycle shut down. So now I'm going to go back a few slides and see what does this mean. Fat burning, carb burning, and energy production have all been impacted. And this is our worst-case scenario. Now, what do we need to do for this person? Let's look at it from a perspective of this slide here. She needs carnitine. Now, there is some carnitine in the mitochondrial energy, but for someone this deficient, I would give them extra carnitine. She needs support for burning glucose or burning her, her, um, sugar, and she needs support here. So now, this person, rather than just giving that single product, I would give all three things. Now, remember I said earlier that it's kind of nice to use products that don't have tons of pills. This is why, because she also needs carnitine separately, and probably a fair amount of it. Let's say 2,000 milligrams twice a day, maybe. And then that mitochondrial energy also. Okay? So you can see the supplements are kind of racking up here. And the most that you want to dose that one on is four twice a day. So somewhere between two and four. Some people are really sensitive and don't need as much of that one. So for that particular patient, this last one, we've got blood sugar support here with alpha-lipoic acid. We've got carnitine to get that fat burning metabolism going so she can get back out and start running marathons again, get into her fat stores for energy. And we've got the mitochondrial energy to crank up that Krebs cycle. Okay? This deals with the pyruvate and hydroxybutyrate markers. This deals with the ethylmalonate marker and the carnitine marker. And this deals with the Krebs cycle. So let me cut back over to the test again. You can see here what we're correcting specifically is carnitine so she can burn fat. Blood sugar support so she can handle her pyruvate and hydroxybutyrate properly. And then things to spin the citric acid cycle. So three products, one for this, one for that, one for that. All three products. And if you want to look at it from the lab perspective, real quick, I'll just flash this up there. So hopefully you can start to tie these things together. And I'll tell you, I'm, this test gets more and more interesting and exciting the more I use it because I'm really starting to understand it now. So again, now we've got three supplements. Only one is addressing these markers here to get her to burn fat. Now, of course, someone who's overweight, that's going to help them lose weight, obviously. I know most people that are overweight are tired too. This, the right here, like carb metabolism. We've got that one product to get her carbohydrate metabolism working. And we've got that mitochondrial energy product to get this. So out of all these markers that are positive, rather than going through a crazy town kind of program where you're looking at a gazillion different supplements, and everyone's just a little overwhelmed with too much stuff, you're giving a really targeted three products.
Let me just show you a couple other examples here. We got another minute, and then we're going to wrap up. Okay, sure, everyone has somewhere to go. Yeah, let's look at this. So just to kind of expand the horizon a little bit, because we didn't have time to talk about all these things. But here's again an example that I mentioned earlier. It's a different patient. They have two energy production markers that are positive, and we're wondering, why is that happening? Is there a reason for that? And we will, could be the gut, could be the liver. Okay? So we cut over to the liver portion of the test, and lo and behold, we see that this person is highly toxic. We see three liver markers, no, four, four liver markers are out of balance. That's what's messing up her mitochondria. When we look down at her gut markers, which this test also includes, they're all clear. So this example, we have toxin-induced mitochondrial damage.
Let me show you one more, but we're out of time. I'm going fast, but I don't want to keep you guys late. Oh my gosh, this is a great one. Look at that. Oh, man. Look how messed up that person is. Okay, I get excited by this stuff. I'm sorry. It's like a kid in a candy store. Okay, look at that. How, I mean, you couldn't miss that. You couldn't miss that if you wanted to. Energy production markers, citrate, succinate, fumerate, malate, hydroxy. This is a total blood bath, right? The mitochondria are just like completely shut down. And you're thinking, okay, why is that happening? Is that gut-related or liver-related? Maybe it's emotional stress. And then you look at the rest of the lab, and what, and we're not going to be able to talk about all this tonight, obviously, but they're toxic, and they have a gut problem, both. So they have two reasons why the mitochondria are messed up, which we're going to fix. This is the basic concept. You don't have to fix the underlying causes in the beginning, as long as you keep that in mind. Now you have some tricks you can use to treat symptoms for people who are tired, can't lose weight because their mitochondria aren't working properly. We always want to come back and eventually get around to treating the GI and the toxins. You can put that on hold for a few months while you use your carnitine, your, um, mitochondrial energy, while you use your, um, alpha-lipoic acid supreme or your DHEA, while you get the blood sugar stable, get the fat burning working, get the energy production levels up. Okay? So that is really the key to making all this work. And for your overweight, tired patients, it's like just lighting a match under their butt, and they're just like off and running out of your office because they got their energy back. It's a wonderful, wonderful thing. And a lot of the things that I do in my practice take a long time to affect people, and you got to wait. You do a heavy metal program, you might have to wait for two or three years, five or six years sometimes. A heavy metal program, you're waiting years for someone to get better. It's nice to have things that you can do that just make people feel better in the short term.
All right, so let me, uh, wrap up for tonight. There's a couple questions that came in. Let me try to answer them if I can here. And by the way, this is recorded, obviously, and we'll send out copies of it if you want to see the recording or listen to the recording. That is fine. Um, John asked a question here. Oh, uh, Casia asked a question. It's alpha-lipoic acid. Yes, it's alpha-lipoic acid. Uh, John asked a question, how quickly does a person go into the Cori cycle? Uh, it's an immediate source of energy production, but the problem is when it becomes, you know, used for long-term, you know, done for long-term use. Um, if you have really stable blood sugar and you're pretty healthy, you could skip a meal and do intermittent fasting and not have a problem. But, you know, most of the patients that we're working with are pretty sick.
All right, I think we got most of the questions answered. All right, guys, I hope that inspires you to order some tests. I hope you also get interested in signing up for our classes. We have some great offerings coming up this year. Pretty excited about all that, as you can tell. And I look forward to catching up with you next month. We'll be doing another one of these in a month. And let me end on an up note here. We go. There's our class sign-up if you're interested. It just keeps getting better. And we have a great community to offer you guys. If you like this stuff, you'll want to check it out. All right, have a good evening, everyone. Take care now.