Connecting the Dots—When Organic Acid Test Results Warrant GI MAP® Testing

Hello everybody, and welcome! I am Dr. Dan Kish. I'm super excited to be here to talk to you about connecting the dots between my two favorite tests: organic acids and the GI map. What could be better than this? And my effort in educational endeavors to teach the integration of multiple labs.

I strongly believe that every new patient should have a basic functional medicine workup that includes organic acids testing and the GI map. It's what my teacher did. It's what I've done for 31 years. It's what I teach to all the students, mentorship students at the Kish Institute. So, we're on the third generation now of doing this. It works. Why not just follow the masters that came before us and, uh, make it work for yourself as well?

So, I'm going to talk a little bit about myself and my background for those of you that are brand new. I'm going to talk a little bit about Diagnostic Solutions Lab, who is partnering with us to present this free webinar. Let's start with the lab. So, what can you say about Diagnostic Solutions? I've known these people for over 30 years. They're on, we're all on the third generation of this. When I was at a conference a couple of years ago, I walked into a dinner, uh, of a board that I'm on, and I saw David Brady in one chair, and I saw Jonathan Lazat in another chair. I saw Tony Hoffman. And these are the people that, you know, were primarily behind, um, the supplement industry rising in our, uh, functional medicine space and the lab industry. And David Brady and Tony Hoffman paired together a bunch of years ago to create Diagnostic, Diagnostic Solutions Lab. But they've both been involved in laboratory testing at the highest levels of science and functional medicine for their entire lives. And so, I've known these people since I was a very young person. I trust them as I would trust a family member to get things right, to do things right. They have Betsy on the science side, they have Andrea on the marketing side, they have Jeff. I've known all of these people for decades, and it's a really amazing group of human beings that are trying their very best to get us accurate lab data. So, you can't say enough good things about Diagnostic Solutions, and we bet our careers on them, and they live up to everything that you could imagine.

So, I just want to let you know that the background here. And then in terms of the Kish Institute, and what the heck, who am I, and why am I even standing here talking to you guys? Well, I started functional medicine in the early 1990s, um, practicing it. And then I started teaching around 20 years ago. I've trained over 7,000 practitioners now through the Kish Institute. I've worked with the Mayo Clinic during research. I've worked with Dr. Richard Lord, who is the chief scientist that that developed organic acids, uh, over 50 years ago, in terms of using organic acids testing for integrative medicine. He didn't, you know, invent the field. Organic acids was already around. It was used for identifying genetic disorders in newborn babies, but he took that science and applied it to human nutrition for the first time. So, he created organic acids testing as we use it in integrative medicine. And I've worked with Richard. I just talked to him the other day. I've worked with him for like 14 years now, and he has loaded my brain over the last 14 years with everything that he ever learned about organic acid testing, which is everything that is known about organic acids testing. And he did that so that I would pass that information on to people like you. And so that's why I'm here because of the, again, the masters like Richard Lord and, and all these folks who really developed this industry. And now we're looking forward to having new practitioners coming into this industry so you all can take the charge and get this work out there to a world, world population that needs it desperately, desperately, desperately.

So, we have a bunch of free things set up for you if you're interested in that. We have a free masterclass specifically on the organic acids profile from Diagnostic Solutions Lab. You scan that QR code, you enter O24, and you'll get access to the free webinar, which is much more in-depth than we're going to be able to cover today. So, hopefully, some of you will take advantage of that. And we will be emailing out this information if you don't have your phone available to scan that. Not a problem. You're going to get an email with the same information.

And then what's even better is that all of you should rush out, like right now, go grab your cell phone, scan that QR code, and get this 45% off. That's a crazy discount for, um, the interpreting organic acids profile class. And now, this is not a free thing. You have to pay for this, but this is when we really get into creating your high level of expertise at interpreting this work and applying these tests to your busy patient practice. So, that's starting in December. We don't do these very often. If you really want to master how this test works and apply it to all your new patients, then sign up, and you get like, it's almost half off. It's like a ridiculous, I don't know why we're doing that. It's like a holiday. We're being extra nice to you, kind of thing. So, if you've ever thought about taking a class from us, sign up for this one because it's a good deal, and you'll learn everything that you need to know in this course. And in this course, we actually do interpret labs. So, you will have a chance during this class to submit your own lab testing from yourself and your patients, and we will analyze it in class and apply all these models that I'm trying to teach. So, again, a whole bunch of you sign up for this. We want to fill that class up and get you guys up to speed on how to do this work.

So, um, I'm going to talk for a little while over these slides. I'm going to try to keep it short. Then we're going to pause. I'm going to get a glass of water, and then we're going to get into interpreting labs, and we're going to look at a series of labs, and I'm going to try to show you how to apply what we're learning right now in these slides to actual lab tests. And then I'm going to pause and take another drink of water, and then we're going to get into Q&A. So, if you have questions, type them into the little chat box there, and I will get to as many of them as I can at the end of the session. Okay, uh, I think that's all the game plan.

So, what's the first issue that you face? I already said this. What lab test are you going to order? You need to have a core set of tests you order on every patient. You can't just decide on every new patient you're going to order a bunch of different core tests. We're doing systems medicine. The systems don't change. A two-year-old with eczema has the same body systems as a 72-year-old with dementia. You've got to check the same body systems. It's the human body that we're checking here. And just because the kid has eczema and the adult has, you know, some memory problem, it doesn't mean that you're going to check different systems. There's a core set of labs you have to do on every patient.

Organic acids is part of that core because it forms our, it tests for metabolic function, neurological function, inflammation, oxidative stress, insulin resistance, stress itself with the catechol markers. Like, you can't get more fundamental than that. So, you have to run organic acids on who? On every single new patient. Anyone over the age of two. I personally don't work with children under the age of two, so I never test them. But from the age of two on up, every new patient should get this test. When you start to implement that in your class, in your practice, uh, because you're going to take this class, this one here, you're going to sign up for this one, and you're going to actually have the confidence to order this test in every patient. Okay, and you get 45% off on this class because you're going to take that class, you're going to be like, "Oh, now, now I've ordered this test on 50 of my latest new patients, and I can't believe the results that I'm getting, and all the things that I would have missed if I didn't know about their oxidative stress, their neuroinflammation, their mitochondrial function, their liver detoxification pathways." These are not optional things that you check once in a while. The two-year-old kid with eczema, the 72-year-old with memory decline, you have to check these basic functions.

I also believe, because I'm a functional medicine practitioner, that you absolutely have to check the gut. I mean, that's even more fundamental in functional medicine than basic cell physiology that you see on the organic acids. Organic acids, you check the cells. You're looking at cell physiology, the health of the cell, the health of the mitochondria, the health of the brain cell. Are the cells inflamed? Are they getting damaged? Is there oxidative stress? And then the GI map, you're looking at the microbiome itself, which, as you all know, is super critical. Okay, so just these two tests, you can do more. And maybe you want to do some fancy other testing with people, whatever, that's fine. But these have to be your core presentation that you're doing with every new patient. Um, if you're not doing this, you're just kind of missing out. Okay, it's fun. Believe me, once you learn how to interpret these, you're going to enjoy it. It's going to give you like magic powers to see inside the person's cell. There's not that many practitioners out there that really know how to test for and correct mitochondrial function. Okay, so we want you to do this. And this is not like a sales thing. We don't want you just buying stuff that's not going to help your practice or getting patients to buy things that are stupid. This is like, do you want to check the functioning of their cells? Yeah. Okay, you've got to do this. Do you want to check the health of their microbiome? You kind of have to. These are like basic core concepts. You want to add to this other complicated stuff? That's fine. But you've got to have a philosophy of your practice that says that there's a core set of issues I want to check with everybody.

I think we all know by now that the microbiome is important. So, I just have a slide on this just to remind us that this is important. And, and, and specifically, we're going to look at today the relationship between organic acids and the microbiome itself, and that crossover between the testing. Okay, and there's a couple of points where they cross over, and, um, we'll talk about them. Okay, especially in regards to, uh, beta-glucuronidase and whatnot. Okay.

And then if you're running a GI map now on people, but you're not doing organic acids yet, if you see any substantial microbiome issue, an infection in the gut, beta-glucuronidase is screwed up, uh, gallbladder markers are screwed up, commensal bacteria screwed up, then that tells you that there's some damage going on in this person's system, the GI system, and that you should check their cellular system, their metabolic health, with the organic acids. If the GI map comes back and it's clean and it's perfect, and even the commensal markers are dialed in and perfect, then the organic acids becomes less important. But any marker that you see that's positive on a GI map immediately implies there's inflammation and oxidative stress, probably there's a liver problem, and you want to check organic acids so you can dial in on those treatments as well. Okay.

So, now, within organic acids testing, it's a little confusing. We have the GI map. We already agreed that we're going to do that test on everybody. But also, within organic acids testing, they have a GI section, and that looks at polyphenol markers, commensal bacteria. It even has some markers for yeast overgrowth. So, there's some overlap. A small portion of the organic acids test from Diagnostic Solutions includes a GI section, but it's not in any way a substitute for the stool testing. Okay, it's a complement to the stool testing, not a substitute for it. And here's the actual test, Diagnostic Solutions Organic Acids Profile. So, so many stories I want to tell you, but I'm going to try to stick to like educational stuff. So, we want to get proficient with four sections of this test. Okay, and then we want to see how this data may show you that you need to do a GI test, and how the GI test may show you that you need to do this test. So, I'm going to cover off on that right now, just for a brief second, and then we're going to come back to the slides, I promise. But I just want to show you the actual lab reports here for one second. Okay, just so you can see the sections here. So, here's a typical organic acid profile from Diagnostic Solutions, and it has these sections: Mitochondria, Nutrition, Stress, Toxins, and Microbial Metabolites. That's the portion of the test that relates directly to the GI. Okay.

So, if you're running an OAP and you see any substantial mitochondrial markers that are elevated, you kind of have to do a GI test to see what's damaging the mitochondria. Is it coming from the GI? Right. If you, if you run this organic acids profile first, and you see that there's any markers to do with nutrition, of course, you've got to check. Because what if it's malabsorption coming from the gut that's causing the nutrition problem? When I, when I was a very young doctor, I was in the very first year or two of my practice, and I ran an organic acids profile on a patient, and I was very, very excited. And I, like, really excited. And I went to Dr. Timmons, who was my teacher at the time, and I was like, "Bill, look, I ran an organic acid profile. Look at all these nutritional things that are screwed up on this person." I, I had this whole plan I'd written out. I spent days preparing for this meeting with Dr. Timmons, and I was like, "I'm going to give him B12, I'm going to give him folate, I'm going to, I'm going to fix this thing." And then he looked at me and he said, in a very kind way, not in a rude way, he said, "Um, looks like malabsorption." I was like, "Yeah, it does, doesn't it?" And then he's like, "Did you run a GI test?" I was like, "No, I didn't." And I was like, "Oh, shoot." And he basically was saying, "Hey, kid, don't get into this nutrition supplementation thing before you check and correct the malabsorption issues with the gut." So, if you see nutrient deficits, check the gut because it could be malabsorption, and it more than often is.

And then you need to test and correct the gut. Stress and mood, as we all know, when you're stressed out of your mind and these markers are out of range, that high level of stress affects your gut quite profoundly. So, again, you want to check the gut. In particular, stress levels will, will change, either increase or decrease, but probably decrease secretory IgA. And you'll see the sIgA on the GI map. That's a stress indicator, but it's on the GI test. If sIgA is low on the GI map, it implies that the immune response since the gut, in the gut, is low. And a component of that low sIgA is going to be stress. So, stress markers out. You need to check sIgA on the stool test. I just want to give you a broad picture here. Oxidative stress and toxins. If those markers are out of range, then you're thinking, "Oh, do I treat this?" And Dr. Timmons is shaking his head. He's dead now, but he's up in heaven somewhere shaking his head, going, "No, kid, don't treat the oxidative damage until you understand where it's coming from. Is it coming from the gut?" I don't know, Timmons, I didn't do the gut test yet. Do the GI map. Okay, it's not that, not going to treat the toxins. It's not that they're not important. You're not going to treat it. It's just that you need to know where all this stuff is coming from.

And then the very last portion of this test is actually the microbial metabolites. So, these are the markers that are actually GI markers. So, it's kind of important. And if this section is really screwed up, then guess what? You've got to do the GI map because you've got to figure out where it's coming from. This is not enough data. You could easily have all these markers messed up here and have an H. pylori infection that you missed, because H. pylori is not on this test. Right? So, just briefly on, want to look at the GI map. If you see any infection on the GI map, then, and this is a bad example because I don't see any infections, or if you see low commensal bacteria, you're wondering, "I wonder if there's a lot of oxidative stress in this person's body." Oh, here we go. This person has dysbiosis. So, you're wondering, "I wonder if there's a lot of oxidative stress and neuroinflammation and mitochondrial damage from this infection in this person's body." How are you going to know that? You do the organic acids profile as a pair to this test. Similarly, if there's a yeast overgrowth or there's a parasite, then you need to know, "How is that affecting the cells and the cellular function?" Test is organic acids profile. Oh, here's that example I just said. If your sIgA is low, you need to know, "Oh, is that stress-mediated?" I don't know. Let's do the organic acid profile and look at those stress markers. In other words, you can fix sIgA when it's low by testing and correcting the stress markers on the organic acids profile. Okay, you can fix beta-glucuronidase if it's high on a GI map by testing and correcting liver detoxification capacity. Those, these tests are completely intertwined, and when you do them together, you'll be in a really high level of clinical expertise. Right?

So, here's what the test actually looks like. They have these summary pages in the beginning. We're going to talk about now the connection, specifically because this is sort of a GI map organic acids class, the specific, uh, connections after that broad introduction, um, to the GI markers and how they overlap between the two tests. Okay. So, on organic acids, they're testing and a whole series of those markers I just showed you under microbial metabolites. They're checking polyphenol levels. And why are they doing that? Because polyphenols are required in our diet to get a healthy microbiome. I had my polyphenols today already. I hope you did too. If you didn't, and you're listening to this in a recording, if you're live, don't do this. But if you're listening to this in a recording, just hit pause and go out to the grocery store and buy some cranberries, blueberries, or pomegranate. I had dried cranberries, a handful of them, in my oatmeal this morning. So, I'm like, I'm, I'm good on my polyphenols for the day. You have to have polyphenols with every day. Probably it would be good if you had them with every meal. So, you don't know what that means, you can Google what are foods that are high in polyphenols and start to incorporate them into your diet. If not every meal, then at least every day. Very, very important. Those polyphenols are what feed, or one of the things that feed the healthy microbiome. And people with high fiber and high polyphenol diets, their microbiomes look beautiful, and they are very, very much, um, protected from many of the gut problems that would impact us if we don't have these foods in our diet. And on the organic acids test, we're actually measuring that specifically. Okay, I'll show you those markers in a second.

So, here are the polyphenol-rich foods. We eat them, but here's the trippy part. We're not eating them for our own tissues directly. In fact, many of these polyphenols are molecularly large structures, and they don't get across the intestinal lining. So, in case you're wondering, tomorrow my polyphenols are going to be blueberries, and I'm pretty much looking forward to that. And they're kind of expensive. It's like nine bucks for a little thing, but what the heck, I'm worth it. But it's really not for me. Those blueberries I eat tomorrow, the molecular structure of the polyphenols in there is too large to get into my body. They hang around in your intestinal tract, and there are the food supply for your gut microbiome. Okay, they're for your gut bacteria, not for you personally. And when you eat polyphenols, and your gut microbiome uses them as a fuel supply, it helps protect you against cancer, it helps protect you against metabolic disorders like diabetes, they are anti-inflammatory, it very much protects your brain and your heart. Okay, so we eat the polyphenols, the gut microbiome, those bacteria use them for their own purposes, which have a net effect of preventing cancer, heart disease, diabetes, brain disorders. You couldn't ask for anything more. Okay, and we can test for this with these polyphenol markers, and you can see if the person's eating enough polyphenols or not, based on the test. And if they're not eating enough polyphenols, then the intervention is, you know, increase the polyphenols in your diet. That's actually the treatment. You can also give supplements, and I, I do short-term that have polyphenols in them. So, you're giving them the polyphenol supplement, and then over time, they're going to build it up, uh, on their own. Okay.

And so, this section here, some of these you can tell are, are, uh, just based on the name, are polyphenols. Okay. And if these markers are categorically low, the person's deficient in polyphenols in their diet. If these markers are extremely high, then it could be an overgrowth of bacteria, but you've got to confirm that with, now you guys know, right? The GI map. And here's another slide on polyphenols. It's kind of the same thing as that slide I just showed you, but a little more in a graphic form, right? Of dietary polyphenols. You eat them, the gut bacteria take them, and they're the making the benzoic acid and hippuric acid there. And you can see a lot of these, uh, chemical compounds or these metabolites have phenol in them. Polyphenols, right? Phenol acetate, phenol propionate, hydrox, let's see, para-hydroxyphenyl propionate. Okay, they're coming from polyphenols in the diet, and that's what we're measuring on the test. So, when you see the benzoate and hippurate on that slide, that's the benzoic acid and hippuric acid, right here, you see that? Second. These are two extremely important ones out of all the polyphenol markers. These two are like the most important. See that right there? Benzoic acid, hippuric acid. Those are polyphenol markers. They're metabolites that show you the polyphenol status of that patient. And then again, the treatment would be polyphenols in a supplement form. You have your choice. There's a million different versions of that. And then long-term dietary change, short-term supplements.

Fungal metabolites. The most famous of these, and I, I believe the most accurate, is arabinitol. You can see the arabinitol marker there. So, if that marker goes high, there can be a fungal overgrowth. And you can see on this slide, sugars feed the yeast and fungal organisms. So, if you eat a lot of junk food or a lot of sweets, that can raise the arabinitol, and you'll see that on the test, a yeast or fungal overgrowth. Now, if you see that, what do you do? You run the GI map because if they have yeast or fungal overgrowth, who knows? They could have Giardia also. They could have Crypto also. So, you've got to rule out other infections. If you only see the yeast, great, then you can treat the yeast. Right? But you've got to do the GI map. If you see a yeast overgrowth in the gut, it's irresponsible to not do that. Okay. And then again, high arabinitol means yeast overgrowth. You feed that. Now, that could be antibiotic use, could be stress, it could be high sugar diets. There's lots of different reasons why that can happen. But make sure that you do the GI map as a result of seeing that. Okay.

So, the high markers, as I mentioned, on the metabolites can indicate an overgrowth of intestinal microbiome, uh, microorganisms. How are you going to know? You're going to do the GI map. And here are ones that you can see typically high, but again, you need to, this just means investigate with an additional test. It doesn't mean treat this without knowing what you're doing. Right? Low bacterial markers, as I mentioned, would mean low polyphenols in the diet, and that's an issue too. Then you want to make the dietary change and give them, you know, polyphenols in a supplement form. So, in addition to the polyphenols, you also have fiber products that will stimulate the growth of bacteria. And usually, people give these together. So, they'll give the polyphenols and the fiber together to get the commensal bacteria to grow better. Okay, you can also use butyrate and probiotics, obviously. So, you have a bunch of different treatment options to bring this microbiome back up to its normal performance levels. Polyphenols, fiber, prebiotic fiber products, butyrate, and probiotics. Those are the four treatment options for a screwed-up microbiome. And you know, we just had in the mentorship class, I don't know, maybe two weeks ago, we had a doctor submit a GI map that had a perfect section. The commensal bacteria were just perfect. It was the doctor's own test, actually. So, I asked her, "What the heck are you eating?" And I'm not making this up. She said, "I grow my own food." I'm like, "Really? You are, doctor, and you grow your own food?" She's like, "Yeah, I grow all my own food." So, this woman is a doctor, and she has, wherever she lives, I think it's like, I don't know, somewhere in the countryside, and she grows all her own food. If you grow all your own food and you eat fresh vegetables and fruits right out of the garden, and that's the primary source of your food supply, of course, you go to town, buy some chicken or meat or whatever, maybe she has her own chickens, I don't know, I didn't ask her about chickens. But anyways, you got your protein somehow, then you're going to have a perfect microbiome too. Okay. But if you're not doing that, and you're living a normal life where you actually buy food in the grocery store, and you're not that great with your diet all the time, then you need to have these tests done. A short-term reset, and then, you know, you're back on your way.

Oh, and this is, I really want to point this out. Okay, where this is like a little, this is like a clinical tip thing that nobody knows. And so I wanted to explain it because knowing this is going to help you. So, this is sort of a diversion we're going to take. This is like a little, uh, short-term commercial for glycine. Okay, um, but I just snuck these slides in because, um, this is super important clinically. So, there, there are these markers that I just talked about, benzoic acid and hippuric acid. Let me just show you here, uh, where did they go? There we go. Benzoic acid and hippuric acid. Okay, and these are the polyphenol markers we talked about. So, if they're both low, you know the person needs more polyphenols. But there's another pattern that you're going to see frequently, and this is really important. And if you don't, I learned this from Dr. Lord like 10 or 15 years ago. So, I was in practice for like 15 or 20 years, and I didn't know this, which is embarrassing and bad because this happens a lot. And this is going to really help you clinically. If benzoic acid is high, and hippuric, it should then also raise hippuric acid because in your liver, your body takes benzoic acid and it converts it into hippuric acid, and it does that by using glycine. Okay, so within this microbial metabolite section of the test is one of the best glycine indicators of all time. If benzoic acid is high and hippuric acid is not equally high, it means that the body not having enough, doesn't have enough glycine. And this comes up a lot, and glycine helps people a lot. How much glycine do you give? At least 3,000 milligrams a day. If you see this pattern, you can do it on an empty stomach or food. Is probably maybe a little better on an empty stomach. And glycine, you can get it in a powder, you can get it in a capsule. So, if you, again, this is a liver detox kind of pattern that shows up under the gut section, but I just want you to have one like really clear, great takeaway if you didn't know that already. And the reason why that's important is because it shows up a lot, and it allows you then to work on, you know, getting the liver to work better in regards to, uh, these metabolite, these, uh, metabolic markers. And here, this, this is a picture that shows the actual mechanism here. If you, here's your benzoic acid, here's your glycine, okay, and hippuric acid. So, if you see that pattern that I just showed on this slide, it means there's not enough glycine in the system to run that pattern. Okay, benzoic high, hippuric not high. You want to treat it.

Another marker that is directly related to GI map but also bleeds over to the organic acid profile is beta-glucuronidase. So, this is a standard marker on every GI map test. If it's elevated, it's a big problem. Okay, and it's on the intestinal health marker section of the test. If you see beta-glucuronidase and you see that's high, then what does that mean? It means that there's a connection between the gut and your potential risk for estrogen dominance, and even things like breast cancer. And there's some article here, there's thousands of articles like this if you want to study this. Just a little bit. This is from Johns Hopkins, and it's about the microbiome, estrogen connection, and breast cancer risk. And I'll show you here, here's a picture from that article, here, that kind of describes it really well. So, if your beta-glucuronidase is high on a GI map, what does that mean? It means that there's a bad bacterial situation happening in your gut. And those estrogens that you have metabolized and broken down, there's your estrogen up there, you've metabolized them in the liver, which is a lot of work, you dumped those metabolites into the gut, not just for fun, to get them out, right? This is the exit route. But if you're beta-glucuronidase is high, the body reabsorbs those estrogens back. Those estrogen metabolites get back into your bloodstream. That's not good because high levels of these estrogen metabolites put you at risk for ovarian cancer, endometriosis, breast cancer, all these different problems. Okay, so again, this is a gut, hormone, liver detox connection. You have estrogen levels, the estrogen is metabolized and broken down, you've got these metabolites trying to get out through the gut, beta-glucuronidase goes high, you reabsorb those estrogens, and that's not a good thing. So, people usually use calcium D-glucarate to knock that out. And you can also look at the glucuronic acid pathway, which is obviously related to beta-glucuronidase, and if that's messed up, then you know, aha, it doesn't have to be messed up. Okay, but it can be. Doesn't have to be, but it can be. Meaning that you could have high beta-glucuronidase with or without this glucaric acid problem. I just picked this because it's an easy example. Okay, so it doesn't always occur this way, but hey, if this is high, you want to support the glucuronic acid pathway so the liver can start to clear things out. And these pathways are not, it's not, we're not just talking about estrogen being a problem. Like, for example, if you think about it, when one liver detox pathway is screwed up, what are the odds that there's other screwed up liver detox pathways? Pretty high, you know, pretty high. If you think about a situation where there's a whole bunch of stuff, a whole bunch of things somewhere, and they're all trying to get out, you know, through different exit routes, it's rare that if it's just one route that's a problem. If you think about, I don't know, let's say there's 2.5 million people in Manhattan, and they all, and it's Friday at like 4:30 in the afternoon, and they all want to get out of the city and go to the Hamptons or go back home to Brooklyn or whatever, but there's all these people, they, and then there's like five bridges or whatever, you know, if one of those, if you're driving and you're like, one of those bridges is blocked, I mean, it's pretty likely that there's other ones that are congested too. So, it's unusual to think that just a single liver detox pathway is going to be blocked. So, you want to correct. This is a big problem, right? So, if you see these indicators like beta-glucuronidase is high, you've got a gut problem. It could be that you want to check the organic acid test and see how the liver detox pathways are working because it's very likely that there's going to be more issues there with either phase one or phase two liver detox. Okay, gut problems are one of the main contributing factors to liver detox problems in the first place, is what I'm trying to say. And so, you want to look at phase one and phase two, and that's done on organic acids testing. You'll see the B vitamin markers and the oxidative stress markers, you know, antioxidant levels are, are checked for. That's phase one. You'll see all these different, uh, phase two pathways they measure for in a variety of ways on organic acids testing, and you get a pretty good sense of what you need to do in terms of treatment. So, again, on the organic acids profile test, you'll have these markers here that give you a really good indication of glutathione status, which would be one, one of the major, if not the major, uh, antioxidants that, that's protecting this system, that's making the liver work well, right? And so, hydroxybutyric acid is related to glutathione status. Alpha-ketoglutaric acid and pyroglutamic acid is kind of the most famous one. All right. And if those are screwed up, pretty straightforward, you're going to give the person glutathione. Not that complicated. Or you can use N-acetylcysteine. Also, you also are going to see this marker, 8-hydroxy-2'-deoxyguanosine. This is a really important marker. I was in New York about 10 years ago, and there is a very famous scientist and clinician lecturing. His name is Walter Kranian. He died recently, which is very sad. But he gave like a three-hour lecture on this marker. It was one of the most brilliant lectures I've ever attended. He was one of the funniest, smartest people I've ever had the pleasure to listen to. I never knew him personally. I wish I did because he seems like the coolest guy, you know. But this marker here is worthy of your study. This marker here is worthy of whatever they charge for this test these days, a couple hundred bucks. If you only got this one marker on this test, it would be worth it. Okay, it's a very, very important marker along with that glutathione section I just showed you. Because if you have a lot of oxidative stress, and this is a very well-researched marker, too, 8-hydroxy-2'-deoxyguanosine. Nobody wants to say that, so everybody calls it 8-OHdG. Normally, it's called 8-OHdG. Okay, super important marker, something that you should, you know, read about in relation to all kinds of different chronic diseases. And look, there it is, right on the test. Okay, it's pretty important. I don't know if that, anyways, Walter Kranian was such a brilliant person. If you had, if you had been in that lecture, you would have walked out like I did thinking, wow, like this is like one of the most important things I've got to check this on everybody. And then you combine that. So, you can check for low glutathione and high oxidative stress. I mean, that's the fundamental way that you can protect cellular health, anti-aging. Low glutathione and low, you know, high oxidative stress. This is what causes us to age. Chronic diseases like diabetes, cardiovascular disease, many forms of cancer. Low glutathione, high oxidative stress. Long haul COVID, poor COVID outcomes, meaning the people that died from COVID. Low glutathione, high levels of oxidative stress before they got COVID, right? If you walked into a COVID infection with high oxidative stress and low glutathione levels and low vitamin D, your potential for going to the hospital and dying was pretty darn high. In fact, again, at John's Hopkins, they did a whole series of studies during COVID on glutathione levels of people who are hospitalized, and there's a very direct relationship. In those years when COVID was hitting hard, the lower your glutathione levels were, the more likely you were to be hospitalized and die from COVID. So, these docs at Hopkins were trying to figure out, "Hey, we'll just give them glutathione as soon as they're in the hospital." Just try to, you know, give them something that can prevent, you know, complete collapse from this infection. We talked about beta-glucuronidase, ready? Some treatment options in there. Okay.

And I'm going to leave time for lab interpretation. So, for those of you that joined us late, we are having a holiday special, I will call it, on this class. And this is my, I spent a long time. I spent nine years working with Richard Lord to learn how to interpret organic acids. And then I sat down for like a year and I put together this course for you guys. So, it's short. Doesn't seem like very long because, because I want it to be something you can get through. In this actual class, you will have the opportunity to submit your own labs on yourself or on your patients. We'll review them during the live calls. There's also a curriculum, which is all pre-recorded, that explains each important portion of the test, how to interpret it, and how to start to design supplement protocols. This is starting December 3rd. We don't offer this class very often. So, if you're at all interested in learning how to do this, you get almost half off. And starting in a few weeks, just sign up and make it part of your life for a couple of months to learn and master this. You can scan that QR code to get going.

If you're into free, and you're not ready to pay us for anything yet, I get that. You know, I like free. I sign up for free things all the time. And we have a free mini version of the larger class. So, this is like a tiny version of the paid class, but it's a way to get started if you're not ready to drop some money, some cash yet on our training program. You know, and you're just like, a little new to functional medicine, you still think that we're kind of sketchy in the functional medicine industry, you're not ready to commit yet, then this is a free one. You can't really go wrong with that. All right. And we'll send out emails on this momentarily today or tomorrow. I mean, by momentarily. All right, let's look at some labs. So, and then please do type in questions because we'll do a few minutes of labs, and then we'll get to your questions.

So, now let's scan this test for real. So, here we are, Diagnostic Solutions Organic Acids Profile. Here we are, Diagnostic Solutions, uh, GI map. You've got, I don't know if it's hundreds, you got a lot of people working on the science, working on the actual lab itself, working on the educational stuff. I mean, there's a lot of people that are involved in this lab, okay, to bring you these two tests. We just want to thank them for getting us accurate data.

Now, I'll be honest with you. When I look at this test, I'm just thinking, are there one of four things happening? That's it. This test is so complex. As an example, like you could, and I have spent weeks, literally weeks, just talking, just talking to Richard Lord about about succinic acid. And he and I used to talk twice a week for two or three hours each time, and we spent weeks talking about this one marker. So, I've probably got at least 10 or 12 hours of training with Richard Lord on succinic acid directly, just that one marker. You don't, the thing is, if you wait that long, it could be nine or 10 years until you start to interpret this test. So, I want you all to get started with the interpretation and start to fill in the details later. So, to that end, and this is the way that I look at it now, anyways, to that end, you're just looking for four different problems: mitochondria, brain, detox, and gut. Mitochondria, brain, detox, and gut. Mitochondria, brain, detox, and gut. Those four things out of this mess of science that's in front of you. Okay, out of all these markers that are all, we can't even pronounce half of them. Okay, all of this, you're just looking to see, are there four problems happening? Yes or no? Mitochondria, brain, detox, gut. That's it. You start with that high level, you can design impactful programs. You want to spend a couple months understanding quinolinic acid? You should. Okay. And I've studied each of these markers for either weeks or months individually. But at the end of the day, when I'm like, in front of a patient, and I just did this yesterday with one of my patients, we'll call her Anne. That's not her real name, but Anne tested her and her two kids. She's been doing this once a year as long as I can remember. And I had to present to Anne about her son and her daughter and her in an hour. She doesn't have a lot of money. She can't pay huge fees. So, we did it all three of them in an hour. I had to present three of these exact lab tests to Anne in an hour and have Anne, the mom, walk away understanding what was happening with her and each kid. Okay, so if you're going to do that, you can't spend, you know, 10 hours on succinic acid. You have to say, you know, for, you know, for, um, for your daughter, you know, we've got this. For your son, we've got this. So, let's say, let me try to remember what actually happened with that case. So, with the kid with the son, it was just straight up neurotransmitter, okay? And then, oh yeah, yeah, yeah. With the daughter, her test was perfectly clean except for, uh, the yeast and fungal overgrowth problems. It's a good example. Okay. So, we're going to go through this test. Let's pretend like this was me yesterday, and we're looking at this test. So, uh, and the son also had a mitochondrial problem. So, the son was mitochondrial and brain. And then the daughter was, uh, gut, yeast overgrowth. And yes, they all did GI maps. And I'm not making that up. I'm not just saying that so it seems like I'm being consistent. They actually all did GI maps too, all three of them. They just do it every year. It's kind of cool.

So, energy and mitochondria processing. This whole section, and that's going to bleed over to this next page here. And this whole section here, see it says energy and mitochondrial processing. If those markers, oh, and this even bleeds into the B vitamin section here, into nutrition or B vitamins. If these markers, you see a preponderance of high markers on these, this whole first couple of pages really, then you've got a mitochondrial issue that you need to address. Yes or no? There's a different pattern where these markers can be predominantly low, which, which we call a hypometabolic pattern. Either way, you're going to treat the mitochondria. Okay, so the first two and a half pages, uh, are just that question: Is there a mitochondrial issue? Yes or no? If you see a whole bunch of high markers or a pattern where they're all low, then you have an issue, and then you treat mitochondria. And what are the treatments? CoQ10, magnesium, B vitamins, amino acids, carnitine. It's like stuff that you would expect for the mitochondria. So, that was the son. The son had the problem. So, I put him on a powder. They have, they make powder versions of this stuff because he's a kid, he doesn't want to take a ton of pills. CoQ10, magnesium, B vitamins, and amino acids. That was it. That was the whole program for her son. Uh, oh, and then some tyrosine because he has his brain thing, he can't focus in school, plus some tyrosine, right?

So, that bleeds over to the second section, which is stress and mood. I would call that brain. So, mitochondria, brain, detox, and gut. So, in this section, if you see high markers or low markers, depending on the pattern, you're going to recommend support for either dopamine or serotonin, again, depending on the pattern. There's also a section here, which is very important for neuroinflammation. So, if you see these markers down here elevated or out of

Range, you've got a neuroinflammatory problem on your hands, which is pretty significant, right? Nobody wants their brain inflamed. So, the solutions are simple: tyrosine, Muna, 5-HTP, tryptophan. That would be the brain section again. You're looking for high markers or low markers there. And then liver. So, remember mitochondria, brain, liver. Liver is obviously oxidative stress, toxins, glutathione status. I would lump all that under liver, okay? How the body's getting rid of things, how the body's protecting itself. And that's right back to, uh, let's see, this slide here. It's basically this slide. All of this stuff: phase one, phase two, B vitamins, antioxidants, and phase two detoxification capacity. All these nutrients measured by looking at the pathways, okay? And, you know, and that's basically that section. So, mitochondria, brain, liver. And then the very last section, we talked about microbial metabolites. Lets you know about the gut, okay? So, those are the four areas you need to be looking at. And there's four potential treatment options there.

I'm telling you, like, even if you spend like 15 years working with Richard Lord, you still end up having to talk to Ann and her two kids and figure out, okay, we're going to give the kids some tyrosine, the son some tyrosine and a mitochondria program. He has this strange problem where it's not super common where I don't know how old he is, he's like 10 or 12 somewhere in there. And he, um, he's really active. So, like, he'll play sports and he does, I think, some kind of martial arts thing, but he'll like, you know, run around the baseball field for like two minutes and then he's exhausted. And it's just really hard for him to keep up with these other kids. So, we're working on his mitochondria right now to try to fix that. He has a little bit of an attention problem in school. So, we're working with, uh, catecholamine markers with tyrosine to fix that. And then the daughter's a little older, I think she's 15, 16 because she was talking about the teenage years and how her daughter just won't listen. I think it's kind of funny. Her daughter, like, if she says, "You shouldn't eat sugar," honey, this girl, as soon as she gets out of the house, is eating sugar. So, she's got a pretty big sugar problem, the girl does. And she had a massive yeast overgrowth. So, we're going to treat that, okay?

So, again, mitochondria, brain, uh, detox, and GI. And yes, they all also did, uh, a GI map test, okay? And let's just go through a GI map real quick here. I think we already looked at this one. Let me find a different one for you guys. Uh, a second. Um, I downloaded it already. Let me just pop it up here. That's that one. One. Oh, gosh, didn't show up. Hang on a second. I'm not sure why. Let me pull it up here. Already downloaded. It's kind of stuck in my download thing here. Uh, here we go. Should pop up in one second on your screen. So, GI map, H. pylori present. That implies, that doesn't imply, that tells you that there's inflammation in the body. Inflammation in the body. So, then what do you have to do? You think, oh, if there's inflammation, there could be oxidative stress. I better check that 8-OHdG marker and that glutathione section because Kayla said that Richard Lord said that that's the most important part of cell physiology and cell function. If your glutathione levels are low and your oxidative stress is high, doesn't matter what else you do for that person. Their cells are getting hit in a negative way and they're going to develop some kind of problem from that, okay? Commensal bacterial markers, as we talked about earlier, you can compare and contrast this with the, uh, these markers here because they should, you know, there should be some correlation here. That's what I'm trying to say here. These microbial metabolites, these are the polyphenol markers, all right? And then on the GI test, we see it from the angle of the stool sample. Low commensal bacterial markers mean the person needs more polyphenols and more fiber in their diet. You can also then check and see as a backup, not a substitute, but as a backup, low microbial metabolites means the person needs more fiber and more, um, polyphenols. High levels of these markers on organic acids means you don't know what's going on. It means like it could be dysbiosis, or it could just be that they eat a lot of fruits and vegetables. You don't really know. So, what do you do? Well, you run this test and if you see that they have dysbiosis, like this person does, then you got it. Nailed it. You saw organic acids markers high, you're kind of wondering, is that a problem? You're like, oh, the GI test says absolutely yes. So, now you want to treat it. Or yeast overgrowth, like this one, okay? You're going to go, okay, there's a yeast overgrowth on this. And there's a specific yeast marker section on this test as well. They don't always correlate. That's why you're doing both tests because you're going to catch yeast sometimes on these organic acids profiles and miss it on the stool. So, it's really helpful to have a backup here. But if you see yeast on the organic acids, you're going to check the stool and see, gosh, I wonder what's going on there. What kind of infection is going on this person's gut? And then the last one I'll mention here before we go to questions is the beta-glucuronidase. So, if that's high, that's a gut problem, but that it means you should at least check the liver detox pathways because there could be, not necessarily, but there could be a liver detoxification issue depending on how long it's been going on for, right?

Okay, so now let us pull up this here and remind everybody that we have classes starting in a few weeks. We have a free one you can sign up for. You'll get an email on this momentarily, probably today or tomorrow. And then we have a paid one that's starting on December 3rd. So, those of you that are incredibly enthusiastic and really want to change your practice and learn how to do this with every patient, you can get a couple months of this, get deep into the subject matter, and start to really add this to your practice. 45% off that. All right, so that's go to questions now. I, I promised I would pause and drink a glass of water. So, let me have some water here. Staying hydrated. Water's the most common. I think it's, I haven't looked at this recently, but when I looked this up 20 years ago, water was the most common nutritional deficiency, you know, dehydration. Crazy is that?

Okay, so let's see. Allison has a question here on organic acids concerning fatty acids. What exact markers do you look at to determine if the patient needs to be treated? Well, let me just show you, uh, what I would do. There's a whole page of these, but let's keep it simple because remember, we're trying to be simple here. And let's talk about what do the fatty acid markers mean. And this, to me, is one of the most important missed areas. Areas that's missed. People just miss it. Beta-oxidation is the burning of fat for fuel as we're all just sitting around right now. Maybe you're on your bike as you're listening to this or running, but if you're exercising, it's different. If you just ate a big meal, it's different. But for most of the time when we're rested, 60-70% of our energy, of our mitochondrial energy, comes from burning fat. So, this is not like a peripheral question. Allison's asking like a central question, meaning that if you cannot burn fat, your mitochondria cannot work properly. This section, this is going to be screwed up no matter what else you do. So, the markers that are the most prominent there are here: adipate or adipic acid, succinate or succinic acid, and ethylmalonic acid. So, adipic acid, succinic acid, and ethylmalonic acid. If those markers are high, it means that you're not burning fat for fuel very well. And then the treatment is incredibly complex. And only I have the supplement that you can buy to fix this. I'm being factious. All you have to do is get the person some carnitine. You can buy carnitine from any supplement company. It's a little expensive, so don't get the cheap kind though because it's not going to work. Get good quality L-carnitine, 2,000 milligrams or more a day, and that'll start to get them to burn fat. And you want to accompany that with some B vitamins. This is really important. It's not a peripheral pathway. Remember, it's like the majority of your mitochondrial energy production is coming from fat. And of course, if this pathway is not working well, then, you know, you're going to be tired, you're going to be overweight, those kinds of things.

Uh oh, Clay orders these tests on every single patient, both of them. Awesome. Oh, and Clay is asking, do you order them at the same time? Absolutely. I think you should. I think the psychology of this is, patient walks in, you do your battery of testing. It's much better to get all your tests done. So, I do, uh, hormones, GI, and organic acids, just all together on day one. It's much easier than coming back later and asking them to do it, you know? Uh, plus, you want all the information at the same time in the beginning. So, in my practice, I also order, uh, adrenal hormone testing on every new patient in addition to these two. You don't have to do that, but there's reasons why it makes sense. Let's see. You can do this on kids. Yeah, you can do this on two, three-year-old kids. You might need to get some a little fancy with reference range interpretation, but you can do this on children. Uh, let's see. Another, if this is Russell asking, if adipate, succinate, ethylmalonate are normal, does that rule out carnitine need? No, it doesn't. It just rules out that one reason why carnitine might be necessary. That's a good question, Russell. No one's ever asked me that question before. That's a really good question. Let me just say that again. So, if these markers here, if these fatty acid markers are normal, you can, you you often still give carnitine. Often. Okay? It's just that if you, if those markers are high, you have to give carnitine because the person's actually got a deficiency state. Oh, let me back up. So, the, so Russell's question really is a, let's talk about the biggest picture question here, which is that if there's a deficiency state, if you don't have enough of a nutrient, then you have to give it. That's like if your car runs out of gas, it, it's just, you don't, you're not going to call anybody and ask them what to do. You just like, you have to get gasoline in it. Even if it's broken in some other way, you know, if the taillight's broken or whatever, okay? You have to have gas. So, now, if you have gas in the car and running down the road, you know, you can still have a whole another reason for, you know, doing some, you know, correction for it. So, in other words, if you have a deficiency state as it's indicated on these tests, you have to supplement the person. But independent of that deficiency state, carnitine just helps people burn fat. So, even if you're not deficient in carnitine, you can still use carnitine, okay? Absolutely yes. So, even if your magnesium levels are normal, if you want to make more energy, you got to give the person magnesium. Even if your CoQ10 levels are normal, if you want them to make more energy, you got to give them CoQ10. So, there's the deficiency state which absolutely necessitates giving the nutrient. But then there's the just, you want to get something to happen, right? You want to get the person to make more energy. CoQ10, magnesium, carnitine, and B vitamins and amino acids are going to do that. Whether they're, if they're deficient, they have to have them just to get normal. But you can force the body to make more energy, get encourage the body to make more energy by using these supplements as well, okay? That's pretty important.

Um, you can absolutely use polyphenol extracts. Yeah, if you want. What poly? I have a personal preference on the polyphenol supplement. Um, it's called Poly Prebiotic Powder from Pure Encapsulations. Poly Prebiotic Powder from Pure Encapsulations. I like that one specifically because it's got the polyphenols and the fiber together, okay? Sometimes you may not want to do that. There may be reasons why you want to separate them out, but it's usually easier to have them together. So, if you see now, um, not these tests are not always going to agree with one another, especially when it comes to yeast. So, you're going to see yeast markers show up on organic acids that are not showing up on the GI map. In which case, you should treat the yeast. All right. That happens. Since there's a lot of science behind what it happens with, I don't have time to explain it now. Probably. Oh, yeah. Tom was just shouting out on Walter Kinian. Makes me want to cry. Such a fine human being. Died so young. You know, hi Tom. Let me tell you, Tom is on the call. Oh my God. It makes me want to cry. I love Tom. You guys, you don't understand. Functional Med. This is why I started this talk off with, you know, there was like a couple hundred of us. Like I remember when Jeffrey Bland coined the term functional medicine in the early '90s. There are people like Tom who's listening to this talk right now, all terror. And and I was saying, you know, uh, Jeff at Diagnostic Solutions, and Betsy, and David Brady. And you may not know these people personally, but they are the finest human beings. We've all been in the trenches of functional medicine for over 30 years. All of us could have made a lot more money doing anything else. I could have made more money being a janitor, okay? We, none of us did this because it was a hot item or it was cool or social media crap. We all did this because we cared about human beings and we wanted to make the world a better place. And that is the core group of functional medicine people. And Diagnostic Solutions Lab represents that as much as any other company in the industry. There are many other companies that have that same kind of core group of people. But, you know, we, we were on a mission. We were all in our late 20s and early 30s and on a mission. And we didn't know that, um, we'd end up where we are now. So, anyways, I just want to do a shout out for our industry in general and and how this all started for those of you that are coming in now. And as you work with me too, you guys sign up for my courses, the ones that are paid, where we get to talk online because anytime you pay for one of these classes, uh, even the shorter boot camps that are just a couple months, we'll have a few sessions together where we review labs. And one of the things that I want to do is just kind of indoctrinate you into this community of people and let you know all the wonderful people out there that you should be connecting with. And that's a large part of the Kish Institute. It's like a functional medicine community building center, really. I'm very proud of that aspect of it, okay?

Um, I think we're running out of time. I got to stop. I could go on for hours, everybody. But thank you so much for joining us, and I hope to see you in the next one. Take care. Here now.