Detoxification In Clinical Practice Detox 101, Finding Glutathione Deficiencies

Hey, welcome back to our summer series. Um, I love this. It's like summer in the park, but we're all online and we're learning about functional medicine. So, um, today is detox, and I wanted to talk about two things. One is just like stuff you're supposed to know, maybe you already all know, since I don't want to spend too much time on it, but I should talk about it a little bit. And then the other is like stuff probably most of you don't know because we were never taught this, and it's like super important and you should know it. So, two general categories: glutathione and urea cycle disorders. Uh, so that's what I want to cover.

And so, we talk a little bit about me first, uh, in case this is your first one of these. So, I am Dan Kalish. I am, uh, been in practice forever. I have a lead faculty position at the Institute for Functional Medicine, which just is a miracle when you really think about it. But I'm their practice implementation guy, like, make my practice work kind of guy. That has become my role. I think that's because I'm part chiropractor, part naturopath. The chiropractors were always kind of scrappy, you know, economically. They just had to make it on their own. Never had a hospital to work at, and had never had insurance stuff, never had, you know, a steady job. So all the chiropractors that are successful are pretty much entrepreneurial, or you crash and burn. In my chiropractic class of 30 people, 90 of them were out of business in like the first month. It's just like the death rate is really high. Naturopaths really understand functional medicine, and I might, the majority of my teachers, mentors were naturopaths, but, you know, also had a couple chiropractors in there. So, anyhow, that's kind of what we're talking about with what functional medicine is, its origins, right? Naturopathic medicine, primarily started by chiropractors back in the day when I was involved. Anyhow, I've gone on, I've done other stuff, research with the Mayo Clinic. Right now, we're going to talk a lot about Richard Lord's materials and how all that works. I'm in practice still. I practice all day today and just kind of squeezing this in right after patients. We have a summer special to go with our summer, summer mini-series. So, Caleb's Method 101, we're just blowing it out, giving it away. I think it's like $99 bucks or something like that, and it's a good introduction to the mentorship class that I teach if you all may be interested in going on further and signing up for the more advanced courses that I teach. And, um, yeah, you can sign up at that really complicated URL down at the bottom there. We will for sure send out an email tomorrow. So if you guys want to get your, the deep discount on Kelly's Method 101, you can score that. Okay, so you don't have to memorize what's down there. And if you're interested in the training program, you can ask questions during this class. If you're interested in the training program, you can email info@kalishinstitute.com and go more information on there. And again, the Canvas Method 101 class, I think we're doing it for $99 bucks right now. It's just a broad introduction to what I do in the year-long course, and it kind of touches on all the major, big subjects that we cover there, right?

So for today, I wanted to kind of hammer detox pathways and then look at some labs and do labs, labs, labs. And then maybe talk about a little bit from a business perspective, why this is important from a clinical perspective. We live in a really toxic environment. Everybody wants to detox, but no one really knows how to do it. No one has knows how to do it with the precision based on the labs. So this is a great practice builder that you can do lab-guided detox programs that are very specific, very personalized, and very clinically effective. And mastering this, you know, you can become like a special person in your neighborhood or your area that really understands how to do this because everyone says they know how to do detox. But honestly, just throwing some, you know, random liver supplement in somebody and hoping that things work out is not really the solution for this. This is complicated. And when we get into the genetics of it, this is like really complicated stuff, and you need to understand it down to the really minute detail. You don't want to screw this up either. You can make people really sick if you detox from wrong. 90% of the detox programs that I see patients coming in having done are just stupid and ineffective, you know, to be honest, compared to what you can do with the labs. I don't know, it's like, you know, the precision of this is just intense. And, uh, and a lot of this, if not almost all this, is based on faulty genes, right? So in a world, you know, if you look at my entire practice right now, we'll practice two days a week. Almost every one of my patients has a combination of really bad health problems mixed in with really crappy genes. And, you know, the genetic, one of the major problems that we all see in our practices every day is people that just don't detox very well because we live in a really toxic world. And so learning how to take care of these folks is super important. Understanding the genetic underpinnings of this is critical because that's where almost all of it comes from.

And so what we do in these particular tests, let me just show you a lab, is what I call, or what Dr. Lord calls, functional genomics. So we're not doing snips, we're not testing for snips. And I can and do do that, and I think you guys should be doing that too. But what we're looking for in these tests are the functional expression of the snips. So, for example, one of the more common genetic disorders in the human species is ammonia detoxification, or what the medical docs call urea cycle disorders. That is represented very well on this organic acid test by the measuring of orotate. The higher your orotate goes, the more likely you have genetic urea cycle disorder. Really, really important to be able to ascertain that. That's one of the more common genetic disorders that human beings suffer. And so you're going to see it in your practice a lot, and you should know how to handle it. This particular person had some bad luck. Another problem that people can have is with methylation, detoxification phase one, phase two detox pathways, in which case you'll see these markers here elevate. Things like pyruv, pyroglutamate, sulfate, hydroxybutyrate, either go high or low. Glucorate can either, glucorate can only go high as a problem, okay? And so if you see patterns like this with all these detox markers, all kofui, it's very likely that the person has some genetic component to what's going on, okay? And then there's another sort of stealthy marker, and this is an organic acids test from Genova, in case you're wondering. And this test, you'll also see there's a stealthy little problem that you need to learn how to identify. It's under bacterial compounds here, it's benzoate and hippurate. And this is just something you've got to memorize. If benzoate is super high, and this one is super high, look, anything above that 2, anything above 2.1 is considered high. This person's at 41. Okay? This person's 20 times higher than where the high level cutoff starts. That's super high. Super high. So what do you think is high cholesterol 300? This is 20 times that. This is like a cholesterol of, I don't know, what's 20 times 300? 6,000. Okay? That's super high. If someone had cholesterol of 6,000, you'd say that's super high. You'd say that couldn't happen from your diet. You'd say that's a genetic problem. This is exactly the same thing, okay? Benzoate super high, that couldn't happen. You could have 100 microbiomes generating a gazillion bacteria, it could never get that high from bacterial overgrowth, right? So that's happening, it's a genetic disorder, you're not clearing benzoate effectively. And you can tell that because the hippurate levels are not commensurately high, okay? So that's a glycine problem, detox. This is an arginine problem, detox. This is phase one, phase two, and down here are glutathione. So that's what we wanna cover today and understand the genetic underpinnings of all this, okay? That's the goal. Uh, now, that's kind of where we're going to end up. Oh, and I'll just show you this so you can see urea cycle disorders. This is, you got to learn this, or like, I didn't understand any of this stuff until recently. You guys, it's really embarrassing. You're really supposed to know this. You've got to learn this like right away. So very common, the most common genetic disorder in human beings are the variety of urea cycle disorders. What they all end up creating is ammonia toxicity. Having a lot of ammonia in your body is not a good thing. This makes people really sick. Brain fog, mental confusion, depression, you name it. Not a good thing to have ammonia build up. And it's a very common disorder, and you need to know how to identify these various enzymes down here that become damaged due to genetic disorders, right? They're not working right, that lead to ultimately a buildup of ammonia, okay?

So let's go back to the lecture notes here, and we can kind of dig into this all. All right, ready, set, go. Liver detox, and most of this is genetic. So in my treatment model, we treat a lot of different stuff. Symptoms, causes, systems. I look at this in a lot of different ways. I think this is a nice schematic here, so you can, sorry, you know, the symptoms we're thinking about tonight: weight gain, fatigue, depression, anxiety. Any of those could happen because of toxins. Brain fog, even, yeah, insomnia for sure. If your liver is not doing well, you're going to always have insomnia. So then the cause, though, we are saying tonight, we're thinking about toxins, heavy metals, and chemicals, and genetics, epigenetics, these factors. So we can treat the underlying cause, we can relieve the symptoms. And what the toxins cause on the road to causing symptoms would be inflammation, catabolic physiology, insulin resistance, oxidative stress, right? This physiological damage that's happening that starts to impact all the different systems, and eventually we get symptoms. So we're treating all along this spectrum. And then I always think about treating this in a certain order. So in general, you want to start off with neuroendocrine, clear GI problems, and then work on detox in general, unless you have to flip the order and start with detox. But that generally is not a good idea because it can make people really sick. People don't detox well when their microbiome is screwed up. People don't detox well when their mitochondrial energy systems are not working. So you generally want to work on adrenals and mitochondria and get this working better, make sure their GI is in decent shape, and then start in with a detox process. That's the usual sort of, what we now call Kalish Method. You know, this is basically what Dr. Timmons taught me in a PowerPoint slide, and he taught me this based on his experience working with detox clinics. So Bill Timmons ran massive detox clinics, one in West Virginia, one in Mexico, and they detoxed people left and right. This back in the '70s, early '80s. They're just like detoxing everybody. That's all you got to do, like everyone's toxic, let's detox them. And people are getting sick and dropping like flies. And over the years of detoxing thousands and thousands of people, Dr. Timmins learned that you shouldn't start with detox because some people crash and get really sick from that. So we created the sequence here of how to do this. We're not saying detox isn't important because for most of our patients, it's probably the most important thing that you can do. But you want to stage it towards the end when they're in better shape and they can handle all this, okay? And it's generally, this is done from organic acid testing. I'm going to skip through these slides so we can look at the labs and not drag this out. But let's just all agree that we're surrounded by toxins, right? And we know that there's this body burden. We have chemicals and heavy metals just saturating every one of us. Um, and that a lot of these chemical toxins get into the brain and cause neurological damage. And that's what I call a broken, broken brain, right? Chemical toxin gets in, damages the neurons, eventually it changes how the brain's functioning. So we want to do this and make sure that we're protecting our systems, okay?

So with the liver, there's two basic detox pathways. You're all familiar with, probably, phase one and phase two. And we want to be able to identify which one of these is problematic with the lab. And why is that important? Because they're really different, and you want to support the right one. You know, basically, so that works. So phase two contains, is made up of, in terms of supplements that we use to fix it, sulfur-containing amino acids. Sulfur-containing amino acids. Phase one primarily revolves around the B vitamins and oxidative, and antioxidants are somewhere in the middle in here, right? So you don't want to stimulate phase one really aggressively if stage two is broken. That causes symptoms. We call pathological detoxification. It makes people worse. So you, if you want to play it safe, always work on phase two first, and then you can chime in with phase one when the time is right. And the labs measure all of these things. The B vitamins, the antioxidants, and the phase two sulfur amino acids are all measured in detail on an organic acid test. So you don't have to guess, you can see exactly what's going on if you know how to interpret the tests. And why does this matter? Because people get fat and tired, and they get the mitochondria get messed up, and they get heart disease, and they have all kinds of issues when these systems aren't working well. And here are the solutions. You want to learn, you should know how to use each one of these supplements like by heart, inside and out. Arginine, glycine, NAC, methionine, magnesium, antioxidants. These should just be part of your general vocabulary as you look at the test, all right? And so let's look at some examples in a second. Let's see, uh, oxidative stress, right? We're going to kind of going quickly through these slides so we can look at labs. The idea being that if you have a lot of oxidative stress, one of the systems that's going to get damaged is your mitochondria. So you're not going to be able to make cellular energy, that ATP. Mitochondrial damage can cause all kinds of things: diabetes, heart disease. It's not a good thing, right? When your metabolic system just kind of shuts down. And free radicals that are, you know, generated as a result of excessive amounts of oxidative stress, excessive amounts of exposure to environmental toxins, chemicals, and heavy metals, are going to damage everything that you can imagine, right? Oxidative stress is responsible for most deaths in the United States, at least, right? Heart disease, cancer, all these horrible things, diabetes that happen when we've got too much oxidative stress. Either your DNA can get damaged, and then cell replication becomes abnormal. You can have liver damage. You can have lipid damage. That's really common to have lipids damaged from oxidative stress, putting at risk for heart disease. So this is important, right? One of the ways that we protect ourselves is with methylation. And methylation is kind of a buzzword, so you should know about that. Methylation is going to be how you repair and make your DNA and RNA work, and all these good things. And so that's an important part of detoxification as well, all right? Okay, there's another plug for the thing called Method 101. You get a 75% discount. We'll send out some emails on that pretty soon, I'm sure, tonight or tomorrow.

So let's look at some labs and what we're really worried about here is that there's a lot of oxidative stress from the toxin buildup, DNA damage, which would trigger higher risk for cancer, lipid damage, which would trigger higher risk for cardiovascular disease, mitochondrial damage, which makes people really tired and causes everything that you can imagine when ATP doesn't work very well, right? The brain, heart don't work very well. So these are really important variables. We don't want cell damage, we don't want oxidative stress just proliferating, all right? So let's take a look at some labs and I'll show you some examples here. So this is an organic acid test from Genova Lab, and we're just focusing in on the toxicants and detoxification section. So you can interpret this section, well, correlate it with other parts of the test. So the obvious thing that you have to know first, we're going to start with, which is that these three markers here, alpha-hydroxybutyrate, pyroglutamate, and sulfate, are all three looking for glutathione levels. And yes, if you only see me in the image, then you can minimize the camera because I'm running a PowerPoint here too. You can even turn the camera off. You can click around on it, should be able to adjust it. Okay, carry. So these three markers here are all checking glutathione. Why did Dr. Richard Lord put three, devote, three, three, three markers all towards one nutrient, glutathione, or why'd he do that? One antioxidant? Because this is the most important part of this entire lab. How do I know that? Because the man that invented the lab told me that three years ago when we started to work together. This is the most important part of the entire lab. How was your glutathione status doing? If these markers are either high, or even worse, if pyroglutamate and sulfate are low, you have a major crisis with glutathione. And that takes precedent over, that's more important than anything else you could deal with because if the person doesn't have adequate glutathione stores, they're heading down a very dark path. Single most important antioxidant, and without it, mitochondria fail, oxidative stress becomes rampant, insulin problems happen, the whole system is just going to collapse. This is a really, really important series. So high markers are bad. Low markers are even worse. Low markers mean there's, uh, what Richard calls glutathione collapse. Means the system's not even trying anymore. High markers mean, okay, you're in the, you're in the fight here, you're trying to get rid of toxins. When these markers are high, that's a bad thing that you have the toxins. At least you can fight, you're in the fight, right? When these drop, pyroglutamate and sulfate drop, you can't even make that response anymore, and things are even worse, okay? So three markers devoted to glutathione. Any one of these that are high is an issue. If these two are low, it's an even bigger crisis, and you want to boost up glutathione levels as a strategy. Uh, yeah, and this is all from, I'll show you the actual test here, the header for it, you know, so you can see. Did you know the Diagnostics Organics with an X Comprehensive Panel? The best thing that ever happened to functional medicine.

So the origins of this test are really quite interesting. Dr. Lord, before he became a doctor, he somehow finagled his way into graduate school, right? So he was telling me the story the other day. He wasn't a very good student, Richard wasn't a very good student. He just told me this. So he wasn't a very good student. He didn't pay attention in class, he just kind of daydreamed all the time. But, um, he got like a perfect score in his GREs. How's that go? So this little guy from this little town in Georgia, no one in his family ever gone to college. He somehow scraped it together, went to, you know, state school in Georgia, and blew off, you know, all his classes because he didn't really understand what's going on, he didn't care, he thought he was bored. And then he got a perfect score in his GREs because he's brilliant, right? So he got into the University of Texas at Austin, which at the time was the greatest nutritional powerhouse school in the world. And they just were like, oh, perfect scoring the GREs, poof, bring this Lord kid over here. So here he is in the 1960s, and he's thinking, hmm, I'm in graduate school, I wonder what all this is all about. And he learned about organic acids testing, that was used in conventional medicine to determine pediatric disorders, right? Rare endocrine disorders, rare stuff that's going on. I'm sorry, rare pediatric, um, disorders. Like, um, well, we've got like PKU was probably the classic one that we all learned about, right? So when that, when that started to click in his brain, he realized, wait a minute, we could use the same kind of organic acids tests, but maybe not to determine if you have PKU or some, you know, life-threatening disease as a newborn, but to see if adults have these problems as well, as an investigative era, you know, what do you call it, uh, pursuit, right? And so if you look this up, and you can, you know, um, this is pretty easy to find, just look up like urea cycle disorders, all right? And you'll see that they're listed as inborn errors of metabolism. There's newborn babies are screened for all of these endocrine disorder. I was kind of off in a different tangent there, sorry, that was like a, my brain kind of kicking out of gear. Another classic one would be lactic acid urease, that's a different thing. We can talk about some other, damn, you see lactate being quite high, okay? So these are all rare genetic disorders that happen in newborn babies that can be life-threatening. But in adults, they can just be basically life-ruining. So of course, these are not people that had these problems in childhood, they would have died if they weren't identified. But what we see with these kind of folks is that they have the same genetic disorder, but it's very mild. It's just a very, very mild version of what could be life-threatening in a newborn baby. And here you have a urea cycle disorder with high orotate, okay? And there's dozens of these that play out throughout this test. So you can see what Richard calls the functional genomics expressing in these important areas of metabolism, okay? But they're very, very mild versions of what a child would experience. So when you look at urea cycle disorders, you read all about what pediatricians look at when they're worrying about a newborn baby having this problem, and what we're thinking about is that child, minor, minor problem in childhood, made it through adulthood, but now we're seeing the manifestations in these chronic illnesses that we all treat every day, okay?

So let's take a look here at another example. Oh, shoot, I didn't mean to do that. Sorry, I just nuked the thing I was trying to pull up. Hang on, let me pull that back up. While we're waiting for me to do this, we'll give a short commercial break. Let's see here. If you guys are interested, I don't think I have a detox master class, but we have the Kalish Method 101 that has detox in it. So you guys should check that out if you want more information on this. Here we go. Here we go. Sorry about that. Bring this back here. I'm going to have lost my place now, but I'll find it real quick. So when you're thinking about inborn errors of metabolism, this is the most common cluster, urea cycle. Now, in Richard's books, he's talking about not the childhood disorders, that's something that you would read about in a different kind of book, right? In standard medical text. He's talking about what happens when people are able to get through till adulthood, but they have the same genetic problem. Well, they're going to have these really frustrating symptoms of urea cycle disorders, but they're really mild. Let me show you an example here of how the genetic, oh, here we go. Back. Headache, fatigue, confusion, poor concentration, and food intolerance. What does that sound like? Familiar. Urea cycle insufficiency. Headache, fatigue, confusion, poor concentration, and food intolerance. Does that sound like half the patients you treat? You're treating this all the time, just not seeing it without ordering these labs. And so again, we can take that conventional medical literature and start to understand there's minor versions of the same thing, but the dynamics and the mechanisms are identical. That's the important part. Now, I'm going to show you how this actually works in terms of the enzymes, real quick here. So when your body consumes protein and then you're trying to break it down, you have to get rid of the nitrogen that's in that protein or in that amino acid that you're breaking down. It turns out that if you can't get rid of that nitrogen very effectively, it can build up and cause a toxicity problem with ammonia. So this doesn't mean you should not eat protein. It just means that some people who have enzyme defects are going to have a problem here. And here's an example from the book. Here are the different enzymes that can be faulty. There'd be a snip associated with what each one of these enzymes. Sometimes there's, you know, a dozen or two snips that are involved in one single process like this. And so the more enzymes there are, the more potential snips there are, the more likely this is going to be occurring to the people that we treat. And so urea cycle disorders, top to list here. So the net, net of all this, the end result of all this, whatever enzyme is faulty, is that ammonia builds up. And when ammonia builds up, you get headaches, confusion, you know, that whole list I just showed you. Even food intolerances can happen from high ammonia levels, okay? And what happens when ammonia builds up is orotate eventually goes high, and you see that on the lab. So high orotate means high ammonia, means brain fog, fatigue, anxiety, food intolerances, all the things that we would associate with excess ammonia in the system. Does this happen to newborn babies? Absolutely. Can they kill them? Absolutely. That's when we all take it really seriously. That's what Richard was thinking about in the '60s. It's like, wow, I wonder if this same genetic disorder sometimes is really mild. And so they don't identify it in childhood because it's not that bad. Maybe we could do organic acids testing in adults and find these mild problems that are causing chronic health problems. And that was the origins of this test. This test was designed to screen for genetic disorders. This test was designed in Richard's mind in the '60s and '70s to screen for genetic disorders. It didn't come to reality until the '80s. He designed it to screen for genetic disorders before we could even measure all these snips in the whole genome thing that everyone measures now. This test was designed to screen for genetic disorders, okay? That is the bottom line. And yet, it was presented by his professional partner, Dr. Braley, as a nutritional evaluation or screening test because Braley, Andy Braley was the guy that had to bring the money into the lab every week and every month and pay the staff and the salaries. And he's like, I don't think anyone's going to understand this genetic stuff, Richard. So that got put on the back burner and it was presented as a nutritional evaluation, nutritional screening test. It has nothing to do with that. Forget your diet, you don't eat your way into an ammonia toxicity problem. It's not because you were drinking glasses of ammonia. This is straight up genetics. It was just never taught that way because when Andy had to sell the labs, they wanted to sell it as a nutritional screening test so people could understand. So we're coming back around now, 40 years later. Richard gets on the phone with me three years ago and goes, yeah, actually, you know, I designed this as a genomic, functional genomic screening tool. That's how cool this stuff is. And that you could go on and on and on with each one of these markers and the snips that are associated with them, okay?

So what the take home message here: orotate high, give the person arginine. How much? At least 3,000 milligrams. At least three thousand milligrams, more if they need it. Start them with three grams a day. That's not enough arginine to really make things rock and roll. Then bring it up. Maybe they need six grams, maybe they need nine. Use your experience and don't hurt anybody, but start with three grams and go up from there if you have to to get this response that you're looking for. Underdosing the person is not going to work. The more damage there is and the more that the snips are impacting the system, the more arginine you need to dump in because what you're doing is overcoming these faulty enzymes, you realize that, right? The enzymes aren't working well, they're not converting arginine to ornithine, they're not converting ornithine to citrulline, they're not converting citrulline to aspartate, right? These things are, these mechanisms are stuck. So dumping them extra arginine in here forces these enzymes that aren't working well to, you know, start to perform adequately. You're just dumping more substrate in. So even though the enzyme is damaged, you're going to get hell, you know, a response, and then the body will start to dump out the ammonia. So that's one important detox mechanism. And how easy is that, right? Off of orotate. Okay.

So another important detox mechanism, and we have time for this. I'm going to just keep going here. We still have a few minutes. If you get into these more advanced tests, you can see this in a different way. You see where it says urea cycle and ammonia detox. You can also measure the individual amino acids. That's a whole other thing. We may not get into right now, but there's more. You can get into more detail. This is an ion panel, ion, ion panel from Genova. So you can get into more detail on this. Oh, look how toxic this person is. High arsenic, high mercury. Ah, that's not good. But let's look at the, um, let's go back here and see. So many things can get screwed up in the human body. It's just frightening. It's really amazing that any of us are alive at all when you think about how complicated. Oh, okay, here's a good one. So pyroglutamate, remember I said if it's high, it's a glutat, it's a glutathione deficiency. If it's remarkably low, it's a glutathione crisis. There's not enough glutathione in the system any longer, okay? Major, major, major detox problem because D, you know, glutathione is the master antioxidant, the max master protector. So again, if you see low pyroglutamate or even worse, low sulfate, you can use glutathione if you want. There's nothing wrong with that, right? Or you can use N-acetylcysteine, sort of the classic way of getting glutathione levels to come back up. And then how much do you use? Kind of same answer. At least 3,000 milligrams a day of NAC. If you give them a month or a few weeks and nothing's happening, bring the dosages up, 4,000, maybe 5,000 if you need to. If you really can't get a change with NAC, then you can think about the constituents from which we build glutathione, and maybe the person needs glycine or glutamine as well, okay? So glycine, glutamine, cysteine, N-acetylcysteine, or you can just give straight up glutathione these days. It's easy to get your hands on glutathione. Just to show how old I am, when I started my practice, you couldn't get the liposomal glutathione. Hadn't been invented yet. It's like 30 years ago. And we used to buy, uh, from Dr. Abrashamian, no one can say his name, Dr. A, used to call him. He is this biochemist, crazy biochemist guy in New Jersey. I was in California at the time, and we would order glutathione from Abershamian's, uh, CAM Lab, and he would ship it. There's no joke. He would ship in these little brown glass bottles with no label or anything in freezer packs. And it was only good for like a couple of weeks because there's this pure glutathione that was intensely kept cold and it would spoil or go bad if it got exposed to air or heat. And it looked like we were doing drug deals, right? Because we'd hand these glass bottles with no label, you know, and no kind of protective anything on them to patients. Oh my gosh, I can't believe I did that. But it really worked. But, you know, oral glutathione is a problem. But now they have all these liposomal delivery systems that work really well. So you have to worry about that anymore, okay?

Let's look at one more test here. Oh, that one's not that messed up. Well, it is in a different way. Okay. Well, should we look at this? That's just going to be confusing. Let's find another one. I'm going to have to make one up here because I just ran out of tests here. So let's, I'll just pretend. I'll mark on one of these so you can see. I didn't pick the best example, sorry about that. But let's just pretend. We can pretend creatively for a moment here that this person's sulfate is really low. Sulfate low, pyroglutamate low, and hydroxybutyrate, alpha-hydroxybutyrate, not detected. So that's the worst-case scenario. Pyroglutamate and sulfate are low, and they can't even find the hydroxybutyrate. If that's happening, that's total glutathione collapse. It means that the worst-case scenario for detox, antioxidant protection. So an glycine, glutamine, a lot of companies that we work with, I have a combination product that'll have all these together in it, or you can use straight up glutathione if you feel like it's warranted, you know, to really bring these levels back up. And the difference this makes for people is really dramatic. So what would you expect the effects of that to be then? What would be the effects of low glutathione? Well, number one, you would expect right off the bat that you'd have a problem with your mitochondria, right? Because that oxidative stress is going to target the mitochondria, and you're going to have mitochondrial issues. The other area that you're going to often see there's problems, and this is a little more convoluted, but you see it routinely, not every time, but mostly, is that low glutathione is going to be tagged with low magnesium. Low glutathione is going to be paired with low magnesium. The magnesium operating on the mitochondria to help make cellular energy, the glutathione providing that oxidative stress protection in the mitochondria. So if magnesium is low and glutathione is low, that's a very common and very bad combination, and you need to bring them up together. And that's what Richard calls the glutathione magnesium diad. And it's very important to bring them up together because if you just do one and not the other, you're not going to get a really complete benefit, okay? You can have a so-so benefit. So if you see low glutathione, immediately check for magnesium levels. If you're running a more complete lab, if you're not running that, you're just doing organic acids and you see low glutathione, then go to the beginning part of the organic acids test again. Organics here from Genova, okay? And look at the mitochondrial markers and see how they are. So low glutathione means lack of oxidative stress protection, means the mitochondria are vulnerable, they're not protected. And what you'd expect would be to have something like this, where the mitochondria are just wiped out, low, low, low, so low they can't detect it, so low they can't detect it, low, low, right? This is just a mitochondria, you know, the poor little mitochondria are just like, are you kidding me? I'm trying to make energy for you all day long, and there's no glutathione around to protect me. Just forget it, I'm gonna collapse and just give up. And how is your patient going to feel? Not very good. They're going to be tired when they walk up the stairs, they're going to be so exhausted they don't want to get up and exercise, they're going to be depressed, their heart's not going to work that well. It's a horrible, horrible circumstance. So low glutathione allows the mitochondria to become damaged. Eventually, the mitochondria are just like, screw it, I'm doing the best I can here, but unless I get some protection, I'm just gonna take a little break, and energy production drops. You get chronic fatigue, you get depression, all these kind of symptoms, okay? So high level of toxins, glutathione drops, glutathione can't protect the mitochondria, mitochondrial function drops, patient ends up tired, depressed, unable to get much done. That's the one scenario. The other scenario, I see this like literally every day in practice. You guys learn how to fix this, you'll just be like super, super good. The other scenario is, I don't want to hunt around, I'm just going to make up the lab here so we don't have to hunt for that other test. The other scenario is high orotate. Completely different problem in a completely different section of your liver. Now you've got a urea cycle disorder. It's often genetic. It's often related to these, you know, genetic disorders that we identify in young babies. Often genetics. So you must see it running in families. Half the time when you find this, people say, yeah, it's kind of weird, sometimes my urine smells like ammonia. They're peeing out ammonia. It's just really gross when you think about it. So arginine, manganese, alpha-ketoglutarate, B6. You got to give them like a program. So arginine along with a little bit of manganese, some vitamin B6, magnesium, of course, you probably always want to do that, right? To give me. So arginine is the main hero product, but you want some alpha-ketoglutarate, some manganese in there, and some magnesium. Poof, hit them really hard, detox, just flush that ammonia out. People will feel better, I promise. I've done this now hundreds of times. If you underdose people, it's not going to work. That's my only caveat. Don't underdose people because then everyone gets frustrated. How much did you give? Three grams a day to start with. Some B6, alpha-ketoglutarate. If you really want to make this happen, alpha-ketoglutarate, manganese, and, uh, magnesium, okay? All those kind of packaged together. If that's like overwhelming and confusing, you can just buy Richard's book. He's got all this in the book in excruciating detail. So you can absolutely do that, not feel like you have to memorize everything I just said. So let's go back here. I'll show you, there's a chart in here. It just lists out every supplement I just mentioned, so you don't have to. Urea cycle deficit, here again, headache, confusion, fatigue, poor concentration, and food intolerance. Sounds like every patient that we're always working with. And then he's got another chart in here that gives you the exact dosages and the exact products to give. Let's see if I can find the chart. Oh, yeah, here it is. Arginine, uh, citrulline. It's even down to the amino acid, individual amino acids. He's got it in here for orotate too. Um, and it'll just have a list of all the supplements you need to use, okay? And that book is, uh, did you kind of assume you all know the book? But it's Laboratory Guides to Health, Richard Lord. You can buy Laboratory Guides to Health, Richard Lord. You can buy it from iBooks or iTunes, wherever you get your iBook stuff. Okay, laboratory guides to health, Richard Lord. So with the same place you buy an iTunes song, iBook, iTunes, all through Apple. You have to download it onto an iPad. Um, it's not available as a regular book, and there's some reasons for that, probably not time to get into. But it's, and when you, when you really get into this stuff, if you're wanting to like get all tech nerdy about it, and you're like, okay, well, which genetic defect is this? Which inborn error of metabolism is this? Then you can see, like, for example, arginine is high and ornithine is low. That's probably this enzyme here, number five, the arginase enzyme. Or citrulline is high, but aspartate is low. That's probably the, I can't even pronounce it, arginosuccinate synthesis enzyme, okay? And then if you really want to get techie and detailed about it, you can get in here and you can click around on these links and go to all the research studies and read about all the genetic aspects of this, right? In other words, every time you see a link like this in the book, you can click on there and it takes you out to the research study that's talking about that. Pretty cool, I think that's pretty cool.

All right, so let me, uh, wrap it up. We have another couple of minutes. So I'm just going to answer a few questions and, um, make sure that I remind you all, you have access to a huge discount on Kalish's Method 101 if you want to do a little more coursework. It's $99 bucks and it's an introduction to the mentorship. Give you a general look at that. So usually, to answer Dan's question, yes, we would want to do adrenal/GI and then detox once that's working pretty well. And I think I answered some of Je's questions. The amino acids that are most important: glycine, arginine, methionine, taurine. Those are probably the ones that are in the top. Let's see, this is a Genova test, to answer Nancy. Dr. Laura developed the Genova test. So I'm a total Genova fan. That's all I know how to interpret, to be honest. Um, let's see, make sure I cover all the questions here. Does the master class cover the same info? No, this is much more detail. The Kalish Method 101 class does get into detox, but it also gets into all the other aspects of what I teach in the course. Okay, histamine can be related to this, kind of an offbeat way. Yep, we can. You don't need to give citrulline with the arginine, that's for Cindy. You can do, but usually people don't use citrulline, usually use arginine, magnesium, manganese, and B6, and maybe alpha-ketoglutarate. It's just the stuff that you use to clear ammonia, basically. Yeah, so you can give ornithine. I do this sometimes. It's just kind of a pain in the butt because it's another product. There's some companies that make arginine and ornithine together in a single supplement, so you can use that if you want. That's definitely doable, especially if ornithine tests low, if arginine is excessive. Okay, this is Lindsey's question. This is a really good question. If arginine is excessive, what does that mean? Well, let's look at our thing. If arginine is excessive, that's the very definition of the genetic disorder, correct? So if arginine is excessive, it means that you're not able to convert it into the next pathway. If arginine is excessive, that's kind of the very definition of the genetic disorder you're talking. It means that there's an enzyme that's broken. Uh, you can figure this out with NutraVal. The NutraVal is an excellent test also. Okay, you can use whey protein for glutathione. Yep, I don't, but you could. If glycine is super high, what does that mean? That's not good. That means that it's circulating and not getting into cells, so you're not utilizing it. That means again, there may be a snip involved in that. Glycine converts to serine and back. So if your glycine's super high, look at your serine. If serine is low, then you have a snip related to glycine. That's a good trick. Uh, oh, so for supplementing with, if orotate is high, start with 3,000 milligrams a day of arginine and go up from there if you need to. Let's see, I think I'm going to run out of time now. Name of the book, I got that covered. I don't know if Sarah, ammonia will be elevated in these patients, and I've never checked for that. I'm not sure. I do an organic acid test on every new patient for sure. Yeah, if when an amino acid is high, the answer Chris's question, it usually means it's not being used. So if, if glycine's super high, it's usually there's something wrong, right? It's something that's not being broken down, uh, properly. So you have to kind of investigate that. You guys have a lot of questions here. Um, when do you use NAC? I use NAC all the time. I don't like using glutathione. I don't know, it's just kind of old school. I only use glutathione if the NAC is not working, and usually NAC works. Uh, yeah, you have to be careful with arginine. If you push too much arginine up, if they have a herpes problem, they're going to get worse, you know? Would I never recommend supplements without labs? I think that's kind of dangerous. Yeah, for the nutritionist out there, Shauna, yeah, you could. I think the Kalish Method 101 would still help you, um, to figure that out. Okay, I gotta run now, guys. Thanks for all the questions. I'm glad you have a lot of interest in this, and, um, if you're curious, end on an upbeat note. Yeah, you can do the Kalish Method 101 if you want to get more into all the detox and how this stuff works from a supplement perspective, okay? Take care, everyone. Catch up next week.