Transcription
Let me grab question number two, then. This was a deep one, also. And, um, how are you addressing retesting of your patients? Talking about adrenal testing here. I have the test, and this is a great quote. This is, you can tell, uh, this is just a real-world question. You know, I have the test done. Let me blow this up so we can see it better. I have the test done, follow up to get them started on a protocol, and then follow up monthly. Perfect. I tell them at the outset, we'll retest in three to six months, depending on how they respond. My issues are twofold. In the patients who say they feel great in two to three months, everything is improved, and they're doing really well, they're reluctant to test again because they feel so good. How do I encourage them to do another test? Second issue is the opposite. Patients were improving, but very slowly. By the time three or so months comes along, I'm struggling with retesting them because I'm not sure what new info it will tell me to change your treatment plan. And then the question is, Dr. K, how do you address these two aspects of retesting?
So again, I want to give you like a historical context to this so you can see because a lot of the, um, a lot of where I have arrived at now has been through trial and error and from me learning how to not do things properly. So in the beginning, when I first did my first adrenal panels, I never retested anyone, primarily because I was afraid of what the retest would show, and because I thought it was expensive, and I didn't have the energy or focus to talk people into retesting. So my first couple years of doing this, I, my first, I know, in all honesty, probably my first four, five years of doing this, I never retested anybody ever. Once I was just scared to because I was like, "What if I retest them when they got worse?" I don't want to retest. I just didn't want to. And so I never did. Uh, and then I thought, wow, retesting is really important. And then I started to retest everybody. And I retested every patient as much as I could for at least a dozen years. At least 10, 12 years, I was just all about the retesting. As a matter of fact, the way that I would gauge my consultations in those years was I was like, "Kind of like you had to retest. Like, the whole point of this is to retest." And so I had a lot of retests that came back because I was forcing people to do that.
And, um, what I learned from doing all the retesting was that retesting isn't really that necessary. You know, uh, because of some of the questions that are being brought up here, or, you know, or facts that are being brought up here. One is that if you get a patient, you do a test, you get a patient on a protocol, and they're feeling better, and all their symptoms are gone, why bother retesting? They can just stop the program and move on with their lives and do something different. You know, put them then on a maintenance supplement program without all the things that require testing to to dose properly. So a maintenance program would be, you know, the multi-packs and some probiotics, or maybe an adaptogenic herbal product if you want for the adrenals, just to help them with stress. So with patients who are doing great, there's very little motivation to retest, and in fact, there's really little need to retest necessarily. I would say it's fine to keep people on these programs for six months and then just stop. And if their symptoms stay away, then they're basically done. Now, if they do want to retest, probably see the retest looks like they're a lot better, but, you know, as long as they don't just keep taking the product, it's fine. So the longest that I keep patients on a program without retesting is like about a year. Um, the dosages that we use are so low, I don't think you're going to get in any trouble or cause any problems if someone does a low-dose adrenal protocol for six to 12 months and then stops. What you don't want to have is for them to take DHEA, you know, every day for the next 10 years, um, without some kind of monitoring or testing. You should at least know what the doses is to be. But I would say, you know, it's fine for people just to not retest. And in fact, I kind of am now, at this point in my career, I sort of embrace not retesting. Now, again, I'm trying to present the whole spectrum so you guys can see where you may be in a, "I want to retest everybody" mode. I totally get that if you want to do that.
The second issue that he brings up is that the opposite, patients who are improving but really slowly. By the time three months comes along, struggling with retesting them because you're not sure what new info it'll tell me. So absolutely. If what I'm looking for with patients is a, a minimum of a improvement of 10% per month. So if it's three months into the program and they're 30% better, that's fine. There's no need to retest at all. And in fact, if the progress is really slow and it's not going well at all, then the, the setup and the way I try to structure this is I'll, when I first start the program, I'll say, "Okay, let's assume they've only did an adrenal panel. You know, we got this adrenal test result back. Now, going to start you on this program. This should be a 10% improvement per month. So within two or three months, we should see that, you know, majority of your symptoms are 20 to 30% better. And if you're not hitting that level of improvement, then I'm going to suggest that we do this additional testing, which I mentioned earlier, but you're not doing yet. We should do the stool testing for parasites. We should do the organic acids testing for energy production and all these other markers." And so if, again, the two or three month mark, you're not progressing as we would hope, we're going to do some additional testing. And if you say that, um, when you present the labs for the adrenals, they'll remember that. I find it's amazing, people always remember that little statement. And then when the time comes, two, three months later, and they're not improving fast enough, you can say, "Oh, you remember there was that additional test? I really think that we should do it." And they'll almost always do the test. If you fail to warn them that there might be additional testing later, then they'll just get resentful after two or three months if you try to tell them that that's necessary. You know, it's like, um, just them knowing that there's this possibility makes a huge difference in the psychology of all this. So I always just warn people ahead of time, "Hey, I know how well these programs work. It should work within two or three months. If not, we're going to need to do some additional testing." So for those folks, rather than redoing an adrenal test if they're not improving, I strongly encourage them to do a stool test or an organic acids profile.
Now, in my practice right now, I have the luxury, and this is because I've been doing this a long time and people have a perception of me being important. You know, um, a lot of that revolves around, um, just how much I charge, and I've been doing this for a long time. So because of all these things now, um, and this was not true 20 years ago, but I, I really, basically everybody in my practice wants to do every test, which is again, like this amazing, wonderful thing. So everyone's doing an adrenal, GI, and organic acids profile. 90% of my patients do all of them because the amount of money I charge, you know, it just makes sense to just get it all out of the way so they really understand exactly what's going on. Um, it's really rare now that I get a patient that only does an adrenal panel. However, for, you know, 10 years, I had a lot of patients where I only had an adrenal test result to go on, and so I had to learn how to, you know, address all these issues. Now, now I then went from, if you look at this, there's probably an arc here which you could draw. I went from in the early part of my career being afraid to test anyone, you know, to the later part, to the mid part of my career, to trying to test everyone. And then to this point in my career, you know, I don't retest that many adrenals because I'm more interested in retesting things like the stool test and the organic acids profile. Now, that part of that is also because I've seen a lot of adrenal retests, and it's not that interesting to me anymore because I can often tell just from how the patient's reacting whether they should stay on their program or not.
So let me tell you some of those clues that may save you from retesting. So the most common, easy one is that patients on an adrenal program, they're feeling great, they stop all their adrenal supplements because they go on a trip and they forget to bring them, or they just run out, they don't buy anymore, and they crash, and all their symptoms come back. So there's no need to retest that kind of person. You can just say, "Hey, program is not complete yet. Let's get you back on that program." I don't even think we need to retest. Another example of someone you don't need to retest is someone who's under a huge amount of stress. So, um, you know, I'm trying to think of things in my practice recently. Uh, oh, how about, how about three raising three developmentally disabled kids? You know, three kids with varying levels of autism spectrum problem. I've got this one family, they have one normal child and three kids with major developmental disabilities. And this woman is raising all four of these kids. That's intense. That's a huge amount of stress. We're not expecting her adrenals to ever get better, ever. She just needs the adrenal support. So I might want her to test every year or two, but to me, with someone under that kind of pressure, um, this is just like a sustenance, maintenance kind of program. Because that's another example of someone you don't necessarily need to retest. Um, some people like to retest because in their emotional mindset, it really fits and it, um, uh, it gives them a sense of accomplishment and reward. Okay, now where that gets a little tricky is that interpreting the retests is difficult, and you're not always going to see the numbers looking better in the way that you would expect. So typically on a retest, the most solid piece of information you have is a DHEA, and is the DHEA actually getting better or not? Is it going up? From most of the people that we're working with, um, cortisol levels can bounce around a lot, and so sometimes on an adrenal retest, it can be deceptive. So like the most common example of this would be, you run the initial test, their morning cortisol is like a 40, and so they look like they're, you know, stage one adrenal case. You retest them six months later, they feel tremendously better, their morning cortisol is now a four, and they feel better, but now they look like they're at stage three all of a sudden, because their cortisol levels are really low. And a parasite that drives morning cortisol up on an initial test can make someone look like a stage one. Now they're better because the parasite's gone and they're feeling better, but their lab looks like a stage three. So it's hard to retest and always correlate. Uh, the retesting is, there's a lot you have to read into it because this is a, a picture of a process that's moving. And it's very common to have high cortisols on initial tests that go away, and so a person starts to look like they're getting worse, but they're not. So, so retesting has its ups and downs as well. Um, I always try to encourage people to, uh, retest the, uh, positive on, um, stool testing. But you run into the same problem. Let's say on their initial test, they have, uh, H. pylori, and they have really bad heartburn, and you treat the H. pylori with herbs, and their heartburn is gone, they feel completely better. How much motivated, how motivated are they going to be, you know, to do a bunch of stool testing for H. pylori? Probably not. So again, at this point in my career, I'm really happy with people not retesting for everything. Um, and use retesting more as a problem-solving tool. And then always try to escalate people to do the next test. I think that's more helpful. So if they're done their adrenal program and they're feeling great, say, "I wonder how much better you could feel if we ran your organic acids test. Look what this test includes." So rather than focusing on so many retests, I would try to escalate people to do the complete battery of tests. Um, I think you'll get better patient outcomes in general that way. Okay, and then the adrenals then become a subset of what you do. So like for me in my practice now, the adrenal protocols are probably 20% of what I do. You know, the GI protocols are probably 20% of what I do. Probably 60% of what I do with patients is based on organic acids testing. So as you learn more about the KES method and how all this works, you're probably going to drift towards these other tests more because, um, it allows you to treat a whole bunch of other things you wouldn't have known about. Okay, so that's retesting. However, however much that helps.
Next question that came in this week. Uh, what bugs like Klebsiella? Sorry, that's spelled wrong. Klebsiella and Blasto show up? Oh, I'm sorry. When bugs like Klebsiella and Blasto show up, what do you use to determine whether these bugs are treated or not? Uh, give a little bit of background. The controversy of the bugs. So, you know, there's some infections that are really, like, everyone agrees should be treated. Anistic, Giardia, Dientamoeba fragilis. There's some infections that are kind of controversial, like even H. pylori. A lot of doctors don't treat H. pylori unless it's symptomatic, and there's some research that shows H. pylori could actually be healthy for certain people. Then there's like, in-between bugs like Klebsiella, Blastocystis, Entamoeba. Let's see, Endolimax nana. I mean, it's a pretty long list. Probably the majority of the ones that we end up treating are in this in-between zone where they're not really considered true pathogens. And then you need to decide, well, is it worth treating this or not? So there's certain of these bacteria like Klebsiella that are implicated in autoimmune cases. So I would say one thing that you can look at in general is the overall health of the patient. So the healthier that the patient is, the less you need to be worried about treating these, you know, non-pathogenic bugs. The sicker the patient is, the more important it is to get rid of these because a sick patient with a low immune system is going to struggle to fight these bugs, and then the bugs can cause a lot of problems. Whereas a healthy, vibrant person with something like Blasto, it may make zero difference for their whole life and their entire, you know, existence. It may not matter whether they have Blasto or not because your immune system is handling it and it's not causing any problems. Um, my personal rule of thumb within my practice is that every patient I want to work, every patient I work with, I feel like should be infection-free. So even with a minor bug like Klebsiella or Blasto, I try to eliminate them with herbal programs. Um, that seems reasonable, but that may seem overaggressive to some doctors who may want to let some of these bugs go. I also, you know, in all complete honesty, I'm a little bored. You know, I've been doing this for 25 years. Like, how many times can you treat Blasto? You know? And so, um, one of the ways that I am entertained in my practice, and this is kind of a, I never admitted this before, but it's true, is that I just want to know what's going to get better when I treat H. pylori. And, you know, I've done this so many thousands of times that if I were just going to let an H. pylori case go and say, "Oh, you don't have any obvious H. pylori symptoms, so we're not going to treat it," I would lose a lot of the amazingness of what happens in my practice. Because when you take something like Blasto, let's say the patient has no digestive symptoms at all, and you treat Klebsiella or you treat Blasto, the amazing part about this job that to me is not boring and is actually really exciting is what's going to get better when that Blasto is gone. And the things that I hear are just incredible every day that I'm in practice. When I treat these bugs that are not causing digestive symptoms, that are digestive bugs, the things that clear up are just incredible. And in the, in the Mayo Clinic research study, this is one of my favorite ones, okay, of all time. And there's a woman in the Mayo Clinic study, and she had, I think it, I think it was Blasto. It was either Blasto or H. pylori. She had one of those bugs, no digestive symptoms, but the study required that we treat everything because that was kind of what we were doing. And so we treated her Blasto, we treated her bug. She came back at the end of the six months, and we're talking. I'm like, "Okay, so Emily, what difference did this, you know, Blasto treatment make?" And she said, "This is the craziest one I've ever heard." She said, "During the time that we treated the Blastocystis, I decided to get back to doing art again." And I have raised three children. I hadn't done a painting in 30 years. And I don't know what happened to art's itch during this time, but I started to pick up a paintbrush again. I'm painting again, and I feel better than I have in in decades. So for this woman, treating her bugs gave her the energy and intention and ability to reignite her artistic interest. You know, how crazy is that? Now, was that worth two months of herbs? Absolutely. You know, so again, just for our own, almost like entertainment, like you can't even believe these stories that happen during the times when people are treating these various bugs. And so like, if that woman had came come to me in the beginning of the study and it said, "You know, one of my goals is to restore my artistic passion that I had before I had children because my real love is painting and I haven't painted since I had kids." I wouldn't have, what I have said, "Oh, maybe we're going to treat your Blasto and you'll start painting again." You know, obviously, you couldn't even make these things up. So we don't know what treating these bugs will will trigger in our patients. And to me, again, that is why, um, this job to me is exciting still. Okay, because I want to know, you know, what's going to happen when this Blasto goes away. So anyways, I treat every bug in my practice that I can find because I found over the years that that is, um, a key to kind of unlocking whatever the next step is for a person's health. Okay, now on a clinical level, though, like if you were doing doing, uh, you know, looking at this from a more scientific standpoint, okay, the Blasto is gone in Emily's body now, she's painting and artistically expressing herself after 30 years of bottling all that energy up. Was that really, could we prove that's related to the Blasto? I mean, is that really why she did the program? I mean, you could question that a lot. But again, to me, there's sort of a magical element to functional medicine, which to me makes the job incredibly exciting. And if I lost that magical element, I think I would fall into the boredom thing. I would be bored all the time. Okay, and there's no more greater magic that comes in functional medicine from than from treating gut bugs because you never know what's going to happen to the person when these things are gone. And I'll tell you, half the time it's completely unrelated to digestive symptoms, right?
So now, um, couple other quick questions and then we'll get into the questions you guys have for the day. Uh, question number four. Can you explain about C. diff toxins? You mentioned that they're positive for both. Should refer out. Could explain in more detail. And those who come back positive for only one of the toxins, how you determine whether they need antibiotics or if the herbal protocol will be enough? So if, uh, C. diff is present and both toxin A and B are present, then the person could have, um, a major GI problem. You, this should almost always be incredibly obvious because they'll have blood in their stool, they'll have a lot of pain with bowel movements, they'll have a history of going in and out of emergency rooms with GI complaints. So someone who has, you know, variant form of C. diff that requires medical attention is going to have a lot of digestive symptoms, may be diagnosed with ulcerative colitis or pseudomembranous colitis, or they may have, you know, just crippling 12 bowel movements every day with blood in their stool. So that should be really obvious. If they have those kind of, that level of GI complaints and the C. diff is positive, then they would require medical treatment. Now, the vast majority of people with C. diff only have one toxin positive, and they don't have, you know, extreme pain, they're not having blood in their stool, they're not having a really extreme inflammatory bowel problem, in which case we can treat them really successfully, um, with, uh, the Saccharomyces protocol. Okay. And so I think the only people that really need the antibiotics for C. diff are people who have acute and obvious GI symptoms. Now, you may get patients like that who have C. diff with acute GI symptoms and that just a C. diff was missed until you picked it up on the test. Those are the folks that would need to go in for antibiotics. Otherwise, the Saccharomyces does quite well.
Last question here, number five. Are amino acids such as Kava, Rest, 5-HTP, tyrosine protocol safe to use during pregnancy? And is it possible for the amino acids such as 5-HTP, tyrosine to aggravate GERD or stomach acid? I'll answer the second one first. So I don't see the amino acids causing stomach acid problems very often at all. I think that would be rare, um, that they would trigger that. But the first question is, you know, during pregnancy, none of these supplements that we use have been studied enough so that we know that they're safe during pregnancy. So there's no research on 5-HTP or tyrosine, on any of the adaptogenic herbs, any of those things. So I think during pregnancy, really, we just have to stop all these products except for things that are known to help during pregnancy, which would be essential fatty acids, as long as they're mercury-free, fish oils, basically. Digestive enzymes could help. Probiotics are always a good idea during pregnancy, of course, you know, either a multivitamin or a prenatal vitamin product. But I eliminate all these other things during pregnancy just because we're not sure if it's safe. It's not worth the the potential worry. Okay, so.