Transcription
We [Music] are good to go. So, a third of the fat in your body right now, as you're sitting there, is related to fat that you ate. Okay? Two-thirds of the fat in your body is related to fat that you produced. You made your body. Your liver makes fat, not constantly, right? So, the fat that we burn for energy, the fat that we burn for fuel, is a combination of about one-third fat that you eat and two-thirds fat that your body produced, that your liver made primarily, right?
So, this is right off the bat confusing because when we talk about fat, we don't really, we just say "fat." We don't really talk about where it's coming from. And it matters where it's coming from because if you're eating it, certain things happen. And if, in order to produce it, other things have to happen. So, right off the bat, that's totally confusing and something that you should just think about, you know, and try to sort through. These are the things I've been struggling with for the last little while. Okay?
Um, now let's see. I'm gonna cut the camera out because I think the sound is a little off. Let's see if we could cut the camera out. You guys can see me all the time anyway. So, the second thing to think about is that we need fat for a whole variety of life-critical factors, like number one, cell membranes. Number two, your brain is mostly made out of fat. Number three, it's the primary source of energy, the primary way that we make ATP when we're at rest. Okay? When you're exercising is different, but at rest, it's our primary source of energy. So, we're not only eating fat and making fat, but we're using fat to make things in our body, right? We're using these fatty acids to produce things in the body, and then we're burning fat for fuel. So, it's, it's completely confusing. And then we are making fat at the same time as we're breaking fat down. So, there's so many dynamics here. And, you know, and I've been studying this stuff for a couple of years now with Dr. Lord, Dr. Richard Lord. And, you know, everyone always teaches this kind of in its component parts. But it, to conceptualize it, you have to think of the whole. And that's kind of a little bit, I just want to present that as an idea because you guys have all studied the component parts of this. But if you can think about the putting it together as a whole, and then think about how this presents in on the patient's side, like neurological conditions, chronic degenerative neurological conditions. We had, we're going to do case studies at the end of this talk. And we had an amazing case study recently from one of our doctors that presented a case from, you know, an advanced, an older gentleman, I think maybe he's in his 80s, with advanced neurological degeneration. And you can just see the fatty acid production, the dietary fats, the cell membrane function. I mean, all of that was just completely destroyed. And so, this matters a lot for depression, for fatigue, for any kind of neurological condition, for anyone that is overweight, obviously, that's kind of a no-brainer, right? For diabetes, for cardiovascular disease prevention. I mean, this really, really matters.
And I think what, as I've studied this over the last few years, I mean, we all have our prejudices and sort of dogmas and sort of, um, you know, like reflexive understanding. Like, I say "fat," and you think what? You know, when I say "fat," you don't think, I mean, when I say "fat," the first thing you should think of is that's the number one fuel supply for the human body when at rest. All of us, hopefully, are resting right now, unless you're on a treadmill or listening on your bicycle or something. But assuming that you're resting, and if I say "fat," you should think, "Oh, I love fat. Fat's a primary energy source for my body right now. It's making up, you know, 80 and 90% of my ATP." But that's not what anybody thinks, right? You say "fat," you guys can conjecture up all kinds of things. And so, what I want to present today is more a little theoretical, maybe. And we'll do labs at the end too, because I want to show you how you can interpret labs related to this. But that, just to broaden your understanding about this whole subject area, because it has massive clinical relevance for, again, depression, fatigue, cardiovascular disease prevention, diabetes prevention, obesity. Uh, just most of the common conditions that we're treating are, you know, are going to be tied into this. And because almost everyone that we work with has a metabolic health problem. I mean, it's rare. And the Chaos Institute, you know, we do these mentorship calls and doctors submit labs. I mean, it's once a month that we see a normal metabolic test on a person, at the most. You know, it's like, that's being generous. It's probably more like once every six months. It's rare to see normal, normal metabolic function in human beings these days. And certainly, in your typical patients, you're not going to see how much at all. Okay?
So, that's kind of what we're talking about. For those of you that this is the first one to use these, that you've done, I'm Dan Kalish. I've been teaching functional medicine for a while. I've been training doctors for a really long time. I'd love to do this. It's like, kind of my, my passion. I ran the Chaos Institute for 15 years. Um, and we lost money for the first 15 years, every year. And I worked in my private practice to fund the Chaos Institute, which is kind of funny. I did that for 15 years. And I'm kind of proud of it now. I was embarrassed at first, but hey, you know, just stuck to my guns. Um, I've done some research. And I'm, most importantly, right now, working with Dr. Richard Lord, who's one of the, you know, original scientists to develop a lot of the work that we do. And certainly, he was at the bleeding edge of, you know, fatty acid and amino acid testing, uh, you know, back in the 1980s. And, um, Richard and I just had a wonderful conversation just a couple hours ago. He and I work together twice a week. And super excited to be able to present to you a lot of his theories here. And I also, I'm IFM certified. You know, I actually am in practice as well. And just so you know, what's happening at Kalish Institute, we've got our telehealth business essentials bootcamp coming up in August. Those of you want to work on your business, whether it's a telehealth business or a regular clinic, doesn't really matter. That class is about business building, practice building. And, um, and then in the end of September, we're going to have a cardio metabolic bootcamp, which is the first time that we've presented that information. That's going to be kind of a deep dive into what we're skimming the surface of today. Okay? And you get 20% off if you use those codes, uh, for showing up for today's talk.
How we make fat. And I, today, I want to cover the things that I wish I had known before, you know, that I don't know, I just missed the boat on somehow. Um, not that there was a lack of going to classes, right? From 1992 for a couple of decades, I went to every single functional medicine class I could get my hands on. I traveled all throughout the United States, sacrificed a lot of my personal life, which is probably not a good thing, to try to learn this work. And it's, it's not that this just isn't taught very often, you know, because people don't think about this way. Because there's, again, some traditional ways that we think about these things. And I want to try to blow that up for you today so you can start to think a little bit outside the box and learn how to interpret the labs. Once you learn how to interpret the labs and your thinking gets a little creative, you can get some really great solutions for patients. And the supplement side of this is not that hard. Okay? The supplements are easy. You'll see the supplements like, "Oh, that's kind of obvious. I knew that already." But it's the thinking process, I think, that we could all improve to be better clinicians, right? So, um, and I don't say that in an arrogant way. I say that because I'm in the process of doing that, right? I'm in the process of learning how to think differently. That's what these last five years with Dr. Lord has been about. Um, that's what I want to try to share with you today.
So, um, we will learn how we make fat. How symptoms arise when this is done to excess. So, you can make too much fat. Everybody knows that. You can make too much cholesterol. We all know that. But whenever you say, "We can make too much of something, or too much of something is bad," then you have to think of the inverse immediately. And if you just do that, you'll just open up your horizons so much. So, if we can make too much cholesterol and too much fat, can we make not enough? Yes. And you can see that on the labs. If too much oxidative stress is bad, is not enough oxidative stress bad? Also? Or is, is oxidative stress, if too much oxidative stress is bad, does that mean the less oxidative stress, the better? No. There's a point where you can get not enough oxidative stress, right? Everything is on a spectrum. We also then want to look at how fats are burned and transported. Really want to focus on that because you can get some great simple solutions here with this carnitine and vitamin B2. Doesn't have to get more complicated than that. You really learn how to use carnitine well in your practice, you can solve a lot of complicated problems with that one supplement. Okay? And then we want to look at the omega-3s and omega-6s. As I look at those learning objectives, I'm like, "I don't know how we have time for this," because we've got about another 20 minutes. But we're going to try to cram it in. And then cram in some labs, right? Okay.
So, lipids, fatty acids, cell membranes, triglycerides. Already mentioned this, right? We're thinking about fatty acids. And when we look at the labs, you'll see they're broken, they break them out into saturated or unsaturated. There's all these different types, right? And then one of the most important things to think of clinically is if the lipids are screwed up, the cell membranes, by definition, are going to be having a problem. Okay? Let's say that again. If the lipids are not doing well on the lab work, the cell membranes are not going to be doing well either. And that means that the person has a big problem. And then also to realize again, if I say a word and you think about, what do you think about first? If I say "cholesterol," you immediately think bad thoughts, right? Negative thoughts. But cholesterol's role is in it, as a, it plays a role as a structural component to cell membranes. It's super important. Okay? And then CoQ10 has got this whole story behind it. We probably won't talk about today. All right? But let's look. This is, this is like the basis of what we're talking about for the cell membrane, right? It's got that top part that looks like a, uh, kind of looks like a pool ball. And this picture looks like a, I don't know what pool ball is red. It's like the five or something like that. Anyways, it looks like a pool ball. But then there's little skinny legs coming down there, right? These are these carbon, these carbon chains. Um, and then here's a side view of it, you know, again, these are all fats. So, these fats come together to form our cell membranes. Your brain is primarily fat. This is what a triglyceride looks like. Wow. It's like three of these things, hence the tripod. Look at all the carbon there. You can see all the stored energy, huge amount of stored energy there. And then we've used lipids or fats to, to make prostaglandins, the carcinoids, right? All the anti-inflammatory stuff we're talking about, immune support things. There's just the list goes on and on, all the good things that fats do, right?
And then on the supplement side, before we get into the details, before we get into the labs, if you can learn how to use omega-3, omega-6s, carnitine, and acetyl-L-carnitine, if you want to get fancy, CoQ10, and B vitamins, especially B2. But if all you take away from today is when to use omega-3 versus omega-6, there's some patients you have to use six but not three. Some patients you want to use three but not six. Does everybody get threes? Not really. What if they're high in threes and low in sixes? They need the omega-6s. Many of my quote-unquote healthy patients have been avoiding omega-6s because they thought that was healthy, to their detriment. You run the lab, you're like, "Whoa, your omega-6s are really low." "I thought those were the bad ones." It's all about a balance, right? So, if too much omega-6 is bad, does that mean the lower you go, the better? No. If too much omega-3, if not enough omega-3 is good, does that mean the higher your omega-3s go, is the better? No. Because high omega-3s will drop your omega-6s, and then you're hitting, heading into like depression and anxiety territory, right? Low omega-6s cause sleep. In fact, if they get low enough, you don't go into REM sleep very well. Low omega-6s cause anxiety. Low omega-6s cause depression. I know that's what we know about threes also, but they're equally important. Threes are not good and six is bad. They're equally important. And you can tell which one your patient needs based on the lab testing. I'm telling you, I spent 20 years of my career giving every single, this is true, true story, every single patient I would give one of these multi-packs that had omega-3s. I did that for 20 years. 20 years. I didn't understand for two decades that a lot of those people were low in omega-6, especially in a practice like mine, right? Because, like, you know, I attract whatever people, you know, people that are kind of health-conscious already, and they want to see an integrative doctor and blah, blah, blah. And they know a lot, a lot of them know more about diet than I do. They've just read every book and they're eating super clean. And then we all collectively have been doing a ton of omega-3s and avoiding omega-6s, both as clinicians. And then the patients coming in are doing that with their diet. And so, I see low omega-6 to the level of a crisis, every, every, I don't want to exaggerate, not every day in practice, but every week, I'll say that again. I see low omega-6s to the point where it's a health crisis, every week in my practice. And in the old days, before I met Dr. Lord, I would have just given those people omega-3s. That made it worse. Ah, that was so crazy. So, threes and sixes, we can distinguish that. And then how to use carnitine. If you guys just get those two things today, I'd be super psyched, right?
And then here are the lab markers, just to get the lab part out of the way. You measure the threes and sixes. You measure saturated fats. You have to learn what meat is. What the triene, tetrene ratio means, for sure. You have to understand lipid peroxides, that's oxidation or damage to fats. You need to under, you know, how to test this. Pretty easy part. But how to test for the fat-soluble antioxidants, right? For the fat-soluble ones are the ones that are protecting our lipids. That's CoQ10, E, A, beta-carotene. 8-HTG is an oxidative stress marker. Beta-oxidation. You have to learn about adipate, subarate, and ethylmalonate. Citric acid cycle. I mean, the reason why I put this list together is just to let you know, if you can master these, whatever they are, 10 or 15 things here, then you're going to have a really good sense of how this all works. And it's not going to happen today, obviously. You know, I've spent 29 years and I'm just scratching the surface of understanding these things. So, it takes time. But I feel like, you know, when I was first practicing, when I was not even in practice, but when I was, you know, in school, I met this, my Methodist naturopath, Dr. Glenn Frieder. And he just made a list. He was so good to me. He made a list. And I was like, in my first month of school, he made a, I went to a conference in the evening and he was teaching. And I went up to him. He must have saw how lost I was. But he made a list of, "Hey, kid," he said, "Look, this is what you need to learn." And he made a list of like 10 or 15 things. And I didn't even know what most of them were. And I just took it home and I spent the next four years like going through that checklist he gave me. And I did every single thing on that list. And then I went at the end of school and asked him for a job. He gave me a job. I worked his clinic for a long time. But, you know, Glenn giving me that list, it gave me some like grounding. I was like, "Okay, this is what I'm up against." So, I want to just do that for this subject. I know we're not covering all these things now, but you should at least know what you need to know. And here's the, the short list right there, okay? Just that. And these are the basics that you should just know off the top of your head, all right? And Glenn did that for me. I'm kind of passing that same idea on. And we're just, here's the cell membrane again, right? With the CoQ10 wedged in there. This is kind of a cool picture. I like.
So, I want to talk about, and this is the confusing part, right? Is that we take fatty acids, and we go through beta-oxidation, we turn them into acetyl-CoA, and then they go into the citric acid cycle, and we make energy. 80% plus of your energy at rest is made this way. We take fatty acids, we break them down into acetyl-CoA. Okay? We also take acetyl-CoA and convert it over to some other thing that's not on this diagram, and we turn that into what? Cholesterol. We also turn acetyl-CoA into CoQ10, sometimes represented just as Q. And we turn acetyl-CoA into this stuff called geranylgeraniol, GG, let's just call it, which is responsible for, um, locating proteins in membranes. Okay? So, acetyl-CoA does a lot of stuff. It can go into the citric acid cycle and make energy. It can make cholesterol. It can make CoQ10. And it can control and regulate, um, basically how proteins work in membranes. Now, if you eat too much food, and you have too much energy, too much food in your body, right? Typically, that's usually overeating carbohydrates, but you could be overeating fat too. Then you get too much acetyl-CoA, and then you get too much cholesterol. Okay? And that's a bad thing. But that doesn't mean that cholesterol is bad. Right? If too much cholesterol is bad, is too little cholesterol good? No. People get suicidal when their cholesterol drops too low. Right? It's a balance here that we're talking about. And so, as they say, the center of lipid metabolism is right here. It's acetyl-CoA. Everything's coming in there. Glucose or sugar converts to acetyl-CoA. Fatty acids convert to acetyl-CoA, right? And then acetyl-CoA goes out and does all these other things. But what I want to talk about a lot today, because I think this is something that you'll be interested in learning about, is beta-oxidation and how we take fat and turn it into acetyl-CoA where we can make, so we can make energy out of it. And this mechanism is not working very often. It's an easily disrupted mechanism because it's complicated and it's involved. It involves a bunch of different enzymes that have to work just right. So, it's very easy for the ability to burn fatty acids to get dysregulated. And then what happens? Patients get tired. They're not making energy, right? They're not burning fat very well. And it's a relatively easy thing to fix. And, you know, it's just something you should know. So, if we just learned that today, that'd be like, oof. Just, if all you just start giving everybody carnitine, I'd be so psyched. Um, you can do a lot of these things change when we do intermittent fasting. And I've really been sticking to this for a long time, you know, where we eat like around, I don't know, six or seven at night. Hopefully, we eat kind of early. If I work a really long day and teach a bunch of webinars, maybe I don't get around to eating until around eight at night. But usually, we eat around six, if we can. And then let's say six to eight, have food in the evening. And then don't eat, not eating again, you know, until maybe 11 the next morning. You know, and all kinds of different things happen when you do that in terms of ketones. We're not talking about putting yourself into ketosis. I'm not talking about that. I'm just saying that you can burn fat for a long period of time for energy. So, you digest your meal, obviously, you're burning the food that you ate for a while. But then somewhere in the middle of the night, you stop doing that, and your body starts to flip to burn fatty acids, right? And go through oxygen, you know, lipid metabolism. You're breaking down fats, and you're, it's a clean and good fuel source. And so, if you don't eat for a while, you know, until like the next day at like 11 in the morning, this goes on for quite some time, okay?
And, uh, let me show you. Oh, yeah, here we go. So, um, you can use supplement-wise, you can either use acetyl-L-carnitine or plain old carnitine. You can get it in capsules. Some companies make it in liquids, right? And the acetyl-L-carnitine has certain advantages for brain function. It does some other things that are kind of a plus. It does all the things that carnitine does, plus some other extra things. And also, with certain cardiovascular conditions, sometimes the acetyl-L-carnitine is safer or better to use. But, you know, use either interchangeably depending on the, the case. You may use regular carnitine or acetyl-carnitine depending, right? And I want to show you. I'm going to skip around a little bit here because I got the slides in the wrong order. Here we go. This is what I want to look at. And I'm going to cut back to these others. I just want to show you the picture first, then we can look at the detail, because I think seeing this might help. So, now, this is a diagram Richard put together recently. And I'm going to spend a while on this because it's important. And you're going to see this problem all the time, right? So, does lab testing for everything that we're talking about tonight? And especially for this. And we'll look at some example labs in a few minutes. So, your body, again, at rest, is running on 80 to 90% fatty acids. And here's what we're looking at here. Is the mitochondria is in green. You see the mitochondrial matrix here, all right? Here's the intermembrane space, that's the space between the inner and outer membrane of the mitochondria. And here's the cytosol in blue. Okay? So, your body has to somehow get the fat or the fatty acid from out in the blue zone, you know, through both membranes and into the green part where the mitochondrial matrix is, so you can burn it up for, for fuel. And yet, you would think that this would be an easy thing to do, but it's not. So, you can't just take and palmitate is the fatty acid they're using. It's sort of representative because that's the most dominant fat in the human body, right? By far, palmitate. I know you probably never heard of that one unless you listen to a bunch of my lectures. But anyways, when we look at labs, you'll see what I mean. So, you take palmitate, this is a fatty acid, and you have to somehow get it all the way over here, except for these two membranes that you have to get through. And so, if your body, if it could just diffuse in, then if we ate a really big meal, or ate a really fatty meal, or ate a bunch of carbs or something, then the mitochondria would just be saturated with fat. It would just break down. It would be like, um, I don't know, it would be like sticking a bunch of, you know, glue or super glue in your bicycle chain or something. The whole thing would just get gummed up, right? So, your body highly regulates this process with a series of transporters and enzymes and translocase proteins and all these complicated things. But one of the things that is very interesting, and I think when you visualize this, it makes so much more sense, is that we have to take this palmitoyl-CoA, right? This palmitic acid derivative, right? And we have to bring that across that barrier. But your body can't do that because the CoA part of this thing is so big, just physically large. You see how large this is there? That won't fit. So, your body needs to convert that palmitoyl-CoA with the CoA thing on it to a palmitoyl carnitine with carnitine. And see how teeny tiny carnitine is? Carnitine can fit. And so, if you can do that process well, then you got it. And I'm going to show you again here. It's a size-related problem. So, you've got to get this palmitic acid, this fatty acid, across these membranes. You convert it into a palmitoyl-CoA, but that thing is huge, right? So, instead of just being able to transport that, here it is again, palmitoyl-CoA. It's big. You can't transport that. So, you take the CoA group off. You cram on a carnitine. Here's your carnitine. And that tiny little guy goes right through here. See? The palmitoyl carnitine fits right through that translocase protein and ends up inside the mitochondria, right where you want it. The carnitine goes, "Thanks for everything. Uh, you don't need me anymore." And they split up. Carnitine goes back out and you use it again. And that palmitoyl carnitine gets converted into palmitoyl-CoA again, which is what it was out here. It's crazy, your body does, isn't it? So, in other words, to get the fat, and this is the primary source of energy in the human body when at rest, okay? Let me just say that one more time. This is the primary source of energy in the human body when at rest. You have to get this fatty acid from the cytosol way over here, and you go through this crazy town thing of converting it into palmitoyl-CoA, then turning it into the carnitine version that allows you to size it down so it can get through these translocase proteins that are in the mitochondrial membrane. The carnitine splits, goes back out, and the palmitoyl carnitine converts into palmitoyl-CoA, and then you burn it up for energy. That's a lot of complicated steps. That's why this can go bad so many times in so many different ways. There's a lot of genes that can disrupt this, right? A lot of genetic disorders can disrupt this process. If you Google later on, carnitine genetic disorders, you could probably read for years about that. And if any one of these genes isn't working quite right, or if you're low in carnitine, or low in vitamin B2, this entire process falls apart. You can't burn fat. And you can test for this with ethylmalonate, subarate, and adipate on an organic acids test. And I'll show you how to interpret those, okay? So, if those markers are high, it means you're low in carnitine. And it's not a very complicated solution. You either give the patient acetyl-L-carnitine or regular carnitine, and this thing will start to work again with the B vitamins, and especially B2, okay? So, that should be something that you just know how to do because it's going to resolve a lot of fatigue, a lot of exercise intolerance, you know, people that can't work out very well because they can't burn fat very well. What seems like blood sugar problems can be resolved with this. A lot of different issues show up around fatty acid oxidation. And I see it in patients. I don't know any of you guys that are in the mentorship class could probably chime in, but we probably see it, not all the time, maybe 20% of people that we test have this. That's common, though. You see it regularly, okay?
So, let's go. Yeah, I think that's enough of that, right? That kind of explains why you should use carnitine. I have too many slides and not enough time, so I'm going to skip around things. This is a diagram of the exact same thing I just said, but let me, because it's so important, sometimes, you know, people relate to different pictures or colors or whatever. So, again, same exact thing. Here's our fatty acid, right? And here's our carnitine. And in order to transport that fatty acid through the membranes into the mitochondria, you need carnitine. It's the same diagram showing, and that's showing how it then gets into here, and then it starts to be broken down for energy, okay? That fatty acid is, uh, clipped. It gets shorter and shorter. And this, you know, energy gets spun off of there. Here's another diagram of the same thing. Carnitine is carrying the energy supply, right? The fatty acid into the mitochondrial matrix. All right? And remember that oftentimes, you will see either a nutritionally based, either a nutritionally based or genetically based defect with the body's ability to do all these things because it's a complicated process. There's a lot of places it can break down. If you don't have enough carnitine because your diet is not supplying it, or if these enzymes have a slight defect, you know, one of these translocase proteins has a defect, then this whole process falls apart. And you can fix it by giving the person enough carnitine to make the system work. So, in other words, it's a silly example, but I use it with patients all the time. If you had a garden hose, you're watering your lawn, everyone has experienced this, then you get a kink in the hose, and the water's not going through quite as well as it was before, right? If you have a sprinkler and like there's a kink in the hose, now the sprinkler is not sprinkling much, right? And if you just crank up the water and you push more water through, then the thing will start to work. So, if you have a defect in one of the genes that regulates carnitine and how carnitine works, if you just give more carnitine, that gene will start to work properly. So, you can override a snip in this area, or the person may have a nutritional deficiency of carnitine, which is even easier, I guess, to fix. You just give the carnitine, they get better. So, that's item number one. Want to make sure you can prescribe carnitine. We'll look at some carnitine-related labs in a minute. Then item number two, I wanted to make sure I cover off on is essential fatty acid deficiencies related to everything that you can imagine that's bad, from alcohol cravings to chronic inflammatory problems, right? And anything to do with the brain, etc. And you guys probably know this already, the benefits of, you know, the fatty acids. But let's look at, um, when we get to the labs, this, this diagram is important. So, I thought I'd kind of sketch it out. So, here we have the omega-3s, the good ones. And here we have the omega-6s, the equally good ones. Okay? Equally good. We're all equal when it comes to fatty acids. So, alpha-linolenic acid converts into sterodonic acid, converts into this one, converts into this one, etc. The omega-6s, linoleic starts the game off, converts into GLA, dihomogammalinolenic, and arachidonic, and so on. And they even put their economic in red to show you that it's bad. However, these two systems, the omega-3 and omega-6 systems, right, are using the exact same enzymes. Delta-6 desaturase is used by both. Delta-6 elongase is used by both. Delta-5 desaturase is used by both. What that means is that if you give somebody long-term supplementation of omega-3s, you're going to soak up all this enzyme activity. All that's going to be on the omega-3 side, and your omega-6s are going to drop. So, I'll say that again. Long-term excessive supplementation with omega-3s is going to pull all these enzymes over to the three side. And then there's only a certain amount of delta-6 and delta-5 to go around, right? Only certain. So, if, and they have a preferential tendency to work with the threes anyways, these enzymes do. They work more easily with the threes. So, if you give omega-3s into high dose for too long, the sixes are going to drop because these enzymes are going to get, um, you know, kind of hogged by the, by the omega-3 side, okay? And I see this all the time in practice. And if the omega-6s go low, really bad things happen to your brain and to your body because you need the threes and sixes in equal balance. Just because we have a situation where people who eat a lot of fried foods and people who just eat unhealthy food in general have too many omega-6s, doesn't mean that omega-6s are bad. That's unfair to characterize any, you know, that's just not the case. And again, you can see all this on the labs. All right? So, threes and sixes. And we look at some testing. This is my little slide about, you know, sixes are important too, you know, okay? Arachidonic acid, it's not all bad. It helps us make leukotrienes and thromboxane, and there's all kinds of good things that happen with the right amount of arachidonic acid. If arachidonic acid, this is an omega-6, right? It goes too low. If it goes too low and you don't have enough omega-6s, then you're going to have problems with all kinds of things, right? And there's some other random slides here we don't really need right now, okay?
So, we're going to look at some labs. We're right on schedule, all right? And then we'll do questions at the end. So, this is just to show you the two extremes. And these are, um, fatty acids that are being tested with plasma, okay? And this is a summary of a Genova lab, a Nova lab, I'm sure you've all heard of. And so, you can have what they call the greater than sign here, where certain fatty acids are quite high. And you'll see down here, these guys right here are high, okay, leading to that arrow-looking thing. This is a body, this is a body that's making too much fat. How do we know that? Because palmitic and stearic are primarily made in your liver. And if they go high, it means you're eating, I'm sorry, it means you're making too much fat in your liver, okay? And why would you do that? Well, remember we talked about acetyl-CoA. If there's too much acetyl-CoA, you're going to convert it into fat. Your liver is going to turn it into fat. Your liver, obviously, can turn carbohydrate into fat. However, to balance out our discussion, because today is more about adjusting your brain and adjusting anything else, right? You can have, if you can have too much palmitic when you're diabetic, for example, or, you know, or you have fatty liver disease, or whatever. Can you have not enough palmitic? The answer is absolutely yes. And here's an example of not enough palmitic. Here's another example of not enough palmitic and stearic, okay? So, it can go either way. You can have too much, which would be your typical metabolic disorder. A person probably has high triglycerides, high cholesterol, high risk factors for heart disease, high saturated fats produced by the liver, maybe fatty liver, maybe their blood sugar is not regulated well, right? That whole package of problems. Or you can have this situation where there's not enough of these fats being made. The polar opposite, polar, polar opposite. And that is kind of what makes this interesting in a way, is that you never know what you're going to see next, all right?
So, now I'm going to take a second here. I'm going to give him a second here, going back in time. And we're going to look at some cases for maybe 10 minutes, and then we can do questions for maybe 10 minutes, then we'll wrap it up. But I want to focus on carnitine and then omega-3, omega-6 balance. And then tell you guys, for those of you that think this is an interesting topic, we have, and I've been working on this for like, literally two or three years. I'm going to release this cardio metabolic bootcamp in, uh, September. So, if you're really interested in this, you can sign up for the cardio metabolic bootcamp. It's a two-month kind of immersion into this work. Lab interpretation, lectures. There's a whole bunch of talks that Richard Lord gives that are in here that are pretty mind-numbing but really good. You learn a lot. Everyone live loves listening to him. No one really understands him, including myself. But just listening to him talk, you're like, "Wow, this is like so important. I really gotta learn this stuff." So, there's Richard's talks, there's my talks, there's case studies that I'm presenting. That's the cardio metabolic health bootcamp that's starting in September. And don't be intimidated. We're starting at simple levels, you know, moving up to advanced. So, that one's going to be good. And then we have the business bootcamp starting in August. If you want to work on your business, if you think about a telehealth practice, that class is oriented around that. If you just want to work on your regular clinic, we can do that as well, okay? That class is kind of designed just for people that want to build their business, right? Okay.
So, now let's look at some labs, as promised. And, um, what I like to do with these is just make it real, you know? And pull up real labs that real doctors have submitted to real classes that I've been teaching in the recent past. And then I also have some of my labs as well. But let's look at here. This keeps me on my toes. So, I don't like, you know, cherry-pick these, you know, these are just like real ones. See, oh, here we go. All right. So, this is from class from a few weeks ago. One of the doctors submitted this. David. And in the mentorship class, this is what we do all day long. We just read labs that doctors submit. All right? So, David submitted this. It's an investment company owner, not on any pharmaceuticals. Let's see. And David's practitioner, that's been in the mentorship group for quite a while, he's gotten quite good at interpreting labs already. One of the patient's top complaints, sinuses, GERD, allergies. Wants to use labs to maximize his health. So, we're going to skip through the parts of this that we're not talking about. But just so you can see, this is an Ion Panel from Genova, and it's very similar, if not pretty much identical, to the NeutraVal, if you guys are familiar with NeutraVals, okay? And we're going to look at the markers that we're talking about tonight. There's a lot going on with this patient. Look at this, okay? All right. All right. This is a good one. I, I swear I just picked this randomly. This, I, I swear I did. So, lipid peroxides, that's high, right away. Your alarm bell should go off. You should be, you know, calling 9-1-1. If there was a 9-1-1 for functional medicine doctor support groups or something, you should be, I don't know, what does that mean? Okay. It means that your lipids are getting oxidized. Why does that matter? Cardiovascular disease, diabetes, neurological conditions, right? The cell membrane is getting nuked. Your cell membranes are getting hit. Anything that your, your nervous system, your brain is getting hit, right? It's getting oxidized. These fats are being damaged. So, right off the bat, this is an extra bad thing. And then we're going to look at the actual fatty acids. Okay? So, there's the omega-3s, and there's the omega-6s. I swear I just picked this randomly, but this is exactly what we're talking about, right? The threes are good, except for alpha-linolenic. Who knows what alpha-linolenic is? Does anybody know? Do you guys know? What I don't know how much you guys know. Like, I don't know who you are in the mentorship classes. I get to know everybody. Type in if you know what alpha-linolenic is. Okay. And if no one types that in, in like 10 seconds, then I'll tell you. One, two, three, four, five, six, seven, eight, nine, ten. Nobody. Okay. So, that's flax, okay? Flaxseed. And it's the first one in the sequence, and it should be able to convert to the others. So, this is an easy one, just to tell them, "Hey, you do a tablespoon of, you know, ground flax seeds every day." That knocks out the threes, all right? But look at the sixes. Are they in good shape? David circulated in red. He's got red marks all over this thing. The lab's got blue marks with L's. This is like Defcon 10 functional medicine crisis. How could your brain work properly with omega-6s this low? The answer is, not the cat. Okay? You have to see the arachidonic low. We are not saying that high arachidonic is a good thing. That's bad too. We're just saying that low arachidonic is a mission-critical problem. Also, okay? So, this is a patient that could use some flaxseed oil and a whole ton of omega-6s. And they're going to, I promise, this stuff works. I've been doing this for a long time. You can trust me. I promise. If you give a patient like this omega-6s, they will come back in 90 days and they will tell you they feel better. They will be less depressed, less anxious. Something will get better, okay? Because you have to have these fats. So, GLA is usually the preferred supplement form, the GLA, evening primrose oil, borage oil. So, a normal dose of evening primrose or borage oil or GLA would be around 250 milligrams, maybe twice a day, maybe 500 milligrams a day. If the someone's really low like this, I usually either double or triple the dose. So, I'd probably give them 500 milligrams of GLA at least twice a day for the first 90 days and then see how they're doing. If you're in the mentorship class, I'd say to do higher dose. But for the purposes of this class, that probably is going to get me in trouble. So, I would start with that 500 milligrams twice a day, see what the response is like, okay? That won't get you into trouble. Um, it's double, doubling the normal dose. But still, this person is quite low. But I said 90 days, I didn't say the rest of their life, right? 90 days, okay? So, now, now we dealt with the threes and sixes. And surprisingly, they don't need fish oils, right? Oh, and to make things even more interesting, here's our palmitic. So, what's, what's palmitic again? Okay. Palmitic and stearic, where they made? They're made in your liver, okay? Are there, is it a dominant fat? We'll look at the reference range here. See how the reference range on palmitic is 667 to 2526? Are there any of these other fats that come even close to that? You could take all these other saturated fats and add them together in terms of the amount, it doesn't even come close to how much palmitic you have. It's the dominant fat in the human body by far. This is by a volume thing here, right? The 95th reference range gives you a sense of volume. So, you're talking about 2,000 units of this particular fat is normal, whereas 20 units of this one is normal, or six of this one, right? So, these are whole orders of magnitude difference. It's like two orders of magnitude different. 27 times 10 is 270 times 10 is 20, right? 2,000. So, like, we're talking about a hundredfold difference. Your body has a ton of palmitic in it, primarily made by your liver. If palmitic is low, right, it means your liver is not working right to make it, okay? How do you correct for that? Give the threes and sixes that they need. In this case, it's the flaxseed and then the GLA. All right. Now, when David went to town marking this one up, um, I don't see him on this call. I'm sure I'm glad because he already talked about this with him. But here are the markers for fatty acid metabolism or beta-oxidation. They happen to all be normal. But I just want to show them to you. Adipate, subarate, and ethylmalonate. Okay? If any one of these is high, if any one of these is high, it means you want to give the person carnitine. How much carnitine? They usually come in 500 milligram capsules. So, maybe two capsules, three times a day to start with. See what the response is like. See if that's enough. And then also give them a B complex with, with B2 in it, right? Pretty much all B complexes have B2. So, do a B complex plus a gram or two.
of carnitine a couple times a day to start to see if you can get that carnitine shuttle to work. Remember, we saw that how carnitine your body has the fat that's trying to make energy out of it, it has to cram a carnitine on there in order to make it work. And again, if these markers were high, it would show a low level of carnitine. This person doesn't happen to have that problem. Um, I think that's it, right? Those are the major things that we're talking about. Let's see if there's another lab here. David sending another one. Oh, look at David. This is a whole different one. Okay, 86-year-old homemaker. Um, let's see, anxiety, hypertension, poorly controlled back pain, about 10 years of that, started when her husband died. Um, questions for Dr. Kalish. Okay, so there's other labs obviously that we're done. So the patient has an adrenal test with a stage three, so they have low cortisol. They have a GI test with Citrobacter, Klebsiella. Couldn't tolerate either protocol. Patient has severe sensitivities to most interventions and medications. What are the priorities in the ion panel?
Okay, so again, David ran the adrenal lab, he ran a GI Effects lab, he ran the ion panel. She's not responding well in treatment, so we're thinking, what can we do now? We're going to skip over the things that we're not supposed to be talking about, but let's go to the relevant portions. And again, ion panel, pretty much identical to a Neutroval. Most people prefer the Neutrovales. I'm old, I like the ion panels more. Well, there's a problem. Aluminum and arsenic are high. Cadmium, lead, and mercury are not far behind. So what, when you, when you see heavy metals, what, what do you think about immediately? You think about them damaging the brain, right? The fatty tissues, the body. Okay, fat-soluble antioxidants. We talked a little bit about, remember, they're CoQ10, alpha and gamma tocopherol, it's a fancy name for vitamin E, vitamin A, beta-carotene. These are the fat-soluble antioxidants, and they're low. So what does that mean is happening to your fats? They're getting lip, they're getting damaged, right? And then, ouch. Okay, well, this is a good kind of contour example. Omega-6s look pretty good. Omega-3s, not very good. Okay, so you would give EPA, DHA, etcetera, to get this going. And then let's look at, oh, look at this. How convenient. We've got high ethylmalonate. What does that mean? It means there's a carnitine deficiency. All right, so let's do a little program design. This is my favorite subject. I feel like patient program design is an art form. You know, I have a lot of people I've met throughout my life that are real artists, um, where they're making art, you know, and in my mind, um, I can't do that or don't do that, you know, and so I feel like this is an art form though, to design a program that a human being can actually do. That's the hard part, right? All right, so let's look at a little program design. And when you know, when you go through this, I mean, we've been talking for a while now, we're almost an hour into this, and most of you probably dozing off by now, but the, um, when you, when you get into this stuff, and this is why people are in the mentorship, because they want to figure out how to design programs. When you get into this stuff, you realize, okay, we know this patient. Let's deal with this patient first, right? We know this patient's low in omega-3s and they have, uh, a carnitine problem, right? So we want to work with their fatty acids. So I would do an omega-3. Depending what company you use, they're very similar. It's usually in a thousand milligram capsule, and they're going to have EPA and DHA in them. If the person's, I'm going to tell you what I actually do in practice. You can do this or not, you know, if you're not very experienced, maybe be nervous about doing this, but I give triple the normal dose for 90 days if they're really, really low on the labs. So normally you would give someone two capsules a day, I give them six for a very short period of time. And I would write in all capsules here, 90 days only, because this is not a program for them to do for any longer than that. After 90 days, then stop and cut in half. So you start with this triple dose for 90 days, looking for a clinical benefit, a loading dose. Then you cut it in half. If they take this much omega-3 for a long time, they're going to get screwed up. We just talked all about that, because their omega-6s are going to tank. So you can't do this for very long. Short time therapeutic program. Short time therapeutic program. Very brief therapeutic program. It's not meant to. How long is this 90-day program for? It's for 90 days, and then you stop. We'll ask that, they'll say, how long is this 90-day program for? Well, it's for 90 days, then you stop. Even if you feel good, you're going to stop. Then I would use carnitine, and you have your choice. If you want to get all fancy pants, you could use acetyl-carnitine. If not, you can use regular, plain old carnitine, 500 milligrams, and somewhere around at least two of them, three times a day, also. And then you always got to use whenever you're doing anything along these lines, you have to use a B complex, usually, you know, one a day is enough for that. Okay.
Now, if we're working with that first patient, they had, I would do the exact same thing, but in the opposite, right? Omega-6. Let's say a 250 milligram capsule. Usually those are given two a day. I would do six a day for how long? Only for 90 days. How long is a 90-day program? Is for 90 days, then stop. You can't, even if you feel like a million bucks, stop and cut the dose in half. If you do a therapeutic dose for a short period of time, you'll be okay. Okay, you don't want to use it for longer. And then that person also needed flaxseed. I usually use ground flax seeds for that, one tablespoon a day, right? Oh, and I think that first one had high lipid peroxides, remember that? So you want to use fat-soluble antioxidants. And in fact, the second one had, let me show you guys this. This may be confusing. Um, this one had, is it easy? They had low fat-soluble antioxidants. So you know they need fat-soluble antioxidants, right? The lipid peroxides are normal, but they have low fat-soluble antioxidants. Why are you going to get the fat-soluble antioxidants to protect the fats? That's the whole point, right? You remember these fats, the membranes, these are the guards of the membranes, the guardians of the membranes, like guardians of the galaxy. But these guys are guarding, guarding, guarding the membrane, guarding the brain, guarding the breast tissue, guarding anywhere where there's fat, right? Fat-soluble antioxidants, that's their job. They just sit there around the fat tissue and protect it from oxidative stress. So you got to give, in this case, E and A and beta-carotene. Now, in this other case, um, and this, let me just show you the first one, the fat-soluble antioxidant levels were okay, remember, but the lipid peroxides were high. So they need fat-soluble antioxidants to protect the cell membranes, to protect the brain, to protect anywhere where there's fatty tissue, okay? So both of these patients need fat-soluble antioxidants. And what are they? Vitamin E, get that 400 IUs, usually a couple of those. Beta-carotene, the one I use is from Pure Encapsulations, I think it's 7,500 IUs, probably give like three of those. And then if you just go on, you know, you can use CoQ10, that's a classic fat-soluble antioxidant. You can pick and choose depending what the lab says, but you can do, you know, you want to use fat-soluble antioxidants when the fats are in danger, right? Okay.
So now we're right around time where I gotta switch over to questions. Uh, let's see. These are the things coming up. You guys want to interact with us more? Sign up for a boot camp. We'll also have a mentorship class starting at some point, I'm sure. All right, let me go back up and look at questions. Um, [Music] yeah, so let's see here. Not be able to get to all these, but let me just try here. What if you see high markers and low markers for any given category? That depends. So there's no simple answer for that. It depends on what the markers are. You have to really learn each individual marker. But remember, this is a multi-decade process, okay? Um, let's see. Omega-7s, have any role? I don't think in what we're talking about, at least not that I've read. People don't talk about that very much. Um, what about commercial chicken? I'm not, I don't know anything about commercial chicken and the fats and the chicken. I'm not sure. Oh, product names. If you, well, any of the companies, the ones that I use the most are Pure Encapsulations and Designs for Health, and they each have amazing omega-3, omega-6, and carnitine supplements. They're basically interchangeable. So you can just look at those two catalogs. I just recommend those two companies at this point in my career. You know, I just come down to those two. Why not just tell people to use more fat in diet? You should get the diet dialed in. So for example, if you want to get more omega-6s, you should get them eating omega-6 rich foods. But I think you'll find when people are extremely low like this, the diet takes so long to correct them that they won't feel a clinical benefit right then. To Joseph's question, yes, I didn't mention this, but you can have a genetic defect in the delta-6 or delta-5 desaturase enzymes or those elongate enzymes. Many of these fatty acid deficiencies are related to enzyme defects, okay? And they're genetically based, meaning that the person needs to take the fatty acids potentially for the rest of their life. Best sources of natural omega-6? Just nuts and seeds, basically, right? Almonds and walnuts. And I use hemp milk just because I like hemp milk. Um, let's see. Might there be a, in first case, are super-8 adipate low due to poor availability of fatty acids in general? Yeah, so that's an advanced question. Robert always asks the advanced questions. So you could absolutely have artificially low adipate, super-8, and ethylmalonate. And on a retest, you can see that shoot up. There's an absolute yes to that one. Okay. Um, oh, the omega-3 is about a thousand milligrams per capsule. So you can start them off at six grams a day and then cut it back after 90 days. Um, let's see here. Thank you, JE, for that comment. I designed those programs for you. Um, so if people are allergic to flax, then for sure don't give it. You have to have a workaround. There's other threes that you can use. So adipate, subarray, and ethylmalonate are generally a problem when they're high. When they're low, it's confusing as to what that might mean, okay? So we usually retest every six months, and you'll learn more from the second test than from the first. So the second test just kind of will open up a whole bunch of more questions. Yeah, and so for in terms of, uh, uh, Paul's question, we use Rupa Health for all the lab, uh, workups. If you guys haven't heard of Rupa yet, then you should use them. Um, they have saved me a huge amount of money. And Rupa is like, basically an online distributor of lab tests. They work with all the different lab companies, and they'll take care of all the logistical hassles of ordering labs. It's kind of a company I was just waiting to be created, and now they're here. This has helped save my practice. I estimate about 10 hours a week of employee time. So they work with all the different major lab companies. You can use Rupa Health here. They are Rupa Health. Okay, tell them I sent you. They'll be nice to me if you tell them I sent you. It's a great service though, Rupa Health. So check them out for ordering labs. They take care of all the hassles. And then for ordering supplements, I use Fullscript to answer Rita's question, okay? So Rupa Health for ordering labs, Fullscript for any supplements. And then your staff time just got cut in half by those two things, by the way. That's the kind of stuff we talk about in the Business Essentials Bootcamp, just how to save money on your practice. Rupa to order labs, Fullscript to order supplements, that'll cut out 15, 20 hours a week of employee time. And I don't know where you guys live, but my employees are in California, and it's expensive to hire.