Transcription
That's let's see if my new headset is working. You guys hear me? Because someone raised their hand if they can hear me. Testing. Yeah, I think it's working. There we go. Thanks, Maria.
Okay, we are ready for action. This is kind of a different theme than usual for today. It's like the hard cases, then we're gonna do. See if that helps you guys at all in your pursuit of knowledge. So, alright, let's get going. Let's do the intro. And so this, the topic for today is managing difficult patients, sequencing patient treatments. And this seems to be something that's pretty complicated and takes a long time to learn. I think usually it's a trial and error kind of situation. So we try to take away the error part of the trial in here.
So, just most of you probably know me. I just do a short introduction. I've been in practice forever. We have to keep updating these slides. I think it's like 23 years now. In 1992, I started seeing patients. And 23 years, tons of patients, trained tons of practitioners. Kind of into my spiritual side now. I meditate pretty much two hours every day. I wake up. How do I do that, you ask? Well, I go to bed at 9:00. I wake up at 4 a.m. Meditate from 4:30 to 7, usually. Then it gives me an hour to get ready for work. I start work at 8. If I go to bed at 9, the whole thing works out beautifully. And I value my meditation time enough now. I'm willing to turn a TV off at 9:00, go to bed, and and have a better day the next day. You know, and it's really tempting to watch that one, you know, TV show, but I try to avoid that. Finding now, in my senior years of functional medicine practitioner, or anything practitioner, that spiritual side really is pretty important. You know, in terms of keeping us vital as as part.
So I want to cover a couple of new ideas. I'm sort of provocative things, maybe that'll help you with your practice and and help you with a little bit of development in terms of patient treatment programs. And always interested in patient education as well. You know, we just got back from the I FM meeting on detox, two detox module in Chicago, and had a really great time, great seminar, and a lot of interesting and wonderful doctors. And really, just see this explosion now in functional Mis. And that's very exciting for me to watch. And as I'm getting more into it, and you know, you know, after 20 years, and you do the same thing over and over, you start to think about it a little differently. So this is my present way of thinking about it. And I use this as a model to explain to patients what the heck we're trying to do here. Because you guys know as well as I, you know, we get a lot of these really like overly educated patients. And that translates into they spent too much time on Google, you know, trying to figure out why they have an autoimmune thyroid problem. And that, a lot of what I do now is not explaining things, we're trying to simplify things. Because people are so overly educated, they often know more about their specific condition than I do. You know, and it's a matter of kind of taking them off the edge and showing them some of these simple things. And I want to, I want to show you one simple way I explain things to patients. Sound, hopefully this is of any benefit. You can use it in your own practice. And this is what I call my FM treatment chart, where we're going to cover underlying causes, physiological damage, body systems, and symptoms. We go into that in detail. Talk a little bit about the three ways people get sick. We're going to get into sequencing of the different programs. And then we can do a couple of case studies. I'll show you how this actually rolls out in a real practice in terms of what we do here at the Kalish Institute. For those of you that aren't familiar with us too much, we have practitioner support. We laugh, we cry. I spend hours every day on the phone with doctors. Why? Because, like, you know, we all need to support each other. And, you know, I have this training program, but a lot of it centers around us staying healthy ourselves. You know, and how is that going to work? And how are we going to test our own adrenals and and make sure that we have a network of support? And I'll show you about the community in a few minutes so you can see how we help support each other at the key lessons too, as well. Then, you know, always been my absolute passion is the clinical mastery of this and having clear clinical models. And then now, in in like the latest couple of years, I'm trying to develop this business mastery. Not there yet. As a matter of fact, if you really could look inside at my business, my accounting and bookkeeping, you'd say this guy isn't a business master. But I'm trying. I'm really trying. And we've got business consultants running around everywhere trying to get practices going. I do have a very successful clinic, and I do make a lot of money. But, you know, I'm streamlining that and making it so like it's a real business. It's not just this Dan show. You know, and we have a business module that we're launching now as part of the training program, which is pretty cool too.
Okay, so I want to go back to these four general categories. I want to show you some lists. This is just to get you thinking about it, kind of questioning session here. This isn't like a definitive list by any means. But we should all, and you should write this down. You can write down right now if you have a pen handy. You know, what are the underlying causes of the health problems that we're treating? That's a broad, general, essential question in functional medicine. And I think, in general, we could come to some overall agreement that there's a finite list of underlying causes. Now, here's a list. This isn't a definitive list. It's just something I jotted down. Number one for me is the emotional spiritual connection. Because if that's there, we're, you know, you have to address it. Trauma, childhood sexual abuse, child your childhood physical abuse, addiction problems, you know, other really heavy-duty stuff that plagues people. Is there a dietary problem? Is there a gluten problem? I separate dietary from gluten. Dietary, in my mind, is kind of like poor diet, blood sugar control. Gluten, sort of separate. GI infections, toxins. You can see the list. Genetics, epigenetics, structural, sleep, exercise, over exercise or under exercise. That make you sick? Was there surgery? Was there a dental problem? You have Lyme disease or viral thing or SIBO or some like that. So the idea is that there should be a list of underlying causes that we all have written down somewhere. And just add to it as you find new ones. Okay? And we could keep a repository of underlying causes somewhere. But my point is that there's a finite number of underlying causes. This really not that many. And we should know them all.
When the underlying causes got going, and you've got that gluten problem and that infection, then there's again, a pretty finite number of physiological damage things that take place. There's inflammation, there's oxidative stress, there's mitochondrial dysfunction, there's nutrient deficiency. The types of physiological damage that take place. That's a really short list. So think about inflammation, just as a simple one, right? If you have a GI infection, you get inflamed. If you have toxins, you get inflamed. If you don't sleep enough, you get inflamed, right? So there may be a bunch of underlying causes, but not that many physiological damage scenarios play out. That's a short list.
The third area is body systems. And there's a whole bunch of body systems here. In my practice, I only deal with three or four, which keeps it simple. I deal with adrenal, GI, liver, and brain. And of course, we have other patients with other problems. But in terms of patient education, I keep it really simple. And then maybe thyroid, if we have to. Okay?
Now, where it gets interesting is in the number of symptoms that people can have. And this is an endless list. You know, constantly hearing about new symptoms. I don't know, it could be anything from toenail fungus to depression or anxiety. But, you know, the symptom list goes on and on and on. But when you throw this all in a chart, and this is where it gets kind of interesting, and I'm trying to do this for every new patient now. Okay, Sue, my new patient, what are the underlying causes of your problem? Let's write them out. What's the physiological damage that those problems occurred? Let's write it out. What body systems have been affected? Okay? And how does that all add up to the symptoms that you're experiencing? Okay, I get that you're depressed. But in your case, Sue, I think that depression is because you've got a leaky gut, your adrenals are not doing that well, you're inflamed, you've got oxidative stress. And I think that all happened because your blood sugar and your gluten and your dietary problems, and you've got these talk sensory, you know, whatever the individual scenario is. To try to, like, physically lay this out on a piece of paper so you can show people. Here's what I think your underlying causes are. Here's the damage I think that's happened. Here are the body systems I think that are impacted. And that's why all these symptoms are happening. And now, if we can do that, it just makes it all crystal clear for patients so they can see what's going on. And then you can say, and this is where it gets fun, is, okay, well, what do we want to treat here? So, of course, we want to treat the underlying cause. That's kind of obvious. But do we want to treat the inflammation too? Maybe we should work on your adrenals? Or maybe not? Maybe your thyroid? You know, do we want to treat a symptom? Do we want to give you some amino acids to address the depression or some energy boosting thing for your fatigue? So you can have treatments that are based on each one of these categories: treating the cause, treating the damage, treating a body system, or treating symptoms. And, you know, I always thought in functional medicine that we shouldn't be treating symptoms. But that's not really true. I think it's really important to learn how to treat causes, damage, systems, and symptoms. We should all be good at all these things. Because treating the symptoms is what gives the patient motivation to want to keep going, you know, in terms of doing a program.
So here's just a super simple example of how I model this. The underlying cause of your problem is gluten, Sue. That's caused a lot of inflammation. That inflammation has weakened your adrenal glands. Maybe that's why you're depressed. We're gonna treat the underlying cause by cutting gluten out of your diet. We're gonna treat the inflammation with some curcumin. We're gonna treat that body system for the adrenals because I like to treat adrenals. We're gonna test and correct that. And hey, if you want to just deal with the depression real short-term, we could use some fish oils, we could use some vitamin D, etc., amino acids, whatever it may be. So you can operate and move. And this, to me, is like mastery. That you can operate and move between all four of these different treatment types. And I think the key is just knowing where you are. So if you're going to treat symptoms, as long as you know that's what you're doing and you're not missing the underlying cause, it's totally legitimate. We're obviously people get into trouble is when they set up a symptomatic treatment program, they give an antidepressant, and they miss out on all this other stuff. But just because symptomatic treatment by itself is a little dangerous, doesn't mean you can ignore symptoms or symptom treatments. You know, we want to be able to move seamlessly between these four different types of treatments. Anyway, so that's my theme for patient education. Now, I just want to present that quick. And then, you know, in terms of, you know, the actual sequencing of protocols, we want to just kind of dial it down a bit. Because, like, how can you sequence a protocol that has this much going on? I mean, I know this is a reality. I know that, you know, most of our patients have like six things in this category. They pretty much all have all of the damage going. Almost every time, you've got half of these body systems or more cranked up, and they've got 20 symptoms. You know, but you can't make a clear clinical model about 16 underlying causes that are causing 35 symptoms. It's just too messy. And you can't treat people based on that because you just get frozen with like too much information. Right? So when I try, I know this is an oversimplification, but I promise this works really well. We just boil it down to three: adrenals and brain, I call that neuroendocrine. GI and liver. Okay? Every patient can wrap their minds around that. And even though when we're tossing out immune, and we didn't include cardio metabolic really very well in this, this is a model that patients can understand, and you can explain things well. And this can guide your program design parameters, which makes the complicated patients really easy.
I just interviewed Ben Lynch, who's an expert on MTHFR. Dr. Schwag, who's an expert on Lyme disease. And Allison C. Becker, who's an expert on SIBO, just in the last couple weeks. I interview all these people for an hour. You know, I was talking to them and asking them questions, and we have it all recorded. And so every one of those practitioners, if you listen to their talks carefully, said the same thing at some point, which was, "I treat the basics first, and then I move on to the more complicated stuff." So the Lyme expert treats these basic issues first, then goes after the Lyme. Doesn't treat the Lyme as the very first thing on the very first day. MTHFR, the same thing. Doesn't necessarily, Dr. Lynch doesn't necessarily go after really, you know, snip-oriented MTHFR treatments as the first thing on the first day. He wants to get the lifestyle factors and these basic issues resolved first. And in fact, if you talk to anyone who's been in this industry for, you know, 15, 20 years, and has treated thousands of patients, they'll tell you the same thing, which is that the more complex the patient is, the more important it is to do the basics well. First, get that foundation in place, knock out a bunch of the symptoms, and then hone in on your Lyme or your MTHFR or whatever these other additional issues are. So we don't always want it, and this is something that's so confusing. Like, if you figure out that the underlying cause of this person's whole problem, and their whole life has been ruined by environmental toxin exposure, and that's really the underlying cause of the problem, for real, for real, that may be the last thing that you treat. So just because something shows up as being an underlying cause doesn't mean you treat it first. And that's one of the classic mistakes that my teachers have helped me avoid, which was that you get that toxic patient, you know, it's a mercury problem, straight up, and that's the main problem, and you go after the mercury first. It's just an unmitigated disaster every time we try to do that. So just because you found the underlying cause, that's not going to determine the treatment sequence that we're talking about tonight. That really doesn't. The treatment sequence is a term, really, in my mind, of determined by the body systems and how the body systems flow in terms of one thing causing another. Okay? So I just want to mention that.
So let's take a look at that. Then, with the way that I teach this in the training program, is pretty simple. So that we have these twelve key design tools that we master throughout the class. Stage 1, Stage 2, Stage 3, and Torino programs, cycling and menopausal female hormone protocols, all that gut-related stuff, and then liver and brain support. And so I'm gonna kind of present it in this context. And, you know, most of you should be able to relate to this from your own work, even if you haven't taken the class before. That we want to then, you know, take these body systems, take these tools, and start to manipulate them in different sequencing sequences depending on on the patient. And so there's one standard sequence that works most of the time. And if you can get away with doing the standard sequence, usually things go the fastest. And usually it prevents most of the negative side effects. Okay? I'm gonna say that one more time. And this is, this is a hard-learned sequence. This is a sequence that was learned by myself, by my teachers, by my teachers' teachers. This is going back an array of missions for a way that you can treat patients with the least likely number of side effects and the fastest. Okay? Usually. And okay, something to try to explain this. So we can start off with a neuroendocrine or the hormone part. Now, why do we start there? Because we're controlling inflammation, we're getting some buy-in from the patient because these programs, the brain and hormone programs, get people feeling better. But most importantly, we're upregulating the immune system and downplaying the inflammation. That sets up the stage for us to be able to do the digestive protocols. Because by the time we get to the digestion protocol, it's a few months into the program, the inflammation in the gut is reduced, the immune system and they got is stronger. Much easier to do the killing and repair at that point. Once the gut is working reasonably well, we've pulled a huge burden of toxins off the liver, we've gotten digestion and absorption to improve, we've got the exit route for these toxins established in the gut. You've done all this setup so that now you can finally get to what is often the most important treatment, which is detoxification. So, in other words, the hormone program sets the person up so that you can clear the digestive problems. The digestive program restores normal absorption and elimination so you can run the detox programs. And that standard sequence works beautifully. If you can run it in that order: hormones, gut, detox, in that order, is ultimately, you know, what we're striving for, if it's possible.
Now, that doesn't always work. And I'll just say this one more time. I already said this, but this is such an important idea. Is that we're gonna treat in that order: hormones, digestion, detox, even if the problems occurred in a different order. And I'll show you some slides on that in a minute. Even if you think the most important thing is their gut, you really will do better in the long run with most patients if you can put that second in the protocol. And if you think that the main problem is toxins, it works much better if you do the detox at the end. Now, sometimes you can't do this sequence. And this is common. You know, you give a person a hormone or brain-related program, and they flare up and they get sick from it. All right? Well, that's okay. So we just back up and we might need to work with digestion and leaky gut first. Or you give a person a hormone-related program, and it just works. You know, it's just all kinds of side effects happen. Again, you can start with a detox program, get the person ready so they can handle the hormones. So sometimes we have to break with the sequencing order. But ideally, we'd like to try to follow it that way. Okay?
Okay, now I'm gonna do this. This is like an advertisement. So if you need to go to the bathroom or you want to go get a drink of water, you can go do that right now. This is a commercial. If you like listening to commercials, you stay on the line. And I've come, you know, I'm a sort of a little bit of a Netflix and Hulu junkie. And I kind of miss commercials because commercials give your mind a little break. Also, the human mind can only really take in new information for anywhere from maybe twelve to fourteen minutes at a time. So we just hit about the 20-minute mark. So I'm gonna give you guys a little mental break here. And we're going to talk about some other things just for a sec. So, um, I don't talk about my, my training program because it's a really cool program. You guys should at least see this and know about it, even if you're not about to sign up for it. So number one on the training program side is what it looks like. And I'll show you what it looks like right though. Kind of looks like that. And here's the live version of it. This is the actual class itself. It's six modules. You click into a module, you get an overview, you get all these lectures broken out by the week. You click into an individual lecture, you can see all the different talks that we have and the reading assignments and the tools. All this really amazing stuff. And we have an advanced class. We have a basic level class. So there's tons and tons of curriculum you can get into as you go through this. And then once you've done all the classwork, and you're a little tired for that day, and you want to just chitchat, you can get into the community. So we have a community feature here too, where you can see doctors answering questions, posting questions. And what are the latest questions? Client having major stress due to birth control pills. Okay? So one of the practitioners posted that question earlier today. And guess what? We have a couple of OBGYNs in the class. And one of them, Anna, no, sorry, Anna asked a question. One of the OBGYNs in the class, who's Jessie, answered the question. But now, do I know exactly the answer to that question? Not really. I'm not an OBGYN. So we have a community of people that are like-minded, that are all participating. And it's a really wonderful thing. Also, in the materials, we have content. Okay? Within the course itself, we have now over 1200 case studies. So if you have, you go to the case study library here. And let's say you have, I don't know, it could be anything. You could find a, you have a patient, they have crypto, and you're wondering, I don't know what to do with crypto. I haven't had a crypto case before. You just search in the database. And we have literally, let's see what, how many crypto cases we have tucked in here. Case after case after case. I mean, it's a lot of cases on crypto, right? You, you, you, it would take you hours to just even listen to all these cases. And you'd probably find one or two of them extremely helpful for helping you with your particular crypto person. So we have pretty much on any subject in functional medicine. You can search on a gazillion cases and examples. I'll show you one more example here. Let's see, that's, let's say we search for fertility or something like that. You have a patient that's got a fertility problem. You run some labs, and you're not sure exactly how to handle it. Of course, we go over this in class as well. Oops, I started a discussion. Sorry about that. But, you know, you can also, at the same time, get all kinds of information from the other doctors and from other, from the other cases that are in the class. And everything is also transcribed and posted. So that's pretty cool too. We also have quick fix protocols, educational webinars, tons and tons and tons of information in here. Okay? So that's the basic features of the class. And then, of course, we have live calls as well. So every week, we have a live call. We go over cases. And then those cases are all transcribed. Now, let's just show you one example. So if you're in class and you have a case that you present, we transcribe the actual recording. So you can watch a video of the case here. And you can read down below what that's actually said during the class. And everything is just kind of stored for informational purposes. But my favorite part about the community now is just the interaction that occurs between the doctors. And we have hundreds of people in here that are asking questions and answering questions and sharing all kinds of information. So it's pretty cool. That is our mentorship ad for the moment. Now, we're going to get back to our regular programming. Oh, and this is the mission. You know, because I started this class with other intentions, just wanted to teach functional medicine. And what I'm realizing now is that we're actually just helping doctors get their lives together. You know, we're helping doctors transition to a full-time functional management practice, which is something that the sport supports them, that's sustainable, something that they really enjoy. And then they can make a big difference in their patients' lives. That's really our mission now is is focusing on that. If you're curious about the class, set up a call. And we had a class that just started yesterday too. Okay.
Now back to the clinical side. So on, on the just sort of the origins or their of the clinical model, is we're looking at, you know, neuroendocrine problems, they trigger GI stuff that eventually lead to toxins. And so we try to treat in this order, as we saw earlier. Now, you might have someone who's initiating event was a GI infection. You might have someone who's initiating event and why they got sick was a toxin. Of course, we see this all the time. The GI infection or the toxins started the problem. But the key is that that's not going to change the sequence by which we treat. Okay? That's the, hey, that's the hard thing to understand in all this work. Is that we want to try to treat in this order: address the hormone and brain-related issues, then work on the gut, and then work on the detox pathways because of what I mentioned earlier. So regardless of the order in which the person got sick, we try to focus on this kind of a treatment order. And of course, what's underlying all of this are the lifestyle changes. So we've got, you know, diet, exercise, sleep, and stress reduction. That all go into this initial round of treatment. Then we go after the GI issues, the pathogens, and the food intolerances, and fix the leaky gut. And then we start the detox protocols off towards the end of a program. Now, that order often has to be changed. But that's, you know, what we're striving for.
So let's look at a couple of real cases here. And I want to show you some examples of patients and how this actually rolls out. So here you've got the patient. And, you know, we've all heard this story a hundred thousand times. Woman in her 30s, former teacher, this case on a bunch of meds, sensitive to a bunch of foods, can only walk for exercise. Now she's in pain, GI pain, inability to eat and gain weight, just hurts when she eats, can't walk really easily, severe pain in the legs. And this is so sad when you have patients like this. Mental fogginess. You know, someone is just trying to get by in their life, look after a kid, and and work a little bit, and, you know, just laid out by this kind of a chronic illness problem. So in my practice, I run the same three tests on every new patient. We do a hormone eval, we do a GI test, that's a 401, and then we do an organic acids profile. That's the basic workup I do on every new patient. And I want to just show you some examples here and then some patient workup so you can see how you can roll out a program. So let's, and let's say that this is a typical patient too. I'm trying to, you know, pick examples of real patients of mine that have come in, but that also are common in our practices. And this is the 30-something, 40-something year old female that's just basically chronically on reacting to every food on the planet. And there's, you know, she hasn't gotten so sick that she can't walk anymore, but, you know, she's not able to even go out for a jog or for a bike ride because she's so tired all the time. And that doesn't make any sense. And then she's also got this whole syndrome, you know, what they call it sickness behavior. You know, when things are really getting bad, and you're in this much pain all the time, you get anxious and depressed. And, you know, nothing about your life is going to feel good. So this is the symptomatic presentation. I'm immediately thinking body systems, you know, neuroendocrine, gut, detox. Neuroendocrine, gut, detox. And then, okay, how does that translate into the labs? Well, there's a lab for adrenal HPA axis function. There's a lab for the gut. And then there's a lab for detox and all the nutrient replacement stuff. So three body systems, three labs, pretty easy to explain to a patient. Because, you know, in her case, we would say, so, you know, I know that you're in a lot of pain and you're just exhausted all the time. I want to test and correct your hormones that are related to controlling pain and energy levels. You have these vicious, you know, food reactions and food sensitivities and GI pain all the time. I know that the conventional doctors say you're fine, and you have IBS, and there's no treatment. But I think that you might have an infection. Let's do a GI test. And then this anxiety and depression has gotta go. You know, we've got to figure out what's going on with your brain, your detox pathways. So I want you to order the organics profile. So again, tying the symptoms back into the labs. Every one of my new patients now, well, not every, that's an exaggeration. Eighty, at least 80 to 90% of my new patients will just immediately order every test, all three of these. Okay, guys, just make sense to do it all. You know, and now let's look at what happens when these tests come back. And I want to show you some sample programs.
So here's her adrenal labs. And this was a shocker. Because I'm thinking, oh, this is for sure adrenal burnout. Now, but look, her DHEA is perfect. Her cortisol is good, maybe not great. She's got this one low cortisol in the morning, but she's not an adrenal burnout. Who would have thought? Surprise, surprise. And so, you know, all these years of doing it, you know, I guess, you know, when you're in years five to ten of doing this work, you really started to thinking that, you know, what you're doing. You know, that's when you get a little dangerous. Like by year five, you're like, yeah, I've cut this figured out. And I, you know, if she had come in at year five, I would have been tempted not even to order an adrenal lab. I would have, but this is adrenal burnout. I know what I'm doing. But, you know, the more experience you get, the more you realize you have no clue what's going on with anybody. And so here we go. It's a great example. I'm thinking, adrenal, adrenal, adrenal. Didn't have adrenal burnout. Or adrenals are in great shape. How could that be? Well, there's something else going on. That's the whole point of doing the labs. So right off the bat. So that's what your adrenals are. Right? First test. I don't want to go too fast here. Adrenals, but they're okay. Not bad. Cortisol is a little low, but it's not a disaster. Second item up here is, wait a minute. She's got Dientamoeba fragilis on the stool test. Okay? So she's got a really major GI infection. No wonder why she was in pain. Too bad everyone else missed that. The more accurate testing finds this stuff all the time. And I routinely, because I order the right tests from the right labs, have, you know, results that show up in these tests that, you know, have been missed by my labs for decades. So anyways, we find the Dientamoeba fragilis. 401 H is my friend. And then on the last part of the test, the organic acids profile, I'm going to show you this because it's pretty interesting. Look at this. Her energy production markers. And we'll get into some more detail in a minute on what that means. So clearly, there's a problem with her energy production. So all that fatigue that I was just geared up and ready to treat with the adrenals, turns out it's coming from her mitochondria. Mitochondria are all shut down. And she's got some level of toxins. And of course, she has these bacterial overgrowth problems in the gut. You know, I mean, that's she has done to me. Fragilis. You would be shocked if her gut was okay on this. But the real, you know, like wake-up call. And this is, you know, where we still learn. I learn every day from my patients. Is, hey, it's not an adrenal lab. This woman's poor mitochondria function is just completely shut down.
So let's look in a little more detail about what that means. Here's the citric acid cycle. And what are we doing here? Well, our body has to take fat, carbohydrate, and protein and burn it up for fuel. And, you know, you can remember biochemistry. We all have to take this class. Remember pyruvate and lactate? And there they are. They're still there. And your body takes fat, uses carnitine to convert it down over here into acetyl-CoA. Your body takes carbs, runs all these B vitamins, boom, you get this C loco A. You can take protein, if you have to, and make energy out of it as well. But ultimately, it all ends up here in the citric acid cycle. And at the end of the day, you spit out a bunch of ATP or cellular energy. So this is a pretty important process. I don't think we would be alive very long if this wasn't working. You know, and so, though organic acids test measures these different steps within the citric acid cycle. It also measures the conversion of fat and carb and protein coming into the Krebs cycle. So you get a general sense of why this woman's energy is so low. Turned out it wasn't adrenal burnout. That wasn't what caused it. It was complete roasting and toasting and destruction of her mitochondria. And imagine her poor mitochondria just sitting there. You know, something damaged them. What do you think would damage the mitochondria so bad? Well, some kind of oxidative stress. That's what oxidative stress does. It destroys mitochondrial DNA and stories of mitochondria and its function. So now we have a map of this. And you look at the actual lab. I'll show you here. Here it is. This is what the organics profile presents like. Here's the energy production section here. And you can see there's 1, 2, 3, 4, 5, 6, 7, 8 markers that directly relate to the Krebs cycle. And what are those markers? Well, they're measuring these steps. How clever is this? Whoever thought about this should get a prize. They're measuring these eight of these different steps within the Krebs cycle to see how well it's working. And you can see the steps are measuring. They kind of highlight them on here. You know, it's one there. There's one there. And there's one there, etc. So there's various nutrients that get these cycles to work. And in this poor woman's case, look how much of her Krebs cycle is shut down. That's the red stuff. The red stuff is bad. You got a high marker there, high marker there, high, high, high, and high. So one, two, three, four, five, six out of the eight markers are not properly functioning. So her mitochondrial production of energy is just completely shut down. I don't know what it would be like. It would be like a, I don't know, if you're watching an action movie. I watch a lot of bad action movies. And the guys like walking towards them, and this happens a lot in bad action, and he gets shot. You know, he gets shot once, and then twice, and then then he's like, shot six times. But he's still walking, and he's still got his gun. He's shooting back. You know, it's like six bullet holes in her mitochondrial production here. This is not a good thing. When the guy gets shot six times, you know, he's shooting back still, but clearly he's going to be dead before the movie's over. It's, you know, but, you know, he's still fighting. That's like what's happening to her. Her mitochondria is just completely shut down. If you actually look at the pattern over here. So when you're analyzing these tests, you not only look at the little computer flag thing, but look at the pattern. Those two markers that were not flagged by the computer are just a millimeter or two away from being in the red zone. Green zone's good, red zone bad. You know, so her whole energy production was just completely shot to bits, completely. And so how is she possibly going to feel good every day when she can't even convert energy into ATP? You know, protein, fat, and carbs, food energy. So you can't make the food conversion into. So anyway, this is a really big thing for this patient. How would you know that if you didn't run the test? You wouldn't really.
And now this is like a cooking show. You know, the cooking shows where they, they show you like how to make the thing, and then all of a sudden they pull it out of the oven. So because I knew we were going to be a little short on time, I wanted to, I pre-designed these programs. So these are the, here's the program for her. Because I didn't want to take time just writing all this stuff out. So instantly out of the oven comes her protocol. So now let's remember what her problems were. Dientamoeba fragilis, which implies your gut is damaged and inflamed. That inflammation and oxidative stress for some reason in her system didn't hit her adrenals hard. They completely destroyed her mitochondria and that my conscious ability to make energy. And so we want to fix these two things. So we want to fix the mitochondria and get the energy production going. And we want to fix the infection. And so here we go. If you look at her program, number one up here at the top is, let me pull this up here. Number one, the top here is the mitochondrial program because we want to get her feeling better, get that working better first. Number two, parasite treatment. And then number three, leaky gut repair. Now, you can re-sequence. And tonight's talk is about sequencing. So I want to show you some tricks about that. In a perfect world, you can work on the energy systems first, and then work on clearing the parasite, and then repair the gut after the parasite is gone. But in some cases, if people are really sick, and here's the leaky gut protocol, it's let's throw in some probiotics there too. Helmuth at, just to be nice because we feel bad about her. She's got a kid. There may be some cases where you want to re-sequence this. And I like to design programs in a modular fashion. Because watch what happens. Presto, leaky gut program gone. Presto, put it up here. So oftentimes, you may want to do the leaky gut repair first, and then get into the parasite killing if you think they're going to be reactive, reactive, and not do well in the parasite program. Or you may want to run them together. You may want to run the leaky gut and the parasite program all the same time. Now, that's a lot of supplements for some people to take. But in other cases, you're almost required to do that because they'll be reactive if you don't. So here's a beautiful protocol. I can, well, I know I was gonna say, I was gonna guarantee you she's gonna get better. But I know what happened because I've already treated her. This worked really well. Let me just say that. Energy levels back. Gut is gone. Gut problems come on. You know, in a story. And this is one of those wonderful, you know, situations where she's just better. It's just over because the whole problem was that Dientamoeba fragilis and her mitochondrial. We just nailed it. Boom, boom, boom. Done. Now, not everyone in my practice is that easy. But I want to show you stuff that I do. You know, I have to admit, I was in, I was practicing all day today when I had maybe five or six hours of patients. And I, I had one patient out of the whole day that really wasn't doing well. I did as this woman, Karen. And I am a hundred percent sure now after that conversation that she's a food addict. And she's not following any of the rules with the diet. I could kind of tell. It took me a couple months to figure it out. But Karen, food addict. I'm gonna have to get some food counseling advice. If I follow up with her properly, I'm gonna do that. But besides her, whole rest of the day, you see, no, it's just kind of cases where everyone's getting better. That's a wonderful job. I really love this job. And want to encourage you guys to learn how to do this stuff.
So an ex-patient, 68-year-old female, married couple, kids, retired childcare center owner. Sleeps about seven hours a night. Always taught to take a sleeping pill. Gluten-free. Just about everyone I work with is gluten-free now. It's amazing. Even before they come see me. Works out every day. Taking a ton of supplements. Symptoms: exhausted, anxious, overactive immune system, can't detox medications, can't detox supplements. In other words, she's highly reactive to stuff. As micro fatigue, depression, headaches, hypoglycemia, peripheral neuropathy. That doesn't sound good, does it? Well, and she had mold exposure in her home for 17 years. As if that wasn't enough stuff before that. So now, now we're thinking, okay, this is a complicated case. What are we going to do? Well, you know, this is the beauty of thinking simply. The more complicated cases, the more we retreat to this simple model. Maybe she's gonna have to treat for mold later. But we're not even going to go towards the mold or towards the Lyme disease kind of complicated stuff. We're gonna do the basics really well. So I'm gonna test her adrenals. Now, testing the adrenals, it looks like a cortisol test, but it's an HPA axis test. So we're measuring cortisol levels. And DHEA. And DHEA is down at a 1. Should be between a 2 and a 10. Cortisol is normal, but kind of scraping the bottom of normal. And we have this really low cortisol level at the noon hour, down at a 10.8 at night. So this is what we call a stage 2 of your adrenal burnout. That's defined as one or more low cortisol's during the day plus low DHEA. So this is what we call stage two. So this is adrenal fatigue. The GI testing, not a whole lot. A little bit of a, no parasites, no bacteria, but a light growth of Candida. So that's something to think about. And then on the organic acids profile. Okay, remember the last case we saw? Energy production markers were a problem. Well, there's a couple there, but not nearly as bad as last one. And what do we see? There's a real big problem. Oh, oh, not good. Under detoxification indicators. Or, oh, take glucurate. Usual. Actually, butyrate, pyroglutamate, sulfate. One, two, three, four, five. And there's only six markers. Five of them are either high or very high. So let's cut over to that. I'll come back to this in a sec. Here it is. So here's the liver detox portion of that test. Toxicants detoxification. And look at.
This look you could never miss. That right there's, well, there's five red H's in a row. That's kind of a big clue. And again, that other marker here is just close behind. So this is a person whose liver is just in the serious emergency mode. And let me said, I can pull in this diagram here. As you can see this, that's not working very well. To see if I can make it work. I had this special diagram. I thought I could figure this out. Sorry, there it is. So yeah, there we go. Alright, I like this one. This is off the Cleveland Clinic's functional medicine website, by the way. If you guys haven't been there, you should go there. Well, you'll have to go to Cleveland, but you should go to the Cleveland Clinic functional medicine website and check it out. For those who they haven't heard, back in September, Cleveland Clinic launched this beautiful initiative. First major medical center in the world to create a functional medicine department. Not an integrative medicine department that includes functional medicine, but a functional medicine department. It's a beautiful and wonderful thing. Of course, Dr. Mark Hyman is heading it up. They got the best functional medicine doctor in the world at one of the best, you know, medical institutions in the world. What could be better? So check out this is off their website, but almost want to mention that if you guys hadn't heard that news because that's pretty important in our industry.
So here's, um, you know, we got phase 1 and phase 2 liver detox. So this individual has problems with this whole sequence of events here. None of this is working well. Now, a whole concept of liver detoxification is shut down. As we saw with our earlier patient, energy production was a problem. This is just an, just an absolute disaster in terms of the body's ability to bind up and remove toxins. So how does that really work and what's going on here? Well, in a perfect world, in a normal healthy liver, you would have a bunch of toxins. And by the way, we're all exposed to toxins. Depending on what studies you read, you could have anywhere from 120 to 400 or 700 toxins in your body right now. All of us are super saturated with toxins. If you took a deep breath today, if you took a shower today, if you drove to work today, if you did anything, and touched any kind of plastic, I mean, we're all basically super sad with flame retardants, benzene, toluene. If you were alive in the 60s and 70s, like I was, you probably got a bunch of DDT in your system as well. We were all exposed to lead and mercury. I mean, this is just ubiquitous, right? Everyone's going through this now. You really do a complex workup on any of our patients, you're going to see they're just riddled with toxins. So we're all struggling under this toxic burden. We're trying to bind these toxins up, running phase one, the cytochrome P450 enzyme phase, breaking them down into intermediaries, and then flushing them out of the system by running phase two or the conjugation pathways. Eventually, these water of these fat-soluble non-polar compounds become water-soluble and polar, and we can flush them out in the stool, the urine, or the sweat. And that's what we're trying to do. Now, this test is measuring these different detox pathways and that's saying, hey gang, this whole system is shut down. You're not able to run phase one or phase two anymore. Emergency, emergency, emergency. Now, how do we see that in terms of the actual lab? Well, here it is. It's all the red H's here or take glue, create, hydroxybutyrate, pyroglutamate, sulfate, all elevated. That means the liver is just go, go, go, go, going and losing this battle to try to get rid of toxins. Just massively elevated here. Okay.
Now, I want to just show you some ramifications of this. Oh, and there's one more thing on this patient's lab that was really cool. Now, check this out. This is really amazing. I know I talk about this every class I teach, but I just, I just think it's so amazing. Look at number 24 and 25, hydroxyethyl acetate and kynurenate. Okay, those are both really elevated. Now, that we had a patient that's highly toxic, and you kind of knew that from the history. Remember her history? Let's go back a few pages here. Sorry, it's growing. There we go. Remember she already said this to us. She told us she doesn't know. What did she say exactly? Oh, she can't detox meds and supplements. Well, in other words, she takes the medication, she reacts. Takes the supplements, she reacts poorly. Just to be really careful with the stuff that she's doing. And now look at those markers. So here, this marker is elevated, indicating a large breakdown of serotonin. And ironically, this one is elevated too. It's kind of a cool combination into this very often. So what is happening when kynurenate is elevated? It means that she's taking her available tryptophan. A lot of her tryptophan is going down towards this pathway over here to kynurenate. And kynurenate is an inflammatory marker. So when you're inflamed and you're making a lot of cytokines, you actually make inflammatory cytokines from tryptophan. Amazing. So when that's happening, you have a compromise of your brain chemistry. So what that means is that when we're inflamed, our brain chemistry can suffer. Anything there can be a direct impact on the brain. I'll just show you one other diagram here because I think this is so cool, which is that the same thing happens with dopamine, epinephrine, and norepinephrine. And here are the pathways on that. So again, if you're inflamed, you have a lot of inflammatory cytokines that are activated, you make picolinate and quinolinate, and you literally rob the brain of dopamine, epinephrine, and norepinephrine to do that. So the short version of this is that the more inflamed that a person is, the more depleted and negatively impacted their brain can become. And another little side note on this particular lab is the B6 markers that show up here. So B6 is the critical nutrient for neurotransmitter production. And if you don't have enough B6, there's no way you're going to make enough serotonin, and there's no way you're going to have a normal dopamine production either. So you often will see toxins, highly toxic people who have a negative impact on the brain. Why? Because many of these toxins are neurotoxins. And because the inflammation that meaning the neurotoxin mean that these toxins are in the brain, right? And the inflammation drives all these inflammatory cytokine production problems, which depletes the brain chemicals. So you can have two of these problems going at the same time. Meaning that you got a lot of toxins, many of them are neurotoxins. Those are chemicals and heavy metals that are literally in the brain destroying brain cells. And at the same time, the inflammation from the toxicity weakens your neurotransmitter production. So you have two things happening. Two, you have damage to the brain cells themselves, so they're not firing well, and you don't have enough neurotransmitters to fire those damaged brain cells. Now, if we're going to continue our actions, store, you know, bad action movie analogies here, and I apologize for this, but it's just a personality quirk I have. This is like when the guy runs out of bullets, right? He runs out of bullets where the gun jams. But to say he runs out of bullets because it happens more often. So boom, boom, boom, he's shooting, shooting, shooting, runs out of bullets. Okay. All of a sudden, you don't have enough brain chemicals. What's your brain going to do? It just does nothing. It can do. And at the same time, if you're inflamed, you're running out of bullets, right? Because the inflammation is pulling your tryptophan and pulling your dopamine. But then at the same time, you, you have damage to the brain cells themselves. Okay. So this is a double whammy that's pretty damaging.
And now because I, I took off a little bit of time to do this here, I'm going to show you. There's the thing again. We'll show you the protocol that I designed for this person. Is that, that's the wrong one. Sorry, that was our last patient. I only got two of them. One cup for picking the right one here. There we go. So now what are we going to do? Well, remember the treatment model is, if we can, adrenals, gut, detox. Adrenals, gut, detox. Adrenals, gut, detox. So here we have an adrenal stage 3 protocol. Says AM, DHEA, pregnenolone, licorice, all based on the labs, adaptogens, multipacks, and vitamin C. So we're resetting the HPA axis. That's kind of our neuroendocrine part of the program. Alright. And then we want to treat the candida. After she had a candida problem, that's like, kind of my more of an annoyance than a major issue, I would guess, but I'm not sure. And then we really want to focus in on the liver. So here's the liver detox. So what does that include? Okay, we have general liver support, silymarin, etc. We have some methylation support because we're going to force these detox pathways to crank up. You better help with methylation. That's critical. We have phase 2 software containing amino acids, and we have phase one, some antioxidants. So we're supporting everything here. Liver, basically, it's not like complicated. It's just like giving everything general liver support, methylation support, phase 2 support, phase one support, everything you can imagine. Why? Because she had the problems across the board with all the liver detox pathways. Remember, here's her test. So my kind of goal in life now, if you want to simplify my whole life, besides riding bicycles and driving a really fast out for a mail, which I, I love cars and I love bikes, but outside of the cars and the bikes, my goal is to enable doctors to get tests like this. I want you all, once you're done with my class, to be able to look at an adrenal panel, a GI panel, and an organics test and say, man, I could nail this one. I see everything that's wrong with this person from a functional medicine perspective, and I'm going to generate this beautiful and elegant protocol. And here it is. I'm treating all three body systems. I may have to sequence this in a certain way. Well, Kalish does it this way. His teachers all did it this way. There's probably a reason why generations have been doing it this way. Go after adrenals, gut, and detox. You sequence it out just like this. And that's my goal at the end of the six-month training program that you can take that mess of labs, look at that patient, and come up with a beautifully designed program like this. It's going to change their life. And I'm pulling this off. If you talk to people that have done the class, at the end of the six months, practitioners are figuring out how to do this. You know, and it takes at least that much time to get enough training so you can understand all this and be able to effectively implement.
Alright, so this get a final thought here, and I'll open it up for some questions. Oops, right over scrolled. Sorry, didn't mean to do that. But I'm missing my final thought slide. Seems like it's important. It may have been an unimportant final thought, but let's see what it was. There it is. Okay, here's our final thoughts. Most difficult patients present unique challenges. What do you tell them as well as in terms of protocol design? I hope kind of drilled into that, you know, endocrine, gut, detox. Ideally, do that first. Neuroendocrine first, do the detox last. Even if the detox, like that last patient, is the most important, resist the temptation to detox them right away because they're very likely to make somebody sick when you're doing that. It's not that hard, you know, hopefully, you know, you can learn this stuff in six months and have a general sense of what to do. That's really the goal. And then if you're curious about the class, set up a time, a time to talk with me. I talked with doctors a couple days a week. Today was my doctor talking day, and I loved it. It's fun. And, you know, I'll try to talk you into doing the class if I think it's appropriate. If it's not appropriate, I'll try to talk you out of doing the class. But schedule a free consult with me if you're curious. The next class started yesterday, so you can still get into that group. If you're warm on, okay, we take people a few days late. You can get into it the next few days. Alright, so let me, I'm going to go through some questions while we're there, our last little bit of time here. Let's see. Okay, David is asking, what 5-HTP reduce the amount of inflammation? That's a good question. So the way that this is taught, let me go back to the slide. The way that this is taught, let me just show you that diagram again. So where'd it go? Here it is. So the way that this is taught is that if you give tryptophan to someone who's going through this inflammatory problem, you're going to make them worse because that tryptophan is just going to accelerate this kynurenate pathway and potentially make them more inflamed. So this would be a situation you absolutely do not want to use tryptophan. But guess what? And this is Dave, maybe was already thinking about this, I'm not sure. You can use 5-HTP. You know why? Because 5-HTP is further along on this pathway, and the 5-HTP will go to serotonin, but it won't go backwards down here. That won't happen. So the answer is yes, you can use 5-HTP, and that does help tremendously with people who are going through this inflammatory cytokine diversion of tryptophan. But you can't use tryptophan because that could make it worse. Good question.
Okay, Anika is asking about Canada because you guys can't use DHEA and pregnenolone in Canada unless you have a medical license. We have tons of Canadian practitioners who have taken my class. We have worked around every possible problem for Canada, and there are our protocol. Basically, we have a whole sort of sub-page of Canadian protocols that I've developed. And so, yeah, where's Canada? It's fine. The only problem with Canadians, and this is a pretty deep problem with Canada itself, is that they're also nice. That we're not exactly sure what to do with you guys sometimes. And that's a joke, okay? Because when the Canadian practitioners there, this is really true, they're all really, really, really nice people. And so we treat you really well. Don't worry, we won't make fun of you too much. But we have tons of Canadians, and there's no problem doing this work of the Canadian. And then SNIPs question. Okay, this, I've been to many, many days of SNIPs seminars in this last year. And the question for Margot is specifically, are you doing anything with genetic SNIPs? Do these affect treatment protocols? So you can run any of these tests without 23andMe or whatever the labs are that you're using to look at all that you would probably polymorphisms. And you can, and I've done this a few times, correlate the polymorphisms with what you see on the organic acids profile. So as an example, you might find a methylation problem on the organic acids profile, then exactly matches an MTHFR SNIP thing, right? So you see that their genetic profile has predisposed them to having this methylation problem. The reality of it is, it doesn't change your treatments at all. It, it deepens your understanding of what's happening to cause this. This is a methylation problem, but it has a genetic origin versus this is a methylation problem, but it has a toxin origin. But I don't find that the treatment protocols change that much. So if your mind works in a way, and you enjoy doing the SNIPs, and you like the more, I guess, a more in-depth view of it, you can absolutely correlate the SNIP workups with all these kind of stuff. I don't teach that in the class because honestly, that would be like a six-year training program. It's hard enough to get what we're talking about done in six months. But that's definitely more advanced concept.
Claude asks, what's the likelihood of having a patient on a six-month supplement program with good compliance? And do you really need six months? Well, I think there's, there's a couple of things to that. And in my patient practice, absolutely. I don't really get people better in a month. But I think that the way that we get patient compliance is that let us go back to the original diagram. This is where we start off the whole talk. And because it scoot back up there, how do you get patient compliance? Let me show you how you have mastery of symptomatic treatment. I'll just share with you in the last few minutes we have here. When I was first being trained, I was trained in clinical nutrition by some of the most amazing naturopaths you could imagine. And I learned in my first three or four years of practice how to alleviate symptoms really quickly in patients. And that skill set has come in handy because the way that we get compliance over the long term is by improving symptoms so dramatically in the short term that the person wants to stay in the program. And then the lab testing and the retesting are like the cement or the glue that hold them into the program. And we just let people know, you know, it's basically a patient education issue, saying your symptomatic improvement is going to happen early, and we're doing some things to treat your symptoms, but there's no way, sue, that we're going to get all these chemicals and heavy metals out of your body tissues in 30 days. We'd be lucky if we could do it in six months. So I want to treat the underlying cause and make sure that this program is successful for you for the rest of your life. And that's going to take six or twelve months. And at the same time, we can some of your symptoms right up front, get your energy better, gets you to lose some weight. So that balance between symptomatic control, getting the symptoms under control, and also making sure that they are invested in doing a long-term program. Now, if you present this well, I think it works almost every time, which is you can, you know, I don't know, it could be the toxin. Let's pick another example. Maybe, um, let's say a lifetime of poor diet. You're not going to turn around chronic nutritional deficiencies in someone in 30 days. It's just not physically possible. So just a patient education as to the fact that your magnesium is low, your fatty acids are off, you know, your amino acids aren't doing it very well either, based on these labs. We know that you're deficient in, you know, everything from CoQ10 to lipoic acid, and it takes time to repair nutrients. And I'll use analogies like one of my favorite ones is a plant analogy. So I'll say, hey, if you took a plant, let's say you took a tomato plant, you planted it in the ground right in front of your house, is it going to be fully grown and have tomatoes on it the next day? No, because we're limited by the force of nature that's growing that plant. It's the same thing for the healing process. Your body's not going to heal in 30 days from a 27-year problem with heavy metals or a sixteen-year infection in your digestive tract. Just like the plant, we're limited by the healing power of nature, which is incredibly powerful, but it takes time. And that's one of the downsides to doing a natural program is that you don't just remove a gallbladder and they're better in a few weeks. So the gallbladder is gone, right? This, we're using nature to make all this work. So it's a little different. But I think with a good patient education, you can get all that to happen properly.
Alright, we're at an hour. I'm going to wrap up. Thank you, guys. If you're curious about the class, give us a call. And we do have a group that just started this week, so you can jump right in if you want. And we should have another one of these coming up, you know, about every month. We're doing a free one of these. So I hope to have you join in on the next call. Okay, see you soon.