Intro to Organic Acid Testing Part 1

Now, some of you I have met, some of you I haven't met. And by the way, we just filled up our webinar. This is this hasn't happened in a while. So, some people aren't going to be able to get in. So, those of you that are here, welcome. Here I am. Hi. Those of you I haven't met before. Dan Kish here. And uh we're going to try something a little different. We're going to try some uh drawing in the board stuff. And then we're going to get into this pretty intense lecture on organic acids.

So, I wanted to start off by welcoming you and thanking you for showing up, taking time out of your busy day to to talk with us here at the Kish Institute. And I had this epiphany last week and I want to share it with you because um I realized, you know, I talk to hundreds of doctors every year. We have 150 going through our training program. I'm on the phone every Monday and Thursday talking to people who are interested in the course. And of everybody from medical doctors, chiropractors to osteopaths, naturopaths, lots of acupuncturists, talked to a lot of different practitioners, some who are in school, some who've been practicing for 30 or 40 years, people who are all over the map. And you know, we just always were talking about functional medicine. I've been doing this for a while. And so the epiphany was that there's this fundamental confusion within the functional medicine community. Let's just call all of ourselves members of this community. And I just wanted to clear that up and then we can get into our regular talk.

But this fundamental confusion and it bothers me a lot is that we're all always saying that there is a um individualized approach that we're using in functional medicine and that that's the hallmark of functional medicine is that these are individualized treatment patient programs. And this is very, very true. But where that trips up everybody is that then they think that every single program that they design has to be completely unique and completely different for every patient. And that is not true.

What's the commonality that we see in patients and this is what I want to start off talking about today is that there are these three or four body systems depending on what how you want to count the neuroendocrine system, the digestive system, the detox systems and that every patient that we're working with has problems with the neuroendocrine, the GI and the detox pathways. That's universal amongst all the patients that we're working with. Therefore, we can have a unified approach to functional medicine where we are testing the neuroendocrine, the GI and and detox systems on everybody. So the starting place for a basic functional medicine program can be the same for every new patient. That part is not individualized. What's individualized is what comes out of the labs. And we'll look at a lot of individual labs today when we get to the workshop portion of the class at the end of the class. Okay? I'm going to do some workshopy stuff. I'll show you some labs and some protocols once we get through the the sort of more academic stuff. So what's what's unique is not what you do with every new patient as a basic workup. And that's assuming that you want to follow the model that I follow, which is what I would call a not chronic illness-oriented practice. So if you're going to work with a chronically ill patient, with the chronic illness crowd where the majority of the work that you're doing is with people who are very, very sick, then you do have to very much individualize every single protocol, do different lab work with everybody, and it's very complicated.

But what I try to advocate in the beginning as we're training people and the beginning for me is like the first five or 10 years, like literally the first five or 10 years of your practice is the beginning of this right? Because we're learning as we go and it takes 10 years to get adequate at doing functional medicine. So for those first five or 10 years, I really advocate a simple model where you're not working with very complex chronically ill patients and and you're instead developing your expertise in an easier patient population. We really try to push people towards that. And what I find is the most common pattern that we see with all practitioners, whether they're chiropractors or medical doctors or acupuncturists, is that as they get better and better at what they're doing, they attract a sicker and sicker patient load. And most of the successful doctors that I talk to are burned out because they're working with really difficult patients. And it doesn't have to be that way.

So I want to try to draw what we're going to do today, which is that we're talking about this neuroendocrine system, adrenals and brain, thyroid, etc. We're talking about the GI tract. And today we're also going to focus a lot on on detox. And as we go through the other sections of the course, we'll talk more and more about detox. So there's three body systems. One, two, three. And there's a lab test for each one of these areas. There's some overlap. It's a little confusing. We'll get into that in a minute, but we can keep it very simple. Adrenals, gut, detox for every single patient. And then what varies and what is highly individualized is how patients express these various problems. So, for example, you could have a patient that has a stage three adrenal burnout and cryptosporidium and their main symptoms are an autoimmune disease. You could have another patient that has a stage three adrenal burnout and cryptosporidium in their gut and they might have a chronic yeast overgrowth problem. You could have another person that has the exact same lab, stage three adrenal problem and cryptosporidium, and their main problem is that they're a 10-year-old kid and they have ADD ADHD. So what is individualized is how a highly individualized is how these various problems express themselves. But what we can count on, which is really good news, is that most every patient we're working with is going to have a neuroendocrine, a GI, and a detox problem and that we can start to assess people with some simple testing.

So what we're going to talk about today with the organic acids profile is a little bit of the neuroendocrine, a little bit of the GI, and a little bit of the detox. Whereas in my practice, the way I usually practice, in addition to doing this organic acids test, is we're doing an adrenal panel and a GI panel specifically also for these first two body systems and then we cover the detox workups with the work that we're going to look at today. So, we're not presenting the entire model today. We're kind of narrowing it down, looking at just this one test. But I want you to see the context in which it exists. We're always thinking about three body systems. Testing and correcting adrenals, thyroid, female hormones, sex hormones, testing and correcting the gut, which we're just going to brush over today a little bit. Uh GI protocols, that would be infections like yeast, bacteria, parasites, etc. And then a really big focus on detox and nutrient replacement. And the organic acids profile spans all three of these body systems, but it doesn't replace a good adrenal lab and it certainly doesn't replace a really good GI workup. You have to do those independent of that.

So again, the conundrum is that we're trying to do individualized patient programs, but if you're working in a non-chronically ill patient practice, you can be very standardized and very sort of methodical about the basic testing that you do for every new patient. You don't have to do a whole new series of labs with each new patient, and you don't have to worry about a whole separate protocol for every new patient. What's going to really be the individual expression of that particular patient's case is how the symptoms express themselves more so than the original problems. So we'll see hundreds of patients with adrenal, GI, and detox problems that each manifest with a different set of symptoms. And that's a very confusing thing because we were all trained really to focus on symptoms. And you know, regardless of what your background or training is, we're always keyed into symptoms because patients are always keyed into symptoms. And what I'm trying to do tonight is sort of look at some of these labs and start to break that pattern and we start to look more at the lab work and how the body systems are functioning in isolation from and separate from the individual symptoms that people are expressing. And that's kind of the theme for tonight.

So let's go over. I'm going to start the PowerPoint up now and uh I can't go over here and get going now. Oh, um I should mention with the camera, you can um with a camera um let's see something happened here. Sorry, people are still trying to get into the webinar. Um with the camera, you can um minimize it. You can make the camera smaller or larger depending on on what you want to do there. And uh so if you look in the left-hand corner of your um of your screen, you'll see that there's a camera. You should be able to make that bigger or smaller depending on the size that you want the camera to be. And now um I'm going to you should minimize the camera now because we're going to get into the PowerPoint, but we'll take some time later and um you can bring up your camera again if if we do a little more stuff on the whiteboard maybe at the uh at the end of the class. Okay. So again, the left-hand side of your uh computer screen, you should see uh camera. You can make that bigger or smaller. And I'm going to be away from the camera for a little while now. So we'll go into the PowerPoint and start talk about all this good stuff.

Now, number one, I'm going to introduce you. I'm going to stop the camera for a minute here. Okay. Number one, I'm going to introduce you to myself just for a moment. Some of you probably know me pretty well. We've done a bunch of these, some not so much. I've been in practice for over 20 years. I've worked with thousands of patients at this point. And we've trained over a thousand doctors now in the Kish method, which is pretty exciting. um really picking up some steam in terms of getting people trained and uh practitioners out there. We have a really, really great community. I'll show you in a few minutes. um I've spent a lot of different things in my past. In my 20s, I spent a long time in Asia doing various monastic trainings and whatnot. And um that was all pretty exciting and and a good thing. And um now I'm kind of unifying my spiritual background and my spiritual practices with my patient practice, which to me is really rewarding. and talk a lot about spiritual work with my patients now, which I was afraid to do those first 20 years of practice. I was sort of afraid to talk about it, but I find most my patients really receptive and open to that now. Okay.

Now uh right, we just finished two weeks ago this study with the Mayo Clinic, which is super exciting. um and we'll get more information out about that as it goes on. But um the the research uh data gathering phase is over now and we'll have a a published study hopefully later this year. You guys can all read about the Kish method under the scrutiny of the Mayo Clinic doctors, which is a really great collaborative effort that we've been working on for several years now. It's finally come to fruition. Done a lot of other work with interesting people. I've worked with the uh Kennedy family and Patrick Kennedy specifically on the one mind for research program looking at integrative neurology and we have all kinds of different people who have taken the class, alternative doctors, more conventional practitioners like those at the Mayo Clinic, and it's really a a free-for-all at the Kish Institute about what we do.

So now um let's take a look here at the learning objectives. So what we're want to focus on tonight is how to use the organic acids testing just to do a broad uh scope of of how you can start to look at this work. Okay. And then learn how to interpret the test using the three body systems model, which I just tried to show you. And I'm not sure if the camera was working there. Apparently some people are uh some people didn't see it. I'm not sure what happened, but um and then um to begin to learn the nine sections of the test as well. Okay. And organic acids testing basically is a way to measure whether your body is getting and using the nutrients to drive optimal health. And you think about like a car's gauges that warn potential problems, right? Your body has these predictable chemical indicators known as organic acids that are going to tell you if there's potential problems coming up. And so you can measure everything from intestinal function to neurotransmitter activity, detox demands, all these things. So you can see with your patients, especially the challenging patients, um, you know, where things are at in terms of uh whether you can find something that may not show up on a traditional lab or may not show up on some of the other functional medicine testing that we do, but it'll show up really clearly in terms of uh these organic acids profiles.

So, one of the sort of most exciting parts of this test, and we're going to go through nine different aspects of the test, but one of the most exciting aspects of the test is looking at the Kreb cycle. And as you all remember back from school, you know, with the Kreb cycle, we take dietary protein, carbs, and fats or lipids, and we burn them up for fuel. You can measure all these various steps with the organic acids profile. That's just one simple straightforward application of this, right? Which is pretty profound when you start to think about what that really means. And what that really means is that you can take and I'll just show you here. You can measure whether people are converting amino acids into fuel, whether they're able to take carbohydrate or sugar and convert that into fuel, whether they're able to take fats and convert that into fuel. Now, obviously, if someone's got a lot of body fat, then that's an important thing to figure out if they can actually convert fat into fuel or not. You could be tired because you can't do that. You could be overweight because you can't do that. And you can measure this with some of the test results that I'll show you in a few minutes. Okay. You can also check the various phases of the Kreb cycle and see if energy production is working properly in that regard as well and look at the electron transport chain. Vague memories. We all have this from school when we had to memorize all this stuff, right? Where you can see if the person has enough CoQ10 in their system to make energy inside the cells or not. So, there's some real depth to the biochemistry of what you can discover with these labs. and I'll show you the different steps. That's just one, you know, facet of the lab. And in fact, I have um an advanced class that I teach, which is four months. It's four months of regular coursework just going over this one test that we're talking about tonight and in the next class uh next session we're going to do because we we broke this into two parts. I didn't want to try to squeeze it into an hour.

So, you can also, you know, the problem with this test, really the biggest problem with this test is that it's so um overwhelming and there's so much information that people just get kind of frozen and they're not sure exactly how to address all this stuff. Okay? And that can be a pretty big problem. That can be a really big problem and it dissuades people from wanting to do the lab, which is unfortunate. And so what I have really tried to do in my own mind over these 20 years because I've known this this test is fascinating is to try to dumb it down and to simplify the lab so we can actually wrap our minds around the portions of that individual test that are important for that individual patient. Okay? So I mentioned this earlier. This is individualized care. We talk about this all the time in functional medicine. But if you're overwhelmed with too much individual data on an individual, you're not going to be able to do anything. So we also want to as much as we want to be customized, we also want to be generalists. So we can approach this test and understand what the main indicators for any given patient are.

So I'll show you there's maybe four different ways that you can use this lab. You can use it in a context of the three body systems, adrenal, GI, detox. You can use just the sections of the lab and address each section one at a time. I'll show you that in a second. You can look at the organic acids and the supplements that are associated with it. You can look at this in its most simplistic form. The most simplistic form would be okay, we're measuring these micronutrients. Jane is low in CoQ10. I give Jane CoQ10. Jane's CoQ10's level is better now. Okay, that could be like the most overly simplistic way to do this. And in fact, that's kind of the intuitive way because when you see the way that the labs are reported, you'll just see that the CoQ10 markers show up all over the place and you just assume that if you give this patient CoQ10, they're going to feel better. I'll tell you after 20 years of trying that, that is absolutely a total disaster. It never works. And anyone who's done a lot of this lab work, if you talk to them about it, they'll tell you the exact same thing. They'll, you know, do patients really get better if they test low on CoQ10 and you give them a boatload of CoQ10? Absolutely not. It's just not that simple. Human beings don't operate as a micronutrient deficient entity, right? They're human beings and there's a lot of moving parts to us. And so just seeing one nutrient that's low and giving that single nutrient is absolutely 100% doomed to failure. And it's such a doomed to failure problem that I did something radical. I don't know, you could ask my staff maybe two months ago, month and a half ago, is I went into my office and I was I don't know if I was angry. I was in a mood and I went in and I took all the arginine. This is true. I took all the arginine and I grabbed it because arginine is one of the individual supplements that shows up on these tests that never works for anybody. And I threw it in the garbage. I just got rid of a couple hundred bucks worth of arginine. Yeah. And I was going to throw out the CoQ10, but it was so much it was kind of a lot of CoQ10 and it was very expensive and I couldn't didn't quite have the heart to do it. But I really went through this epiphany and I realized, you know, individual micronutrient replacement is not what this is all about. This is not how human beings operate. So you can look at the test in this way, but be careful because that really doesn't work and I don't want you guys to get tripped up on that one.

Then you can also look at patient archetypes, which we'll talk a lot about where you have your fat patient and what are you going to do for body fat burning? How does this test tell you how that person can lose weight? You have your tired patient. How does this test tell you how you can get more energy into that patient? So that you're not having to treat every single thing on the lab, but you're honing in on what the major problems that that patient is suffering from are. and then f focusing on those. Okay. So, you can use the three body systems. Highly effective. Totally recommend doing that if you're into the Kish method stuff. Don't have to do it that way. You can look at it in each individual section. And we'll look at those in a minute. You can do the way that is the doomed to not work way, which is looking at it as a micronutrient imbalance that's devoid of any other connection in the human body. Right? This just not how the body works. We don't just all of a sudden get low in CoQ10 and that's our sole problem. It's not how it works. That's not how functional medicine works. And you can look at it, which I would say was like the highest level of this in a patient archetype way where you're looking at what's the gestalt of the patient. What's that totality of that patient's problem? And then how does this test relate to that? And how are you going to make that patient better? Not make the lab better and treat the lab, but physically, energetically, spiritually, emotionally treat the patient themselves using the lab data. Okay. So, those are the different ways that you can do it. And just be really careful about the micronutrient thing where you're giving someone an individual supplement because it just never really works. um, it's not how human beings work, but it's how we were trained.

So, like if you think about I there's several of my really good friends that did long stints as emergency room physicians, you know, these ER doctors for 5, 10 years, one of them 15 years in the ER, you know, and so when you're an emergency room doctor, and I've had lots of conversations with these friends, you know, if someone walks into the emergency room and they're having really intense chest pain, you have to figure out in a very short period of time whether they're having a heart attack or not. And there's a one-to-one correlation here, right? Heart attack, yes, certain things have to happen. Heart attack, no, completely other things have to happen. So, we're all trained when we're doing differential diagnosis type stuff to try to figure out exactly what's going on with that patient in a one-to-one kind of relationship like is this a that is this a patient with small intestinal bowel overgrowth? Is this a patient with a yeast overgrowth? Is this a patient with a parasite? Is this a patient with heavy metal toxicity? But once you've been doing this job for a long time, you realize that it's very rare and really almost never happens where you see one person that has one problem and that's the only problem they have. In the functional medicine model, it doesn't operate like in conventional medicine where someone could just be having a heart attack. And when you're diagnosing whether they have a heart attack or not in the ER, you're not really caring why they're having that heart attack. You're not thinking about their diet and exercise patterns. You're not thinking about their parents' history. you're just trying to figure out does this person need treatment for a heart attack or not. But in functional medicine, it's completely different. But we have this model of thinking, oh yeah, that person probably has mercury toxicity and that's what we're really going to focus on. But the human body from the functional medicine perspective breaks down in this really complicated way. But the good news is it breaks down in a very consistent complicated way for all human beings. There's not a lot of variation on this. And here's the three body systems that I mentioned. Hormones, detox, and digestion. And most of the people that we're working with have problems with the hormones, detox, and digestive systems. And we can assess each one of these with this lab in addition to doing other lab work as I mentioned earlier, adrenal testing, other gut related testing, etc. Okay.

So the nine sections of the test, the nine sections of the test are fat burning, carb burning, energy production, B vitamins, methylation, which is all the avail, you know, very, very popular right now. Methylation, super important, neurotransmitter markers, oxidative damage and antioxidant markers, detox markers, and bacterial, clostridial, and yeast markers. Okay, these are the sort of general nine big sections and you could, if you wanted to, treat one section at a time. Okay, that's a legitimate way to go. That's better than doing a single micronutrient at a time. Like you could, for example, address the energy production markers as a group and just go after that section if the person's really tired all the time. If the person is highly toxic, you could go after the detox markers. But what I wanted to try to emphasize tonight is that very much so all the time it's an integration of these various problems. And so we want to treat the the patients as an integrated entity and and look at how these sections combine to create the various patient symptoms that we see.

Now I'm going to break down the sections just so you can see what the components of the test are and then we can look at some cases and uh wrap up the class with some case study stuff. Okay. So again, there's nine sections. The first one, and these are in the order in which you see them on the lab report itself, is fatty acid metabolism. And that tells you about your body's ability to metabolize fatty acids and convert them into energy. So what could that result? Well, poor fatty acid metabolism could make you tired a lot and that could make you overweight also because you're not being, you know, effectively using fat as a fuel supply. Your brain is going to suffer, your muscles going to suffer if you can't use fat for energy. So, you might have someone who is a professional athlete and they're a professional endurance runner and they're really tired all the time because they can't burn fat. You could have someone who's 35 pounds overweight and even if they starve themselves, they can't lose the weight because they can't burn fat. So, this fatty acid metabolism marker is really important. They track ethylmalonate, and they can tell if the person's low in carnitine, which is one of the major fat burning nutrients. That's the shuttle that pulls fat from storage sites into the parts of the cell where you burn it up for fuel.

Equally important, I don't know, some people might say even more important in some ways, it'll be carbohydrate metabolism. How well can your body metabolize glucose? And they're measuring this. It's pretty amazing. Pyruvate, hydroxybutyrate, bunch of different markers to let you know how well your blood sugar is being stabilized. Why is this important? Well, you're thinking about energy production. You're thinking about the body's ability to utilize carbohydrates for fuel. You're thinking about the adrenal glands because if your blood sugar is unstable, the adrenal glands are not going to do very well. A lot of different components, right? And here again is a diagram that shows fat burning. And in order to burn fat, remember we need carnitine. And this test by measuring adipate, succinate, and methylmalonate is assessing that patient's carnitine stores. Do they have enough carnitine to make this work or not? Do they have enough carnitine to pull fat from storage and burn it up for fuel? If not, they're going to either be fat or they're going to be tired because they can't burn fat, especially if they're an endurance type athlete.

Carbohydrate metabolism, the second section we just looked at, they're measuring pyruvate and lactate and the conversions here, right? If that's not working well, then the person's going to have a problem metabolizing carbs. So now they're not being able to utilize sugar or glucose to make energy inside the Kreb cycle or citric acid cycle. And you can also have a problem with protein, meaning that they are not able to burn amino acids in the uh citric acid or Kreb cycle as well. Okay? And also as an aside, we won't get into all the detail now, but there's other little steps within the citric acid cycle that they're measuring, things like alpha-ketoglutarate, etc. that are going to let you know about energy production in that phase. And then a really important marker here that I mentioned already is CoQ10. CoQ10 is here at the bottom of the Kreb cycle or citric acid cycle. It's that final rate-limiting step that allows the body to make ATP or cellular energy. So if everything up top is working great and you don't have enough CoQ10, the system falls apart and doesn't work very well. However, and if you only learn one thing tonight, this is totally worth listening to this for a while. If you just give someone CoQ10 and the whole Kreb cycle or citric acid cycle is messed up, I can guarantee you it's not going to help. The patient's just not going to feel better because look how complicated this system is. We need to address this as a system, not as an individual micronutrient ratio. Okay? And and maybe it's a personal problem that I have. I got so hung up on individual micronutrients and trying to provide just the right individual special micronutrient combination to each individual special patient that I was just completely missing the point of the fact that what's happened here is this integrated system is falling apart and we have to address the patient as an integrated system so we can get them better. Okay, that's super important.

So, I'm going to talk a little bit about the class for a few minutes because I'm excited about the class and I think it's a really great thing and then we'll get back to the uh presentation uh on the actual content for tonight. Okay. So, this is something that we address with almost every person who's interested in the class. Even if you don't want to sign up for the class, this is something you should really think about for a while, which is that what's your business model? What's your clinical model? And how are they different? And so, and this is something every practitioner should be struggling with, you know, which is that did we learn how to do things from a clinical perspective, from a clinical process perspective? And and and is that totally void of a business model? You know, and in general, in my experience, all clinical protocols are taught in devoid from any kind of business model, right? Because in fact in the practice of of medicine and natural medicine, you know, the idea that we're in business is is sort of a negative. It's not seen as a positive. Most business people are happy that they're in business. They're happy that they're making money and that they're happy that they're deriving, you know, profit for their investors or whatever. But in in especially in natural medicine, it's sort of almost like a negative that we're actually making money doing this. So I think what happens to a lot of us is that we get really focused on a clinical model and we don't ever assess whether it's going to work as a business or not. And I'm really dedicated to making that go away and integrating it so that you have a clinical model that's effective that gets people healthy that also works as a business model. Okay. And and my basic version of this is that as we go through the patient education process and as we teach people about functional medicine, about how important these labs are, you're really also selling them on the idea of buying the tests. So the patient education process is very much a sales process. And if you're not good at educating patients and you're not good at communicating why this stuff is important, you're not going to be able to sell them the labs or the supplements and they're not going to get better. This whole thing falls apart. So good clinical results are predicated on you being able to sell people stuff. And I'm sorry, but that's just the way it is in functional medicine. You can't get around that. Okay. I got really, really good at a clinical model and at selling people things for many, many years, for almost 10 years before I realized that this was really a sales model because I grew up in an environment where, you know, Berkeley, California, a very liberal family where, you know, profit and sales and the man and corporations were all, you know, very, very negative in my family. The idea that one would go into business and make money in some corporate environment in my family, especially my father was seen as like evil to him, business and money were evil and academics and you know, liberal politics were where it was all about and so I it took me 10 years to figure out I was actually running a business and what we're trying to do with the training program now is teach you guys that this clinical model is a business model and that you can have these two things at the same time.

Let me show you how cool what we put together is. So um we have a community now. We started last year which is um rather than just having an online class. You actually join into this community which is really pretty amazing. So the community is a a page like this like you're seeing I'm scrolling through which is kind of like Facebook where people post questions. They can interact with one another. They can ask each other questions. They post their homework assignments and everyone's kind of interacting uh and asking each other questions. And we have naturopaths, chiropractors, medical doctors, um acupuncturists, all kind of addressing MTHFR problems. And we have that whole same community of people talking about the different um problems that happen when you try to do a yeast treatment. So when practitioners are stumped and they're in a class and they're wondering how they're going to get out of a particular bind, they can pose questions there and we all respond. Here are the different classes that are available. So you sign up for a time and you get an actual class. And um then we have this other feature which is pretty amazing which I want to show you is that um we have all this content. So at this point we have about 6 or 700 case studies that have been loaded into the content here. So, if you're curious about a given subject, I don't know, let's see, MTHFR, because everyone's always talking about that, MTHFR, and you can type that into the search box. And you hit return, and boom, all of a sudden, all these discussions pop up that are all what the practitioners are talking about in terms of MTHFR. You can join in one of the conversations. You can read about what other people are posting, but you have a community of practitioners that can really help you accelerate your learning process. It's an amazing group of people. We have hundreds of people in the community now. All of whom have taken the class at some point and are all participating in this kind of uh joint effort to educate one another. And then in addition to that, you also get the actual course content. And here's what the course content looks like. The six-month class has got six different modules. You can click on a module like the first module is adrenals. And you click on that and you'll see there's a series of lectures on the adrenals that you can read about. You can watch the videos that are associated with these various sections. So like if you click on that, you'll see within the stress and fatigue section. There's a series of videos, reading assignments and tools and whatnot that you can utilize. So there's a curriculum that rolls out throughout the six months which is based out on these six different modules. Uh there's a GI module here for example and you can look at all the different lectures and whatnot that have to do with gluten and food addiction, food allergies, etc. So the content is really well laid out and really quite organized in a modular form and then you have access to the community of amazing practitioners and we tend to attract which I'm very proud of just incredible doctors. It's it's it's just really a privilege to be in this community and to be I guess the one that started it really. But it's it's a little bit more than just about me now. it's really become about the group of people that are binding together here through a common interest in functional medicine to figure out how we can get the p, you know, the best possible patient outcomes. And so having um couple hundred doctors that you can ask questions of that you trust that are all kind of on the same page, it's it's a huge huge benefit. So that's one way that we're our program is really different. um also, as I mentioned, I think the other thing that really stands out in the way that I'm trying to teach is that it's a practice management system along with the clinical side, right? We're not just teaching you a bunch of random information showing you how you can set this up in a practical in a practical way and run it as a business. And then we also each week have a live call. So doctors are spread out into groups of about 15 or 20 and we have a weekly live call where you send in your lab work, you send in any questions that you may have and I I teach all the classes myself. So we'll be in a small group of doctors going through all your cases and reviewing everything each week. So there's a live component, there's a community component which is active day and night. And then there's the actual coursework. Okay, that's how the program rolls out. We're starting the next group May 13th. um, and then basically what we're looking at is a step by step to figure out the best labs to order, how to design supplement programs, and as I mentioned, the ed the patient education process so you can really start to master every side of this and feel comfortable running your practice in a way that's going to be successful. That's our goal. So, if you're curious about it, you can schedule a call with me. We're starting a group in a few weeks. And if you mention this ad, if you mention this uh webinar that you run on the webinar, you get 500 bucks off. So, um that's kind of a nice little perk for you all who are interested in this work. Check it out. Give me a call and we can talk about the class.

All right. So, let's get back to the stuff. So, in terms of energy production, remember I said that there's nine different sections. We talked about fat burning, carb burning. The next big section is energy production markers. And that's right to the Kreb cycle. And there's many, many different steps in there. But this is important because most of the patients that we're working with are tired. It's a pretty common thing. People are fatigued. Another section is methylation. They check um uh methylmalonate and figlu. Okay. And these are markers that look at folate and B12. Now this is different than the MTHFR testing, but they are related. Obviously, if a person has a problem, genetic related problem with folate, it's going to also show up on this test typically because you see this as a functional problem. So, in other words, this test, figlu and methylmalonate are markers for a functional need for more folate, which is really interesting because sometimes you may see that the blood work looks okay, but the person's not able to utilize the folate and you'll see the functional need show up for it with the figlu here. Okay? And it's that's the whole point of functional medicine, right? is that we're assessing this at a functional level versus just looking at it from a perspective of um of what a blood test might show, which is always a starting point, but this is getting into more depth.

Now one of the most exciting portions of the test and we could talk about this for six months literally for six months and we're going to just cover it in a few minutes is how they have attempted to analyze neurotransmitters. So as you all know neurotransmitters, the ones we really care about, the chemicals we really care about are inside your brain and there is something called the blood-brain barrier which keeps those neurotransmitters out of the general circulation in your blood. Right? So we do make serotonin and dopamine and epinephrine, norepinephrine in the periphery. We make them in uh all sorts of body tissues including the adrenal glands, etc. And the gut is make, you know, making tremendous amounts of serotonin. But those uh chemical compounds, those uh serotonin and dopamine, epinephrine, norepinephrine molecules made outside the brain stay outside the brain. So there's a really distinct measurement here between what's going on inside the brain and what's going on outside the brain with these different chemicals. And so a lot of different labs have attempted to try to resolve this in different ways. But the blood-brain barrier really puts a damper on this whole activity because it means that the stuff that's happening inside your brain, you can never actually measure the serotonin or dopamine levels inside the brain effectively. Okay? Unless you do some kind of puncture of the cerebrospinal fluid or you get into the brain itself, which is not something most of us are going to be doing in our practices, right? So, it's not practical to measure serotonin or dopamine inside the brain. However, many, many decades ago, scientists discovered that we can clearly see the urinary byproducts of these chemicals. Homovanillate, vanillylmandelate, quinolinate, picolinate. These are urinary byproducts that indicate what's happening with the neurotransmitter production. And this is a huge, almost it's almost hard to believe it's possible kind of thing because all of a sudden we can see inside the brain by measuring these urinary byproducts.

So the way this actually works is pretty complicated, but I'll try to describe it a little bit. I've been studying this for about 12 years in depth and it's the more you study it, the more complicated it seems to get. But let's just take one chemical. Let's take dopamine for example. So you have a bunch of dopamine. Now where is dopamine made? Well, obviously it's made in the brain, hence the name neurotransmitters. But you also make dopamine in the adrenal medulla. Same with norepinephrine and epinephrine. It's confusing, right? Because we make these chemicals inside the adrenal glands themselves, the adrenal medulla, which is obviously not in your brain, right? It's part of the adrenal gland. And then we also make the exact same chemicals, exact same version of the same chemicals inside the brain itself. And so when you're trying to assess this, if you're measuring dopamine or serotonin in the urine, what you're actually measuring is a serotonin or dopamine that was made recently by the kidneys and then dumped into the urine. So that doesn't work very well. But what does happen with dopamine is very predictable and the same thing happens with serotonin is we break it down with these enzymes MAO and COMT and that then gets converted into homovanillate, which does show up in the urine. So even though you're not seeing the dopamine directly in the brain by tracking what these enzymes are doing and measuring the urinary byproduct or metabolic byproduct, the breakdown product of dopamine, you can get a pretty good idea of what's happening with the dopamine levels in the brain. And similarly norepinephrine and epinephrine are broken down by these same enzymes COMT and MAO into vanillylmandelate. And you can measure vanillylmandelate in the urine. It's an indirect measure, yes, but a very accurate indirect measure of what's happening inside the brain. And I found these to be incredibly reliable and helpful over the years that I've been doing them. As a matter of fact, the more I do these tests, the more I begin to rely on on their accuracy and the validity of of of the data and the information you get.

So now think about it this way and I always kind of am interested in the where these words come from. So uh epinephrine for example, epi above, nephrine the kidney, the kidneys also known as adrenaline, add above renal, kidneys. You know, depending on whether you like the Greek or the Latin, you could call it adrenaline or epinephrine. But again, we use the word adrenaline. It's easier to understand the Latin root than the Greek root, right? Adrenaline made by the adrenal medulla in the adrenal glands, but adrenaline also made inside the brain. So, hence this neuroendocrine axis, right? It's kind of confusing. Not only are they intimately connected, but we're making in some cases the exact same chemicals, for example, adrenaline in the adrenal glands as we are making inside the brain itself. So, not only are these chemicals interacting with one another, in some cases they're the exact same chemical either produced in a gland like the adrenal glands or produced in the brain itself. Confusing. When we're under stress, obviously we make a lot of adrenaline, noradrenaline, and dopamine. And the more stressed out you are, the harder the adrenal medulla starts to crank these things out. And eventually that can start to affect the brain.

Now, another little factoid on here which I find to be just incredibly fascinating is is what happens with these markers down here. Okay, so when we're inflamed, these inflammatory cytokines are activated and picolinate and quinolinate elevate. And when those chemicals go up in the urine, you know that you're pulling your B6 to these cytokine production issues and you're going to see low brain chemicals as a result of inflammation. So, it's a direct measure of the gut-brain axis and I'll show you some examples of that in a minute. Okay. Anyways, this is a fascinating part. We could

talk really like not exaggerating for six months about that. And just think about it this way. You got the flight oright response, right? So, you've got the ability to when you're stressed crank up your cortisol. named for where it made is made in, right? The cortex, the adrenal cortex is where you make cortisol. And we're also cranking up our adrenaline in response to stress, meaning the adrenal medulla. And these two things are interacting, right? So when we're under stress, you immediately have a neuroendocrine response. The whole thing gets dragged into it all at the same time.

You'll see similar issues on the serotonin side of all this. So with serotonin as a marker, serotonin is broken down into five hydroxy acetate. So we take our tryptophan, we convert it into 5http eventually into serotonin and then it's broken down and excreted as five hydroxy acetate. You can measure that in the urine. So again, we're measuring a urinary byproduct of serotonin, but it's a very accurate measure of what's going on.

And here's an example test. And we'll do a couple of little workups so you guys can see how this might play out. Okay? And do a little workshopppy thing here. Now, number one, let's just look at this. These are just we had um I had uh my um content person, Lissa, pull these for us today or yesterday. I think these are uh just right out of my patient practice. It's just regular old patients that I've been working with. 71y old male. Actually, this was a really interesting case. If we had more time, I'd get more into detail, but let's look at the lab part first.

Now, we talked remember about the nine different section. Fat burning, carb burning, energy. Those are the first three. Fat, carb, energy, then B vitamins, methylation, and neurotransmitters, antioxidants, detox markers, and then all these gut markers. Those are the nine different sections. And this is how the lab gets displayed. The unfortunate part about this is that it's presented typically in very complicated ways. And so people get overwhelmed really easily. I know I did. But let's look at it by section. For a 71y old guy, fat burning is not working well. Turned out if he's overweight, you may want to address it. If not, you may want to leave it alone. But also, the carnitine that's indicated helps with energy. So, if he's tired, you might think about it. Two of the neurotransmitter markers are elevated, quinolinate and picolonate. And we remember we just mentioned that those are related to cytoines and inflammation. So, now we know he's inflamed. Now, what's that about? Think about this. We have a neurotransmitter metabolism marker, but the two markers that are high are the two markers that relate to inflammation.

Now, let's just go back a few slides and I'll show you that. Remember this right here. Here they are. Sorry. Here you are. So, rememberate and quinolinate are markers that the body is inflamed. markers that the body is inflamed. So now we go here and we look at this lab and we're thinking, okay, well the neurotransmitters are clearly involved. It's under neurotransmitters. We know it's related to that, right? But the two markers that are showing up are the two markers that are related to inflammation. So what this tells you is, yeah, this guy has a major brain problem, but it's being driven by some inflammatory source. So now you could treat the brain, but that's really not going to address the issue. You could treat the brain and get some symptomatic relief if you're lucky. But if you can figure out where that inflammation is coming from, you could eliminate his depression and anxiety because you could reduce the inflammation enough that these brain markers start to normalize. So sometimes this test is not what it appears. Even though it's a neurotransmitter marker, that might be screaming out at you, inflammation, inflammation. And now you have to go on a hunt, find the inflammation. Where is that inflammation? Where are the places it could be? And as you all know, there's a 100,000 places it could be, right? But in the Dr. Dan world, we're talking about adrenals, gut, and detox. And if you follow this, it really works extremely well. The most common source of inflammation would be in the gut. So you're looking at foods and infections and that kind of stuff. Second most common source of inflammation for sure for most of us would be with the liver. So you're looking at chemicals, heavy metals, etc. So, right away you can see there's inflammation, but you're wondering, is it coming from the gut or from the liver? And we're still sticking within our basic threebody systems model. Hormones, gut, detox. This lab is just telling us we got to find the inflammation to help this guy. And then there's a couple of bacterial markers that showed up down here as well.

Now, if you want to look at the individual aspects of the test, I'll show you how that works. Again, remember there's nine sections: fat, carb, and energy. That's the first page. Fat, carb, and energy production, B vitamins and methylation. Next two sections, cell regulation markers, neurotransmitter metabolism markers. So let's look at here again 26 and 27 just as an example with this one patient. Those are the two markers that are under the brain, but they're the two markers that let you know he's inflamed. So this guy has got an inflammatory derived brain related problem. And if he's depressed or anxious, which he was, you can see why. And rather than just treating his brain, which we can do also, of course, we would treat his brain so he feels better. Now you know where it's coming from. And that's just one example of the depth of understanding that this test can give you.

Now, just to give you one other idea here, I'll tell you this is a true story. I was in New York a couple months ago at a conference and one of the great functional medicine people of all time the privilege of being in the audience and listening to him Walter Kinian if you don't know Walter Kinian you got to listen to every lecture you can from Kinian because he's the really I don't know he's the father of environmental toxicology right he's the guy that just created this whole field and he spent an hour and a half in New York just talking about this one marker here hour and a half talk from one of the most brilliant doctors of our time and all he chose to talk about for the hour and a half was dehydro uh eight it's 80 oddg is the name of the marker it's it's it's number 29 here okay an hour and a half just on this one marker and he barely scratched the surface and I was taking notes faster than I could even imagine it was fascinating I wish he had talked for three hours about it because it was incredible so there's a lot of depth to this test okay there's a lot of stuff going on here there's just one marker here you could literally spend six months studying adog and cranian made you want to do that so an important marker for um oxidative stress, right? Which is implicated in cancer, heart disease, diabetes, etc., etc. That's what his talk was about was how this one marker is implicated in many forms of cancer, cardiovascular disease, and diabetes, just that one marker. Okay.

And now we're going on to the sections, detox markers, very important. And then uh this is all the GI section here. Okay. So, you can see how robust the test is. Nine different sections. Let's look at one more example. Now, the first one I showed was kind of easy. This one you're looking at and you're just thinking, "Wow, that does not look easy." Looks like a lot of things, but it doesn't look easy. Okay, so what do we got here? We've got, remember the nine sections. Fat burning, no problems. Carbohydrate metabolism, yes, is a problem. Energy production markers, yes, she has three problems there. One, two, three. B vitamin markers, oops, three problems there as well. Methylation. Yep. Figu's elevated. She needs folate. Neurotransmitter markers. Ouch. One, two, three, four. Neurotransmitter markers. There's a lot going on in her brain. Oxidative stress. Absolutely. That one I just mentioned that Crinian talked about, 80HD, elevated. In fact, they say very high, not just high. As well as the other antioxidant marker. Detox indicators. Absolutely. Two detox indicators. and then a bunch of bacterial stuff going on in her gut. There's a dozen or more markers on this, right? Are you going to give her, you know, 12 or 15 supplements? Absolutely no. That's just not going to work. We're not treating the individual nutrients that are off. We're trying to treat this per treat the system, you know, the person as a system. It's an integrated system. So again, remember there's nine different areas. Fat burning, carb, and energy production markers. She's got problems in two of those. Here you start to see things really degenerating. B vitamins including methylation are messed up. And and look at the primary problem here. Look with her. This section is not doing well. And this section is not doing well. Tons of oxidative stress, tons of brain related problems. And then you flip the page and you see the detox indicators are all laid up as well. So, here's someone who's highly toxic, whose liver isn't working really well to get rid of waste, who's got a lot of neurotransmitter stuff going on, and has got oxidative stress through the roof. Her 80HDG marker down here is at an eight. And we want to see that at a four or lower. Okay. So, she's losing this battle trying to fight antioxidants. That's going to make her incredibly inflamed. All kinds of tissue damage going on because she can't protect herself from free radicals. You can see the brain is starting to get damaged. you folate is falling apart. That's another really important nutrient for detox. And then you look at the detox markers themselves. And two of them are elevated. So with someone like her, you know, it's going to be incredibly complicated in terms of making this all work.

Now, I just want to show you real quick a sample protocol and then I'll open it up for some questions, okay? And we'll do a little summary. So here's a basic adrenal program. We do these all the time with patients in the training program. was kind of basic, but with a with a 71-year-old gentleman, right, he needed some support. So, we would set up a separate protocol to go along with his adrenals. Let's say a three-month uh you could call it a nutrient replacement program or something like that. But remember what was going on with him. He had we would want to pick on the things that were most important. Now, his anxiety and depression were his main complaints. So, we could work on controlling the inflammation that we saw that was impacting his brain. And so I use a lot of GI repair stuff for that purpose. Um, you might have other, you know, favorite anti-inflammatories, something like turmerics or something like that, right? Whatever you can do to calm the inflammation down, right, to help his brain. So an anti-inflammatory protocol would really help. And then of course chasing down where the inflammation is coming from.

Now in the second patient's example here, it's a 30-year-old woman, right? With a lot going on. You can't there's no way you could possibly try to treat all this. So you want to try to pick on the things that you're thinking you're going to get the biggest benefit from, you know, without trying to do everything because everything is just not realistic. So in her case, you might do folate. That's pretty easy. Get her methylation working and get her detox pathways working. Get her methylating, get her detox pathways working, and get her some antioxidant protection. So, as a simple example, if we were doing her protocol, rather than focusing on inflammation, we would need antioxidants in her protocol. Remember, because those markers were really elevated, you would want some uh liver support, liver detox support. And there's many different companies, many different supplements obviously for all these different things. Um, you would want to get her some of the folate, B12, and B6 that was indicated based on that one marker. And all of a sudden, you have a really great protocol for her where you're giving her some combination powerful antioxidants, some liver detox support, and a bunch of support around methylation. And you have a beautiful three-month program for her that would parallel with her adrenal and GI protocols as well, you know, to show um again honing in on one specific or two specific aspects of the test, especially when you get a lab back like that that has so many different things wrong with it that there's no way you could try to treat all of these. But for any human being, if you just get their detox pathways, their methylation, and their antioxidant levels under control, you're going to have a whole new patient, you know, a person who's starting to feel like a normal human being once you get those basic things done. And then you can come back around in 3 months or 6 months and start to address some of these other things. So, that's kind of where I I I want to head with this. And we'll have another session uh to go over this, but just to summarize, right, we've got this organic acids test. It's incredibly complicated, but you can get specific with it, too. Remember, I started this whole conversation off thinking about, yeah, well, functional medicine is about individualized programs, and every program is different, but there's always these same systems that are broken. Adrenals, gut, detox. We're always working within these same systems in different ways. Yes. But there's some commonality to this. There's a very consistent clinical model here which I want you guys to also use as a business model so you can build your practices and have a really profitable practice. Not so you can buy a jet or a boat and I don't own a jet or a boat. Although anyone who knows me well does know I do have five bicycles. That is my one weakness. I do have a lot of bicycles. But we're not talking about you know you generating a lot of money so you can buy a lot of stuff. We're talking about you generating a lot of money so you can be in practice for a long time and you can help a lot of people. That's really the goal here. And I've I've met a lot of functional medicine practitioners who are excellent clinicians and couldn't make it financially and had to drop out of practice. And I see that as a total waste of resources. So I'm really dedicated to you all making enough money to make this work. Hey, it's an important phase here. We also want to um you know, in terms of the testing, complicated patients, we want to work with simple patients, too. We tried to show you with a 71-year-old man that you can use a really uh complicated test in a really simple way as well. And make sure that you always think about viewing these results in a bunch of different ways. Think about it from a threebody systems perspective. That's the easiest. You can treat by section. If you just want to deal with fat burning, you could just look at the fat burning section. You could break it down by individual organic acids. You could break it down by individual supplements, but I'm guaranteeing you that's never going to work. Although I I did try to do that for a long time. And then most importantly, and we'll talk about this in the next class that we do, you can look at it as a patient archetype, as an assessment of what is that person trying to get? They're trying to get more energy. They're trying to get weight off. They're trying to get their brain back. Maybe with that brain example we saw a minute ago, they're trying to get their brain back. They're anxious and depressed. And you realize that their inflammation is driving that. Okay. Now, you've got inflamed, you got an inflamed brain on your hands. Okay, that's a patient archetype for you. Got to calm the inflammation down. You got to support the brain, but you got to find the source of the inflammation in order to get that depression, anxiety under control. It's also a really great if you want to be lightweight about this, and I'm all for being lightweight. You don't take life too seriously, you know. Um, as a matter of fact, probably the more mature we get, the more lighter weight we get in some ways. As you get older, you realize, wow, I don't take this too seriously, you know. Am I really going to fight with a person in the Whole Foods parking lot over a parking space? And I don't think so. Let's go find a different parking space. Right? So, in a lightweight kind of way, the organic acids test is really great. Woman comes in, she's totally healthy, wants to get pregnant. What should I do? Do an organic acids test. We'll give you a bunch of nutrients. What you know, whatever you're deficient in will bring those levels back up. Get a professional athlete that comes in, they're feeling great, season's going great, everything's good, they're healthy. Want to optimize their nutrition. run the organic acids test and give them individual nutrients. That's not going to affect anything in terms of profoundly changing symptoms, but it could make the person a lot healthier as a wellness program, as a preventive program. You can use this test and I use it all the time in those in those contexts. If I get a wellness patient that just wants to know how healthy are they, maybe run this test and you can just do it as a standalone test even and just see where the nutrient glitches are, get them on a simple program. So, it doesn't have to go to the real depths of all this stuff. You can you can do it in different ways. Okay.

Now, I want to open this up uh for the last couple minutes for a few questions that have come in and let us see here. Uh okay, first one. Oh, was uh Walter Kinian. C R I N. Walter Kinian, founder of environmental toxicology. I think his website is drinian.com. C R I N I O N. Dr. Uh, next question. Uh, in the case of the 30-year-old woman, at what point do you treat her gut issues? Do you find that that once the adrenals, gut infections, and dispiosis are treated that the neurotransmitters start to balance out? I think all natural health practitioners for the last thousands of years have seen that when we treat stress and when we treat the gut that a lot of brain related problems clear out. If you're in a hurry and you want the person to feel better faster, you can also treat the brain earlier on. But countless cases of depression, anxiety, brain fog, and fatigue clear up as we de-stress individuals and make sure that their um their guts working properly. That's really, I think, in my mind kind of like the foundation of naturopathic principles. There's two different uh labs. Terry just brought this question up. Um organic acids testing. You can do it through Great Plains or you can do it through GOVA. There's a few different markers on each one and some practitioners prefer one over the other. I grew up using the GOVA test, so I just prefer that one simply because I know how it's laid out proper. You know, in my mind, it's laid out properly because I'm just so used to using it. But Great Plains is an equally good lab. And some people prefer Great Plains. I think it's um it's very much like a do you want vanilla or chocolate ice cream kind of question. Just totally personal preference. And there's slight differences, but they end up not being uh significant in in the bigger picture. Okay. And let's see. Um any other questions? All right, you guys. I'm going to keep it to an hour here. We're just at the right time. Um, thank you for listening in. I'd be happy to talk to you about the training program if you're interested. And we're going to have a part two of this where we get more into uh the patient archetypes and we'll look at some more examples. And if you're just curious about what I would say is the next step that you could do, run an organic acids profile on yourself. You know, I just did one on myself a couple months ago. It's always an enlightening test and it's it's really well worth doing. All right, take care everyone. Have a great evening out there and we'll talk with you at our next class. Thanks.