Longevity and Mitochondrial Health: The Underpinnings of the Aging Process

Hello everybody, and welcome to our free webinar on longevity and mitochondrial health. We'll talk about the underpinnings of the aging process. I am Dr. Dan Kish. For those of you this is the first one of these you've listened to, I'm going to introduce myself a little bit. I'm going to talk about the subject matter. We have some slides to get through, and then we're going to look at some labs and design some programs so you can see how the protocol design portion of this actually works.

I want to thank our partner in this, Goova Diagnostics, for helping gather together such a large group. You guys can't see because you're all online individually, but there is a lot of you, and that's a wonderful thing to have a big crowd that's interested in this subject. Let's just get started.

So, who am I? I am Dan Kish. I started the Kish Institute back in 2006. We have trained thousands and thousands of practitioners. My essential life mission has been to help people create successful functional medicine practices. Whatever that means to you, to me that personally means being good at lab interpretation, being excellent at patient communication skills and program design skills, and making enough money that you are financially successful and happy and can do whatever you need to do funding-wise. We're not talking about buying airplanes and boats, but we're talking about putting your kids through college, having a nice place to live, maybe have a few cars, you know, that you can drive around in, and not being stressed constantly about your work life and your finances. And most especially, not working too, too much. You cannot survive as a healthcare practitioner if you're working extremely long hours. It's just not sustainable, and we see that in the burnout rates in people that try to do that.

So, I've worked with a lot of different groups. I've worked with the Mayo Clinic. I've worked, you know, more extensively. What we're going to talk about today is the work that I've done with Dr. Richard Lord, who's the developer of many of these tests. The first scientist to do organic acids and fatty acids and amino acids. The scientist that created the GI Effects test. And, um, I just talked to him a few days ago. He's still alive. Speaking of longevity, he's in his early 80s, and he's like, "Dan, I just built a path for my kayak and I put up a kayak rack." So he's like kayaking in his early 80s and living his life. And all the principles that we're talking about today are right out of the Dr. Richard S. Lord playbook. And it's nice to see it working in an older individual.

I myself apply these principles every single day. Uh, I sleep appropriately. What does that mean? I get to bed by 9:00 p.m. at the latest. I wake up early before the sun comes up. That's an essential component. I'm outside every morning getting light exposure as the sun is coming up. I do my saunas every day. Well, not every day, three or four days a week. I do my cold plunge on a regular basis. I have a whole schedule that is keeping me alive, and it's all based on the principles we're going to talk about today. And it's nothing new. You know, my main teacher in longevity, uh, in terms of the lifestyle, is a Taoist teacher whose lineage goes back like 10,000 years. None of these concepts are new, not even a little bit. They've been thousands and thousands of years people have been applying longevity principles. We're just modernizing them, putting the lab tests on top of them so you can track people accurately and really understand how this stuff works.

Okay, so, and again, we want to thank Goova and introduce you to the, uh, "Interpreting Goova's NutraEval and Protocols That Work" class that's coming up. That is, uh, September 19th. If you like this talk and you're interested in this subject, you get a 40% discount. Um, that's a huge discount, by the way. And, yeah, anyways, uh, that's a huge discount. So one should take of that. Whenever I see something 40% off, I'm always like, wait a minute, do I really want that? Yeah, I do. So scan that QR code, enter the GDX24 checkout. You'll get your exclusive Goova discount on the class. And this class is like serious stuff, right? We're looking at labs. There's a curriculum that you go through that's punchy and short and all really oriented around you interpreting labs. And then we interpret labs in class, the students like yourself. If you sign up for this class and send in your NutraEval, you can send in your TrueHealth test from Goova, and we just work through these tests, and you learn how to design programs in real time with real cases from your colleagues that are in a course with you. It's the best way to learn, in my opinion. Fact, they, people actually study how people learn, and there's like, people learn like three to four times more quickly if there's an active participation of the learner, which obviously makes a lot of sense. And so for doctors, if you go to a class like this and you interpret Goova labs with me and your colleagues, and you're seeing real cases, you just pick this stuff up really quickly. Kind of a classic way of doing it.

Okay, so now let's jump into, oh, and by the way, we'll have time at the very end for questions. So if you have questions, uh, please, you know, uh, send them in, and, uh, we'll take a look at them at the end of the class. Okay.

So we want to talk, you know, the lifestyle I just mentioned is important. Meditation or spiritual practices, sleeping properly, exercise. Has to be exercise. Exercise is the most important variable in all of these things. You have to be physically fit to live a long time. You got to work out. What do you have to do? You got to do a couple times a week of high-intensity exercise, not for very long, you know, maybe for five or 10 minutes twice a week. That's enough. You need to lift weights at least three times a week. You need to be getting stronger every year, not weaker. I'm stronger today. I can bench press, I can deadlift, and I can squat more weight today at age 60 than I could at age 20, 30, 40, or 50. You want to get stronger as you get older, not weaker. And how do I do that? It's because I work out three times a week and I have a trainer that tells me what to do. I just say, "Nick, what am I supposed to do this week?" He writes it all down, and I do it. It doesn't take a lot of time. It's three 30-minute workouts for strength training. It's two 5 to 10-minute high-intensity workouts a week. That's enough. Okay. Then I walk my dog for hours and hours and hours. So I do a lot of walking on top of that, right? That's what it takes. But I just don't want to ignore that because the physical fitness and the amount of muscle tone and muscle strength that you have is going to supersede anything else that we're talking about today. So, in other words, if your mitochondria are nutritionally balanced, then you're not physically fit, it's not going to work. The exercise is more important. But this is not an exercise class.

Okay, uh, these are all like kind of disclaimers, like longevity disclaimers here, but you got to get this right. We don't want you to get this wrong and then all of a sudden you're not living a long time. We don't want that. So we're going to talk a lot about the production and utilization of CoQ10, electron transport chain, how these things can get messed up, how the, and then basically how to restore mitochondrial function.

Drivers of aging. The mitochondria sustain damage from a variety of sources. That's an understatement, isn't it? And this is what accelerates our aging process. So once the mitochondria get damaged, then they lack the ability to function properly. Their signaling functions don't work. Their energy production, you know, functions don't work. When you really look at what mitochondria do, in a sense, they're kind of regulating all of these processes much more than making ATP. Um, they're signaling and controlling and regulating many of these body processes, including things that impact the brain and the heart, muscle tissue, etc. So if this is disturbed, the system is disturbed, then you get tired, you gain weight, you get depressed, you have all kinds of other inflammatory type symptoms, and, you know, people start to go down the tubes. We want to reverse that.

So where do you see the actual damage? You can see the damage in cell membranes. You can see the damage in your DNA. And you can see the damage at the level of the mitochondria themselves. Okay.

So the basic story, and this is like a story that, you know, when I say story, I mean story, you know, way that you can explain this to patients, is that what we're worried about here are is oxidative stress and the damage that can occur to mitochondria. But the major source of oxidative stress in the body is from the mitochondrial production of energy. That's a little ironic when you start to think about it. So too much oxidative stress, reactive oxygen species, too much is not healthy for the mitochondria. Excessive amounts. That's why excessive amounts of exercise isn't particularly healthy for in terms of longevity purposes. Excessive exercise. Adequate exercise is critical. Excessive doesn't help. More glutathione is the protector of your mitochondria. And so glutathione is the key player in making all this work. And yet, glutathione has this little back and forth thing it's doing with the process we call methylation. So oxidative stress is the enemy. Glutathione is the protector. And glutathione has to deal with our methylation processes all the time. That's the basic areas: oxidative stress, glutathione production, and methylation. Getting those dialed in.

Oh, you know, I should mention food. We're not really going to talk about diet at all, except for I'm just going to mention like, obviously, you have to be eating really well, or this is not going to work. The exercise part is more important. You have to have the muscle mass, or it doesn't work. But we're assuming that there's a healthy diet in here, whatever that is to you. We could argue about that all day. I'm not going to get into that. The most undervalued, underappreciated, not really talked about part of this are the are the B vitamins, because that's what makes all of these processes work. And it's very common to see people to have genetic issues with their B vitamins, meaning that they need more vitamins, B vitamins, than the average person does.

So the movement of the electrons is what we're talking about, and how this electron thing moves throughout the mitochondria so that we can do all these different functions. And that's completely B vitamin dependent. So I don't want to forget about the B's. If you think about the flow of electrons, you're going to see, and there's lots of stuff if you get into long longevity literature and longevity podcasters about NAD, NADH, etc., etc., etc. Um, I don't think you need to go to extremes to make this work. You know, I think the fundamentals work really well, assuming that the person is pretty healthy. But you do need B vitamins to start this process off and continue it going. You do need CoQ10 in order to actually move the electrons along in in the electron transport chain. And there's no substitute for B vitamins or cut. If those aren't present in adequate amounts, then you have a problem. And the testing that we're looking at measures in detail B vitamin levels and measures in detail CoQ10. So you don't have to wonder if this is a problem. But low CoQ10 or low B vitamin markers is a substantial problem to what we're talking about.

And then the overarching picture for all of this is magnesium. And most of the people that we work with are magnesium deficient. How do you res deal with that? Just give magnesium to everybody, which is what I do. So I use these multi-packs. There's many different companies that have them. So every patient gets a multi-pack with magnesium in it right off the bat, no matter what. Okay. And if this system is breaking down, your B vitamins, your cutan, your magnesium, that's not working properly, then that's the definition of cells aging, excessively aging too quickly, and then we're in trouble.

Okay. When we think about life, you can't really think about, you know, like, like short-term ways that you really kind of appreciate your life. And just try holding your breath. I do breathing exercises every morning, and, you know, I hold my breath in different ways, and don't hold my breath, and breathe fast and slow. And you really start to appreciate, you know, oxygen. If you try to hold your breath, you can all try this just for a second if you haven't done this yet today. Take a deep breath in, blow it all the way out, and hold your breath out, and just see what starts to happen. You start to realize after a little while that the mitochondria consume about 90% of your oxygen. And when they don't get that oxygen, the oxygen, the electron transport chain kind of falls apart, right? Because oxygen is the ultimate electron receptor. And if you don't have the oxygen, things don't work. So breathing exercises are key and critical to making a longevity program. Just pointing out the obvious here.

So now, this diagram is worth thinking about for a moment. Uh, let's see, did my sound cut out? Is my sound back? Somebody say yes if you can hear me. I'm not sure what happened. A couple people said that the sound went out. Uh, we're good? Okay. All right. You can let me know. I'm not sure what what happened there. So now let's take a look here at, uh, here this. So oxidative stress is the bad thing that's potentially happening. Oxidative stress is the bad thing that's going to H, that's happening. Excessive oxidative stress that's going to decrease methylation. So now you're not methylating very well. That interferes with a lot of different things that we're talking about today. And it's going to increase your requirement to make glutathione, which is very, very taxing, very, very taxing. So again, oxidative stress, which we're measuring on this test, decreases methylation capacity and increases the need to make glutathione. If your glutathione levels are low on the test, that means this whole thing got messed up a long time ago. In other words, when you first are under oxidative stress, high levels of oxidative stress, your body makes a ton of glutathione to deal with that. It makes it, produces glutathione. It makes an, an this antioxidant, the most powerful mass antioxidant you can produce at will. If your glutathione levels are low, you do not have the ability to protect yourself against oxidative stress. And what's going to get damaged? Your DNA, your mitochondria, your neurotransmitters, right? Your brain. You know, all these things are going to be damaged if there's a lot of oxidative stress and inflammation in the body.

Take-home messages: Methylation takes a hit from oxidative stress. Glutathione levels, first, your body makes more of it at first. But then over time, if the glutathione levels are low, it means that the oxidative stress has been there for long enough to exhaust this system. You're long past the point where it's just a methylation issue. Now you can't make the glutathione anymore, and your mitochondria, in a sense, are unprotected. And you're not going to eat your way out of that. You're not going to, there's no, not enough broccoli in the world for you to fix it at that point. Okay.

And so, I, I'm very interested in diet. I really do make a huge effort to eat heal, heal food. And we go to drive out of our way to get to this farmer's stand to buy food right off a farm. And you buy the food at the farmer's stand, and you look up back behind it, you actually see the farm. I mean, that's like they had to like pick the vegetables, they walk like 10 feet, and then we buy them. So I mean, I'm into that, and I do that. Um, however, there's a point where people cross over. If you see low glutathione on the lab, I don't think you're going to get people to eat their way out of that, no matter how healthy you get them to eat. There's a point where we just have to supplement heavily, get these things back on track, and then the person can sustain it with diet. Okay.

Uh, but there's a point where, you know, there's also a point where people are so screwed up that they can't exercise. They just don't have the energy to exercise. So then saying that exercise is the most important thing is great, but what about those people that can't do that right now because they're so exhausted? Again, short-term supplement programs based on these labs get that person back to the point where they can exercise, and then it's the exercise that sustains them. That's, in my mind, you know, a realistic way to approach these functional medicine, uh, conundrums that we have, you know, lifestyle versus, uh, lab-based supplements.

Okay, so on the testing, you can test for lipid peroxides. If it's high, it means that lipids are being damaged, and that means membranes are being damaged. The mitochondria, remember, have double membranes. They got an inner and outer membrane. So that's a problem. You can also measure CoQ10, which we measured, which is a protector of lipids, a protector of membranes, as well as being, uh, a critical player in the production of energy. And of course, you can measure magnesium with a whole bunch of different, uh, markers on these tests. Now, or the organic acid section of the NutraEval directly checks mitochondrial function by looking at the different enzymes. It's also going to help give your heads up on detoxification capacity because if you have a high level of environmental toxins in the system and the glutathione levels are low, that's going to over time equate to mitochondrial damage, and that's going to be a reason why the person is aging excessively.

You also have the oxidative stress markers here. In addition to the glutathione ones, they have other ones like ADOH, HTG, and some other markers that are kind of glutathione-related, but you may not think of it that way, like glycine, glutamine, and cysteine. So amino acids are how we make glutathione. There's three amino, you got to memorize this. So three amino acids from which you make glutathione: glycine, glutamine, and cysteine. So if those levels are low, that's another way that you can really improve, uh, glutathione and thus improve mitochondrial function and thus improve longevity. So these are the key nutrients that I think of have to be in the system in order for this to work: CoQ10, magnesium, B vitamins, carnitine. We didn't talk a lot about yet, but that's important too. Glutathione. Sometimes we use N-acetylcysteine instead of or in addition to glutathione. NAC converts into glutathione. And then other antioxidants. There's things like, um, curcumin-based products. There's lipoic acid, that's kind of a classic. There's, um, resveratrol, another classic. And each of these has its place, and none of them are single silver magic bullets, right? They, but they all have their place, and it's all lab-based. So if you screw the program up, as long as you retest the person, you're going to see that it's not working. Okay. The key is testing and then retesting.

So here's our mitochondria, the healthy one over here, making energy, lots of energy. See the little green dots are energy, lots of energy, and a little bit of free radicals are squeaking through. That's okay because why? Because you eat healthy and you have all these antioxidants that neutralize these free radicals. So it's all working out. The energy that you're getting from your food to make the energy is accompanied by antioxidants from the healthy food you're eating, and so you can deal with the free radicals. Now, once the mitochondria become damaged, it's, it's kind of hard to see this in the diagram, but these are holes right here. It's like a, a ship that had a torpedo that hit it. But this is a damaged mitochondria over here. Now you have not that much ATP and a lot of free radical damage. So if your citric acid cycle is not working very well because an enzyme has been taken out because of an environmental toxin has hit it, then this is what happens. And you start to go instead of making like 36, 34, 32, whatever, you know, 30-something ATP from each, uh, you know, glucose that you're breaking down, you start to make like two or negative -2, even in some cases. So if your mitochondrial metabolic processes are screwed up, you go from like 30-some ATP per glucose molecule, you know, at down to like two, or sometimes it's even in in a deficit. And this is why people are so tired all the time because they can't make energy properly.

And here's another view of the same process, but we, this breaks it down a little more clearly. So from fat, we go through something called beta oxidation and make energy. Okay. It goes into the citric acid cycle that way. From carbohydrate, we break down glucose, it gets split into pyruvate and into lactate, and they both go into the citric acid cycle. The way we learned this was wrong. If you went to school as I did, you learned that pyruvate, you know, glucose gets split into two molecules, two pyruvates, and then they, it's a six-carbon glucose, a three-carbon pyruvate, and then that goes into this citric acid cycle and we make energy. And then we learned that lactate's kind of like not such a great thing. It's happening over there if you exercise a lot. You don't really think about it. But turns out that's totally wrong. This guy, George Brooks, who's a very well-regarded physiology researcher guy at UC Berkeley, he's been studying lactate for decades. And lactate enters into the mitochondria through its own carriers and it's considered by Brooks to be a preferred fuel source for certain tissues of the body. I'll say that again: lactate is not just a waste product from exercise. Lactate, in in some tissues of the body, is actually a preferred fuel source. So anyways, both pyruvate and lactate go in. We're measuring these pyruvate or pyruvic acid and lactate or lactic acid on the testing. And then what can go wrong, and often goes wrong, is there's something with one of the citric acid cycle enzymes. And you'll see markers down here like succinate go high or malate go high. If succinate goes high, it means that that enzyme associated with that marker is not working right, and so that substrate's building up. Okay. And that's what we want to get moving, get working. And then there's a different nutrient for each one of these problems. So carnitine helps reverse this problem. Lipoic acid and the B vitamins reverse this. And this whole citric acid cycle, you can improve with, and I said this like 10 times already, CoQ10, magnesium, and B vitamins. CoQ10, magnesium, and B vitamins. And then there's one more ingredient to make this work that's ultimately so, so important, and I don't really think of it as a nutrient. You don't have to buy it generally, but it's oxygen. Oxygen. So CoQ10, magnesium, oxygen, B vitamins. And sometimes people also use free-form amino acids if you really want to get the citric acid cycle going. You can dump in some free-form amino acids, and those are very, let's call them energizing in a good way. Okay.

Whoa, that's a slide. But this, this is you, kind of got to know this. It's a little depressing, but this just get, spend a minute on it. I have a few images so you can kind of refresh your memory from school. Um, so this is the electron transport chain, complex 1, 2, 3, 4, and 5. We've all had to learn this in school. And, and what happens, you know, simply put, is that we're trying to force or pump hydrogen ions up here like that, right? And so we're doing that, we're doing that as the energy is being produced, as these electrons are moving around. That's the process. And then eventually there's a gradient. So there's so much of the hydrogen ions up there that they start to slip down here through complex 5, and then we start to turn it all into energy. Okay. And the critical parts of this from a nutritional perspective are pretty straightforward. Number one, CoQ10 is the only nutrient that can move the electron from complex 2 to complex 3. Nothing else can do that. So if you don't have enough CoQ10, there's a complete breakdown in everything else. Doesn't matter what else is happening. I obsessed on CoQ10 for almost a year with Dr. Lord, and he and I talked about it every week, and he did research on it and taught me all that. And at the end of that process, I just realized, wow, like, this is such an important nutrient. It, it does so many different things. It's just hard to even keep track of. But this is one of its vital processes. It does a lot of other things. The other thing that's equally important, maybe even more important, is it's protecting the membranes because it's a lipid, right? It's a fat-soluble antioxidant. So it's protecting the membrane also. So this basically to just say CoQ10 is important. B vitamins are important. Here's all our B's. See this NAD, NADH, FAD. This is riboflavin, niacin, thiamine, even pantothenic acid is required for this whole energy production thing to happen. Okay. And there's no way it's not like there's some alternative physiology that you can do. You know, you're kind of stuck doing it this way.

Now, another sort of ground zero basic fact here is that you have to have enough amino acids in your system in order to make proteins because everything that we're looking at for energy production in these earlier slides, these are all enzymes that are making this happen, and they're proteins. So you have to be able to make them. If you can't make them, nothing's going to work. It's like this most fundamental problem. So if you don't have enough amino acids, you're going to have a really big issue. And so we test amino acids, and you can see on the testing if amino acids are low, then you're going to have a really big problem because you're not going to be able to synthesize proteins. Just a tryptophan deficiency alone, a tryptophan deficiency alone is going to interfere with protein synthesis. And everything that we're talking about is dependent on enzymes that are produced by amino acids. These enzymes are all proteins. So everything you see on these pages here, these are enzyme systems that we're looking at. You have to be able to produce these enzymes, and they're made from amino acids. If you're missing just one of the 20 amino acids that are required to make all these proteins, you're going to have a really big problem. So amino acid testing is a really important part of all this.

Fatty acids is equally important. Fatty acid testing and then supplying the fatty acids that are missing because fatty acids are what make up the membranes that we're talking about. So all this stuff takes place in and on membranes. Everything's going through membranes or it's happening with a membrane, and all these membranes are made up of these fats. And if you remember, you can see it's a phospholipid bilayer, remember that from school? So here's the lipid part. See that little squiggly line? That's a 16-carbon length fat. Here's another one over here, and they line up, tails pointing towards each other. Okay. And if you don't have enough of these lipids or fats, good luck making your cell membranes. So you need amino acids to make enzymes or make all proteins. You need fatty acids to make the membranes. And this is what we're testing on the lab. We're testing amino acids and fatty acids. If you don't have enough amino acids, you can't make proteins. If you don't have enough, that's not all the aminos right there. There's 20 that are required for proteins. But if you don't have enough of the 20 amino acids, even one of them, you're not going to synthesize proteins properly. And if you don't have the fatty acids you need to make membranes, it's not going to work. That's why we're doing all these tests. These are fundamental concepts. You know, and you can see again on the labs, the different, uh, fatty acids are measured, and if one is low, you got to supply it. And here's another example of a membrane. So, and it, it doesn't get more basic than this. This like basic cell physiology. Can you make proteins? Yes or no. Do you have all 20 amino acids present? If you don't have all 20, you can't make proteins. Can you make cell membranes? Yes or no. If you don't have the right balance of fatty acids, it's a no. If you can't make proteins, you can't make cell membranes. What do you think is going to happen to your cells? They're going to age out and die prematurely, way prematurely. And not all, you can control a lot of this with diet, but not all of it.

So here again, we have our cell membrane and just kind of showing the importance of all the things that are crammed in there. Okay. Oh, and mitochondrial membranes as well. So if we go back a few slides, I forgot to mention that here. Um, I didn't highlight this. It's in the diagram. You may have missed it, though. Here's our inner mitochondrial membrane and outer mitochondrial membrane. And you see the electron transport chain. It's in the membrane. It's literally embedded in that membrane. That's where it lives. So if that membrane is screwed up, this whole thing is not going to work. It's very, very, very common that you see low amino acids, meaning that they can't make these enzymes, or low fatty acids, meaning that the membranes are messed up. Okay. Each one of these requires that whole process to take place. And this is like fundamental cell physiology, but it's just sort of applied to a NutraEval so you can fix all this stuff.

All right, let's see here. Yeah, here's another. And, you know, in case you didn't get the point yet, here's a membrane. Here's the electron transport chain in the membrane. So if the membrane's messed up, this thing doesn't work right. If you can't make, if you don't have enough, uh, succinate dehydrogenase is the enzyme that runs this complex too. If you don't have enough of that enzyme, what's going to happen? You can't, you, it's got to physically be there in order for the electron to bump over to complex 3. These are proteins. Each one of these things that we're looking at here, each one of these complexes is a protein. You need all 20 amino acids to make complex 2. If you don't have tryptophan, or you're missing one of the other 20, just one of them, you're not going to be able to produce this enzyme properly. And then, so then you don't even have an electron transport chain. In fact, when this problem gets really bad, people stop producing enough mitochondria, and then the mitochondrial levels actually drop. That's been really well researched too. I know this is a lot of physiology, but when you memorize all this stuff and understand it, and you look at the labs, you can totally fix people at a different level.

So here's our glucose. Glycolysis is a splitting of that six-carbon glucose into two three-carbon pyruvates. They then enter into the mitochondria, and we make energy. We can also take fatty acids using carnitine and transport them across the membrane. If you don't have the carnitine, you can't get the fatty acid in. There's nothing else to do that. Just like CoQ10 is the only thing that can move the electrons over here. So carnitine is essential. That's why carnitine is on the essential nutrients list because carnitine is the only thing that can help that long-chain fatty acid in here so you can run it through beta oxidation and make energy. And then we zip, zip, zip through the acid cycle here, and we're measuring each one of these steps. We're measuring pyruvate and lactate. We're measuring beta oxidation directly. We're measuring if the electron transport chain is working, if CoQ10 is adequate. All these things we're testing for. You're literally measuring cell physiology in real time. It's pretty incredible. You can even do this. Think about, oh, I don't know. We don't need to look at that slide. Let's skip that one.

Complex 2. So I'd like to obsess on just one enzyme because we don't have time to talk about about them all. Okay, now, but just using complex 2 as an example because it's a pretty cool one. So complex 2, succinate dehydrogenase. There's an image of it on the left. That's what it physically looks like, this ribbony structure thing. So it's part of the electron transport chain. It's also part of the citric acid cycle, which is a little confusing. But you have to have enough riboflavin or B2 in order for it to work right. So to make this thing, you need all 20 amino acids to make this thing work properly. You need vitamin B2. If you're missing one of the amino acids, you're not going to make this properly. And if you're missing B2, even if you make it properly, it's not going to work. So amino acids and B vitamins have to be present. That's why if you give people amino acids, free-form amino acids, it's not complicated. Get a good quality free-form amino acid product, give them a teaspoon, which is about 5 grams, twice a day on an empty stomach, and they'll have plenty of amino acids to make all these enzymes. B complex. If you don't want to get complicated, don't give them a separate riboflavin. Just give them a B complex either once or twice a day, and they have plenty of B vitamins to make the enzymes work. So amino acids, B vitamins have to go together for each of these products to work.

Now, if succinate dehydrogenase is not working, you're going to see the succinate marker go high on the lab, and then you're going to know, oh, that enzyme's not working. Oh, what did Kay say? I kind of forgot. I'll go back and listen again. Oh, he said, use amino acids and B vitamins to get the thing working. It's that simple. I don't know. This is just such a cool enzyme. Just to kind of reemphasize this whole thing. This is the succinate dehydrogenase enzyme here. See that's the enzyme part. So what's this that I'm circling now? Who knows? Somebody type in an answer. What's this thing? What's it embedded in? What's that? Does anybody know? Think about it, guys. Think about it. This is really important. What I just, I talked about it. I showed you a bunch of images on it. Yes, Arana got it. Yes, it's the M, it's a membrane of the mitochondria. That's the membrane of the mitochondria. Remember, complex 2 is jammed in there. This is actually the, you can see the molecule itself, the protein jammed in there. Okay. Now, what's that membrane? What's that inner membrane made out of? Who's going to get that one right? Fatty acids. Fatty acids. Yes, Clayton got it. Francis got it. Jolene got it. When you look at the test now, when you look at the fatty acid markers, this is what you're trying to figure out: is how healthy are the membranes? When you look at the CoQ10 level, that's what protects these cell membranes. It's a fat-soluble antioxidant. When you look at the amino acid levels, you're saying, hey, does this person have all 20 aminos they need to make complex 2? So you see how this can get screwed up? Not enough amino acids, you can't make this enzyme. Not enough fatty acids, even if the enzyme's there, it's not going to work right because it's stuck in the wrong structure. It's not going to work. And then B vitamins, just for everything. You just say B vitamins for everything. And, you know, all these processes need B vitamins. So I'm trying to make this relevant. So when you look at the lab, you go, oh, now I see the enzyme working. So on the lab test itself, if you see high succinate or high fumarate, you know there's a problem somewhere in this system. Here's our FADH. Right? We want our riboflavin to be popping down, you know, helping these electrons pop down here. Here's our CoQ10 to carry it over there. So this is like in action. This actual physical structure has to have the riboflavin and CoQ10, or it can't work. And there's not like an alternative pathway here, folks. It's either complex 2 or nothing. There's not like you can't like skip this, skip over this and go, oh, well, you know, we'll just do something else. And so succinate as a marker is like extra, extra important because we're talking a lot about complex 2 and how this enzyme, it's upside down now. They just flipped this. This diagram is up, is, you know, the reverse. But there's our complex, uh, two, our succinate dehydrogenase enzyme. It's flipped upside down now. The last image is it was going the other way, and it's jammed down head first here into the membrane, the inner mitochondrial membrane, which is made up of fatty acids. Okay. But what's trippy about this one is it's not just complex 2. Succinate dehydrogenase is also a key part of the citric acid or Krebs cycle. So if you see high succinate, citric acid cycle is not working. Okay. You want to know how messed up this is. Is when there's many different environmental toxins, chemicals in the environment that target this enzyme. Not kidding. It's one of the first ones to get damaged from environmental toxin exposure. That is so messed up. It's almost like an evil plot, although I don't think it is. I think it's just like nature being kind of a little ironic in some way. So succinate going high on the test means that both the electron transport chain and the citric acid cycle are not working well. And it's commonly associated with environmental toxin exposure, although many other things could cause it. It's just that's one of the things that could cause it. But environmental toxin exposure damaging this system. Now you're not making energy. Now you've got cellular aging. That's the reason why we should be, you know, not eating pesticides. And people are still arguing about eating pesticides. But anyways, CoQ10 is made up of five-carbon isoprene units. So the units are five carbons long. Okay. Who knows how many units are in a CoQ10 molecule? That's a trick question. There's 10. That's why they call it CoQ10. So CoQ10 is 10 of these five-carbon units. So it's really long. It's like 50 carbons long. 50. That's a lot. This is it written out here. You never see it written out because it's so long. You don't want to write it out because it doesn't fit in a textbook page very well. But that's what's happening. And remember, CoQ10 is grabbing the electrons between, uh, complex 2 and then bringing them over to complex 3. It's one of its main roles. You don't give CoQ10 unless the person needs it. It's not like everybody needs the stuff. That's why we do the labs. That's why there's people that spend their whole lives actually doing things like localizing CoQ10 in the center of a lipid membrane. But here's a CoQ10 again. So that's the membrane there and there. And that purpley blue thing there is a CoQ10 molecule, just lodged right in the membrane. How cool is that? And what does it do? It protects. It's an antioxidant. It's a fat-soluble antioxidant. And it's buried in the membrane there to protect the membrane from oxidative stress. It's really important.

Just for the sake of time, I'm going to skip a few of these slides. Let's see here. What we have time for, because I will have time for questions and for, yeah, I'm going kind of slow. I'm going to speed myself up here. All right, now we can skip over this. That's like a complicated subject. You don't need to know about so much. So, but polyphenols are super important. Okay. Polyphenols. And they are measured on these tests. Many of these are polyphenol markers. So we want to study up on that a little bit, and that would be more diet-related. But the main point I want to wrap up on here, just a few minutes, and we'll look at labs, is the triggers of inflammation. Okay. And how does this damage process start? Inflammation, oxidative stress. What's generating this? Infections, food reactions, environmental toxins. If you eat too much sugar, you're going to drive your glutathione levels down. Excess sugar drives down glutathione. Okay. If you have an infection and you're inflamed from that, you're going to have a lot of inflammation and oxidative stress going on at the same time. Does damage? Environmental toxins, I already mentioned with succinate dehydrogenase, are going to, you know, take a toll on the functioning of these different enzymes. So the sources of inflammation, same, same as sources of oxidative stress: gut infections, foods, environmental toxins. These are the most common. Insulin drives inflammation. And you can measure this on the test because you'll see problems with pyruvate and lactate and another marker that I'll show you in a minute. So the more messed up your glycolysis is, the more unstable your blood sugar is, the more insulin resistant you become, the more inflamed you become, and the more oxidative stress that you have. Those are all directly tied together. And insulin-related problems are probably in the top category of reasons why people have accelerated aging. Again, insulin problems generate low glutathione. And we talked about this in the very beginning. Low glutathione is sort of the death knell of the cell. The more sugar you eat, basically, the more your antioxidant levels drop, and the more damage your mitochondria get. It's a simple way of thinking about it. And, um, we can see all this on the labs. We measure pyruvic acid and lactic acid. And then there's one other marker here that's really important, and I never heard a good explanation of this until I met Dr. Lord. So see this one here, alpha-hydroxybutyric acid. If that goes high, that's a sign of carbohydrate metabolism problems. It's the beginning sign of insulin resistance. They may not be insulin resistant yet, but they're heading that direction. But it's also a very famous glutathione indicator. So this is nice to see. This goes up. It means that glutathione levels are dropping, and the person has a problem with carb metabolism. They're yolked together, right? Those two things are yolked together. Which just means if you, you know, that's why fasting is so good for you if you can, if you can get away with it. If you can do it, fasting and you keep your insulin levels really low, um, can be a lifesaver, a life extender. GI inflammation. It's not a GI class, but just want to mention if the person has GI inflammation, you know, that's going to generate oxidative stress and shorten the lifespan. So you always test for the GI ma, uh, the GI function, right? And correct GI problems. That's pretty basic. And then oxidative stress through the mitochondria, you can see on this portion of the labs. And I'll just go over this. There are these, you know, sort of summary or header pages here where they summarize oxidative stress, they summarize mitochondrial dysfunction, they summarize methylation, and then they summarize toxic exposure, which is great. And it's good that this is here, and I look at these on every case. But you really need to get, be able to dig in and look at the individual markers and make your own assessment. Um, once you can do that, and you understand these pathways, then you get to this mastery level of this stuff, and that's is important. And toxins are going to cause inflammation, just like GI issues will.

So let's look at some labs, and then we'll get into questions. Oh, and before I forget, for those of you that joined us late, scan that QR code. You will get a 40% discount, which is a big discount, for our "Interpreting the Goova NutraEval" class. In this class, I will teach you in detail all the stuff that we're talking about now. And there are live webinars like this, but with the class, and you're submitting your labs, and we're going over your cases, and we're designing protocols with you. So you can walk away from that better educated about how to interpret these tests and design effective protocols. You can test yourself. That's a great way to get started if you haven't run one of these on yourself in the last year or so. You can register with the QR code there. We'll also be sending out emails. And just don't forget the code GDX24. Take a snapshot of this with your phone, or do the QR thing, or whatever, and you'll get your 40% discount with that. Right? And we will be sending out emails with all this information if you're on the phone or something right now and you can't record everything that we need to have you record. Okay. Okay.

So let's take a peek at a real case. And just to summarize, oxidative stress is bad. It damages mitochondria and mitochondrial function and accelerates aging. Oxidative stress can come about because of a gut infection. Do a GI Effects test. Oxidative stress can come about, and does come about in all of us, really, from environmental toxin exposure. And you can have oxidative stress, most importantly, from insulin resistance and carbohydrate problems. In fact, that one carb marker I just showed you is a glutathione indicator. Okay, they're like not.

Even similar, they're completely the same thing. Insulin resistance and oxidative stress are the same problem. And when you get insulin resistance or oxidative stress, however you want to call it, you're at increased risk for heart attacks, strokes, diabetes, all the bad metabolic things that happen. We don't want that to happen.

It's a layer on top of that. In our current time, we had a pandemic recently, as most of you probably remember. And there's a lot of people walking around, maybe 10 million, 20, 30 million, I don't think anyone really knows right now, that have continued inflammatory vascular inflammation problems, you know, as a result of long COVID. So that's a whole another thing to think about, and that's certainly going to decrease your longevity, right, if your blood vessels are inflamed.

So now, again, here's a summary page for this lab. And we're going to design one program and then we'll go to questions. So oxidative stress is up there. Mitochondria function up there. And let's take a look at the actual markers themselves. I don't know how you could not do this test. You know, so when the first 15 years of my practice, I only did NutraVal when I felt like I had to. You know, it's like, oh, they're so expensive. I don't know if the patients are going to want to do this. And then I hired a coach to do all my new patient intakes. And Mark was his name. Mark was like, he's he just started this thing. He said, what test do you want people to do, Kaylor? So I was like, do an adrenal, you know, GI-Effects and a NutraVal. And he said, on everybody? I'm like, yeah, that'd be great if you can do that. I wasn't doing this. I was probably doing NutraVals on like 20% of my patients. And the day that Mark started, every single new patient did a NutraVal test. I'm not making this up. And I had never experienced this before. Something that happened like 20% of the time, now it's happening 110% of the time. And I learned so much about each patient. I could not sit down and talk to a patient now without a NutraVal in front of me. Like, I literally couldn't do it. I, I wouldn't have. I like it was malpractice of some kind. You got to do these tests, not just on people that you think need it, on everybody, because everybody has metabolic problems, toxin-related issues, cardiometabolic stuff, and this is affecting, you know, the entire, everyone that we work with.

So let's see. So glutathione is low. That's not good, right? We already said that that's a really significant thing. Now, just to tie it back to the lecture report, here's our, if you want to know, hey, what's the status of the succinate dehydrogenase enzyme? You look at succinic acid. This person's doing fine. It's in the green. What's their glutathione status? Not so good. It's low. Okay. Each one of these markers tells you about a process or an enzyme or a pathway. Each one of these is incredibly important for normal cell physiology, which is what we're striving for. If we just have normal cell physiology, people live forever. So we're going to skip over the gut markers, but you can see there's a lot of them. Positive. So this person has, you know, gut inflammation. You'd want to address that also.

And let's look first at the energy production workers. Oh no, I picked a horrible example here. Okay, well, I just got to deal with it. So cellular energy and mitochondrial markers. If you draw a line down the middle here, we're looking for is there a pattern where they're mostly high? A pattern where there's like maybe more than five or six that are either low or sort of borderline? Though, yeah, there is actually. So this is what's called a hypometabolic state. This is not enough mitochondria present. That's definitely going to lead to extra aging. And there's a whole separate protocol for that. And then, um, we should look at, uh, antioxidant markers, I guess. Now I have to design the program because I picked this one, didn't I? All right, I just have to deal with it. I'll show you how to do it. It's not too hard. So glutathione is super low. Not good. And that's, that's probably enough right there for us to do the protocols.

So let's take a peek here. Uh, let's see. I have a sheet, a blank one right here. There it is. So now, what did we find? We found low glutathione. We found they're in a hypometabolic state. So there's a pattern of very low markers. So we want to rebuild the mitochondria. How do we do that? Well, we start off with free-form amino acids. It's always in a powder. You do one teaspoon two times a day, away from food. There's a more complex version of this if you take the class that we're promoting now, I'll teach you that. But for your purposes now, I don't want you guys to get into trouble. Um, so I'm, I'm making this a little bit watered down. Uh, otherwise, you can get into trouble, meaning that if you don't know all the rules, you can make somebody really sick. So this is a, for those of you that are mentorship students, I know someone's already asking a question, that's not what you taught us in class. This is like a simplified version. Okay. You need the CoQ10 that we talked a lot about. I like to get it in 200 milligrams because then it's not too many pills. So let's say we do two of those a day. We said magnesium, remember, for everybody. I like the glycinate form, but you can use any other kind of form you want. We mentioned carnitine. Carnitine, uh, it's kind of expensive. I don't know why carnitine is so expensive. Um, oh, glutathione was low. So you can use NAC. Comes in a 900 milligram if you prefer. You can use glutathione. I'm not against glutathione at all. I'm just pro-NAC. Your choice, free country. You can use glutathione if you want. Um, what else did we see on there? They're hypometabolic. Oh, yeah. So you should use, um, let's see. Oh, B complex. How could I forget? And then some kind of a multi-pack. You know, whatever your favorite multi-pack is. It has all the vitamins and minerals and stuff in it, you know. And they don't usually have that many B vitamins. So you can usually do a B complex plus the multi-pack. All right. So that would be a basic mitochondrial rebalancing, anti-aging program for this particular patient. If you wanted to make the antioxidant part of it a little stronger, I think there's three good choices. There's berberine, there's resveratrol, and each of these has their pros and cons. And there's, um, I didn't spell that right, there's trol and, uh, quercetin type products if you want some extra plant-based antioxidant support. I use those a lot too. Okay. That would be a basic anti-aging protocol based on that particular lab.

All right. Yeah. Now, if, if the person had this test, somebody noticed, uh, has had high CoQ10 markers. That's almost always going to be someone who's actually taking CoQ10. So I kind of ignored that, sorry. But if they have high CoQ10, you got to figure out what type they're taking. And it's not necessarily a bad thing. I mean, they could be on 100 milligrams of CoQ10, so the test came back high. You know, you just have to sort through that one. It's almost always going to be from supplementation.

Let's just look at one more thing because I looked at it. We talked about this so much. So this is another NutraVal, just so you can see the section of the test you're not familiar with it. Um, here's the amino acid section of the test. And there's a big difference between urinary amino acids and plasma. Plasma is for these purposes better. So if you want to do a NutraVal, you get a blood draw with that. If you don't want to do blood draws, you can do a metabolomics test, that's urine sample only. But then you don't get, obviously, the plasma amino acids. So if you see multiple, one or more of the 20 critical amino acids low, protein synthesis is a problem. You can see this person's got a pattern where a lot of them are low. And then you can also look at fatty acids. Oh, well, look at that. See, you're not going to have very healthy membranes if your fatty acids are all low like this. Okay. So you want to then support with fatty acids to work on the membrane, support with amino acids to work on the, um, protein synthesis part of this, and energy production part. And then let's see here. You can go up to this part of the diagram here.

All right. So now let us go back for a moment. I'm going to, we have questions. Time for questions. If you didn't scan your QR code thing there, you can scan that. And I'm going to go see how many questions we can cover in a couple minutes here. So, um, how do you approach working with someone with extreme fatigue? So for the basic workup, is an adrenal panel with a cortisol awakening response plus adrenals, a GI-Effects, and a NutraVal. Those three tests on every new patient, all up front. And then you can see exactly what to do. So adrenal panel, GI-Effects, and NutraVal on every new patient. That's, now you have to build up to that, right? You may not do that your first day you're doing this stuff because you don't know how to interpret them all yet. Um, and if you're wondering about this sequence, I think it's best to do adrenals first, and then GI, and then NutraVal for a lot of different reasons. Um, yeah, you can always use methylated B vitamins. I don't see any downside to doing that. And most all the companies have them now. I think, you know, any of the professional brands that we're using, they're going to have methylated B's. Uh, yeah, it's helpful to have their amino acids if you can get, I mean, the amino acids from the plasma. And it's helpful to have fatty acids if you can get them. It's not always realistic depending on the cost and what the patient is going through, you know. Um, I think, I think NAC is a lot easier to work with than glutathione itself, but there's some patients that will respond better to the glutathione. But I always use NAC as the first thing. What kind of enzymes are important to take? That's all basic. That's based on lab. So I don't think there's anything that, I mean, everything that I do is lab-based. For Elsa there, uh, when lipo peroxides are high, let's see here. What if succinate is low or absent? Then you, if succinate is low or absent, you look at the pattern. And if there's a preponderance of low markers in the citric acid cycle, electron transport chain, and all those other markers, you know, glycolysis and all that, then they could be hypometabolic, like the one that I just did, uh, which I pulled up kind of by mistake. Uh, I don't know anything about ketamine. Oh, Richard Lord has got a book. If you Google Richard S. Lord, Laboratory Guides, you can buy it from iBooks. It's an Apple book. I think you might be able to get it as a Google book, but it's an online, you know, document. It's not a printed book anymore, but it's called Laboratory Guides to Health. Um, let's see. Oh, fasting. I don't know. I mean, for fasting for patients is not easy to do in the beginning. Most of the people that we're working with, we need to get them eating regularly. But once you're really healthy and you've got great looking labs, then you can start to fast, you know, even just for a day. I don't, I don't do any of the long fasting anymore. I used to when I was younger, but, um, if amino acids are high, you want to look at B comp, B vitamin issues. So if amino acids in the plasma are high, it usually means that there's a lack of B vitamins, most especially B6, because it means that they're circulating in the bloodstream, not getting into cells. So you need B6 to do that. You can do this on children? Absolutely, yes. We test kids in my practice. You know, I've never done anything below the age of two. And, you know, I'd say in general, maybe like age five and up is sort of typical. But kids respond great to these protocols. You can definitely do the metabolomics, the urine sample only. That is a good thing. You're missing a few things, but there's plenty of information on metabolomics with urine only. That's plenty of information there. Uh, so glutathione, um, you, you have to use a liposomal glutathione. Um, and the kind that people say doesn't taste that bad for liposomal glutathione is a brand named Quicksilver. So again, I, I kind of, the, the CoQ10 levels were high because that patient was taking CoQ10. I kind of screwed that one up, sorry about that. That was confusing. Um, let's see. I think we kind, I think we're going to run out of time here. There's still a ton more questions, but we're, we're at the hour. Oh, we got like 30 seconds here. Uh, so there's a big difference in terms of quality of lab testing and different lab companies and what types of testing they offer and how accurate they are. I'm not going to put any lab down because I try to support all these different companies, but I can tell you definitively, Genova is incredibly accurate. 100% of the time, like incredibly accurate. I've been using them for 31 years. I work with Richard Lord, who is a scientist that developed all these. They're incredibly accurate, uh, and have maintained their accuracy for a long time. Okay. All right, you guys, I'm sorry. I'm going to have to stop now. Lots of great questions I can't cover today, just out of time. But I hope some of you sign up for the class, and I really look forward to working with you and getting your labs done and interpreting them together. All right, take care, everyone. Bye for now.