Transcription
Hello everybody, and welcome to our Autumn mentorship miniseries. Has a nice ring to it, where we are talking about functional medicine lab assessments for Women's Health, specifically breast health as it relates to estrogen metabolites. Woo! It's quite a topic. It's quite complex. It is something you have to know.
And we had a case today in class, in uh, female hormones boot camp, of a young woman. She's like 37 years old, wants to get pregnant. So she did all these hormone tests, and she had high levels of oxidative stress on the lab. 8-OHdG was high. She had low levels of two-hydroxy, which we're going to talk a lot about tonight, and she had high levels of the four-hydroxy. Every single variable that you... Oh, and she wasn't methylating well. Four things. She had four variables that would put her at higher risk for breast cancer. And discovered it because she was doing a fertility screening test. This is really important, and you can change people's lives. You can make people feel better if you start to manage your estrogen metabolites better, because estrogen dominance doesn't make people feel very good, and you can reduce their risk of developing a life-threatening illness. It's a pretty common problem that can be, I wouldn't say completely avoided, but you can mitigate the risk, and that's the least that we should do. Everyone should be doing these tests. So anyways, I'm excited to be talking about it.
So for those of you that are brand new to me and the Kalish Institute, I'll introduce myself for a moment. Then we're going to get into a lecture where we're going to talk, as briefly as I can, about the subject. And then we're going to look at some labs and do some lab interpretation, practical application. That's kind of the goal. So I am Dr. Dan Kalish. I've been in practice, uh, it's 31 years now, but who's counting? Trained thousands of practitioners. And the goal of the Kalish Institute is to enliven, enrich, produce functional medicine clinics that are super successful. And by success, I mean helping a lot of people. And by success, I mean having practitioners that are happy, they're doing the work that they love, they're getting fairly reimbursed, they have plenty of money to put their kids through college and live in a nice home, and they're not working on the weekends, you know, and they have a decent life. That's really our goal here.
And so I do that in two different ways. We do a lot of business training, business application, and we do clinical trainings as well. I've also, throughout my career, had a lot of different opportunities that have come to me. We had a group of male clinic practitioners, uh, that took my training program. It was a while ago now, 10, 12 years ago, and we ended up doing a research study with the Mayo Clinic on the work that I teach, which is available if you guys are interested. You can look at a copy of that. I've more recently been working with Richard Lord the last 10, 12 years, uh, doing advanced lab interpretation studies with the master himself. For those of you that don't know Richard, he's a scientist that developed organic acids, fatty acids, amino acid testing. He brought us all these tests. He's the one that also developed the GI Effects test and the first microbiome analysis for our industry. And so Richard and I have worked together really closely for a long time, and it's been really the greatest pleasure of my professional career to know that person and to have him in my life and, and be able to learn all the things that he has taught me, which he has taught me expressly, expressly, so I can teach you all.
And I've also been IFM certified. I passed the exam. Okay, I'm just laughing because I hadn't thought about this for a long time, but the day that I took the exam, there was like Armageddon in California that day. There was like smoke in the skies. No one could breathe. The sun didn't come out. Any of you who live in Northern California remember that day quite well, I'm sure. That was the day I took the IFM and passed it. Okay.
So enough about me. We have amazing classes coming up. You can scan this. I'm really into QR codes now. Now, maybe I'm a little late to the game here, but I'm so excited that we have QR codes. So you can scan that. Even if you don't want to take the class, just scan it as a favor to me. Scan me right there. Okay. We have this, um, discount, 20% off, if you're listening to this class for our upcoming cardiometabolic Health boot camp. And this is a two-month, pretty intensive experience in understanding lipids and mitochondria and why cholesterol does this and that, and how triglycerides work, and what happens to our metabolism, how does it get damaged? It's a really, I would call it a robust class. I've got a whole series of lectures. It's all practically oriented, so you learn how to interpret the labs. And then there's like, honestly, like at least 15 hours of Richard Lord lecturing, which would just blow your socks off. It's like the most intense science that you're ever going to hear, and it's just wonderful. Everything that Richard lectures about is research-oriented and very deep into the physiology and biochemistry, but it's all clinically relevant at the same time. So this is a class taught by he and I together, and, um, me doing practical application, and me doing the live Q&A calls to review your tests, and then Richard giving us all the scientific validation for the work that we do. Okay. So if you guys are interested, that's coming up in November. You can sign up.
And if you're new to Rupa, or new to us, we have been working with Rupa for several years now, and they are the lab distribution company that has transformed our industry and taking away all the stress of doing labs. And if you have not used Rupa yet, I strongly encourage you, go over there, get $100 off your first order. Scan the QR code again. You can see my QR code obsession here is coming through, and grab yourself a lab from Rupa and, uh, check out something about your own self or one of your patients that you've been wondering. Run an adrenal panel, or run a female hormone panel, maybe run one of these estrogen metabolite panels on yourself or a coworker. Okay.
And now we're going to skip some of these slides because I want to get to the good part. But we're going to have, um, the biggest picture focus here that I could start with. The top level is that when you're working with hormone balancing, you have to take into account what's happening with the hormones. And we are very good at testing estrogen, testing progesterone, testing testosterone, testing DHEA, cortisol, thyroid hormones, and fixing the hormones. We're assuming that that's all happening in the background. But at the same time, your results will be impeded and hampered, and less, you'll be less successful if you do not address what's happening with the gut and what's happening with phase one and phase two liver detox.
So in the gut specifically, when you run your GI test, you're going to see a marker called beta-glucuronidase. And that is a GI test marker that shows you that there's a major problem with estrogen going on in the person's body if that marker is high. But it's done from a stool sample, interesting, right? And when you're running your organic acids tests and you're looking deep into the functions of methylation, you're an oxidative stress, you're also going to see from the organic acid liver detox oxidative stress profile how the hormones are being produced and metabolized. So there's one thing to just measure a hormone and then fix it, but there's another thing to understand, is estrogen recirculating because of beta-glucuronidase being through the roof because there's a gut problem? Or is there a problem with estrogen dominance and estrogen metabolites, like we're going to talk about tonight, that's actually coming about because the liver detox pathways and oxidative stress levels are just through the roof? And this happens all the time. We just had this case I told you about a few hours ago in our female hormone boot camp that I'm teaching, where we have a woman in her 30s that has every single one of these problems at the same time.
And so my goal then is to say, let's treat hormones, and we have to learn how to do that. But let's also be inclusive of gut and liver function. And tonight's class will kind of sell you on the, uh, liver function part of that. And maybe someday we can do another one that talks about beta-glucuronidase. You'll see how important the gut is for hormone balancing. And I've, I've said this for years. Some of you, I think I can see on this call right now, I've been in my mentorship class in the past, you've heard this story before. So you could take a little break and check the news or something while I'm telling the story. But there, when I was young, in my 30s, and I worked at one of these lab companies, we were bored one afternoon, and we took out a stack of labs, like a couple hundred labs. And this is when we, everything was still printed on paper. We didn't email stuff. We actually physically had labs and mailed them to people, believe it or not. We took out a stack of labs and we looked at the ones that were not so good on the female hormones, that had major female hormone problems. And then we pulled their GI labs, and there was an exact correlation. The more messed up the GI tract was, the more messed up the hormones were. Just 100% correlation there. Perfect hormones, perfect gut. So it's really important to have this, you know, broader view of what we're trying to do.
And then another experience happened to me just more recently, like a year or two ago, where I was talking with this other doctor, and she was explaining to me about, you know, beta-glucuronidase. Okay, I can, I think I understand that. She explained to me about COMT, which we're going to talk a lot about tonight. And I'm, yeah, I kind of understand that. And then she started to talk about all these cases that she had. And I was like, well, I've never even heard of that happening in my practice. Never had that happen in my practice. Never had that happen either in my practice. And I realized why? Because in my practice, I was trained by Dr. Timmons 30 years ago to always test and correct phase one and phase two detox, and always address methylation and oxidative stress in the very beginning of a case. And if you do all that, you're not going to have near the level of problems on the labs that we're talking about tonight. Okay. So if you're doing these fundamentals well, and you're fixing the gut, and you're fixing the liver detox pathways, you're fixing methylation and oxidative stress, many of these problems that we're going to talk about tonight are going to be gone.
And let's take a look here. The basic concept is that stress, hormones, GI, and detox are connected, as we're kind of saying here. And that we want to correct the body systems all together: the hormones, the gut, and the detox, usually in that sequence. But you can do other sequences if you want. And then we're going to get into this tonight quite a bit. So let's just get the hard part out of the way first, right? So this is a, a diagram that looks at methylation. And so when we talk about, when I say methylation, this is what we're referring to. So your body takes single carbons. The origins of those single carbons are amino acids, including serine, glycine, histidine, glutamine, and tryptophan. So those five amino acids contribute the carbons to the single carbon pool. It's like a swimming pool. You can see the color there. It's a pool of carbons. And then those carbons end up ultimately up here, and your body is methylating. It's grabbing a carbon and it's putting it on something. In the case of what we're talking about tonight is estrogen metabolism. So you're using these carbons or these methyl groups to break down estrogen into what you hope are cancer-protective or cancer-neutral compounds, and you're hoping that you're not breaking them down into compounds that create the increased risk of cancer.
And then the methylation process itself relies upon well-known nutrients like B12, B6, betaine, methionine. You know, and you can't say enough about folate in that process. But this diagram is used, um, or was used by Dr. Lord when he was training me to open up my eyes. And I think I was like, methylation was like this circle for me, you know, I was like, and he's like, let's look at this diagram, kid. And let's just, you know, he's in his 80s, right? I'm in my 50s. So anyways, I'm a kid to him. Hey, Kish, just look at this diagram. You got to think about the amino acids too, because that's where the carbons are coming from. So we want to broaden our picture of what methylation means. And if you are testing and correcting serine, glycine, histidine, glutamine, tryptophan, folate, methionine, B6, B12, and a few other things, then this whole thing starts to work just beautifully. But we won't, it's easy to get myopic, myopic, myopic about things. We don't want to do that because it's not good for clinicians. You want to be broad in our approach. Okay.
And so here again, we have the most famous nutrients related to, to, uh, homocysteine metabolism, methylation, whatever you want to call this stuff. Again, methionine testing, correct. B6, serine testing, correct. Folate, for sure, testing, correct. And B12. And all these can be very accurately and specifically measured on the labs.
Oxidative stress. Free radicals cause damage to the normal cells of the body. This is not good. And when we're talking about this exact example, if you can get control over oxidative stress, you can reverse the damage that's caused by these metabolites. And there's all kinds of research that shows that for a long period of time now. It's not like a, a mystery thing, you know. In fact, we're talking about this today. Let me show you. If you don't have this book, you should buy this book. Walter Kinian and Joseph Poro's Clinical Environmental Medicine. Kind of the text on this subject. And I was very sad when I learned that Walter Kinian died because he was, you know, just a, a great, greater than life person in our field. It was very sad. But the last lecture of his that I went to, and he's really known as one of the founders of the whole field of environmental toxicology, but one of the last lectures I went to that Dr. Kinian gave was in New York. It was three hours, and it was on this one lab marker called 8-OHdG, which we're going to talk about tonight. That's an oxidative stress marker. And it was about the relationship between that one lab marker and breast cancer. He went on for three hours, barely scratched the surface of the tens of thousands of research studies that have looked at this subject area of 8-OHdG in relation to chronic diseases like cancer, cardiovascular disease, diabetes, etc. So this is well known in the scientific literature. This is not like an alternative medicine thing. We just have the technology to do these super cool tests so you can see what's going on and you can treat people really specifically.
Oxidative stress, if it goes up, is bad. That's going to decrease your body's ability to methylate. As it increases, it forces your body to make more glutathione. So what we're going to see on these tests, and what this 30-year-old that I was talking about earlier, low glutathione, not good. Pyroglutamate and alpha-hydroxybutyrate, indicators of glutathione low, also not good. So you've lost your protection against these potential cancer-causing compounds. And if there's enough oxidative stress and methylation is decreasing, then your ability to clear the hormones, to get rid of them, to detoxify them, which happens through the process of methylation, is compromised. So let me just say that one more time in a different way, because it's confusing. If you have oxid, enough oxidative stress, your glutathione levels are going to be taxed and drop, and be forced to make more of it. And then eventually, you're going to burn out your ability to do that. And the oxidative stress is going to decrease your capacity to methylate. But methylation is what we're talking about now, tonight. Methylation is how you get rid of these bad estrogens. So oxidative stress destroys your ability to get rid of the bad estrogen metabolites. You can see how it's kind of a downward spiral from there. All this, you can change if you just order the labs. This is not anything that's fantastical or, you know, outside. I mean, just look at the test, you see what's wrong, and you start to fix things.
Again, these are, this is kind of a blow-up of the things and terms of supplements that we're going to be using. Uh, betaine can come in for the methylation, choline, and of course, um, B6, B12, and folate, right? And you want to just keep your mind on those other amino acids that I mentioned earlier so you don't forget about that. And so this has been studied widely. In general, we're going to keep it simple because this is a short lecture tonight, and we want to look at labs.
The two-hydroxy metabolites are generally considered cancer-protective, and the four-hydroxy are generally considered cancer-causing. And again, you could, I, I spent quite a bit of time. I spent several months reading about this. You could read about this for years. I don't think I even scratched the surface. But here we go. Extensive two-hydroxy. The two-hydroxy, you're going to see on the lab, 2, that's your clue, is associated with lower risk of cancer, right? And the genotoxic, toxic to the genes, for-hydroxylation pathway is associated with increased risk. Pretty straightforward. The twos are good, the fours are bad. And more studies on that if you ever want to look at them. Okay.
So here, let's look at the pathways. And this is going to be, you want to, you need to memorize these pathways because this is how the labs are going to appear. There are genes involved in this, as that last research study showed. There's genetic variability. There's a CYP1A1 gene and the CYP1B1. You don't have to memorize that in the beginning, but probably later on, you're going to learn that because you can actually measure and add to some of these lab companies' tests, you know, how those genes are working at an individual. You don't have to do that. You can look at the functional expression of the genes as well, just by looking at the tests.
So here we have R2-hydroxy and R4. And then that whole section that we just talked about, methylation. Here we have COMT, or catechol-O-methyltransferase. So it's kind of named for what it does. It's transferring a carbon, it's methylating, right? And it's taking that two-hydroxy and breaking it down to a two-methoxy. And it's taking that four-hydroxy, and there's our COMT again, and breaking it down to the four-methoxy. And you want that to happen, right? You want this metabolism to go all the way out because these are the ones that are not dangerous out here. And the dangerous, extra bad one is right here. Okay. And the good one is the two. So that's your basic scenario. And we're measuring all of this. So you're measuring the effect or the function of these enzymes. And if you want to do the more advanced testing, you can measure whether there's a genetic component to it or not.
And then the thing you extra don't want to have happen is for estrogen to break down to the four, and for the four to go down to these quinones, and then start to form DNA adducts. That means the DNA is being damaged. And when DNA is damaged and it goes to repair, I mean, to reproduce, to, you know, recreate, um, you're going to have abnormal cell replication, which is what we call cancer. So if your COMT is working really well, you're going to lower your risk for all these problems. And that is basically a methylation. So catechol, it's a kind of funny name. Like, why do they call it catechol-O-methyltransferase? Because it's the same exact enzyme that's used to metabolize or break down the catechol. Don't ask me. I had no say in this. I don't know why the body has this one enzyme that breaks down dopamine, epinephrine, and norepinephrine, and estrogen. It seems a little odd to me. I, I'm sure if you're, if you have a bachelor's or PhD in biochemistry, I'm sure you're thinking about catechol and how they work and you're like, no, totally makes sense. But it, it's kind of counterintuitive to your average clinician, but it's the way that it works based on the biochemistry. So it's named for catechol for catacholamines, but it also breaks down estrogen. And that would imply too, by the way, that if this enzyme is screwed up breaking down your estrogen, it's probably not breaking down your dopamine, epinephrine, and or norepinephrine very well either. It's the same exact enzyme. Okay.
So we want to then, on the treatment side, if you want to be on a positive, upbeat note, we want to improve and increase the twos, and improve methylation. So we make more of the two-methoxy and more of the four-methoxy. And the bad one in here, we want to decrease that. That is the goal. So when you're looking at the tests, this is exactly what you're seeing. And the bad scenario, this is high oxidative stress is high, and methylation is not working very well. That was the patient that I was talking about from earlier today. She had all four of these problems simultaneously: high oxidative stress, high fours, low twos, not enough of the protective kind, and our methylation was screwed up. Okay. That's going to be four strikes against you. Usually, it's three, right? But four. I don't know if you're really interested in these pathways, but I think it's kind of interesting, and some of you may kind of fit with one of these pathways, and the other ones, you're like, I don't really understand that one.
So here again, we have estrogen, estradiol, and here's our CYP1B1. Here's our CYP1A1. Bottom line is, we're breaking down these estrogens into these different kinds of chemical compounds, right? And the COMT enzyme is a critical part of this. And if things are going bad, or even if things are going well, if you have enough antioxidant protection, then everything just kind of works out. Your body's set up for health and survival. If you're not breaking these estrogens down well, or if you have, like, a high beta-glucuronidase, as we were saying earlier, that's a gut marker from a stool test, or if your detoxification pathways are kind of gummed up, then you're, if you can't, I mean, the hormone level that's in the body is determined by how much you're making combined with how much you're breaking down. So if you're making the normal amount of estrogen, but you're not breaking down the estrogen at the right rate, then you're going to have estrogen dominance. Makes sense. So you don't have to have excessive estrogen production to have estrogen dominance. Normal estrogen production with poor clearance of estrogen is going to lead to a larger amount of estrogen in some women than they should have, and that's going to put you at risk for different forms of cancer, including breast cancer, ovarian cancer, endometrial cancer. You can also have thyroid problems there associated with this. And, um, progesterone plays a role. We're not really talking about progesterone. We can talk about that some other time. Okay.
So now this is kind of biochemical intensive, but, you know, my hope is that when we get to the labs, it's going to all just kind of make sense. Okay. And we'll do some protocols. We'll leave time for protocols. I kind of think like this is how Richard trained me too. He's, he's kind of done with training me, how he's, he trained me for 12 years, is that he forced me to learn all these pathways. And I'm like, uh, but I actually really enjoy it. So it wasn't like he forced me, but he got me to learn all these pathways. But it was only the stuff that I needed to know to make better clinical decisions. And so I've adopted that philosophy because I've been in that world of biochemistry for 12 years now with, with Dr. Lord. So everything that I say tonight that seems like, huh, like really, it's, if you know it, then when you see the labs, you're going to make better clinical decisions. Maybe you have to trust me a little bit on that, because I didn't really see that with Richard. With Richard's work and his training of me, it took me two or three years to see what he was doing. But I'm just kind of trying to call it out now so you can hear it. Okay.
So treatments for estrogen dominance: fix the liver detox pathways, clear estrogens, clear environmental toxins. If you fix COMT, you're fixing dopamine-related problems too. If you fix all the liver detox pathways, you're helping the person to deal with metals like mercury and lead and arsenic and chemicals, everything. You know, you have to fix the gut, if only because of this one connection with beta-glucuronidase, but there's many, many other connections obviously between the gut and the hormones. If, if only to say that if the gut is in bad shape, all the junk that's coming from the gut just goes right to the liver, and that can be the reason why you're not clearing estrogen because your liver is just overwhelmed dealing with the problems coming from the gut. You also don't want to forget about progesterone, adrenals, and thyroid. You don't want to forget about genetic issues. MTHFR would obviously create everything that we're talking about. Problems with COMT would as well, that are genetically based.
And then this is one of the secret sauce treatments would be glutathione to get the free radicals out that damage the DNA. And you can use glutathione itself, you can use N-acetylcysteine, you can use NAC and Resveratrol to reduce the formation of estrogen DNA adducts. There's a whole bunch of studies on this that I just read recently. It's amazing. People actually study this stuff. You know, for all the, what seems like the lack of interest in natural treatment programs among a lot of people, there's a lot of research on these things. Resveratrol has been proven to reduce DNA adducts that are related to estrogen, so as NAC. It's pretty amazing. And when you see the pathways, you're like, oh, okay, that totally makes sense. What else could possibly happen?
So treatments: Calcium D-glucarate, super famous. DIM, super famous. So you can use these. All the supplement companies that we work with have them. And the calcium D-glucarate is going to help with phase two clearance, biotransformation, detoxification, whatever you want to call it, so that you get these fat-soluble molecules, make them water-soluble, and get them out. It also is thought to be a beta-glucuronidase inhibitor, so it can help with those gut bacterial problems that are tied back to this. Because when your beta-glucuronidase is high, you're going to reabsorb the estrogens that you've already broken down. Go figure. Your body takes the estrogen, it breaks it down, it's got it in your gut now, and your body's thinking, okay, well, this is pretty much a done deal, isn't it? Now it's going to come out in the stool. But no, if beta-glucuronidase is high because of a gut bacterial overgrowth in your gut, that's going to prevent the elimination of the estrogen, and you're going to reabsorb it. It goes back into the body, back into the bloodstream. So again, you could get estrogen dominance from this kind of a gut problem. And calcium D-glucarate helps prevent all that, as does working on all the liver detox pathways.
So I really haven't ever seen a patient that just had one liver detox pathway by itself that was messed up. I think it's generally the entire process of phase two. There may be specific elements, like, uh, glycine may be the key to unlocking one person's liver, and NAC and glutamine may be the key to another person's liver. But in general, if you're not getting so specific with the labs that you're looking at 6,000 milligrams of glycine to fix something, if you're not getting that kind of razor sharp, then a broader approach will be much more effective. And when you get really into it, and I have had a lot of interest in this in the last maybe five, 10 years, then it's kind of fun because you can go, oh, wait a minute, this, it's definitely glycine with this person, and you do 6,000 milligrams of glycine, and the whole problem goes away. But you don't, absolutely do not need to get to that level of complexity, because you can do general liver support programs with broad-spectrum products that work really well too. Okay.
Now, people also use DIM quite a bit. And of course, the dietary change here is that making, you're making sure people eat plenty of cruciferous veggies. And the DIM is going to help metabolize the estrogen into the good, or two-hydroxy, and push it away from the four pathway. So I don't know about you, but I eat these foods every day. Broccoli. You don't want to eat too many of them, okay? A thyroid problem, whatever. But, you know, the right amount of these foods. Um, well, uh, broccoli, cabbage, Brussels sprouts. And actually, someone asked this question today in class, like, can you do just foods to fix this? It's like, not at all. So the whole point of functional medicine is that for short periods of time, for three months or six months, we're hitting people with, um, really high dose, high strength supplements to clear out these pathways. And then the maintenance phase is done with diet. But I don't think you're going to be able to eat enough broccoli to fix a major problem with estrogen metabolism, you know, not in the short term. Okay.
So here, the twos are the good ones, remember the two-hydroxy. So here's how you can increase them: sulforaphane, indole-3-carbinol, DIM, omega-3s, curcumin, and then methylation support nutrients. Now, which one do you use? That's discovered or revealed to you on additional tests. So if you do organic acids testing, if you test fatty acids, you'll be able to see people that need the threes, that need the different, you know, phase two products. If you're not doing that kind of testing, you can use combination products to just cover all your bases.
Estrogen metabolism also impacted by xenoestrogens, the chemicals that mimic estrogen. So you can become estrogen dominant simply because you have a lot of chemicals that are built up in the body that are estrogen mimickers. This happens to a lot of people. It's pretty common. Happens to a lot of animals. A lot of species are impacted. You know, there's a, you don't want to read too much about environmental toxins, it just gets to be so depressing. Um, but I did teach a class on environmental toxins about 10 years ago, and it was a one-year course. I had 1,500 PowerPoint slides. 1,500 PowerPoint slides prepared. And I think two or three people took the class, and at the end of the class, they were all so depressed. I don't even know if they're still alive. It was just bad. So the more you study about environmental toxins, the more depressing it gets. Suffice to say, everyone that you're working with today has some kind of environmental toxin burden in their body, unless they are like super human, super juicer, super sauna person, you know, and they don't breathe, if they don't breathe, if they have like air filters around them 24/7, and they, they juice every day, all day, and they do saunas all day, every day, maybe not. But the bulk of your patients are full of environmental toxins. The question is just how, what's happening to them, you know, what, what are they doing to your body?
Excess body fat, of course. We store estrogen in body fat. So when we make estrogen, with the more body fat you have, the more estrogen you make. Alcohol is going to create a huge problem because every day that you drink alcohol, you've got a couple of days for your liver to recover. And your liver is not going to be super happy about processing estrogens if you're chugging, you know, a glass of wine and a martini down every night or something. That's going to completely cause this problem. So you have to get people off alcohol 100% if you're going to try to fix this. And there's not really like an amount of alcohol that you could do while, while you're trying to detox your estrogen. Just stop it, you know.
And then here are the pathways. Treatments. These are the same as methylation, right? Because what we're talking about, this is an enzyme that does methylation. B6, B12, folate, magnesium. Different names for the same thing. Trimethylglycine, betaine, same thing. SAMe, methionine. And then you want to deal with the adrenals. It's a standard, like, methylation protocol. Oh, and you see how to, this is the COMT pathway. You see this? It's the methylation treatments. It's the same slide. That's just a joke. That's me being kind of a wise ass, just to let you know. Okay. It's a methylation enzyme. It's the same stuff that you would use for methylation. There's no difference. Okay.
So quick review here, and then we'll have time for some labs and some questions if I stay on task. So here's our estrogen, estradiol. Here's estrone, that's E1. Estradiol is E2. Estriol is complicated. You guys can hear me? Uh, what the heck happened a second ago? Okay, I'm just trying to make it better. There. Okay, I think we're good. I closed down a bunch of apps. Okay. So the estradiol converts to the two-hydroxy estradiol. If COMT is doing its job, then you get to the two-methoxy. We're going to test for this. The labs we're about to look at, you're going to see two-methoxy, two-hydroxy. From that, you can extrapolate how the COMT is working. Okay. There's a genetic component to this. If you want to get into the genetic testing, you can. That's probably a whole subject that's a little for a different day. Don't have to, because you can see all this without the genes. You can see what's going on without knowing whether it's genetic or not.
And then here we have the CYP1B1, that's converting into the four-hydroxy. That's the bad one. That can convert into the four-methoxy if your methylation is working well. So that's good or bad. Bad. If it goes to the quinones, that's the cancer-causing part. And we're measuring all of this directly. You can tell somebody exactly what's going on. Okay. Uh, liver guys should be familiar with that.
So here's the basics. You're going to test for and correct estrogen metabolites. You're going to address methylation, glutathione production, and the estrogen metabolic pathways. So you got to learn how to deal with methylation, antioxidant support, and supporting glutathione. You should be familiar with DIM and calcium D-glucarate. And then, of course, diet and lifestyle. And I cannot strongly recommend enough that in addition to doing these tests that we're looking at in a minute now, you also want to do tests for glutathione, obviously, and tests for methylation, and make sure that that stuff's working. Okay. That's super, super important.
And for those of you that joined us late, before we look at labs, let me just tell you what's happening around the Kalish Institute. Couple quick things. One is that we have a boot camp coming up in November. Yet, 20% off. You can scan this QR code. And, um, cardiometabolic Health. That's a really good class. I'm proud of this class. That is probably represents maybe two years of my life of working with Dr. Lord and then trying to summarize that two years of teaching into a two-month course. This was a lot of work. It was literally two years of my life to put this together. And I, I think it came out really great. And it's all of Richard's work, me explaining it, clinical application, and then Richard explaining it with the high-level science stuff. So that's what's happening there. Hope you guys can join us.
And let's take a peek here at some labs. So now, with all that information that we just sort of saturated ourselves with, now when you look at the test, you're going to be like, oh, I get that. Totally get that. Here's our estrogen metabolites, and the lab does all the work for you. But just to show you, here's our estradiol that we were just talking about. It's going over to estrone or E1. And then here's our two-hydroxy. There's our two-methoxy. We're forgetting about the 16 because we don't need to deal with that because that's a whole another complicated story. The four-hydroxy, the bad one, and the four-methoxy. So that's just this. Let's go through a good scenario and a bad scenario. Good scenario is you're breaking your estrogen down into the two-hydroxy, and your COMT is just singing along, zoom, and it's converting into the two-methoxy at a great rate, and you got cancer protective everywhere. That's a good scenario. And there's no oxidative stress, and your methylation is working great. Bad scenario: this compound, estrone, is getting converted into the four-hydroxy, and then COMT is not working great. Your methylation is shut down. So this one builds up more and more and more and more. And this is the one that goes out and causes that whole quinone problem. And the quinones then come back and they whack you in the DNA, they damage your DNA, get structural damage to the DNA, abnormal cell replication, and higher risk of different forms of cancer.
So how do you try to mitigate that? You want to knock the fours down and boost the twos up. You want to make sure methylation is working perfectly so all these compounds are broken down to less into their less harmful things. Some of this is purely genetically based. Some people just make a lot of the four and don't much make much of the two, so they have a genetic predisposition to develop cancers. And some of this is lifestyle based, because if you are eating your lettuce every day, and you're methylating well, and you're eating and taking antioxidant supplements every day, then even if you get to the four, to the place where the fours are on the high side, you can still, with glutathione levels that are adequate or high, and with any other antioxidants that you're taking supplementally, and with methylation support, you can prevent this from becoming a problem. Resveratrol works, glutathione works, there's studies on this. You could read for months and months, as I did, and it's really not that complicated. Resveratrol, glutathione, N-acetylcysteine, lipoic acid, those kinds of antioxidants to prevent the damage to the DNA. And then all the things that we just talked about to make sure methylation is going really well. And then, you know, a healthy diet.
All right. So let's look at, um, another lab. This is a HMAP from Doctor's Data. I should say the name of this one. This is the Essential Estrogens from Genova. The HMAP from Doctor's Data. And this has the same breakdown of the estrogen metabolites. Different graphics, same thing happening here. Okay. And the color coding on this lab is really helpful once you get used to it. Takes a little minute to get used to it, but here's again the same kinds of markers. So let's take a look here. So you start to get familiar with it. We're going to forget about the 16 for now, but here's our twos, our fours, right? Again, the twos, two-hydroxy estradiol, the four-hydroxy estradiol, the two-methoxy, and the four-methoxy. That's pretty much the basis of it, you know.
So now let me show you one other thing before we wrap up here and go to lab interpretation, I mean, sorry, and go to questions. Uh, let me just hang on a second. I just want, I'm sorry, I didn't pull this up earlier. Uh, hang on one sec. Um, let's see. Let me go in here and find it. I, so there's another lab that a lot of you are probably familiar with, and I think this might help some of you. Let me just grab it. Grab a copy of one that's not it. Hang on. Uh, it's a DUTCH test by Precision Labs, and they have, uh, these are pretty popular, so a lot of you may be ordering these. Let me find one. Eventually got every other lab company here. Oh, well, maybe I should just give up on that. I don't know. A lot of you may do the DUTCH test, but the DUTCH test lays this out really clearly also. Okay, sorry, I don't have one in front of me here.
So then let's, let's do like a standard protocol, um, for a second, and then you, you know, you usually want to test and then do the program for three to six months, and then retest and make sure that what you're doing is working. And as I was saying to this student earlier today, you know, you know, you should see the oxidative stress markers correct. You should see, um, glutathione levels come up. You should see all the methyl markers start to improve. And you should see the two-hydroxy go up and the four go down. Then you know you're on the right track. I mean, maybe not going to fix it all in the first 15 minutes of doing something, right? But, you know, over time, you're going to start to restore normal function. That's really the goal. And let me see here. Show you kind of like a standard protocol. And obviously, you can also run other protocols, and you usually are going to be running other protocols at the same time. So let's say you got an adrenal case with Giardia and mitochondrial problems, low glutathione, dopamine issues. This is just a typical case I pulled up that we were working on earlier. So right off the bat, here are the things that are directly related to, we're talking about. Low glutathione is going to make a problem, create a problem with the metabolites. Low dopamine could be related to that enzyme not working really well. And low folate is going to create this whole thing that we're talking about. So when you, you're going to get all that information off of your organic acids, your nutrigenomics, or OMAXX tests, you're going to see all that information. So this is just a, a standard case that we did earlier this week with one of our, one of our students, right, that had the patient had all these problems. But look, just right off the bat, this is going to create a problem with what we're talking about. The low dopamine is related, and the low folate would absolutely create the methylation defect that we're talking about.
So when you're doing a protocol to fix all this, you would get into doing the adrenal programs, this and this and that. And for the purposes of what we're talking about today, you may also want to use some extra folate. There's products that you can get that have B6 and B12 and folate all together. That's another option. A lot of practitioners like to use SAMe and choline to help with the methylation part of this. And then you may, depending on how the labs shake out, want to use something like calcium D-glucarate or DIM. And what I use quite frequently, I can show you the ingredients in it that might help, is, um, general phase two liver support. So you don't have to get super specific and know the exact, exact pathway. You can just hit all the pathways, basically. It's kind of a little bit of cheating, but it's called Liver GI Lig Detox. And this, these are all from Pure Encapsulations. All the different companies we work with have these products, so you don't have to use them. It's just kind of my favorite brand. They use a lot. And let me just show you on their website how you can get a lot of this done quite rapidly. So you can target a specific pathway like the calcium D-glucarate. And a lot of people would do it that way. And in the beginning, you want to give a fair amount of it. You'd want to give, you know, maybe two capsules twice a day, and then retest and see where you're at. Okay.
And then to hit all the pathways, I would do both these at the same time for a patient in general, especially for this woman we're talking about from earlier today, because she wanted to get pregnant soon. Liver GI Detox. This would be three capsules twice a day would be like a standard dose to get the pathways working again. And again, here we see what's in there. Well, sort of a hit list of everything that we're talking about. Lipoic acid, N-acetylcysteine, the turmeric, milk thistle, the sulforaphane stuff from broccoli, artichoke, glycine, taurine, glutamine, methionine. It's the exact, it's just a list of the ingredients of the stuff that we've been talking about this whole time, right? And so it's just a matter of how many of these you
want to use it is challenging to try to use individual products. I think it's more advanced, and not that you have to be an advanced practitioner, but it's just more challenging for the patient, more challenging for the practitioner. So combination products are oftentimes the way to go. This three times, twice, three of these twice a day, two of the calcium de glucarate twice a day. You know, good multivitamin, some of this other support that we've got here, you know, listed out for the adrenals and whatnot, and you have a program that's up and running that you could be really successful with, right?
All right, so let's see here. Um, we have how much time we have left? Always. Oh, yeah, we got a few minutes. So let me, uh, do one more thing here, uh, and go through some questions. So what do we got? Uh, so an has a OD question about other nutrients. So absolutely, you have to do vitamin D if they're low in vitamin D, and you have to give magnesium if they need magnesium. So we're assuming that you're covering all these other individual nutrients. We're just kind of focusing on this one pathway for tonight, um, uh, for increasing methylation. I do a lot of the TMG and choline, those two, and obviously plus the folate. But everything's lab-based. Like the program I just showed you, that was all lab-based. So we're not guessing. We're seeing, oh, this person's got a methylation defect and it's B6 generated. Look at their zanic acid. Oh, this person has a methylation defect and it's folate because their Figo is low. So rather than just giving everybody the exact same stuff, we're able to target the exact nutrients in the methylation pathway that are screwed up. And remember, it could be an amino acid, it could be tryptophan that's low along with glutamine and Serene, and that could be screwing up their methylation because you need those amino acids.
Uh, let's see. Can you overmethylate? So that's really the answer to that. It's classic Richard Lord. Every nutrient can be a toxicant. So let's say that again. Every nutrient can be a toxicant. Can you get too much of it? Yeah, that's why we do the labs. So if you have someone that's not methylating well and you do the organic acids, you're gonna be able to tell, is it B6, B12, or folate? Is it, uh, if you do amino acids, you can be able to tell, is it methionine or cysteine? Where's the glitch here? So you can be targeted. That's the whole point of the tests.
Oh, so glutathione or NAC. So glutathione is best done in a liposomal or liquid form. Quicksilver is a popular brand now. Um, Designs for Health has one as well. And then, um, NAC, I get in a 900 milligram capsule from Pure Encapsulations. That one works extremely well. In general, you can use NAC or glutathione. And the, the reason why you would use one or the other is is complicated, or I should say it's complicated. It's gonna differ depending on the person you're working with. There's some cases where you want to use the NAC because it's a biofilm disruptor and they have a gut problem. So that would be convenient to boost the glutathione and help their gut at the same time. So the, depending on the circumstances, it may be that NAC or glutathione is more appropriate. Sometimes we use both. If people can't tolerate cruciferous vegetables, we're going right back to the liver support products that I just showed you. So they're able to do it that way.
Uh, let's see. Uh, let's see. I think, but I'm sorry, I know what the tech difficulties were. I think we're back though. To see the tests do not directly measure quinones, but they usually, they should be measuring glutathione and, uh, oxidative stress in general. So you can get a sense of how much you need to deal with that. That was from Erica. Who can maintain these pathways on diet alone? Nobody, nobody. Not anymore. Maybe a hundred years ago or a thousand years ago. Nobody. Whether you need to supplement every day the rest of your life, that's another question. But, you know, once you do the therapeutic programs and you fixed everything, then you can sit back and think, okay, what does this person need for maintenance? And the way I would highly recommend you do that is that once a year, you do a metabolomics test and you measure their overall nutritional profile and keep them on whatever they need based on the testing. So the amino acids needed are Serine, Histadine, Tryptophan, Glutamine, and I'm forgetting one. I forget the fifth one. There's five. You could look that up though.
Um, optimal DHA level for someone who's trying to get pregnant. So depending on which lab company you're using, would be the mid-range of the of the range for that particular lab. If they are age-based, then same thing for their age, mid-range or higher, but certainly not below the mid-range. Um, you could use acetylcholine for choline if you wanted to. What do you, what do you do to use? How do you determine if you use DIM or calcium de glucarate? I use a product that has them both. That's a good question. Uh, so that's kind of a cop-out in a way, but maybe, maybe it's not a cop-out. I don't know. It's a workaround. Let me show you here if I can pull it up because then you don't have to decide. Just use a combination product. DIM Detox and Dandy. So then you got them both all in one pill. You don't have to sweat about it. The DIM Detox does that. Okay.
Uh, let's see. There's a complicated question from Sherry on Doctor's Data. If we know the comp T is low, but ADOH HTG is low, do we need to focus on hormones or just focus on methylation and possibly gut? You always focus on all of them together. So it's always gut, hormones, and oxidative stress, methylation stuff, all together. Maybe not at the same exact time. Okay.
Um, so which test would I use? I don't know. Everybody has their favorites. It's like a, I don't know if you're a classic car person, it's like the dilemma I'm struggling with. Would you get a 1971 Porsche, Alfa Romeo, or Mercedes? I don't know. Like if you talk to a Porsche person, they would look at you like, what? Alfa Romeo? I wouldn't even look at an Alfa Romeo. And you talk to Alfa Romeo people, like, Porsche, are you kidding me? So it's a personal preference kind of thing. I know all these labs and I know all these lab directors really well, and they're all doing the best job they can. They all work their asses off 24/7 to bring you guys the best tests. You can't really go wrong. It's gonna come down to maybe like the sales rep that you like more or or what it may, you know. And if it's between metabolomics and NutraVal, I'm really into the metabolomics now because the blood draws are a hassle for people to get. Um, if you have blood draw availability in your own clinic, then NutraVal would be far superior. Okay. You can do that.
All right, gang. We're right at the hour. I got to wrap it up. Thank you everyone for joining. I hope to see some of you in our upcoming classes. We have a mentorship course starting next month as well. And if that's not appropriate for you, then cardio meta blog. All right, take care everyone. Bye for now.