Mentorship Miniseries - Getting Started with Functional Medicine Lab Testing

Ready, say, "Go!" And hello everybody. I am Dr. Dan Kalish, and I am here to present to you our spring mentorship miniseries. Which means that, springtime, which is kind of hard to imagine how quickly the year is gone, and we are doing a new class. I've never taught exactly this one before, called "Getting Started with Functional Medicine Lab Testing." And welcome to the Chaos Institute.

So, for those of you that are brand new to this and to me, I am Dan Kalish. I started the Kalish Institute in 2006, which is a while ago. Prior to that, I did a lot of teaching for other groups, and we have now trained over 5,000 practitioners on building successful telemedicine and functional medicine practices. And so, my goal for the last 20 years has been to get practitioners that are interested in doing functional medicine all the tools that they need: business planning, financial planning, clinical skills, beginning skills, just how to order labs, how to interpret labs, how to sell supplements, how to run the logistical stuff, what kind of software that you should use. And so, the whole Kalish Institute premise, since the day it started, has been, "What are the things that are going to make you guys successful that I know about throughout my travels and my experience of, you know, being in the industry for 30 years and knowing a lot of people and having gone to a lot of conferences and having consulted with thousands of practices at this point?" And lo and behold, there's some consistent things that everybody needs, and that's what we try to teach.

I've also done other sort of side projects. I spent a year doing a research study with the Mayo Clinic about 12 years ago. A group of doctors from the Mayo Clinic took my mentorship class, and you don't know how scared I was about this because they signed up. Like, this is like, real. There's like, five Mayo Clinic doctors on this call. Then this all of a sudden, my whole life kind of condensed to this one moment in time. I had actually broken my arm the day of the class, and I taught with a broken heart. It was a whole long story. Anyways, we worked together for a long time, and one of them talks about a mentorship class twice, even. And we ended up doing a research study, which is on the adrenal glands, which is interesting. Can share that with you guys if you're interested at some point. And I've also, in the last, you know, 10 years, been working with Richard Lord, who is a scientist that developed much of the integrative and functional medicine lab testing that we all use. He's retired now, but he and I work together on a regular basis, and it's been a really great experience.

I've been in practice for 30 years, and the way that I've set up applications to classes is we have free calls and classes like this one or webinars. We have these boot camps that are short, they last about a month. We have all the way through business courses, all the way up to our one and two-year mentorship programs for those of you that are really serious and about starting a practice. And I'm very proud of our graduates. I talk to all of our one-year program graduates at the end of their year. They're getting jobs now. They know how to interpret labs really well. Um, they end up becoming, I feel like, you know, top of the industry folks in terms of their lab interpretation skills. So, all that to say, the process has to start with actually ordering labs. And so, we've got a series of lab ordering classes that I'm teaching. And then this call tonight is really about, "What labs do you even order?" Like, "How are you supposed to figure that out?" And "How did I figure that out?"

I had Dr. Timmons, and I would just, you know, he was the founder of one of the original, really, the original company that did lab testing on the adrenals. And he did a lot of GI workups too at his lab. And he took me under his wing in my first year of practice, second year of practice, maybe. And, um, we spent six or seven years together just constantly with him explaining to me how all this stuff works. And if you don't have someone like that, it's kind of hard to figure it out because there's a lot of moving parts, there's a lot going on. And so, one of the most important parts about running a practice, and where we see burnout happen the most, is when practitioners don't have a good business model, and when you're overspending on your overhead. And so, keeping your overhead low turns out to be one of the biggest success stories to making all this work.

And so, when I first learned about Rupa Health, if you guys haven't heard of Rupa, they're a lab distribution company. So, they have all the major lab companies underneath one umbrella. You can go to the website, or your patient goes to the website, orders the labs. It's super seamless, it's easy to do. And the overhead savings, and the convenience, and the customer service that these guys deliver is just better than anything that you could do on your own. So, it takes one of the biggest sort of burdens off of practices to have someone else actually handling all the administrative things that relate to the labs. So, anyways, you get a 10% discount off your first order if you're a new account with Rupa. You can go over there and sign up, and I'm sure my staff will send you a link soon, probably tomorrow, with the, uh, click-through thing. You can click on that and get a Rupa order going if you want.

Okay, and then in terms of things that we have coming up, we have a lab interpretation boot camp starting now. And if you're interested, you can still sign up for this. That is not a problem. And it's on getting started interpreting adrenal labs, both the salivary and the urinary testing. So, again, that's coming up, uh, this week. If you guys are interested, you can sign up for that. And that's one of our intensive one-month classes. Um, we'll get into both salivary and urinary testing.

Okay, so now for tonight's subject. The purpose here is, you know, it's not theoretical. Like, when I met Dr. Timmons, he called me. I called the lab. I said, "I don't know what to do. I've got this progesterone test here. It looks kind of scary because it says it's above the highest reference range that you guys have, and I got a patient who has breast cancer, and I don't know what to do." And so, at 7:00 at night, that evening, at 7:00 at night, Timmons called me back from the lab, and he's like, "Hey, you know, just Dr. Kalish?" I'm like, "Yeah, that's me." And he's, and we spoke from 7:00 at night until midnight with him telling me everything I needed to understand about that first lab that I'd ever run. And if I hadn't had that support, I, I'm sure I never would have ordered another test. And then he also told me what other tests I needed to order for her. And so, you know, my career was launched, really, because of that one phone call.

So, the purpose of this webinar is to get you to order your first labs. Let's just make that happen. And then, in order to do that, you need to be able to explain to patients why these labs are important. And that's what I want to talk about primarily tonight. You got to pick the right patients to do this with. Be super careful. Carolyn was that first patient that I ordered my first lab on. Okay. I still remember her name. I remember her last name too, but I can't mention that because of privacy. Anyways, she was very kind to me. She was a very nice person. It was the easiest person in the world to order a lab for because she was curious. I was curious. She knew I didn't know anything. You don't want to start on your hardest patients. You want to get your first 20 labs or so done in an easy, low-pressure situation. And then eventually, you'll get to the point where all your patients will want to get labs, but you know, you got to give yourself a little bit of time.

Measuring for success. The success of this webinar, I'll be happy and I feel like I've achieved something if you get your Rupa account set up, order a complete set of labs for yourself, at least. If you haven't tested your adrenals lately, test them. Test your GI. Test organic acids. At that point, as soon as you get the lab kits coming in, you should freak out a little bit unless you know how to interpret them. Okay? Then, when you don't know what to do, then you sign up for one of our lab interpretation boot camps. And so, again, it's like what Timmons did for me that first evening. He, he got me over this emotional barrier that I had about the fear of ordering labs because I didn't know which ones to order, and I didn't know what to do when they first came back. And I wanted it's really what I'm trying to offer the world right now in terms of my life's work is to get you past that stage so that you're at the end, eventually, of this one-year mentorship at the Kalish Institute, and you're ordering labs left and right, and you get a job at a clinic in Washington D.C. or New York or Dallas or wherever you live, and then you walk in the door, and you're the best lab interpretation person in that whole clinic, even though you just started to practice, and poof, your career is off and running. That's really my, my goal. And I see this, you know, I accomplish this goal a lot with practitioners, and I'm trying to get more and more people interested in achieving that.

Okay, so here are the essential questions. And, uh, I'm making a big assumption here that my camera and screen are working, but I think everything's working. I don't see anybody complaining. Let me just take a second here to make sure I can see you guys all there. There we go. Okay, good. Now, oh, there's a lot of you too, right there. Look at that. All right, that's good. So, now, and I will answer questions at the end. Okay? So, so type in your questions, and I'll try to get them at the end. Um, why to do lab testing? We're going to cover that. These are just the questions. Which tests do you want to order? You want to figure out that one. Who you're going to test? I already mentioned that. Easy people. Easy people. Easy patients. Don't test hard people. Everybody wants to test their most complex patients that they haven't helped in the 15 years that they've been treating them. You know, you don't do that. You want to test easy people. The Carolines of the world. The easy, friendly people. Okay? So, you don't get discouraged. How you can convince patients to buy the test? That's a tricky one, and we're going to talk about that today. And then, what do you do when the test results come back? You panic and you sign up for one of our interpretation classes, right? All right. So, now, and I'm only half joking when I say that, but it is slightly sarcastic comment.

So, patient and practitioner roadblocks to ordering. Number one, and this is the most infuriating one, is these tests are too expensive. This, me, if you're thinking that, then you know, you should go to therapy or something. Okay? But if your patients are thinking that, then you have to figure out how to explain the value of the test to the patient. The value of the test to the patient. When we see that there's value in something, we would gladly purchase it, gladly. So, I will show you in a few minutes how to start to establish value so that pretty much after you practice this technique for a month or two, pretty much every patient that you work with should want to order at least one test, maybe even all three.

So, now, if it's intimidating for you to order a test, then I'm just going to tell you what Timmons told me 30 years ago, which is, "We start with the adrenals." We'll talk about why. If you get past that, you can do more than one test with this person, then do a GI test also. And if that's going swimmingly well, and they're like, "What else can we do, Dr. Kalish?" Then I would say, "Add in a metabolomics or organic acids test." So, those are the three that you want to do. You can just start with the adrenals and GI. Could you start with the adrenals? You know, you can do any combination of those three, but it's usually best if they're done in that order.

Now, I was talking with one of the, uh, lab sales guys, and I've known this guy for 30 years. His name is Jeff. And we were at a conference recently. And I don't know, honestly, I was, it was a conference, and I had left because I was tired of sitting down and listening to the speaker, and the speaker was a little bit boring. So, I was in the hallway, and I saw Jeff. And say, "Hey, Jeff, what's going on?" We just had this conversation. And I was like, "You know what? I'm really trying to think about how do we get doctors past this barrier where they're gonna just be a good account for you?" You know, because he's a lab sales guy. So, you know, I look at it from an educational perspective, but he looks at it from a sales perspective. He just wants to sell tests. I want to educate doctors so you guys can help people. So, we're compatible, right? We have the same goals. And we were talking about this for a while. And again, he's been in the industry for over 30 years like I have. And he said, "Well, you know, Dan, if they order three or four tests in a row within the first few weeks, then we know they're probably going to be a pretty good client." And I realized, "Yeah, you know, it's really true." Because that, if you order one or two tests, you might just get to that "freak out" stage, but not get to that "I really want to do this" stage. So, there's something about the volume of testing that you do. You will not figure out how amazing this is on your first couple of tests. I really think you need more like 10 or 20. But even if you can get three or four tests done, interpret them properly, put people on programs, you're going to start to see results, and then you're going to get your own momentum going because you're going to see how effective this stuff is, and then you're going to want to keep going, right? So, that's the goal, a little bit of volume.

Now, which test do you want to order? If you order too many tests, and you're not at the expert level, they're not going to help. I mean, if you order a test for mold, what are you even going to do about it? Or Lyme disease test? Or you order some heavy metal toxicity panel? You know, it's really hard to treat mold, Lyme disease, and to detox people's metals. Those are not the kinds of things you do in your first couple years of practice. So, you need to order the basic tests, but then interpret them really, really well. And if you can just do the basics really well, and you get the lifestyle integrated in with this, then you're going to have a really successful practice. That's all it takes to get started. But if you start with the complex labs that are really hard to interpret, where your odds of success are kind of thin, then it's not going to work.

So, my friend Kirk, when we were in high school, I grew up in Berkeley, California, which we won't get into. But anyways, I grew up in Berkeley, and Kirk, who I still hang out with on a regular basis, um, decided he wanted to learn how to do kung fu. And we're like, "Okay." Because one of the things that the Berkeley boys did in high school, and I don't know why we did this, it was kind of stupid, a little embarrassing, but we would have these fights. There would be like, five or six of us, and we would get these like bamboo kind of pole things that didn't really hurt you very much, and just like whack each other with them, and then tackle each other and wrestle. It's just something that we would do when we were bored on a weekend or whatever. Just happens. You know, we'd be off on a hike, and we'd all grab a stick and start whacking each other. So, there was some element of need for strength in our group. And Kirk went to do kung fu, and we're like, "Oh, this is not going to go well." Because maybe he's going to learn all these fancy moves. He went for a year to San Francisco every weekend, and the only thing that he learned was how to do a horse stance. So, he would go to Chinatown, like, take an hour or two on the subway, the BART system here, and then spend, you know, his entire session just doing a horse stance, which is basically standing with your legs bent. And we're thinking, "Wow, that's kind of crazy. Why are you doing this?" Well, it turned out after a year of doing that, he would get into his horse stance. He didn't know any kung fu, per se, but no one could tackle him anymore. His legs were so strong, no one could even push him over. And that's when I realized, "Oh, if you learn how to do one simple thing really, really, really well, you can absolutely be at the expert mastery level." So, if you just learn how to do the basic labs really, really, really well, you could handle almost any patient in their early stages of care. Okay? The complex ones, you'll learn about, and you can refer out. You can still help the complex ones with the basic tests. And then over the course of time, in your first couple years of practice, you can add more complex things. But if you start with a complex, it's not going to work. If they had started Kirk with some fancy kung fu moves, he wouldn't have been, he wouldn't have become invincible. Just that simple horse stance was enough.

So, don't order the wrong tests. If you don't order a key test, that's not good. So, we're just agreeing here: adrenals, GI, and metabolomics or organic acids. Those are like the core that you want to start with.

So, now, the reason why we start with the adrenals first is because we're looking at the stress response. These programs that the supplement programs based on adrenal testing make people feel better. It also allows you to get into the lifestyle coaching, diet, exercise, sleep, and meditation type things. So, the adrenal test is kind of a referendum on how they've responded to various stressors throughout their life and whether they've had enough rest and recovery time. So, with just an adrenal panel, you can get a kick-ass supplement protocol going based on the lab with all the fancy stuff that really gets them feeling better, and you can get the lifestyle programs initiated based on the adrenal testing. Of course, we always test the microbiome and GI for that. You can get into, there's a variety of different tests you can do, but one of the basic GI tests. And then you need to look at cellular function at some point. So, organic acids are metabolomics. Those are the three. And if you just want to get started in functional medicine, you can just order adrenal tests on everybody for the first month or two and see how that works, and then add different components to that over time.

So, when I'm thinking about explaining this to a patient, we got three tests: adrenals, GI, and metabolomics or organic acids. And then how does that tie into a clinical model? If you have this explanation and you simply memorize this, people go for this. We've been doing this now since 2006. This works really well. It's not just my practice. We've got hundreds and hundreds of practices that are using this exact same conceptual framework. So, I think of it as body systems: three body systems, neuroendocrine, GI, and detox. So, we want to look at, like, how does the health, how do these health problems start in the first place? We start with some kind of stressor that pushes the neuroendocrine system to the brink, that ends up triggering gut-related problems. And if your gut is screwed up for long enough, you're going to become toxic. So, you start to think about this as three tests: one for the neuroendocrine, that's the adrenals; one for GI, it's a microbiome test; and one for detox pathways, that's the organic acids. Three tests, three body systems. It's a nice, neat little package.

And then when patients are asking, like, "Why am I even sick in the first place? What's your your conceptual framework? What does functional medicine really saying about my body?" Well, and how this is how the body breaks down. Again, this is a clinical model. Three labs, right? Adrenals, GI, organic acids. Three body systems: neuroendocrine, GI, detox. And then how does this all even get initiated when we're under enough stress? Someone in the family dies, there's a divorce, you have your second or third child, you're working too many hours, maybe all these things happen in the same month. Your stress hormone system just crashes. And as that crashes, the immune system and the guts start to fall apart. And as that goes on for a little bit of time, we become overwhelmed with toxins. And so, we want to test each of these body systems and then start to correct each of these body systems in the order in which the problem occurred. So, if we're saying stress is the initiator, we want to test and correct the stress hormones. That eventually leads to GI problems. We want to test and correct the GI tract next. And eventually, we want to detox the person, get all those chemicals and heavy metals and toxins out of their system based on organic acids testing. Okay? So, again, it's a model that tells you which three labs, a model that has systems to it so patients can understand. And then a model that shows to the patient how this problem gets started in the first place. You don't have to use this model, but you need some kind of clinical model so that patients can go, "Oh, okay. There's three body systems. That's it. Makes sense. Stress, GI, detox. There's a test for each system." Okay? So, it's three systems, three tests. And which one do I have to do first? Well, we're saying that stress is the initiator, so we're going to start there. We're saying the GI is probably the most important, so we've got to include that. And at some point, when you're ready, we want to look at organic acids and metabolomics and look at your detox system, your brain, your mitochondria. And there's a lot more wrapped into organic acids. This is obviously a gross oversimplification, but it's enough that you can communicate to a patient, and it's enough for them to be excited to get out of the chair in your clinic to walk to the front desk and buy a bunch of lab kits.

Adrenal hormone labs, the perfect place to start. Really, we all agree, I think, in the field, that 80% of functional medicine is lifestyle medicine. And so, I don't know any of you guys have kids. You can put your hands up. I can't see you. But if we're at a real stadium auditorium or whatever, a bunch of you'd be putting your hands up. So, if you have children, or if you've been around a child, you know how did they react to something like, "Eat your broccoli"? And then how many parents throughout human history, modern human history, have told their child, "Eat your broccoli"? Everybody's heard that from one of their parents. And when we then become adults, and we meet a healthcare practitioner who's basically saying, "Eat your broccoli," right? The same lifestyle changes. Or how many kids, you know, have been told, "Ah, it's past your bedtime. You need to go to sleep now." If your only tool for lifestyle coaching is bossing people around and saying, "You need to go to bed earlier. You need to eat your broccoli every day," which is kind of what lifestyle changes are, right? You're treating them like they're a five-year-old. That's what we do with patients because patients need the information, and they're not, they're staying up too late, and they're not eating their broccoli. The thing is that if you just are saying that, it just triggers all kinds of memories from when they're a kid, and no one ever listens. Everybody knows they should be eating their broccoli and going to bed earlier, but no one's doing it. That's why they're sick, and they're seeing you.

So, if you have an adrenal lab in your hands and you can say, "Look, John or Joan, whatever the person's name is, it looks like your adrenals are not doing very well. In fact, your look like you're in a stage three of adrenal exhaustion. That's not good, and that can cause this and this and this." And one of the ways that we try to reverse you out of this problem is to address the things that will help the adrenals heal. And that happens to be getting to bed before 10 p.m., eating three meals with vegetables and fruit with each meal, starting to do a five-minute meditation every morning, and let's get you exercising, like, tomorrow, right? So, you're doing, you're using the adrenal lab. I call this "labs to lifestyle." You're using the adrenal lab as the ammunition to get them to make the lifestyle changes. On my favorite one of all is like, if you see a super high cortisol on the test, you're like, "Oh, that is not good." That is like, if you've seen those ads from years ago on TV where it'd be like, "This is your brain, and this is your brain on drugs," and an egg frying, like, too much, you know, a burning kind of. So, cortisol, we know when it hits the brain, destroys brain cells, kills them. It's not good. So, you see high cortisol, you're like, "Well, that's looking like high cortisol. Do you drink coffee?" And Joan or Jane is, "Yeah." "Well, I think the caffeine is going to have to stop for a few months." "Why?" "Well, because, you know, caffeine stimulates the production of cortisol. You're already making too much of it." So, just for things like that, to get them off of alcohol, off of caffeine. If their liver detox pathways aren't working well, you can go, "Oh, that doesn't look good. This liver detox problem here. Uh, we're gonna just have to have you stop drinking alcohol for the next few months at least so we can work on your liver." And from the patient's perspective, if they're paying for an adrenal test, and then they're paying for the adrenal supplements, it kind of makes sense for them to stop the caffeine, stop the sugar, stop all the things that are screwing them up for a little while so you can get the job done. So, in other words, if the labs are used, and probably the most powerful way the labs can be used, is as leverage for you to get the lifestyle changes going. And if you use the labs that way, they're well worth every penny the patient spends because it's going to be the motivation for them to do these lifestyle changes. Otherwise, they're just going to sit around and not do, uh, okay.

There's some other points on there, but I think I made the point. So, one of the nice things about the adrenal test is that it's not your personal opinion. It's a lab test. So, it's an objective view, and it summarizes how much stress that person's been under from diet, exercise, problem, you know, lack of exercise, too much exercise, poor diet, poor glycemic control, insulin resistance, inflammation from the gut, environmental toxins, all these things that accumulate that hit our stress response over time. And so, if you can get the lifestyle changes started along with an adrenal supplement program, you're going to have a super good first couple months of treatment for the patient.

So, another way to look at this, and when you're explaining this to patients, is to think about, "Why are we doing this adrenal test first?" Depending on what they're suffering from, you want to be able to tie in the results from the adrenal test back to whatever their primary conditions are. And stress plays a role in illness, in my experience, and the experience of all the doctors in our mentorship class, almost all the time. There's very few people who are stress-free and all of a sudden have a chronic health problem that just doesn't happen. You know, and anything from a mental health problem to an autoimmune problem is going to be related to, you know, have a component to do with stress. So, we want to do the stress test.

And then for the second step, the GI testing. Many people in functional medicine would say the GI testing is the most important. The microbiome really is the key thing. But if you test for it first, or you only test the microbiome exclusively, you're not going to have this whole package to wrap things around because, remember, the adrenals give you not only an adrenal program, which is very clinically effective, it makes people feel better, but it gives you the ammunition to do the lifestyle changes. So, even though the GI may be more important than the adrenals, and it probably is, it should come second in the scheme of things. And when you put the GI tract testing and treatments first, you're just less likely to be successful because you're not going to have as much support for the immune system, you're not going to have as much leaky gut repair, you're not going to have as much going into the GI treatments as you should. And if you want to get the complete picture at the cellular level, then you add in organic acids and metabolomics.

Now, another aspect, and this is something that's kind of worth memorizing because people are going to ask you this, is what's the tie-in between the adrenals and the GI? Well, there's two easy, easy things that you can say, and there's hundreds of things, but two. One that I say every time I talk to a new patient, and one of them is that cortisol regulates secretory IgA. So, and you'll see sIgA on the stool testing. So, if you have an sIgA problem because cortisol is abnormal, the immune response in the gut is not going to be working well, and that makes people prone to having gut problems. The second connection is that cortisol, when it's out of range, out of balance, means the body becomes catabolic. It turns us into, it generates this catabolic physiology where we're breaking down tissues for energy or for fuel. And you're going to be breaking down not only muscle tissue but gut lining tissue when you're catabolic. So, you end up with leaky gut. So, if you're stressed, you end up with a leaky gut, and you end up with a weakened immune response in the gut because sIgA is not going to work properly. And that was, that's what sets people up for the GI problems in the first place. So, if you want to fix the GI and you want to test the GI and fix it, getting the catabolic physiology under control so the leaky gut goes away, and getting the sIgA to improve so the immune system, the gut comes back, is going to be key. And that happens with the adrenal programs. So, in a sense, the adrenal programs are a precursor or a stage that you will then lead right into the GI testing.

Now, ordering GI labs. Sometimes this is really easy. If they have GI symptoms, it's not that hard. If they have gas, bloating, diarrhea, constipation, heartburn, food allergies, nausea, throwing up all the time, you know, how hard is that? You just have to say, "Well, I think, you know, we should check your GI tract." And I think I have a slide on this here. Yeah. So, if, if they, if they're highly symptomatic, then there's sort of a script for that, which is that, "We want to do this test." Get out a copy of the lab report and just show it to them, like a sample report you can get off a website from one of the labs. And you say, "Hey, you know, I know you have these symptoms. What are they? Gas, bloating, diarrhea, constipation, heartburn, reflux, food allergies, and nausea? We know you have these symptoms. I want you to do this test. This test is going to tell us about three things. It's going to look at your microbiome. Everybody knows what that meat word means now. So, we're going to analyze your microbiome, that's the good or healthy bacteria in your gut, see what their status is. This test is also going to look for functional GI organ issues. So, not for a pathology or disease process, but is your stomach functioning right? Is it making enough hydrochloric acid? Is your gallbladder functioning properly? Is it making enough bile? Is your pancreatic enzyme output good? Is your gut lining immunity and gut inflammation under control? Do you have a leaky gut? So, we're going to look at GI organ function. We're going to look at the microbiome, and it's also going to include a pathogen screen for GI infections. So, as we look for the microbiome and the organs in the gut, the various GI organs, and the pathogens, we'll be able to tell what's causing your gas, bloating, diarrhea, constipation, heartburn, but like that." So, that's usually a pretty easy thing to convince people to do with the GI. I would avoid really complicated patients that I don't know. We had a bunch in the mentorship this week, the pseudomembranous colitis kind of patients, or, you know, "There's blood in my stool, I'm in the emergency room" kind of people, or "I'm having a Crohn's flare-up and I can't leave the house" kind of people. You could work on those people like six months or a year from now. Start with a garden variety gas, bloating, constipation folks, not people that have advanced autoimmune degenerative problems and stuff like that.

Okay, and, um, you want to be able to explain how the lab will identify the potential underlying cause of their GI complaints. So, whatever that complaint may be, it's the same answer here. Show them a sample lab. Say, "We want to look at your microbiome, your GI organs, not for diseases. This is not a medical screening test for like pancreatic cancer or something. This is for GI function. That's a for functional disorders where the organs aren't functioning well prior to the onset of a disease or a pathology. Prior to pathology, right? And then we're going to also look for pathogens, parasites, bacteria, and yeast." That's usually enough to convince anyone who has a GI problem that they should do the test.

Um, I know I've said this like five times, but this is like the most important thing. And so, everybody wants to run labs on their hardest patients. 100% of people that we run into want to do this. So, just start simple. There's something called Fugu. I know if you guys have been to Japan before, but in Japan, they have this delicacy called Fugu, and it happens to be, um, I think the Americans call it blowfish, but it happens to be deadly if you eat it. Like, people die. It has a neurotoxin, it kills you. So, they have like special Fugu training in Japan. You have to get like a license. Like, this is serious stuff. It's like getting a gun license or something. So, you have to get a license if you're a sushi chef or whatever, so that you know how to prepare Fugu so it doesn't kill people because you don't want people to get, you know, walk into your restaurant and then drop dead. So, don't get all complex with this. Like, if you were like at your first day of sushi training school in Japan, you're not going to learn how to deal with blowfish. Just start with salmon. Nobody gets sick from eating salmon. Even raw salmon is pretty safe. So, start with easy cases, please. That'll just ensure that you won't have this pushback from patients.

Now, talked a little bit about a little bit about adrenals, a little bit about GI testing. The third test you're going to want to do on everybody is organic acids, sometimes known as metabolomics testing. And that could be organic acids, fatty acids, amino acids, genomic testing sometimes is mixed in there, but generally, it's going to be done from a urine sample, sometimes from a urine, a blood sample. So, when you're talking to patients about this third category of testing, uh, if you can keep it simple to adrenals, GI, and detox, and just stop there, that's totally fine. If you want to take it to the next level and you want to get into what actually metabolomics is and what it tests for, you can let that patient know, "Hey, we're also going to screen for brain-related problems, things like depression and anxiety and sleep issues, memory problems." That's what organic acids looks at neurotransmitter metabolites. We're going to look at mitochondrial function, insulin resistance, pre-diabetes, diabetes, you know, risk factor for cardiovascular disease, non-alcoholic fatty liver, all kinds of different problems that the mitochondria, if they're not working well, could lead to anything from fatigue to a thyroid problem. We're going to also look at detox pathways. I don't talk too much about this in my practice other than to keep it sort of general. You know, and it's a vague and overwhelming and complex category to discuss. I taught a class on detox about 15 years ago. It was my biggest failure in teaching. I spent a year preparing for what I thought was going to be a year-long class, and I think we had like three people that signed up for it. I had 15. This, I'm not making this up. I had 1500 PowerPoint slides prepared, and I think the three people that actually took the class all got so depressed from taking the class that it was just not a good thing. So, I would talk about detox lightly because you really get into detox issues, and how toxic we all are, it gets so, so depressing. You're going to lose patients unless, the only time when I would talk about detox a lot is if, here's some examples, if you have to, right? If it's a construction worker, and they've been handling, you know, like treated lumber for years, they have all kinds of arsenic, or a metal worker, or a painter, or someone that repairs cars or trucks, or welds, or a firefighter, or an artist, maybe, who has a ton of different, you know, chemicals and metals that they've been exposed to through the paint. So, if you have to, but otherwise, I would like lighten up on the detox because it's just a depressing topic, and it's complex.

However, you can also sell this entire suite of tests: adrenals, GI, and organic acids as preventive. You know, so a patient doesn't have to have any problems. A person could just be worried about having problems. It could be preventing cognitive decline because they just saw that one of their parents died recently after a horrible long battle with Alzheimer's, and they're worried about it. It's like, "Okay, well, this prevents that from happening in the first place." Uh, if you, same with heart disease, or diabetes, or breast cancer. There's all kinds of fears that people have around these kinds of conditions. And the whole premise of functional medicine is that we're looking to look, we're looking, we're testing to look for organ dysfunction prior to the onset of pathology or disease. So, you can also explain to people these tests are valuable for this reason. And you can have, and we've got a couple of people in the mentorship now that have practices that are wellness practices. If you're not working with sick people, they're working with really healthy people that are scared that they're going to get sick. You know, you could, it could be executive coaching, it could be athletes, it could be new moms, it could be, you know, anyone. The Mayo Clinic study that we did was 25 women. We studied 25 women in high-stress executive positions in Silicon Valley. Turned out that they all had bad adrenals. What a shocker, you know? So, it does. But we didn't study a chronically ill group of people. We studied a high-performing, high-stress group of women in Silicon Valley. So, you can frame your practice in a whole bunch of different ways depending on how you want to structure it. I've got some slides at the end on this too.

Personalized nutrient programs. This is where you can't turn around without hearing the term "personalized nutrients" or "personalized programs," personalized medicine, however you want to call it. And if the person's already into this and they're taking a lot of supplements already, but they want a science-based, rational way of figuring out what they should do, adrenal panel, GI testing, and organic acids, and maybe redo that once a year.

Now, from a practical standpoint, when I think about what, what's the role that the labs play in a practice, and why is this so important? So, once you figure out how to do this, you've got your, you sort of mastered all these things that we've been talking about. You've got the skills to do the adrenals and tie that back to lifestyle. You've got the skills to talk about the GI testing, so you, you can talk about the microbiome, the GI organs, pathogens. Okay, got that down. I've got patients doing adrenals and GI. You start to work with organic acids. The person has an issue with your brain or their mitochondria, whatever it may be. And then you get so that you're comfortable with this, and you've done your first set of labs. And then you maybe start to think about, like, "Why am I even doing this?" You know, "Why is this matter?" And how does this matter in the scheme of building a practice? And so, I didn't know any of this stuff I'm about to say when I first started testing. When I was, uh, it was 1995, a little bit before that. I just knew that I wanted to do functional medicine before I even knew exactly what it was. And when I met Dr. Timmons, I just knew that I wanted to learn the labs. And I didn't have any conceptual framework for my business or how this was going to fit into my life or, or, you know, my ability to help people at such a profound level. And I'm sitting here now, 30 years later, thinking I've been through more than 10,000 patients. We've trained a good couple thousand of doctors, you know, really impacted probably hundreds of thousands of lives. And then looking back at this and thinking, having the labs fit in, and what would it have been like without the labs? And the role that the labs perform has these different components, which may not be obvious, but I just wrote them down on a slide so I wouldn't forget in this part of the lecture, just talk about them.

Some people get the labs. I mean, most people that, once you get the person to get the labs, almost all of them, 95% of those people are going to come back and see you again, and they're going to start a supplement program. Okay? And if they start a supplement program because they bought the labs, they're almost for sure going to follow the lifestyle changes, which is the whole point of this job. And then they're going to start to get better. Why? Well, because they spent money on the labs, which kind of forced them logically into buying money and spending money on the supplements. Supplement programs helping them feel a lot better. But then it doesn't make any sense to take a bunch of liver detox supplements and drink alcohol and caffeine all the time. So, then they stop the alcohol and caffeine because they're on this liver detox program. And guess what? It's 80% lifestyle change, is 20% supplements. So, you get that power of the lifestyle change that was created. The leverage you got to make them do that, make that change, was created because of the labs. And you combine that with a bunch of supplements that are well laid out, you know, you're gonna, 100% for sure, have a very successful practice. If you don't have the labs, then, then it's just like the parents saying, "Eat your broccoli." I mean, I wish every five-year-old could say like, "Why?" And the parent would be like, "Well, there's sulforaphane." And then, you know, "No." I mean, five-year-olds don't relate to sulforaphane. And obviously, I'm being kind of silly here, but you can't get compliance. You can't get compliance with people at the level that you can with the labs. If you don't have the tests, plus you don't even really know what you're doing, uh, also. And that's another point.

So, let's talk about Dr. Timmons. There's a picture of him. He died a long time ago, which is tragic and and not good. But I feel like he's still with us in a lot of different ways. And Bill would always say, "The effectiveness of your clinical program is predicated on the depth and accuracy of the lab data that you have." Because I'd be like, "Do I have to order this lab? Patient says it's expensive. I kind of think it's expensive." He had one of his co-workers at the lab had...

A t-shirt printed up that we all wore for like a week, and I think I threw mine away. But it said on the front of it, it said "Do the test," and then on the back, it said, "Or die like the rest." I mean, that was a little extreme. That was this guy named Jerry, who's a little extreme.

But the point is that if you're going to design incredibly effective, life-changing supplement programs, and you're going to really understand a person, I create a personalized program based on genomics and proteomics and metabolomics and gut function and microbiome, you got to have lab data. And the more lab data that you have within this basic context of tests that I'm talking about, the more impactful your program is going to be. And so when you look at the total cost of a program, if the person is spending six months or a year doing the wrong thing, it would have been cheaper if they just bought the testing so they knew what to do in the very beginning. Okay, that's it. Kind of hard thing to get around to explaining to people, but pretty important.

So now, we had, I was in Columbus, Ohio, a long time ago, and I was teaching a seminar, and there was a break. And I went outside to where they had snacks because the lab company that was sponsoring this was great enough to have like, really good food. So we're all out there eating our hors d'oeuvres, or whatever you want to call it, you know, the kind of between conference break snack stuff. And this doctor came up to me, and she's like, "I don't know what you do, Dr. Cash. I've never met her before. I don't know what you do, Dr. Kelly's, but one of my associates in my practice, we call her the lab whisperer." And I started laughing. I was like, "Okay, where is this conversation going?"

And so she was the head medical doctor that was in charge of this group of medical doctors in this clinic in Ohio, and they had driven a bunch of hours to come to the conference. And so I'm like, "Okay, well, what's going on here?" Well, this woman, she said, whatever her name was, Jane. "Jane took this, Jane took your mentorship, and every single patient that comes out of Dean's office orders all the lab tests that Jane wants them to do, and none of our other associates can do that." And I said, laughing, and Jane was at the conference too. So I went over and I was talking to her. I was like, "Your boss just told me that." She started laughing. She's like, "Yeah, well, you know." And I was like, "What do you do?" Because I thought that there is something I didn't know. She's like, "Oh, I just do what you taught us in the class. It just works every time."

So anybody can learn how to do this. Anybody can learn how to do this. And once you've got this mastered, and you've got the ability to get patients to do labs, all you have to do is learn how to interpret them and design the supplement programs and segue over to lifestyle changes, and you're going to be off and running. Okay, now, what are patients going to say? They're going to say, "The labs are too expensive." That's because they don't see the value of the test. Then the patients are going to say, "Well, don't you just give me something without a lab?" So I made a policy. I just made up my own policy a long time ago, maybe 25 years ago or so, after five or six years in practice, that I would only prescribe supplements based on lab results, and I've stuck to that by and large all this time.

So if patients come in and say, "You know, I have Parkinson's disease, and what supplements should I take to help make the medication more tolerable?" I'd be like, "I don't know. Go online and read about it. You know what I do is I design supplement programs based on lab tests. We look at abnormal physiology, the abnormal markers for neuroendocrine, GI, and detox systems, and then we just replace what's missing. And we don't, I don't have a treatment for Parkinson's at all. I just treat what we see on the labs." And so that's been a commitment I've made for a long time. And, um, if you just want to prescribe things, I'm not against doing that. I just don't do that myself. But I find that the lab-based programs, first of all, it's really fun to interpret labs. You get really specific. You can know exactly what you're doing. You know when to stop, not only how much the dose should be, but when the program should end. You could re-test people. It just opens up this whole other world of accuracy and intensity that you're not going to get otherwise.

Okay, now when patients are pushing back and they don't want to pay for the labs, it means that they're making an emotional decision. So all purchasing decisions that we make, and believe it or not, there's people that study this, social psychologists that study sales and money and consumerism and capitalism. And, um, people buy based on emotion, and then they rationalize later with their logic and with their intellect. And so it could be that you're purchasing a new car, I don't know, you could be buying a new pair of socks. It really doesn't matter. People in general are going to be buying things because of a feeling that they have that they need it, and then later they're going to make sense of that feeling in their own mind.

So if you focus too much on the logic of the labs, you kind of lose people. You know, and if it was, we all operated logically, everyone would probably do these tests all the time because it makes sense. Like, you extend your lifespan and be healthier. When you want to spend a couple grand a year on that, of course you would. So the way that you become a lab whisperer like that woman in Ohio is by learning how to connect with people and their feelings and by establishing the value of the lab. Now, I already mentioned the labs is a motivational tool. They're also an analytical tool. That's what Dr. Timmins would have described him. And then the other thing about lab testing is that our culture just understands tests. We've, we all know that cholesterol is bad for you. If you have high cholesterol, it's dangerous. And everybody knows that, you know, high blood pressure. And you don't, you can't look at somebody, you see if they have high blood pressure. There's a test for it. So our entire culture at this point, modern medicine has evolved around the idea of science and testing.

This is an image from a Celtic or you may say Celtic healing water wheel or something like that. But I mean, if you were, I like the Viking shows on TV. I know if you've seen Vikings. But the first series was really, really good. The second one wasn't so good. But anyways, the Vikings, you know, a thousand years ago, 1200 years ago, they had a bunch of healers running around. A lot of healers. They were very kind of healing-oriented culture. They probably wouldn't have cared about lab tests at all. They were doing other kinds of things to heal themselves back then. But our culture at this point in time is very science-oriented. And so if you can capture that sort of energy and thought process that our culture has sort of instilled in people, it's, it makes for an easy segue into what was a healing program.

A couple other things. We're just going to wrap up in a minute, then we'll get to some questions. To guide the process, just make sure you get the patient's perspective first as you're talking with them. Use some complex terms, but try to keep it to the, in general, to terms that they understand when you're explaining what the labs are for. And don't assume what they're interested in is what you're interested in, or they're interested in what you're interested in. You know, figure out what they're interested in, and then communicate that.

And so when I think about that, let's say they say, a typical patient comes in and they have, let's say, fatigue and joint pain and they can't sleep. Then I would explain, "I want to do this adrenal, GI, and detox testing on you. We, I believe that there's a, you know, I look at this in terms of systems. There's three body systems that we want to analyze: neuroendocrine, GI, and detox. And that there's a basic model that we see with most patients is that when they're stressed for long periods of time due to things like divorce or a death in the family or overwork or lack of sleep, that that stress hits their neuroendocrine system pretty hard. It throws their adrenal hormones into a bit of a panic. And as the adrenals start to fall apart, that causes leaky gut and a weakening of the immune response in the gut. And eventually, if the gut is damaged for long enough, toxins build up in the system because you can't eliminate them very well. Plus, the gut generates its own toxins. And so they can be detox system pathway problems. So I think we should do these tests: adrenals, GI, and organic acids, so we can look at these different body systems and start to put together what would be a good healthy program for you." Some explanation like that is really what we're shooting for.

Now, I just want to add in the last minute here or so on these different models because I'm really fascinated by talking to practitioners all over the country. And so we have a niche practice, a niche practice. And that could be Hashimoto's. Or we have, um, Kim Canarian. I love Kim. She's, uh, did the mentorship program and then she decided to just focus on diabetes and she cures diabetes with vegan diets. And more power to her for doing that. I was really impressed with that as a subject area. She's an expert at pre-pregnancy, new moms, athletes, professional athletes, or weekend warrior type people, executive health, men's health, brain health. There's so many different ways that I've seen super successful practices have a specific subject area that is one, one way to go.

You can also have, and this is, I think, what's growing now faster than anything else that I've seen out there, is the whole longevity wellness clinic. Because of the demographics, right? People are getting old. People that are getting old, like my demographic, I'm 58 years old now. People in their 50s and 60s are starting to realize, "Wow, my friend Sean just died of a heart attack and he's the same age as I was." And then, you know, has cancer. But, you know, people are starting to get, "Oh, this is not good." And they're thinking, not only as you're getting a little bit older, the baby boomer-ish generation, 50s, 60s, maybe age, but they're thinking, "You know, how could I extend my lifespan? How could I stay healthy? I don't want to end up, you know, crippled and old and not being able to function." So preventive and health maintenance programs, longevity clinics, wellness clinics. You include some genetic testing in there. We didn't really talk about that tonight, but you included some. They love the genetic testing stuff. So you could have a large group of patients coming to see you who are super healthy and just want to stay that way. Just throwing it out there. I see so many successful, profitable clinics running along that model. It's a beautiful model. It's a happy model.

And then we have the chronic complex illness model. And this is the hardest one. These are the Lyme and mold and cognitive decline patients, the chronic fatigue people, mental health problems, autoimmune problems, fibromyalgia, and that list goes on and on. Not so, that's the hardest model to work. Don't start with these people right away. If you want a chronic illness clinic, you could absolutely build one. If you want a clinic around longevity, you could do that too. If you want to pick an individual specific topic, you can do that too. And guess what? The reason why I'm showing these slides in this sock is because you can use adrenal, GI, and organic acids testing with any of these subjects, whether you're doing diabetes or men's health, whether you're doing female hormones or longevity, or whether you're doing a chronic illness clinic. The same basic construct, the same basic model is going to be put into place. Right?

So for those of you that joined us a little late, we have coming up this month a lab interpretation boot camp, a one-month class on interpreting adrenal labs and the QMAP. A Hue Map is like a Dutch test. It's a urinary adrenal hormone test and female hormone test. So that's starting this month. And then also, you will get an email in the next day or so. If you haven't started to use Rupa yet, highly encourage you guys to try it out. Order your first lab, get $100 off, and order an adrenal test for yourself. Make that work, you know. And then we'll have also a mentorship class for those of you that are ready to get serious and really build a practice. You want to make a one-year commitment to making that happen. We'll have a mentorship class starting later this month as well.

All right, so let me take a look at questions and see what I got. All right, let me go back up here. Uh, if a patient asks, "What labs do you use before becoming a patient?" Um, no one's ever, no one really asks us that. So we, because each patient, if we're doing the same labs, but each patient, we do them for different reasons. So I would just tell the patient that, you know, we're going to talk to them and see what would make the most sense, you know. Um, so we, I don't charge or upcharge for lab testing fees, but I have a lab interpretation fee that we charge for my time for interpreting the lab. Uh, let's see. Let me just see if we get through these. I'm not going to be able to handle them all because we're a little short on time. But, um, Stacy mentioned that shift workers and first responders would be good for. Yeah, absolutely.

The mentorship, if you guys are interested in it, is, uh, well, let's look at it. Hang on a second. I'll show you. I have it right here. Somebody's asking to see. Who's that? That's Leah's asking. So here, if you go to the Cash Institute website and you click on classes, and you can see we have this boot camp coming up. This one's actually already happened. Um, adrenal hormones is coming up now. You can subscribe to our newsletter, and then you scroll at the bottom of the page, you see the mentorship class. So this is starting towards the end of April, and it's $1,200 a month for 12 months. And the class is a year long. And I estimate for a successful functional medicine mentorship student, you should have the entire course fees paid for by the time you do four or five new patient workups. Okay, so the class should pay for itself. If you have a practice running, it shouldn't be, you know, burdensome investment because if you're testing people and starting to put them on programs, you should be able to make this money back within maybe three to five patients. Okay.

Uh, and Canadian. Yeah, so Canadians can do the exact same thing. We have tons of Canadians that have taken the courses that I teach. There's some special tweaks to the supplements, and but I know all the supplement distributors in Canada. So if you're a Canadian practitioner, um, you can sign up and we'll get you straightened away. You can also sign up for a phone call, either with myself or one of my staff. You can talk about the classes in that regard too, if you have specific questions. Okay. All right. And we don't offer any CEUs. This is like an anti-CEU class because we're teaching specific brand, specific products, specific dosages. So I would never qualify for CEU, um, because the doc, and that's what the doctors want, right? They want to know exactly what company and what dose of everything. So we don't have any CEUs available.

All right, I'm going to wrap it up for now. Thank you everyone for attending, and we'll have another one of these coming up soon. Check your inbox, uh, for email. You'll see an announcement on the next one of the classes. Bye for now.