Mentorship Miniseries - Stress and the Brain: Insomnia and Poor Sleep

Hello everybody. This is Dr. Dan Kish, and welcome to our class. This is our winter mentorship miniseries, and we're going to talk about stress and catecholamines and the adrenals and insomnia and sleep problems, and how all this stuff can be tested and corrected.

And so, I will introduce myself. I'll talk a little bit about what's coming up at K Institute, and then we're going to jump right into a few slides, not too many, and then we're going to look at a series of lab tests. And together, we're going to design a program so you can see how all this works.

And then there are, there are quizzes involved in this class. Here's a quiz, and it's a pass/fail kind of situation. So you should be very stressed right now, just that I said the for pop quiz. Remember when you walked to the classroom, the teacher would say, "Pop quiz!" You'd be like, "Ah, what am I gonna do?"

So, but I do actually seriously want you guys to type things in. And first of all, I just want to see where we're at, audience-wise, and who you are, and what's happening. I want you to type in what you think is the number one best supplement, non-prescription product, that you could use for adrenal stress, number one. And you can think about it, you don't have to do it right away.

And I want you to type in what you think is the number one most important product that you should learn how to use, or that you use, for catecholamine correction. So if all of you guys get both the answers right, then I'm going to have a whole different talk here tonight. And if none of you get it right, then I'll be like, "Oh, okay. We should talk about the most important product for an adrenal program and the most important product for a catecholamine balancing program." So that's what I'll focus on. And if you just walk away tonight knowing those two items and start to mess around with how to use them properly, then you'll be well on your way to a super successful career.

And this always happens, happens all the mentorship students always get it right. I'm looking at people typing things and like, "Oh, wait a minute. That's kind of cheating because you're in my mentorship program." So, hey, what that says about mentorship students is that if you were in the mentorship class, you'd have nailed both those questions within two and a half milliseconds because you've learned all that in the mentorship. So I'll talk a little bit about that as we get into this.

So for those of you that are brand new, the first time you've done with these, I am Dan Kesh. I've been in functional medicine for 31 years. I've trained thousands of practitioners, and my goal right now is to create a wave of super successful practices throughout the world for, uh, solving these chronic health problems that we seem to be facing as a planet right now. I've worked with, uh, Mayo Clinic practitioners. In fact, five or six of them took my mentorship class years ago, and we did a research study together. I've worked with some of the original founders of the field in terms of the lab testing.

And tonight, we're going to talk a lot about Dr. Richard Lord's work, who I've spent the last 12 years working with very, very closely. And, um, I've had the great privilege of being around these amazing scientists and have just been a sponge. I'm still a sponge. I've been in practice for 20, we, 20 years almost when I met Dr. Lord, and I thought I knew a little bit about lab interpretation, but not, not even a little bit, you know. So the last dozen years with him has been some of the really most prolific of my life in terms of just understanding the work that we're doing.

Um, I'm in practice. I actually had two patients yesterday. So I still do this work with patients. Um, and I'm very interested right now in business models and business structures and getting you guys to be successful in your practice, both incorporating patient communication skills, program design skills, patient management, practice management, all that part, along with really, really, really top-level lab interpretation skills.

And so when I was very first introduced to functional medicine, like literally the first day that I learned what functional medicine was, I spent like five or six hours talking one-on-one with, uh, Dr. Bill Timmons. And some of you may be old enough to know Timmons, but he was one of the best lab guys in the industry back in the '90s, '80s and '90s. And, you know, he and I then subsequently spent maybe seven, eight years together, just really getting me trained in how to understand catecholamines and the stress response and just thousands and thousands of lab tests and them and talking about my cases. And I really am trying to mimic that experience that I had one-on-one with Timmons, and now one-on-one with Dr. Richard Lord, so that you guys can get this information because it's, um, not easily accessible, this kind of clinical information. You know, it's sort of hidden in people's brains and it's not necessarily on the internet everywhere.

So this is the stuff that we have coming up. Our mentorship class is starting at the end of this month. If you are serious about your career and you really want a functional medicine practice that's just like lab-based and awesome and super successful, and you want to be like the best at lab interpretation in the industry, then take this class. In a year, you'll be like in the top 1% of people who really understand how to interpret labs because it's a, it's a serious class. You know, you have to put a lot of effort into it.

Um, if you scan that code, you get $799 off the mentorship. Um, it's a year-long program, and we just spend hour after hour after hour interpreting labs. There's a huge curriculum about all the lab markers, and I try to present really a comprehensive business model and clinical model all at the same time. It's a great community of practitioners. I love it. I mean, I, I love the class, I love the people. Uh, it's just a really great experience, and it's really great for me to see at the end of the year these practitioners just getting it and knowing how to understand organic acids and adrenal labs and GI and how to integrate these programs together in complex cases. And just one hour of the mentorship class, you learn so much. It's just incredible, um, what happens to people. It really changes their whole perspective on the industry and the field.

We also have, for those of you that aren't ready for a year-long commitment, these protocol design boot camps and workshop intensives. So the protocol design boot camps are kind of what they sound like. They're short protocol programs, just learning how to design protocol protocols. The workshop intensives are massive curriculum, really getting into the weeds on pathways and all the stuff you need to know about fatty acids and amino acids and all these different topics. So the protocol design boot camps are lighter weight. The workshop intensives, they're intense, intens, intensivist, they're very intense.

We have these certifications we're doing this year now too. So you can be a level one or level two or a mentorship certified person. And we have it all organized on the website. You can go check it out. There's a series of level one courses you can do, series of level two courses you can do that are harder, and then you can do mentorship. And there, you can, it's choose your own adventure here. You can jump right into the mentorship as your first class with us. You can jump right into level two if you're ready for that stuff, and you can jump into level one. So you can start anywhere that you want, whatever you feel is the most appropriate, depending on how much energy you want to put into this and how good you want to be, you know, um, and what your financial situation is like.

And then one of the partners that we work with the most closely is Rupa Health. They're probably one of the biggest factors in my practice cutting overhead in the last few years. So super big supporter of Rupa. If you don't know about them, go check out Rupa. Order a test. If you scan that little QR code, you get $100 off. But they basically are a lab distribution company. They take care of all the admin stuff that has to do with ordering labs, and they have 30 different lab companies. So all the testing that you want is in one place, super streamlined and easy. And huge, huge fan of Rupa. It's a really good organization that they, they've done a lot to help our industry quite a lot. Okay. All right.

So now let's get down to content. And we want to think about these, you know, how much does stress really impact the body? And then what are obvious ways that stress impacts the body that we can test for and correct for? So two of the big ways that stress impacts the human body is that it screws up your catecholamines, that would be epinephrine, norepinephrine, and dopamine. People usually don't think of dopamine as a catecholamine, but I think technically it's in there, right? And then what happens with your hormonal response in terms of cortisol and DHEA. And then once the stress gets going for long enough, we start to have sleep problems. And anybody who has a sleep problem is eventually going to have a physical problem that starts to show up, whether they gain weight or or they have food cravings, or they're just tired all the time, or, you know, all the obvious things that would happen if you're not sleeping well. And then the not-so-obvious things like gut problems and immune issues and all the other things that happen when people aren't sleeping well.

And so, and I, I know Timmons used to always say this, and I, I say this to myself, you know, every week in practice. As soon as I get a new patient sleeping well throughout the night, I know I might guess, I relax. I'm like, "Okay, this case is like half over." You know, because it's sleep that triggers all the restorative functions of the body, the rest and repair. That's when it's happening. That's when healing is happening. And so this is not an abstraction. Testing and correcting the HPA axis and correcting for catecholamines, it's part of that is getting the person into a deep sleep cycle. And so, and that's really, if you're not doing that, or the patient's not able to get there, then they're just going to always be battling this huge uphill battle of of their immune system just crashing because they're not getting enough rest. And so being able to design these programs is important. And when people start to sleep really well, you know, half your job is probably done. You've really pushed them into this healing response.

And one of the most important things you can do for sleep is free and easy, and you should tell every patient about this, which is that make sure that the person gets up and outside as soon as the sun is coming up. And you can't just sit in front of a window or do this when you're in your car. You have to physically be outside and exposed to light. The closer to when the sun is coming up, the better. When the sun is coming up, there's this combination of orange and blue light, which if you're a DS person, as I am, is kind of yin and yang, which is kind of cool. But anyways, so at dawn, when the sun is coming up, there's this combination of orange and blue light, and that tells our brain, "Oh, I'm supposed to wake up now." And this whole huge hormonal cascade and all these different body functions, our circadian rhythm is initiated by that.

So as soon as a person can get up in the morning and get physically outside at least for five or 10 minutes, more time is better. If it's cloudy, it still works, doesn't matter. And, um, if they can be outside when the sun is coming up, that's ideal. If that's not realistic, okay, maybe at 7 or 7:30 in the morning, they're outside. But at least they're getting outside first thing in the morning for 5, 10 minutes minimum. That's going to be required to reset all the things that we're talking about. And simple, easy intervention. We had a student last year, this guy in, in one of the mentorship classes I'm teaching, and he completely solved like this complex insomnia case just by doing what I just said. And he was presenting it in class, and he was like, "You know, I always knew this was important, but I cannot believe that all I did was tell her to go outside in the morning and her whole problem solved." So anyways, if you're not doing that, make sure that you do it because it's super important. And we always want to include lifestyle changes along with supplement programs. So we're not just throwing supplements at people when maybe part of the problem is they just need to get outside in the morning.

In terms of conditions, you know, we're thinking about stress affects the GI, fatigue, insomnia, weight gain, anxiety, depression. I mean, if you're stressed enough, you're going to get depressed. If you're really stressed enough for long enough, you're going to end up in pain and inflamed, and your immune system's going to crash, and all kinds of bad things are going to happen. So this is a wonderful book. If you haven't, you everybody should have this book. If you don't have this book, maybe not right now, but in like an hour, go online and pick up a. It's Tom Gilliam's, "The Role of Stress in the HPA Axis." And it's a short book. I don't know, it's something you could read in a weekend easily. Um, it's more of a pamphlet almost. It's not like a big fat book, but it's got really great details and some great images. And this is an image from that book. I highly recommend it. It's like required reading in, in most of the classes that I teach.

And so this is again from Tom Gilliam's book, and it shows really nicely here how we've got the catecholamines on one side, okay, okay, produced in the adrenal medulla, and the, uh, cortisol and DHEA over here, glucocorticosteroids over here, produced in the cortex, hence the name cortisol, produced in the cortex. So the adrenal glands are complicated. There's a lot going on here. You're making hormones like cortisol and DHEA, and you're making catecholamines. Cortex versus medulla, obviously. You also are making the catecholamines in the brain. So usually when we talk about these kinds of programs, we sort of gloss over the fact that catecholamines are also made in the adrenal glands. So they're not obviously neurotransmitters because they're being made in the adrenal glands and not, you know, in the brain. So they're kind of neuroendocrine stuff. Um, but for the most part, in this lecture, we're going to refer to catecholamines as if they're only made in the brain because we're going to look at that, that's kind of how the labs represent them, the lab reports. But just so you know, in the background, when we're stressed, the adrenal cortex and medulla both respond with cortisol, DHEA, catecholamines, and of course, there's also the brain issue with catecholamines being produced in the brain itself. Right.

And what we want to do now, at the end of today, is have an idea of a, a sort of key product that you use for the adrenal side of this, uh, cortex side, and a key product that you use for the adrenal medulla side of this. And then how does this even come about? Emotional and spiritual disconnection seems to be rampant. Diet problems, especially blood sugar related stuff. And then inflammation. And inflammation is a code word for gut problems that cause inflammation and environmental toxins that cause inflammation. So emotional, diet, and inflammatory stresses are going to accumulate and cause problems with this whole system. Cortisol is the key hormone. I'm going to kind of skip through these slides because we're kind of assuming you're pretty familiar with this, so we have time for the labs. Okay. And you can type in questions too. I'll have time for questions at the very end. Um, and I wanted to think, I put in some slides, not so much on cog, you read about that anywhere, but on you guys, you know, like where are you at? I talk to so many doctors every week and like, where are you at in this process? Who, who are you? What do you want to do with your life? What do you be want to be when you grow up? You know, do you want to be a functional medicine doctor? Are you already? What, what's what's holding you back from to taking that next step?

And then when you're ready, like who are you going to do these programs with? Be really careful. Your first 50 patients, be super selective about who you do these protocols with. Your first 20 to 50 people, don't just choose anybody. Be really careful. Don't, don't do super complicated cases in the very beginning. It just, that just destroys people. It's just not a good idea. And then you really have to understand these supplements inside and out, upside down. You have to study clinical nutrition, I think, for at least five or six years, you know, aggressively, before you're going to get it. When I was, when I was first learning this stuff, let's say 1992 to '97, almost every weekend, almost every weekend, I was at a clinical nutrition conference. It was kind of obsessive, but it was just like, there was so much that I needed to learn. And then, I mean, I did that for a lot of years to really start to learn how these supplement supplements work, why they work. And that wasn't even for lab interpretation, that was just for basic, the basics of clinical nutrition. So there's a lot of study there for all of us.

And then we want to get you to the point where you're thinking about lab-based protocols, and then how to sequence them, and how to integrate them into a model. And so I think the skills to develop, then, lab interpretation skills, lifestyle coaching skills, how to motivate patients, basically, to do stuff, you know, um, because if you just get them to do a microbiome program, but they're still eating gluten every day, obviously it's not going to work, right? So you have to get this combination of interpreting the lab and motivating them to get all the supplement programs, and then also motivating them to make their lifestyle changes. And then really, I think the hard part for me, at least in the first few years, was how you're going to present all this data? How you're going to sit down for, you know, half an hour or an hour and talk to a patient about this? What are you gonna say? I can remember thinking like, walking into the room with this adrenal lab in my hand, you know, this, and you got to imagine me, I had a full head of hair. I used to always wear, um, a white shirt and high, and khaki pants. I kind of looked like a very nice young man. And just walking in this room with an adrenal lab, saying, "Crap, what am I going to say? I don't even know what to do." And just thinking, "What did Dr. Timmons tell me? What did Dr. Timmons tell me?" And trying to remember what Timmons had told me, like the day before, and basically trying to repeat that. You know, it's scary.

And then separately, again, if you're on this trajectory of doing functional medicine, you need to learn all the hormone stuff inside and out. The sex hormones, thyroid hormones, insulin, all that stuff. You need to learn all the GI part, the toxicology part, chemicals and heavy metals. And then you got to get into the patient management thing, the side effects, contraindications, problem solving, all that stuff. And then eventually, when you get a little more advanced, metabolomics, genomics, proteomics, lipids, vitamins, minerals. So we have all this in different courses throughout the KOS Institute. And this is kind of in my mind, a sheet here, a list here, of all the things that you really need to do, you know, over time.

And when I was first starting out, my first semester in school, Glenn Fredericks, who is my clinical nutrition teacher for many years, gave me a list. He just gave me a list. He said, "Look, H, you got to do these 10 things." And I was like, "Really?" He's like, "Yeah." I was like, "That's gonna take me years." He's like, He didn't even say anything. He's just looked at me like, "Of course it is, idiot. You know, just get to work." So this is my list. Thank you, Glenn, for giving me my my list years ago. This is my list for you guys. Take a picture of that. That's all the stuff you need to learn. Okay. Um, and then have, as you're learning this, have a clear model, a clinical model that you believe in, that patients can understand. And then you're set. You'll have that model for the rest of your career. And the model has to explain the reasons why you even want them to do this adrenal lab and this catecholamine test in the first place. So you have to be able to explain what the tests are for and why they're going to help that person. Okay. And that comes from watching cases. And that's why I always do cases in these classes so you can see a few. And if you're in the mentorship class, which we're in this month, then you get, I, I calculated at least four or 500 cases in the year, not your own, but you're listening to other people's all week long. And when you listen to 10 or 15 or 20 cases a week, month after month, it just sinks in in a different way, and you'll get it. And then when you're talking to a new patient, even if you don't know anything about, you know, whatever their condition is, you'll have heard it in class before, and you'll have a confidence in your voice and your tone and your communication ability. Say, "Oh, yeah, I mean, this is what you're thinking. You're thinking like, I really don't, you know, this is my first Hashimoto's patient or something. I have no idea if I can help Hashimoto's." This is your inner dialogue. But, you know, Judy in class last night, she had a Hashimoto's patient. She's a brand new mentorship student. She fixed them. I think I could do it. And so then you're thinking, "Well, yeah, so you have Hashimoto's? Well, I think you should do this test and this test and this test." You know, getting you over the hump so you have that ability to have that confidence to really make this work. Okay. So that's my coaching for the moment. I hope that hits some of you in a resonant kind of way.

So now let's look at what an adrenal program includes. Supplements, depending on what stage they're in. And we'll look at a couple labs in a minute. Lifestyle changes. And you have to choose something. Right? Diet, exercise, sleep, or some kind of spiritual work, meditation type thing to get them going with the lifestyle. And an adrenal program is, by definition, a problem with the stress response. And so you have to intervene and break up whatever's been going on in that person's life for decades, you know. And so the lifestyle has to be a big component to it, or obviously the programs aren't going to work. If you combine, you know, one or two simple lifestyle changes with the supplement protocols that I teach, people just get better fast. If you just use the supplements alone, some people will get better really fast, I mean, they will, but, you know, that's not really the point of what we're trying to do here. So if you can learn how to interpret the lab and then to design a program, and the program itself is going to be predicated on the person making the lifestyle change, they're linked together. Okay.

So if you see that they have super high catecholamine levels, you let them know, "We want to stop your excessive catecholamine production. I want you doing five minutes of breathing exercises once a day, and I'm going to give you this entire amazing program of supplements to make this happen quickly." You know, and you have this integration of these two things together. And the supplements should give you leverage to get the person to make the lifestyle change, you know, um, because the supplements are expensive, and you, people don't want to buy these things forever. So these are the things we're talking about: DHEA, cortisol, and then the catecholamines. Mentioned that already. Emotional stress is a big one. And when we review cases in, in the different, uh, you know, courses I teach, and students are submitting cases, it's, there's almost always a huge stress that's involved in that person's life as their health has started to fall apart, you know, that's almost always the case.

Now, inflammation is not an obvious one, but if your gut is inflamed, cortisol is, you know, one of its roles is cortisol. Cortisone is an anti-inflammatory. And so you're going to have some pretty big ramifications on your adrenals if you have a gut inflammation problem. If you have a toxin-related problem that's inflammatory, creating a lot of inflammatory stuff, oxidative stress, all that, the same thing, kind of thing is going to happen. So hidden sources of inflammation, that's why we do the GI and organic acids testing to find out the detox pathways, to find out all the stuff going on with a gut. And that is part of the later part of an adrenal program, but you can test and correct the adrenals as you're figuring that other stuff out. It doesn't have to happen all at the same time.

When I first graduated and started to see patients, the thing that surprised me the most in my first year was how much of a difference diet made. You know, I was like, I knew it was important, but I didn't realize that people, how poorly people were eating, I guess I was kind of unaware of that. And how much change you can get in adrenal problems and stress-related problems simply by regulating people's blood sugar. This is like a game changer for a lot of patients. So you don't want to forget about it.

And then DHEA is one of the main products that we use. And it's, if the DHEA levels are low, you can very effectively use DHEA for a whole variety of reasons, for immune function and memory issues, fatigue. It helps a lot with the sex hormones like testosterone and estrogen. It's an amazing, amazing product. And then this is my blank slide now. I'm going to look and see because this is where I, I had a slide and I took it out just to mess with you guys a little bit because the slide was like, "The most important adrenal product." And, yeah, some, a couple of you got it out right, but it was, you know, people that have studied this stuff before.

So what's missing here? I think what's the most important, sort of unrecognized, underappreciated, not really understood product is is pregnenolone. People often mispronounce it, pregnenolone, like it rhymes with canalone, but no, it's not a kind of pasta. Pregnenolone. It's a steroid hormone, and it's my, like, secret weapon. It's been hands down the most effective adrenal support product I've ever seen. Dr. Timmons taught me how to use it back in the '90s. Everyone in his circle, hundreds of doctors that we used to hang out with and associate with, we were all using pregnenolone, you know. And it just sort of fell out of favor and people forgot about it, but it's an amazingly effective product. So the combination of DHEA and pregnenolone is kind of the core part of these, uh, programs that we do for the adrenals. And we'll do some protocol design in a minute, you can see how that works.

On the catecholamine side, remember there's this one super special product, and some of you did get that right, and it's, um, it's a plant-based product called Mucuna. And U C N A, Muna, or Muna Panna. So it's a plant-based form or herbal form of L-DOPA, and that corrects the catecholamines like nothing else. But you need to learn how to use Mucuna. It's got to be used in a base or a context of tyrosine in order for it to work. If you use Mucuna by itself, you're going to have some big problems. So don't do that. It's got to be used with a base of tyrosine. And pregnenolone also, you need to learn how to use that properly, and it needs to be combined with every time a certain amount of DHEA, depending on the labs. So these are the, these are the pairings you need to learn how to master: DHEA and pregnenolone paired together, depending on the stage of the adrenals, and tyrosine and Mucuna paired together to correct the catecholamines. If you figure those two things out in the next year or two, you'll just be helping so many people, you won't believe it.

Okay. And when the catecholamines are burned out, it is not good. People have mental exhaustion. They can't stop their thoughts. They just have obsessive thoughts. They have anxiety. They just feel bad about themselves and the world, and they feel bad about other people. Just a, not a great place to be. Um, when you're, when you're exhausted with your dopamine, epinephrine, and or norepinephrine, it really, really, really messes with people, and it's a sad thing to see. And it's a very straightforward thing to correct. I'm not saying easy, but it's straightforward. And you can get really good at this. You can help most of these people have this kind of problem.

Oh, this is just like a nice little picture of, of, uh, the stress response, you know, and to remember that this is all related to the brain. It's also related to the gut, you know, and that as we become more and more stressed, you know, the gut takes a hit as well. And then I have this thing. Let me just show you this here. This is, um, you know, I have, I have to modify this a little bit. I had all these things pulled up, and then that my computer crashed right before I started this class. So I'm just going to show you this other way of this. But this was just a reminder. This is an article I was looking at. It just reminded me of one of the really great tips. Is the critical care, uh, literature has a lot of really helpful stuff for us. But I want to show you something else here.

So these 12 images are ones that I use, and it's kind of a core part of my teaching. But a couple of them are relevant for tonight. So this one here. So we're about to look at labs in a minute. And so when you're looking at the lab, this is what you want to be thinking about. If you have a camera on your phone, take a snapshot of this. That was a joke because everybody has a camera on their phone, right? Um, but if I had said, "You know, if you have, if you have a camera on your phone," like 15 or 20 years ago, you all would have been like, "Camera on my phone? Like, nobody has a camera on their phone? That's crazy. What is he talking about?" So here we have, you got to memorize this pathway: tyrosine. Where does it come from? Phenylalanine. You got to remember that tyrosine, where does it come from? Phenylalanine. Phenylalanine converts into tyrosine. Of course, you get tyrosine from your food as well, but it's very important that you have phenylalanine to get adequate tyrosine. And then the tyrosine converts into dopa, or L-DOPA, sometimes it's called dopamine, and then down to norepinephrine and epinephrine. So if there's a problem, you know, past here, it's going to affect potentially any of these. Okay.

So the solutions for dopamine, epinephrine, norepinephrine are identical by and large. There's some variation on that that's a little bit not true, but that the, the primary, let's say this, the primary solutions for correcting dopamine, norepinephrine, and epinephrine are are very, pretty very similar. And what you're going to do is you're going to be worried about phenylalanine in the background. Then you're going to use tyrosine and Mucuna. Mucuna is a plant-based form of L-DOPA in combination to correct all this. And then again, you got to remember on the lab side, you're going to be seeing homovanillate, also known as homovanillic acid, and vanillylmandelate, also known as vanillylmandelic acid, are going to be high or low, and that's going to tell you that there's a problem with catecholamines. So these are the markers on the lab. These are the solutions that we use, the Mucuna and the tyrosine. And these are the pathways. I really love this. This is a great diagram. This is from Richard Lord's book.

And then the other pathway. Oh, let's not even, should we even think about this? No, let's not think about that. It's too complicated. Let's just go right to a lab and get this party started here. H, sorry, hang on a second. Um, yeah, I'm so, I apologize. I'm going to need about 30 seconds here. I had everything pulled up, and then my computer crashed, and this is what I get. I, I, I, I logged on an hour early, and I got the whole thing set up, and then Microsoft decided that they were going to update my computer without my consent, and it kind of threw me off a little bit. Okay. So here we go. You ready? And, um, I will answer questions at the end, but let's, let's do some labs first. Okay. Um, well, no, let me, let me do one or two questions. Let me see. Questions are directly related. Let's see, because there's one here. Annette asked a really good question here. How does high insulin impact cortisol? I understand cortisol increases when blood sugar is low, but how does high insulin change cortisol?

So think of it this way. This is one of the central things to consider is that you've got cortisol, insulin, and oxidative stress and inflammation all kind of in a line because they're all kind of the same. So if your cortisol goes up, you're not going to be handling inflammation so well. If your insulin is too high, you're going to get a lot of oxidative stress, which creates a lot of inflammation. So inflammation, oxidative stress, problems with insulin, and problems with cortisol are a package deal. They all go together. And that's why if you can start to regulate the patient's blood sugar, you're going to improve their insulin response, improve their cortisol response, reduce their oxidative stress, and reduce their inflammation all at the same time. Okay. Okay. That's one of the most important treatments that you can do.

So here's a typical lab. This was just presented in class recently, and we, this is, you know, for those of you that are brand new to this, this is from Genova. It's called an adrenal stress profile. In a minute, we're going to look at a different test called a DUTCH test. It's another kind of adrenal test. Okay. So we're going to look at two different styles of adrenal testing, and we're looking at cortisol and DHEA. And you can see from here, it's pretty clear that cortisol levels are high and DHEA levels are low. That's exactly what happens when the stress response is out of control. So when we're at, when we're stressed for long periods of time, cortisol goes up and DHEA goes up with it. So a stressed-out person should have high cortisol and high DHEA. If you've been stressed for so long that your body cannot adapt any longer, the cortisol stays up and the DHEA starts to drop. And that's when people get into more of a crisis state because now their body is not able to adapt to the stress. It's not able to make that extra DHEA that you need. And so there's some level of exhaustion. And people call this adrenal fatigue or adrenal exhaustion or adrenal burnout. Um, some people don't like adrenal fatigue. They think it's kind of a cheesy term. I don't care. Call it what you want. If you want to get technical, you can call it HPA axis dysfunction, hypothalamic pituitary adrenal axis dysfunction. It's really a problem with your brain. If you want to get pedantic about it, it's not a problem with the adrenal glands per se. It's really your brain that's screwed up. The brain's not communicating properly to the adrenal glands. Okay.

So when you see high cortisol and low DHEA, there's a very specific protocol that you can do to correct for that. And let me show you here. So, and I kind of gave this away in the beginning, y. So DHEA is low, so you're gonna use DHEA. Oh, hang on a second. Let me share my screen. DHEA is low, so we want to use DHEA. That screen should pop up again now. Okay. And so here, here's your cortisol. Sorry about that, the screen blocked. Here's your cortisol being high. All right. And here's your DHEA being low. Just a classic problem. If the cortisol is low, it's an even bigger problem. So high cortisol, low DHEA, that's what we're concerned with. That's the beginning of this problem. If cortisol levels are dropping or dropped, it's even worse. So we want to bring the DHEA up and we want to normalize the cortisol. And DHEA levels are all relative to where your cortisol is at. So if your cortisol is super high and your DHEA is super high, that's actually a healthy person that's stressed out of their mind. There's whole cities that are like that. If you've ever been to New York City, I was just in New York recently, like everybody in New York is stressed. That's just like the way they are. You know, they like it. That's, I love it. I love it too. I love New York City. It's like one of my favorite places. But everybody that, it's stressful just to walk across the street in New York because you can get killed by a cab or an Uber. They really don't care about human life. You could easily get killed by a cab if you're not looking in New York. So it's stressful, but that's not, doesn't mean everyone in New York is sick and has adrenal fatigue. If your cortisol is high and your DHEA is high to match it, if those are high together, then you're a healthy, stressed-out person. It's when the DHEA starts to collapse that the problems begin. And that's when the fat starts to accumulate around your abdominal organs in an unsightly way. That's when your sleep starts to get screwed up. That's when your sex drive starts to fall apart. That's when, you know, your hair doesn't look that great or starts to fall out, or you know, you get exhausted, you're inflamed, and you're sore and achy everywhere. All these things start to happen as the DHEA starts to collapse. Maybe you're getting sick all the time because DHEA has a really, you know, big important, uh, role in the regulation of immune function. Memory is not so good. All that starts to happen. Okay. So high cortisol and high DHEA together should be a healthy person that's stressed. But now you see high cortisol here with the low DHEA, you know, the person is starting to fall apart.

So simple program. And if you really want to get into this, you can take some of the, um, bootcampy stuff we have. If you don't want to deal with the mentorship, we have some bootcamps coming up on, um, on adrenals. And in fact, we just released this whole schedule. Let me just show you guys here real quick because if this is like, I really think I should know this and, and, but you're like, "I don't know, this mentorship thing, it's like a year. I don't think I can deal with that." Then look at our classes page here and just see what we have coming up. Yeah, adrenal protocol design, March 14th. You can sign up for that one. It's not super expensive, and it's not super long. That's one of our level one classes. Okay. That will get you into the groove right there. So if you're interested in this stuff, you want to, you know, perfect your adrenal skills, you know, set up for that one.

But here's a basic protocol. What it would look like. You start with DHEA. I, I like to use these liquids. They're 1.2 milligrams per drop. And for someone like this, I'd probably use like four drops, three times a day. It's very important that it's taken three times a day. Remember, here's our pregnenolone, 1.2 milligrams per drop. And this person was kind of, yeah, say maybe somewhere between eight and 10 drops, three times a day. That's the secret magic one there. And then you need to do something that's going to help regulate and control blood sugar. Control blood sugar, uh, blood sugar regulation. That's called it. And people have their favorite versions of that. I use this stuff called Metabolic Extra from Pure Encapsulations. Um, but, you know, every company has some blood sugar regulating product. And then want to use a multi-pack of some kind. Again, I use this one called Energize from Pure Encapsulations, but every company has multi-packs. That's going to have your calcium, magnesium, B vitamins, all that kind of stuff. And then generally, when there's a big adrenal problem, you want to use extra B6. I mean, extra B vitamins. And if they really can't sleep at night and that kind of stuff, you can use extra magnesium at night. I like the glycinate form, but people have different forms of magnesium that they like. Let's say, uh, at bedtime, maybe two or three of those. So something like this would be a good starting protocol for someone. And then you would want to pair this with the lifestyle change, which is either going to be, always start with, if you're wondering what lifestyle change should I start with, just start with a blood sugar control diet. You know, and just find a good book that you like that talks about how to regulate blood sugar with with food, you know, and make sure that they're starting to do that. And then, um, you can think about additional testing like GI testing, organic acids testing, and the like.

Okay. Now let's cut over to our other lab, just so we can kind of compare and contrast here. Uh, sorry, I can't find this. Oh, here it is. All right. So this is Genova lab again, metabolomics. And we're going to scoot down here to the section on the brain, so titled neurotransmitter metabolites. Remember I said homovanillic acid, vanillylmandelic acid? Those are the urinary metabolites of the catecholamines. So let's make this really big so you can't miss it. I mean, the cost of this test is worth it just for these two markers. This is so important. Look, this is a brand, this is just a, I just randomly went into last Tuesday's mentorship advanced group and pulled up labs. That's what I just did. Okay? These are just like, not like I had to search around to find this problem. It was just like, "Oh, I'm going to see what our students put in to class last week." These are fresh labs that just came in. This happens. You see this all the time. Look at this. Homovanillic acid, it's almost double the reference range. The reference range high is a five. It's said this person's at a nine. That's extremely high. And then the vanillylmandelic is pretty darn high too. Quinolinic acid is super high. That's a neuroinflammatory marker. So just from this one part of this one lab, you know, this person's brain is, this person's brain is inflamed, and they have catecholamine problems like crazy town here. Okay.

So when these markers go high, it means you're just burning through these catecholamines. It's just leaving a trail of death and destruction behind you. It's like a Quentin Tarantino movie. Have you ever seen any? I mean, I love Quentin Tarantino. I've kind of been obsessing about him recently, but, uh, Django. Oh my gosh, that scene in Django when Jamie Foxx just like opens up on everybody and just like, he shoots like 150 people in this building. It's a great scene. But anyways, it's like that death and destruction everywhere. You don't want to have these catecholamines high. That's going to just fry your brain. It's going to make you feel crazy about things. You're going to get addictive. You're going to like want food all the time, or want drugs all the time, or want alcohol all the time. Your brain is running. You can have panic attacks. It just doesn't feel good to be in this state. Okay.

So let's look at a protocol for that. I mean, there's many, many things. I'm obviously, I'm making these protocols extremely simple so we can just have them be in this class. Um, and I don't want you to think that this is like the, the end of the road here. This is just an introductory protocol that you could safely get started with. Okay. And you're going to have to spend a year or two really learning how to do this. Tyrosine usually comes in a 500 milligram. So that's, remember, the foundation of one of these programs for catecholamines. And then there's a lot of choice with Mucuna products. So remember.

The ingredient is Muna. You can get either Dopa Plus from Pure or Dopa Boost from Designs for Health. They're very similar products. The dosing is a little different, but let's say on average, maybe you give, let's say, two of those a day, one in the morning and one maybe one in the morning, one at lunch, just to be on the safe side.

And then to make all that work, you have to have like a good multi-pack. Now, the dosages can go up from here. This would be a starting dose just to see how the person's going to respond. But tyrosine to lay down a base, and then, uh, the Muna products, these are Makuna-based products. Muna products, Kuna products. And again, it's going to take you, you know, a year or two to sort through all this, but I just want you to start thinking about Makuna products and pregnenolone and Makuna. Those are the take-home messages for today. Learn how to use pregnenolone, pair it with DHEA. Learn how to use Muna, always pair it with tyrosine.

All right, and let's see. Was this the one? Now, this is metabolomics. Okay, then let's look at one more adrenal one. So here's a Dutch test. Very popular lab company. Mark Newman is the founder of this company called Precision Analytical, but everyone just calls it the Dutch test. Nobody knows the name of the lab, knows the name of the test. So this is done from a dried urine sample. So it's a little different technically, but, you know, very similar. And you can see cortisol is like super high. That's kind of obvious to see. And then here, DHEA is pretty darn low. And they have a nice graph here that shows DHEA by age. So let's say this person's 35 years old, uh, the DHEA should be between 60 and 750. So in general, you want the person in the mid-range or higher for their age group. So let's say this person should be at like 375 on their DHEA based on their age, and this person is at 48. Okay, so if you should have 375 units of something and you have 48 units of it instead, that's a pretty big deficit. It's not going to feel very good, and that can have a really big impact. So again, high cortisol, low DHEA. I mean, I hate to say it, but it's the exact same protocol that we just designed up here. It's not any difference, exact same thing.

And if you're wondering where to get the drops from, buy the drops. The company that makes the drops is called Biomatrix, and you can get them from Fullscript. Bio, that's Dr. Tim's company. He's no longer with us. Well, he's with us in a spiritual sense, but his body is dead. Um, but his company lives on. His son Brian still runs the company, which is wonderful. So that's straight out of Dr. Tim's legacy there that he left us that product or those products. Okay, so that's a really straightforward version of that.

Now I want to show you one more test and have some time for questions because this was, and again, these are just random ones I just picked up. Uh, where'd it go here? Have I think we have time for this one. This is a Neutra-Ohmics again from Genova. Neutra-Ohmics, if you're not familiar with it, it's very similar to the metabolomics. It includes organic acids, fatty acids, amino acids, and whatnot. I just thought this one was kind of interesting because it has, um, the amino acids on it. So I just want to show you this.

Okay, now let's blow this up. Now, um, to put it in, in, in, in reference to something, remember this diagram here? So look at this diagram. If you want the person to have normal brain function, you got to be able to make dopamine, norepinephrine, and epinephrine. I don't know. I used to have a really nice car. I sold it for a lot of complex reasons, but I, I used to have a really nice car and I sold it a month ago, which is sad in a lot of ways. Um, but if I had that really nice car and it, you know, was, it was an old sports car, it was, you know, like a 20-year-old sports car. So I had my 20-year-old sports car and it was, if it was sitting in the garage and it didn't have any gasoline in it, I don't know, it wouldn't be much use to anybody. So if your brain is sitting there and you don't have enough dopamine, epinephrine, and norepinephrine, you can't make them, what's your brain going to do? It's like a car without gasoline. It's not going to work very well. And so you make, you, you, this is dependent on you have to have tyrosine and phenylalanine to make this stuff. I don't know how else to put it. It's like if you're trying to bake a cake and you didn't have any flour. I mean, it's just not going to happen. You have to have phenylalanine and tyrosine. It's not an optional thing. It's not like, oh, you know, well, I'll get by, you know, what I mean? Without it, if you were in a car and it didn't have any gas, you wouldn't think, oh, we'll get by, we'll still be able to get, you know, down to the restaurant. No, not at all.

So look at this person. Their phenylalanine levels are low. It's low phenylalanine. That means you can't make the stuff that you need to make from phenylalanine. It's just not going to happen. You don't have the amino acid there. This is an even more fundamental problem than what I showed on the last test. And look at their tyrosine. The tyrosine is low too. So who cares about how stressed they are? Who cares about all those metabolites? They don't even have the amino acids they need to make this stuff. So that's like such a fundamental problem. I don't even know what to think about it. So you have to give the tyrosine and phenylalanine in this case to make this person better. You know, there's just nothing else that's going to work. I mean, you could give this person antidepressants. They're going to feel better maybe, if you're lucky, but that's not going to fix this underlying problem. As soon as they get off the drugs, the problem's still there, you know?

Um, there's a really wonderful product, um, which you guys should know about, and I'll just pull this up because I use this product all the time. And, um, Dr. Goldblatt developed it, who is a psychiatrist who's just a wonderful human being. I can't say enough good things about him. He's the most loving, kind, helpful, great psychiatrist you could ever meet. So anyways, he designed this, and he's got a 40, 30 or 40-year track record in, you know, nutritional biochemistry for psychiatric patients. You don't, it doesn't get better than this particular doctor. And this product here has phenylalanine and tyrosine all in one pill. How convenient is that? So just give somebody, you know, if they have both of these, this patient that we're looking at right now, just give them two of these three times a day, you know, and they're going to get them better because you've got the tyrosine and the phenylalanine all in one pill. Okay, that's a really great product for this situation. Uh, it's nice to have things that are all together in one, one.

Now, I, and I, I brought this one up because I thought this was a pretty good example that, um, but okay, so remember we talked about these other markers, the metabol, the metabolites? They're normal. See, homovanillic and vanillylmandelic, they're actually normal. Well, this one's a little high, but the serotonin marker on this patient is super high. Like, I don't even know what to say about that. The cutoff, the high cutoff is 12. They're at 78. What is that? Six or seven times the reference range? That would be like someone with a cholesterol of 200, that's a little bit of a problem, but they have a cholesterol of 1,400. That's a really big problem. So when these markers get this high, it implies there may be some genetic issue going on because it would be very hard for serotonin to go that high on its own. So, uh, the serotonin metabolite to go that high on its own. And it's important to recognize these metabolites can go high if the person's on an SSRI. So if you're taking Prozac, Zoloft, or Wellbutrin, or something like that, these metabolites can go, can go high from the effect of the drug. So you have to keep that in mind. If the person's on an antidepressant, it's going to change the values of these tests. Okay. You're also going to see in this particular case, this person was not on an antidepressant. They're just like cranking out this stuff at a crazy rate, and probably there's some genetic problem going on, but we're not sure yet. Could just be that they're really stressed. But the point of this lab is just to show you, hey, if you don't have the, you may not have the catecholamine problem here. So you're like, okay, that doesn't look so bad, but phenylalanine and tyrosine is showing you that there's a problem. It's not showing up here with the metabolites, it's showing up with the amino acids themselves. So we go right back to this diagram and realize that you can look at this from two different ways with the catecholamines. You can look at it, and you will find some cases where the metabolite is high or low, and then you know they have a problem. In other cases, like the one we're looking at right now, you'll see that the precursor, the, the amino acid from which you make these brain chemicals, in this case, this patient had both of them low. Okay. So you may pick it up on either side. Sometimes you'll have both of these things, but either way, you're going to be using support, in this case, phenylalanine and tyrosine, to restore brain health. If you saw these other markers positive, then it would be the protocol that I laid out a second ago.

All right, now I'm going to get to questions. One second here. Just before we do that, reminder, we have a mentorship class starting at the end of the month. If you want to spend hours and hours and hours a week doing what we just did, but reviewing your cases and watching real cases in real time and figuring out, being able to talk to me and talk to the other students, you know, and these things we don't get to talk because we don't have too many people on the phone, but, you know, in my classes, in the mentorship, it's small. It's like 10 or 15 people in the whole group, and we talk every week. Everybody that presents a case is talking. I'm talking to them, they're talking to me, they're talking to each other. Okay, it's very, a lot of communication happening, and you get to just see lab after lab after lab and really learn how to do this. There was a massive curriculum that I put together too, so you get all these lectures as well as the live calls and the group participation. Okay, so that's starting at the end of the month. Sign up if you're interested. Just jump in and do it. You know, you will never regret it. I've never met a student who regretted taking this class, ever.

And then if you're brand new to this and you're not ready for that, that's like way too much information, then check out, uh, Rupa and get yourself ordered a lab. Order a lab on yourself. Just, it'll save you a hundred bucks. You know, order an adrenal lab if you haven't done one yet. Either order a Dutch test or a salivary adrenal test on yourself. And there's like a Kish bundle that they have at Rupa. If you ask them, what are the tests that Dan recommends? They have a little bundle set aside in their software program somewhere. So say, you know, scan your code, get your hundred bucks off. Say, hey, you know, Kish referred me over here. Where's his bundle? I want to, I want to order one of the tests that he suggests that I get started with. Okay. And order any one of those tests on yourself or someone that you know really well, and you can get things going.

All right, so now let's look at questions. And if you guys need to go, I totally understand that. We're right at the hour now, so I'm just going to, you know, take a little extra time to go over questions, but, um, don't feel bad if you have to split. Uh, so the, the low tyrosine and phenylalanine, that's on the Neutra-Ohmics test. It's also on the Omics test from Diagnostic Solutions, and that's plasma amino acids. You got to measure the plasma amino acids for those.

How much does the gut play a role in the elevation? Yeah, so the gut plays a role in all of these things. If your gut is inflamed, your brain's in big trouble. If your gut is inflamed, your adrenals are in big trouble. So a lot of this is going to be corrected through gut treatments.

For a Parkinson's patient struggling to make dopamine and not responding, that's complicated. I don't know, but I've, I've worked with a lot of Parkinson's patients that that would require a pretty thorough workup to figure that one out. Okay.

Um, can you use adrenal? Yeah. Can you use adrenal C and catecholamine supplements together? Absolutely. Absolutely. So the adrenal products are best taken with food in general, except for the herbs, which can be on an empty stomach. The amino acids for brain chemistry can be either with or without food. You can do it either way, it doesn't really matter overall.

And then for adapting these for teenagers? So for teenagers, I would not do the adrenal hormones at all. It's just risky. I don't give a teenager a hormone. But you can do the catecholamine protocols easily with teenagers, but the dosing would be cut in half of the adult dosing.

Uh, let's see. What does it mean if homovanillic is high but vanillylmandelic is low? Well, you're not always going to get them both elevated, right? You could, one or the other might elevate, and there's some complicated things that can happen here. See, so sometimes one is high, sometimes they're both high, sometimes they're both low, sometimes one's low, sometimes not, the other one's not low. But there's one important little side note here because there's a key indicator of a copper deficiency buried in all this information. So copper is required to make this conversion of dopamine to norepinephrine. That's copper dependent. Copper dependent. Okay. And so if you don't have enough copper, there's going to be a block right here. So if you have extremely high homovanillic and vanillylmandelic is like even low, that that is can be, it's an indicator, it's not definitive, but it's a strong indicator that the person has a copper problem, copper deficiency problem. You can give two milligrams of copper a day, and that starts to correct that.

Um, let's see. So DHEA and pregnenolone together? The pregnenolone very much helps support the cortisol side of things, and then the DHEA helps with the DHEA. And think about it this way, when your body is trying to correct itself, it's got cortisol and DHEA working together. So supplementally, we want to use pregnenolone for the cortisol side and DHEA for the DHEA side.

Would you create the program without having these tests done? So I'm a strong advocate of only doing programs based, based on lab testing. And I'll just give you some simple examples, just things that just happened recently in class. Let's see. What if the person, if their main complaint is fatigue, and their adrenals are fine? This just happened in my practice, actually. This is one of my patients. Their adrenals are fine, and their catecholamines are fine, and their main complaint is fatigue, and the only big problem that they have is a massive H. pylori infection. That would be messed up. You give them all this adrenal stuff, it doesn't help. You give them all this brain stuff, it doesn't help. And then six months later, you're like, I don't know, I just screwed this one up. I don't know what's going on. And the whole time it was H. pylori. So you can never tell. In functional medicine, you can't do symptomatically based treatments. You have to have the underlying cause, the root cause figured out, you know, and that's kind of critical.

Adrenotone is a good product. Let's see. I think I got. I'm going to, we're out of time now. I'm sorry, we're over time here, but, um, hopefully I covered some of the questions. I know not all. All right, gang, thank you so much for being here, and I hope to see some of you in our future classes. We have a lot of stuff coming up, so check out the website, and we'll catch up with you later. Bye now.