Mentorship Miniseries - How to Diagnose and Treat an Inflamed Brain

Hello and welcome to our winter mentorship miniseries. I am Dr. Dan Kish, and I'm going to be speaking to you today about brain inflammation and how you can work with patients that are suffering from depression and fatigue and anxiety and sleep disorders, and how you can see all this on labs. So, welcome to the class.

I'll talk a little bit about myself for those of you that are brand new, a little bit about the Kish Institute, and then we're going to jump in and look at a few PowerPoint slides. Not too many, I promise, just to introduce the subject, and then two lab tests. And we're going to dissect the labs. We're going to set up where I, I'm going to dissect the labs, I'm going to set up supplement programs and show you exactly how you can treat these different things. Um, this is something that you do every day in practice. I'm not saying every single patient has an inflamed brain, but if you have a busy practice, you're going to see this every single day in practice. So, it's something you really got to master, understanding how to see it and treat it effectively. And there was a 12-year period of my career where I worked almost exclusively with amino acids and people with inflamed brains, and it was my entire practice for a long time. And, um, it's very, very rewarding. These are complex protocols to learn how to do. I'm going to try to show you just an introductory, kind of get started version of this, but if you really want to get in this, get into this, you should take some of our more advanced classes if you try these basic programs and you find that they're working and you want to learn more. But once you master this, and I'm not saying you can master it in like a 40-minute talk, but once you master this, it's something that you can apply to two-year-old kids, to 75-year-old people, to people who are suffering from memory loss, to people who have obsessive compulsive problems. It's a pretty, a lot of people have brain issues, and they manifest in a lot of different ways.

So, I am Dan Kish. I've been in practice forever. I think we decided this morning it's over 31 years, so like 32 years going on, whatever, since 1992. I've trained a lot of different practitioners through the Kish Institute since 2006. We've been busily working away here. We've got a ton of new classes that we set up for 2024, the most ever, in fact. We have certifications now. We have this Level 1 certification, Level 2 certification. We have my mentorship class, as always. So, I'll introduce you a little bit to some of the new offerings that we have later as well. And then, um, for those of you that are brand new, it's the first time you've done one of these classes, I've been involved in education in this field for a long time. I've worked with the Mayo Clinic on research projects. I've worked with our, really the top lab scientist in the industry, Dr. Richard Lord, for the last, uh, 10, 11 years developing curriculum with Richard, which is a great privilege. He's a scientist that brought us most of these tests that we talk about on a regular basis, the one that developed them basically since the 1960s onward. He's retired now, and I'm IFM certified. I'm actually in practice working with patients all the time for the joys and pains of practice. I understand very well. And, you know, this occurred to me the other day, it's like, what I always wanted when I was first starting was a training program by clinicians for clinicians. And then I was like, oh, that's kind of what I created, you know? And I look at everything that I teach from the perspective of, you guys are going to have to deal with patients tomorrow morning and talk about this. And it's a different perspective than if I was involved in an academic institution or just teaching theoretical stuff or just teaching science or whatever. And so, that's, if you're interested in that kind of an approach, you come to the right place.

Oh, and we started our, um, Business Essentials Boot Camp. Started this week. You can still join. This is one of our more popular classes. You guys should sign up if you're interested in working on your practice, business planning, financial planning, all that good stuff. Um, you haven't missed anything yet. We just did the initial, "How are you? What's your name?" kind of introductory class. And, uh, the real coursework starts, you know, in the next few days. So, if you're interested, scan that. You can sign up for this class. And, um, it's a very lively couple of month experience on how to really understand, uh, whether you should go into business in functional medicine or how to improve your functional medicine business. Um, and we offer that one like once or twice a year. So, if you're interested, you should sign up.

And then this is the new thing that we're doing now. So, we have a Level 1 certification, we have a Level 2 certification, and then we have our mentorship. So, you can scan there, and it'll take you to all this different stuff that we're doing now. Level 1 are protocol design boot camps, just how to even explain to patients what the labs are for and how to do your first interpretations of the labs. Okay? So, again, protocol design means how to design your first protocols and how to explain this stuff to patients. That's Level 1. And then Level 2 are these intensives where we're like, "Go figure that stuff out somewhere else." You know, we're just going to go deep into fatty acids or amino acids or long haul COVID or whatever the topic is. So, the workshop intensives are really intense, and you don't have to be super advanced to take them, but you got to be in for a fair amount of work. The protocol design or Level 1 boot camps are really introductory, just getting you started kind of classes. Okay? That's all on the website. You can look at all that stuff. And then the certification is all on the website also, and you can see how that's going to be working. Level 1, Level 2, and then the mentorship. Okay?

And then, as always, when I talk about Rupa Health, if you're not a client of Rupa yet, you can scan that QR code there, and you'll get $100 off your first order with Rupa. Pretty much, I would say 95% of the people in the mentorship program are using Rupa. It's just become a standard for our industry now because it's such a much more convenient way to order labs. So, if you don't know about Rupa, you go check them out. Order a few tests, you'll see what I mean. And there's a Kish bundle in Rupa too. If you set up a Rupa account and you poke around a little bit, you'll see that there's a Kish bundle, which are the three labs that I order on all my new patients. You can look at that too.

All right, so now we're going to, I want to be light on the slides so we have time to really look at the labs. So, I'm going to skip through some slides. We're not going to cover them all in detail. Um, if you're lost and you, I skip over something, you're totally confused, just type in a question. You know, I can come back to that a little bit later. But I wanted to really start by just thinking about the bigger picture. There's three different things that can screw up neurotransmitters. All of them are treated in similar ways, and then all of them are treated in different ways. So, you're going to have to be able to differentiate. So, you could have inflammation in the brain because of neurotoxin exposure. You could have inflammation in the brain that's persistent because of physical trauma, blows to the head. And you could have genetic defects which just make that person prone to problems with the brain, maybe not brain inflammation, but this just say problems with neurotransmitters.

And so, I had this patient years ago. She told me this is one of the saddest things I've ever heard in practice, and I've heard some pretty sad stuff. She said, "When I was 5 years old, I can remember watching other kids running around kindergarten, laughing, and not understanding why they were doing that." Like, she had been depressed since she was five years old. Okay? So, some people, that's what's going on, and you can test and correct their brain chemistry. Quite traumatically. Some people might have physical trauma. It could be a veteran that says, "You know, I did two tours in Iraq, was in Afghanistan for a little while. I don't want to talk about this stuff, but, you know, yeah, I was in a couple of different, you know, IED explosive events." It could be somebody that said, "Well, you know, my husband and I have a horse farm, and the horse has thrown me twice. I've hit my head both times." Or could be someone who's skiing accident or a car accident. So, physical trauma is going to set this cycle of neuroinflammation in place, and we can help those people dramatically as well.

And then, of course, neurotoxins are ubiquitous. We're all exposed to neurotoxins. If you're not doing a sauna every day and taking a whole bunch of liver support, then your brain is probably full of neurotoxins too. It kind of has to be. Read the literature on it, you know. There's extensive thousands of research studies on this. I have a 1500 PowerPoint, 1500, 1,500 PowerPoint slides on toxic exposure. This is like a real thing, and it impacts everybody. And if you're not actively removing toxins from your body, then they're in your body, and a lot of them are neurotoxins that get into the brain. So, this is going to be really common things between neurotoxins and physical trauma and then genetic problems. You can see this every day in your practice. So, we want to get a general understanding about those three different categories and then start to look at some labs so you can see how to correct things. Right?

So, how do people experience this? They may gain weight because they're compulsively overeating because their neurotransmitters are screwed up. They could be tired or depressed. They could crave alcohol because their dopamine levels are not so great. They could crave foods and sweets and carbs because their dopamine and serotonin levels aren't so great. They can have anxiety attacks, panic attacks, insomnia. I had an Olympic skier. I mean, she wasn't in the Olympics when I was working with her. She was in her like mid-40s, but she was an Olympic skier for like 15 years, which is a long time to be on an Olympic team. And she had all-over body pain everywhere. You know, and it made sense because she had crashed like a lot at 60 or 70 miles an hour onto ice. And so, everyone's thinking, including her and the PTs and everybody, "Yeah, you know, that's just Andrea. You know, she just has body pain because she's a, you know, skier, and that's just what happens to these people when they crash a lot." The day that we put her on a dopamine program, hoop, all the physical body pain just went away. I couldn't believe it. She couldn't believe it. Nobody could believe it. No idea it was low dopamine that was driving this body pain, not all the injuries that she'd had. So, you never know. Things are never as they appear in functional medicine. You really never know what you're getting into until you start to treat a patient.

So, there's some general categories that you should understand. And one of them is that you should understand how tryptophan converts into 5-HTP and then over to serotonin. And you can measure this. You can measure tryptophan easily. You can measure the metabolites of serotonin. And then you can infer from all that what you're going to do to correct serotonin levels. That's pretty straightforward. We look at the labs, you'll see that here. Let me get a good color here. Is tryptophan? We're going to look a lot at kynurenic acid or kynurenate. We're going to look at xanthurenic acid or xanthurenate. We're going to talk a lot about 5-HIAA or five hydroxyindoleacetic acid. Okay? And we're going to talk a lot about quinolinic acid or quinolinate. It's, it's a little confusing. Different lab companies call these same compounds different things. So, for example, xanthurenate is sometimes reported as xanthurenic acid. Quinolinate is sometimes reported as quinolinic acid. It's just a nomenclature thing. Talking about the exact same subject. So, when you look at one lab company versus one another lab company, or you read one research study versus another, people refer to these compounds in different ways, but they mean the same thing. So, five hydroxyindoleacetate is the same thing as five hydroxyindoleacetic acid. To me, when I first learned that, it was very, very confusing. But you just have to deal with it because you have to. It's just one of the things you have to learn how to do. Okay? So, I'll try to intersperse the terms. But when we use kynurenic acid versus kynurenate, it's the same compound that we're talking about. After a few weeks, you get used to it. It's not so bad.

So, here's our tryptophan converting to 5-HTP. And what we're worried about on the labs are these markers: 5-HIAA, that's the metabolite of serotonin. Xanthurenate or xanthurenic acid, that's a very clear indicator for B6 deficiency. Xanthurenate or xanthic acid is a very clear indicator for B6 deficiency. It's as important, perhaps more important, than the actual tryptophan and 5-HTP themselves in terms of making serotonin. So, just because it's a B6 indicator, don't put it down on the list. It should be at the top of the list as the most important nutrient that we're talking about when you're trying to fix serotonin in the brain. So, xanthurenic acid, more important than tryptophan or 5-HTP. Why can I say that? Because, well, I worked in the lab for 12 years, and we looked at this. So, there's a lot of sort of statistics behind this too. But just from a practical standpoint, if you pump someone full of 5-HTP and tryptophan, and they don't have the B6 to convert it, it's not going to turn into serotonin. It's, it's a limiting step. So, you have to have sufficient B6 for this to work. Now, if you just give B6 by itself, that's not going to fix anything either, right? But I just want you to know that the B6 is not an optional thing. It has to be in there.

And then quinolinic acid or quinolinate, that is a neurotoxin. That is an inflammatory byproduct. It's a product of inflammation. See right there? Product of inflammation. And it causes damage to the nerve cells themselves. Kynurenate and is not a neurotoxin. In fact, somebody just yesterday said, "But kynurenate is neuroprotective." Well, when your brain is inflamed, your brain does these things to try to protect your brain. That doesn't mean that it's overall a good thing. You know, like if I hit you in the thumb with a hammer and you scream, that really hurts. I mean, it's not good that, you know, it's good that you have pain receptors and you know that you got hit, but it's not good that you're in pain. So, um, we don't want to be, perhaps positive or negative on these things or like judgmental. But if kynurenic acid is up and quinolinic acid is up, your brain's inflamed, and that's generally bad. Even if your brain's trying to protect itself, it's still not a, it's a sign that there's a major problem. Okay? So, we're going to talk a lot about that when we look at labs. So, you got to remember those markers there.

Um, fatty acids. I just wanted to mention because you, it's kind of assumed that you're giving all these people fatty acids. Um, you should measure their fatty acids. Even if you don't test their fatty acids, just give them all omega-3 fatty acids. You really want to do that. And then there's also, um, not just the omega-3 fatty acids that are required for the brain to heal and repair, but then there's also short-chain fatty acids. This is going to require a couple of minutes to think about. But your body, your gut microbiome produces short-chain fatty acids. Your gut microbiome makes fatty acids from fiber. And the famous one is called butyrate. And butyrate has a very, very powerful effect on the brain. Who would have thought? You eat fiber and polyphenols, but primarily fiber, and the gut bacteria convert that fiber. You need, need the polyphenols also to help the gut bacteria. But fiber specifically, when you eat fiber, the gut bacteria, the good gut bacteria, make these fatty acids, short-chain fatty acids, acetate, propionate, and butyrate. Butyrate is the most famous one. So, we usually just talk about that. And butyrate is available in a supplement form. And that butyrate travels to your brain and regulates brain function and neuron growth amongst other things. It's a very powerful anti-inflammatory, and it's a very powerful repair product for the brain. Butyrate. You can get it in a supplement form. It's made from the fiber from you consuming fiber in your diet, and then the gut bacteria going on to make that. So, just don't forget omega-3s. Just give them to everybody. Probably like 2,000 milligrams a day. Good for the brain to heal. Kind of required for the brain to heal for a variety of reasons. And then the short-chain fatty acids, including butyrate, you can give those as a general support for brain programs as well. And then, of course, you also want the person obviously to fix their microbiome and eat all the fiber that they need.

Now, glutamate and quinolinate, or remember quinolinate, aka is quinolinic acid. So, let's say that you have head trauma or a neurotoxin that's inflammatory, or that you have a gut infection that's inflammatory, something has generated inflammation in the body. This can happen from the gut, and it starts to be impact, it starts to impact the brain. The mechanisms here, once that inflammation gets going, is that your body takes tryptophan, that's your tryptophan right there, and it converts it into kynurenate or kynurenic acid, and then that gets converted into quinolinic acid. And the quinolinic acid heads over this way to your brain, and it excites the brain cells and causes them to pop. It's like a water balloon blowing up or something like that. So, quinolinic acid, it's like putting pressure on the water balloon, and pop, you know, your cells are destroyed. And the way that you can control this problem when quinolinic is high is using, uh, magnesium short-term. And then, of course, the bigger picture is that you want to reduce the brain inflammation. But we're looking at each one of these. We can test each one of these things. You can see if this is happening or not. You can test tryptophan levels, you can test kynurenic acid levels, you can test quinolinic acid, and see what's happening. It's very straightforward. Either the brain's inflamed or it's not. Doesn't tell you why it's inflamed necessarily, but lets you know that it is.

So, again, inflammation can occur from physical trauma, environmental toxin exposure, gut infections, all those kinds of things. You can also have a genetic problem. So, there's COMT and MTHFR. These are probably the two most famous ones. We just mentioned them. So, COMT is an enzyme that degrades dopamine. So, it's breaking down dopamine. And we're going to measure the dopamine breakdown product called homovanillic acid. This is a methylation process, and a lot of people don't methylate very well. This means it's just not working. See this all the time. Super common. And then MTHFR, I'm sure you've all heard of, can also have a huge impact on what's happening with the brain and with neurotransmitter production.

So, here's our kind of summary of all these pathways. Tryptophan can be used as a treatment. 5-HTP can be used as a treatment to boost serotonin. If you're wondering which one should I use? I would say in the beginning, like the first year that you do this, just use 5-HTP on everybody. That'll be easier. Once you get more into it and you're like, "Well, wait a minute, there's certain people that are going to respond a lot better to tryptophan," and that's true. But I think your odds of success are better in the beginning, like your first year or two of doing this, if you just use 5-HTP with everybody. Later, you can learn the nuances of why you might want to use tryptophan and whom you may want to use tryptophan, and how that can be quite a bit more effective for some people. It's just easier to work with 5-HTP. So, I would just do that.

And then for the production of dopamine, we have this amino acid called tyrosine that converts into L-DOPA and then into dopamine. And so, you can use tyrosine to great effect as a base product to lay down a base or a foundation of dopamine production. And you can use an herb or a plant called Mucuna or Mucuna pruriens, which just put an M there, which is a plant-based form of L-DOPA to really bring up dopamine levels in those people that have a more major problem with dopamine. You always start with tyrosine as a foundation. And if you need more dopamine support, you can layer a Mucuna on top of that. But never use Mucuna by itself because you'll get really jerky, what's that term, "higgly-piggly" kind of reactions. You, the person will go up and down, and it's not going to feel very good. So, you always start tyrosine and then you can escalate with Mucuna on top of that if you need to.

And then here's our COMT over here, right there's the enzymes. So, enzymes can get, uh, the function of these enzymes can get screwed up. In which case, levels are not going to be what they seem, you know, they're going to get thrown off. So, let's not worry about that. And there's research studies, inflammation on the brain affects glutamate, kynurenic acid. I thought this was kind of interesting though. Kynurenine pathway as a therapeutic target in cognitive and neurodegenerative disorders. The British Journal of Pharmacology. So, these are not alternative medicine concepts. These are like basic science stuff that you can see in all these standard journals. Like, what's this one? Uh, top behavioral neuroscience journals, you know? So, this just kind of to show you that, you know, this stuff is actually not as far out as it may seem. It's just that most people don't action this from a clinical standpoint. They just kind of study it in a theoretical way and then they try to develop drugs for it. Obviously, it's a journal of pharmacology, it's obviously trying to figure a drug solution. But, you know, why do a drug solution when you have a better solution that you can use by addressing the root cause of the inflammation and all this stuff? Um, anyway, suffice to say that there's a lot of research in this area about how these markers like, uh, kynins here, the kynurenine, relate to, uh, how we think and how we feel.

I thought this one was particularly interesting. The relationship between, and this is from the study here, that the, uh, sorry, let me go back a page. Oh, my computer's not working now. Okay, there we go. From this study here, right? So, the relationship between kynurenine and immune function may have a wide relevance to quote sickness behavior and lasting effects of infection on motor and cognitive function in conditions such as cerebral malaria. And I can't even try, try to pronounce there. But what we see in terms of sickness behavior, chronic yeast infections, chronic H. pylori infections, chronic Giardia infections, the same exact mechanism of action as they talk about in these research studies. We're just applying it in a slightly different way to different kinds of infections. And then there's a whole thing about butyrate. This one's pretty interesting too. The role of butyrate in and dealing with pathogens in the gut. And there's tons of research on this. This, I was reading all these, we don't have time to get into them. But just to show you, if you ever have time, just get online and go through all the literature on this. It's just incredible, really, what's happening. So much study going on on all this.

But let's look at the important parts here. Uh, okay, we're going to jump into some labs. For those of you that joined us late, reminder, check out our Business Boot Camp. It's coming up. And let's look at a couple labs. So, I'm going to just, for, see if you can remember a couple of those things that we just looked at. And I'm going to pull up the test. That's not it. But here we go. Hit the wrong button, sorry.

All right, so we're going to look at two different tests. One is a Neuro-HPA from Genova Diagnostics. Neuro-HPA from Genova Diagnostics. And the other is an OMAx from Diagnostic Solutions. Very similar tests. They report many of the identical markers. They're a little bit different. You may have a favorite. I'm going to show them both so you can see them both. And I want to design a neurotransmitter-based program for each of these and talk about specific products and dosages and how you might go about all this.

So, let's just imagine the patient. And the patient could be a 27-year-old who's depressed. It could be a 75-year-old who has cognitive decline. It could be a new mom that is anxious and can't sleep. It could be a lawyer, and she just got in some kind of horrible car accident, and now her law firm is falling apart. It could be just about anybody with any kind of brain-related problem. It could be somebody that has neuroinflammation because of environmental toxin exposure, in which case you need to diagnose and treat the toxin part, obviously. Very commonly, it could be somebody that has a gut problem that generated their brain issue. Remember, we talked about the gut bacteria making butyrate. Butyrate's essential for normal brain function. So, you see these gut-brain connections frequently. That person, you'd have to test and correct their gut. And by the way, I just pulled up a couple of gut tests. Um, there's a great one from Genova called the GI Effects, and there's a great lab from Doctor's Data called the GI 360. It's a really wonderful test if you're interested in doing GI testing. And it could be, uh, a genetic issue with COMT or MTHFR or something like that. But the joy of functional medicine is that if you just know how to read these labs really well, you'll see the functional expression of the problem. And you don't have to figure out in the beginning if it's a genetic issue or if it's a neurotoxin. You can just fix the brain and buy yourself some time to figure out what really caused it. You know, we have this in class all the time. And this happened, I think, yesterday in one of the classes where we have my mentorship students, who are all really good, and they've been doing this work for a long time, and they're, you know, excellent practitioners. But there's a, um, they design, you know, at that stage of your career, in your first couple years, you design the whole program, and then you kind of want it to be perfect. You know, and it, I think what happens as you get to be really experienced at doing this is you realize that it's a process. So, you want to be 100% confident in your skills, but not feel like you have to fix everybody right away. What your skill set is, that you should be confident in, is starting a program and then seeing how the patient interacts with that program and starting to make your conclusions once you're in the third or fourth month of the case. So, you don't have to figure out the underlying cause of the problem right away. It may not be handed to you right away. It may take three or four months for you to put all the pieces together. But eventually, it'll happen. And you can have very, very effective programs even without completely knowing exactly what you're doing. If I look back on my first 10 years, and Dr. Timmons told me this, he, I can remember him saying this like 30 years ago. Timmons said to me, "Around year 10, you're going to start to really understand this." And I was like, "Okay, whatever." And I remember right at year 11 going, "Wow, he's right. I finally get what he has been teaching me all this time." So, when I look back on my first 10 years of practice, and I was treating two, three, 400 patients a year, I mean, a high-volume practice. I treated thousands and thousands of patients in those first 10 years without really having a clue as to what was going on. And then at some point, around year 11, it clicked, and I saw the bigger picture of this. So, you can have great clinical effect just following directions and not understanding the entire bigger picture, especially when it comes to these kinds of labs. Because this Neuro-HPA or this OMAx test, it's a decade to really understand the inner workings of it. But you can have clinically effective programs from day one. And in fact, the program that I may have written up 30 years ago for this lab might be identical to the program I write up today. It's just that my understanding of why I'm doing that has advanced. So, I want, as intimidating as these labs are, I want you to just jump in and learn how to do this stuff. Get some basic protocols down. That's why we have all these classes. I spend all my time developing, like, look, we got all these classes here, protocols, this, and the Level 1 certification, that, all this stuff is designed to get you guys the basic protocols to get you started. And the real protocols that really work, even before you may understand all the nuances of all this stuff. Otherwise, you're going to wait around for years and years, and you won't help enough people.

Okay, so let's take a look here. This is a, again, we're going to do a Neuro-HPA first. So, right off the bat, just from scanning this front page, what do we glean? And we're thinking brain, brain, brain. We're thinking just brain, brain problem, depression. Okay, there's a lot of oxidative stress. We know that's not good for the brain. There's a lot of mitochondrial dysfunction. Also not good for the brain. But we're not talking about that tonight because we're talking about, uh, neurotransmitters. But still, that's important. Omega, in the very beginning, I said you're going to give everybody omega-3s. Now, this person desperately needs omega-3s. So, whereas the average patient who you don't know the status of their omega-3s, give them at least 2,000 milligrams a day or two capsules a day of a good quality omega-3. For someone who's deficient in omega-3s, they need omega-3s just to get caught up to normal omega-3 levels, and then they need the extra omega-3s for all the repair. So, I would give this person double that dose. I would give them two capsules of omega-3s in the morning and two capsules of omega-3s in the evening, so four capsules a day because they've got a deficiency. You want to not only get the omega-3s into the system to help the brain heal and repair, but you're also dealing with a deficiency state. So, double the dose. Not for how long? I don't know. Three months, six months. Then retest. Whenever you use a higher dose like that, you stop and retest. And then when the omega-3 levels are normal, you could cut the dose back to just two a day for the repair that you're trying to drive there. But there's two separate issues: using omega-3s for repair, and you using omega-3s for someone who's deficient in them. Obviously, it's more extreme of a problem if they're deficient. Toxic exposure is a seven. That can't be good. So, neurotoxins as a potential source of the brain problem? Absolutely. Methylation as a potential source of the brain problem? Yeah, that's set at a five. So, we're starting to say, get a general picture of where, where this person's at. And now we can hone in on the specific brain markers that are so important. Okay? And let's look at them one by one. There's our kynurenate or kynurenic acid. It's high in the red zone. Our markers for dopamine, epinephrine, and norepinephrine down here. So, the norepinephrine and epinephrine or catechol marker, vanillylmandelic acid is elevated. That's not good. And the serotonin marker is normal. So, there's some neuroinflammation with some impact on the catecholamines as well, and serotonin seems to be sitting just fine there.

Now, just to be thorough, you're going to scoot down just a little, little bit here. And now we're seeing that there's neuroinflammation. So, you ask the person, "What's your history of head trauma?" And you got to list things off. So, people don't remember. Almost all the time, people don't remember head trauma because they don't think that it really was that traumatic. You know, unless they had like, you know, bloody wound and were in the ER or something. So, ask them, "Have you had any car accidents? Your head hit the windshield? Or you got a bad whiplash?" Have you had, of course, a whiplash? Your neck goes back and forth at a great rate, but your brain doesn't move quite as fast, right? So, your brain gets kind of scraped around in your head even from a whiplash. If your head hits the windshield, it's much worse. Have you been in, in service in the military? You know, in, uh, round explosions at all? You've been blown up in a Humvee at all? Have you had, you know, sports accidents? You get hit in the head by a baseball bat? You fall off a horse? You got hit by a hockey stick or something like that? I had a patient 10 or 15 years ago who was the, at the time, was the number one rated kickboxer in his weight class. I can't even remember the guy's name now, but I can remember talking to him really clearly. And he was a kickboxer. That was his job for, and he was really good at it, you know? And so, I, we had his lab back, and he had this really bad neuroinflammatory problem, and he was depressed. And I was like, "Well, you know, look, it, it looks like, you know, there's some neuroinflammation." "Not surprising, given, you know," and he made some comment about like how he kicked more people in the head than he got kicked in the head or something like that. But people in general are in denial about head injuries. They just forget about them or they block them out or they don't think of them as real traumas. So, when you see neuroinflammation and you're talking to the person about the history of head trauma, you got to lead the conversation and say, "You know, what have you done that you could have hit your head? Have it been any times? It could even be in childhood." And it can take a few minutes for people to remember. You know, or like our kickboxer guy, it can take a little while for them to even admit that, you know, they've been kicked in the head a thousand times. So, a lot of denial on head injuries. And it's a very important thing to follow up with. Because if head injury is the main source of the inflammation in the brain, you want to refer them to an osteopath or a chiropractor or a physical therapist or a massage therapist that does cranial work, so they can get their head straightened out and get their cranial bones worked on properly, or maybe get their upper neck reset. So, if there's a traumatic component to this, you want to address that with some kind of cranial work.

And then on the genetic side, you know, there's a whole bunch of complexity to that. We don't probably get into now. But, but we can definitely get into the neurotoxin part of this. And this case is a perfect example of that. So, under toxins and neurotoxin and detoxification markers, pyroglutamic acid is high. The reference range cuts out at 34. This is double the reference range. That's extremely high. And that's a marker under the detox section for, um, glutathione. So, their glutathione levels are deficient, and their brain is unprotected because glutathione is the master antioxidant. That's the master protector against all the inflammatory problems that could happen in the brain. And then you can see every other one of these markers here is elevated, showing a lot of toxin involvement. So, now, if this person's GI test was really good and had no problems, and you saw all these toxin things here, and you asked them for five minutes about head injuries, and they said, "No head injuries, no head injuries. I'm not a kickboxer, not, you know, did all this kind of stuff." You just rule all that out. It's not a head injury thing. It's not a gut thing. Then you can say, "Oh, this is a neurotoxin case." So, in order to correct this brain problem, I not only need to address the brain chemicals and get the brain chemistry working properly, but I'm going to have to do a really aggressive detox, detoxification protocol, and get all these toxins out of the brain and body. This is as bad as it gets. I mean, there's only four markers in this section, and they're all four elevated. It's a problem, kind of a big problem.

Let's see, uh, I'm just looking around to see if there's anything else that I'm kind of missing on this test. There are some gut issues too on this person, but we're, we're not going to talk about that. It's going to get too confusing. Let's see, down here, amino acids. There's a whole bunch of amino acids that are low. The nice thing about brain problems is that you can fix the brain issues without having to fix everything else. You really can. They work, really. I, you want to eventually get all these other things corrected, but you don't have to wait until the person's toxins are all eliminated before you go after that. You go after that as a problem. Okay, let's see. Oh, let's just look down here. Okay, a little bit with some of the heavy metals too. All right, so let's design a program that's not going to really help. Let me pull up the right thing here. We go. There. Okay, so, just let's list out what's happening first. So, kynurenate was high, so that's neuroinflammation. Quinolinate was not high. That's good, I guess. Or is it? That's a whole another conversation we could have later, maybe, because they, they should actually both go up together. If one is high and the other isn't high, that's actually kind of a problem. But that's like a nuance we could talk about later. Um, so there's some neuroinflammation. And then what do we say? Oh, that, uh, pyroglutamic acid was super high, so highly toxic. Uh, they have an ammonia problem and low glutathione. And remember now, glutathione is, glutathione is the master protector of the brain, the main protector, main protector of the brain. So, low, low glutathione puts you at very high risk for problems happening with the brain. And, uh, another way of saying this in neuroinflammation, you can also use the term cytokines, if you like that term. Cytokine. And that cytokine term became popular or commonly known during COVID because of the cytokine storm. That was a huge amount of inflammation such that it could overwhelm the body's antioxidant systems and end you up in the hospital and was killing people by the thousands. The cytokine storm is a big deal. So, what we're seeing in the brain is an example of the same basic mechanism. It's just not life-threatening, usually. And then, um, I think they had high, uh, epinephrine and norepinephrine markers. Remember, that's treated the same way as the dopamine markers. It's the same pathways. Same pathways. Okay, so the treatment's identical.

So, let's just do a quick review about what we're talking about. So, kynurenic acid is high. I mentioned briefly that that should also elevate quinolinic, which it's not there. That's kind of like a question mark. You should, you should be suspicious of that because they should both be high together. Vanillylmandelic acid, the catecholamine marker, is high. So, we know we want to work on the catecholamines. And then we went down to the toxin section, and we saw every single toxin marker elevated. So, now we're suspecting that there's a neurotoxin aspect to this person's problem. You're also going to want to question them about brain injury, brain trauma, head trauma. Make sure that that's not part of the problem. Question them about the gut. Do a good stool test and make sure that their gut is okay. If it's not, you want to fix that. And assuming you got the gut working well, and there's no head trauma, then you can go under the supposition that you want to do a toxin removal program to protect the brain, get the toxins out, boost out the glutathione so you have that master protector to protect the brain cells, and then get all the actual neurotransmitters regulated properly.

So, let's see, the product expression of that, like, how do you actually do that with products? Let's think. Um, well, we want something that's anti-inflammatory for the brain, or do we? Well, maybe we just want the anti-inflam. And, and I'm doing this new thing. I started doing it this week and in class, and the mentorship students really liked it, which surprised me. So, I'm going to try it with you guys. If you don't like it, this is kind of like a comedy show. You can, you can heckle me, except for we're online and you're all muted, so you can't really like directly antagonize me, but you can type messages in. So, you can type, and I read them all, by the way. So, you can type into the little message box, "This sucks," or, "You know, Dr. Kish, the way you used to do it is better," or something like that. Or, "I really like this." But I'm going to try this because it was popular in class, and I hope that you guys like it too, which I'm going to design this program and actually talk about my thinking process. So, this is the exact same stuff that I spent 31, almost 32 years not talking about in front of patients because you don't want them to think that you're wondering what's going on. So, don't try this in front of patients. But I want to try it in front of you so you can see the process that I go through. I have never, ever had a cookie-cutter like sheet and said, "Oh, here's your brain program." This is a pre-printed thing. I've designed every single one of my patient protocols from scratch, 100% of the time, for over 30 years. And I realized about two weeks ago why I've done that. Because I, I was reading a book about, um, artists and how the creative process worked, and it talked about how important it was to always have an original view on everything, even if you've done it a million times. I was like, "Oh, that's kind of like designing supplement protocols." So, I really disdain and dislike automated protocols that are just printed out because something happens. Take this. I really think that we should all be designing these from scratch because it's a creative process, and you want to be able to grapple with the different variables.

So, here the variables up top: neuroinflammation, toxic, and, and then we should mention a little bit about what the patient experiences. So, depression and anxiety. So, there's something that we're, we have a target here. We're not just doing this for fun. We're doing this so that the depression, anxiety goes away quickly. So, everything has to be oriented towards that. So, now I'm thinking, I could give them a neuroinflammatory, you know, anti-inflammatory supplement. You know, but I don't know. I was thinking curcumin or something like that. But what about omega-3s? Because we already said they are deficient in omega-3s. So, let's use omega-3s. Two with breakfast, two at dinner. That's double the normal dose because they're both deficient in omega-3s, and we want to use the omega-3s for their anti-inflammatory effect. If someone's already deficient in a nutrient, just getting it back to normal isn't going to allow that nutrient to do a really great job. That's just getting it back to normal. If you want a powerful anti-inflammatory effect and brain healing effect of omega-3s, you got to get the omega-3s back to normal. That's what these first two are for. Okay? And then you got to get them some extra omega-3s to get the inflammatory effect, anti-inflammatory effect. So, we're doubling the dose for like around 90 days, maybe six months. If you want, you should retest though between three and six months. Three to six months, depending on how the person progresses. Retest. Okay? So, now I'm a little more relaxed because I know these are anti-inflammatory and there's a deficiency. So, it's sort of a two-for-one deal there. And I'm thinking, what else is anti-inflammatory? Well, where's the inflammation coming from? I've ruled out head injury because I talked to them for hours about their head injuries, and there are none. I've got their gut corrected already, so I know it's not coming from the gut. So, actually, the anti-inflammatory part of this program could just be the detox part, because that's what's causing the inflammation. So, what are we going to do? We're going to give them glutathione. And it's usually liposomal glutathione. One to two of those. And that can be in a liquid. Um, so that can be a liquid or capsules. Liquids are kind of preferred by most people. So, it'd be like one to two squirts of the liquid.

Know thing of a little tube that you do and um and aetl cysteine. They make it in a 900 milligram capsule. I give like that.

Now, in order to activate an acetylcysteine, in order to be sure that this glutathione, what you want, you're giving the NAC so it converts into glutathione. You're giving the glutathione because they need glutathione. And in order to make sure that that glutathione can get its job done, there's one key nutrient that you have to add. So I'm just going to say, what is that key nutrient? Somebody type it in. Let's see. This is quiz time. Now, see if anyone gets it. Glycine is a very good guess. Magnesium. Okay, Diane and Gordana nailed it at about within about a millisecond. I have to call it a tie. It's like an F1 race when the cars come so close to each other, you can't tell who won. Yeah, it's magnesium. And if you're wondering about that, you can read in Dr. Richard Lord's book about the glutathione magnesium diad and why they're so yolked together. But you need magnesium for the glutathione to do its job, and you need glutathione for the magnesium to do its job. They, they're interactive. So I usually use the magnesium glycinate, but you, if you have another form of magnesium you like, that's fine.

Uh, okay, so we got that. That should be okay. We now I'm kind of relaxed. I'm thinking, okay, we got Omega-3s, anti-inflammatory effect. We got glutathione and NAC, magnesium to activate it. That should take care of these toxins. You want to give them some fiber or binding agent. You could do a lot more for the toxins if you want, but, you know, let's focus now on what we're going to do for the brain, which is going to be, it's a catecholamine problem. So we're going to use tyrosine. So you can give tyrosine on an empty stomach, and it has a more immediate effect. You can give tyrosine with meals, and it has a more gradual effect. But in the 12 years of that neurotransmitter lab that I worked at, the actual levels of dopamine, epinephrine, norepinephrine don't change much at all with over the long term, whether you give tyrosine with or without food. You want a more immediate effect on an empty stomach. If you don't care about an immediate effect, give it with food. I find it's easier for people to remember to take it with food, but you could do it on empty stomach if you want.

Okay, if you're two weeks into this and the person's like, I don't feel any better, then you could add the Mucuna. There's a product called Dopa Plus from Pure. There's a product called Dopa Boost from Designs for Health. And that would be your, like, after two weeks they're not responding, you want to get a little bigger push on the catecholamines, you would add this product in. So that's a very robust brain program. And then there's always in every one of these protocols, a multi. Okay, except for what's the one thing that I forgot? You got to have the B complex with some extra B6. Remember? So B complex with B6. That would cover it unless your multi has a huge amount of that.

Okay, so now, uh, I want to do questions too. Let's look at one more lab. Maybe we don't. This. Let's look at this other one. I don't even know what's on it, but let me, let's just see. So this is Diagnostic Solutions Omix. It's a direct partner, I guess, a competitor, but, you know, I, I don't think of it that way. It's a direct analog or comp. It's comparable to the Neutra-Lite. Which ones is better? I don't know. You could just listen to me and my best friends, Bjorn and Nelson, talking about cars and try to decide, you know, is it better that I buy, you know, a vintage Mercedes or vintage BMW? I don't know. Vintage. It doesn't matter. BMW, Mercedes, Omix, Neutra-Lite. You know, it's personal preference. There's not like one of these is better. These are, I know the directors, owners, educators at both of these labs and have done for 30 years. They're all in both of these companies doing the best work they can, anyone can, to deliver you guys the best results. And, you know, whether it's a Neutra-Lite or an Omix, it really doesn't matter. Just whichever your personal preference is.

Okay, let's look at the, uh, brain part of this. And it's good to get familiar with them because you, if you use Neutra-Lite all the time, someone could come in with an Omix that they already did, and you should be able to interpret either of these. You know, it should be like, uh, it's just able to kind of go back and forth between them. So here's part of the brain part of this test. It's divided up into different sections. But here's our homovanillic acid. That's the urinary byproduct or metabolite of dopamine. And it's quite low. Tyrosine also low. That's provocative, isn't it? So we, right off the bat, you know, they have a huge dopamine problem. Oh my gosh. It's not getting any better because look, 5-HIAA, five hydroxyindoleacetic acid, same as five hydroxy, uh, the other one, uh, acetate, also low. So they have low serotonin and low dopamine. And let's see here, low serotonin and low dopamine. All right, let's go down. Uh oh, this is not looking good. See the quinolinic, same as quinolinate, quinolinic. I, that's a neurotoxin. One, kynurenic acid, borderline high. Quinolinic, a little bit high. So it's a little bit of neuroinflammation going on. And then the last thing, just to compare it with the other test, is to look at, uh, the neurotoxin markers. And we're not going to look at them all because that would take hours. But the main one, remember we just saw pyroglutamic acid on the Neutra-Lite. Here's pyroglutamic acid again, super high. So detox pathway is not working well. Cysteine, super low. Detox pathway is not working very well. Cystathionine, lysine, super high. Detox pathway is not working very well. Oh my gosh, look. Methionine, undetectable. Detox pathway is not working very well. So this person has a detox pathway crisis. And they have, uh, sorry, hang on a second. And they have, oh my gosh, h a second. I'm gonna, and they have, it's other thing. So hang on a second. Let me find the right window. Here we go.

So now let's forget about the Omega-3s for this person. But you're going to give, well, we're going to give everybody Omega-3. You're going to give him a little bit of Omega-3, just two a day, though. Now, just to mix it up, so you can see, I don't always give glutathione. Sometimes it's really nice to give glycine. Glycine is a precursor to glutathione. And glycine and an acetylcysteine is a lot of research on those two together being very effective at boosting glutathione. So this is another way you could do it. You'd want to give a little bit of the magnesium again. You need the tyrosine. But in this case, you also need the 5-HTP. Comes in 100 milligrams. And then again, you need a multi and you need the B complex. So for this second case, Omega is but a little bit less than the first one. Glycine instead of glutathione. Okay. And then same with the magnesium, the tyrosine, now paired with the 5-HTP because they have both a dopamine problem and a serotonin problem.

Okay, if the person has a major issue with sleep, you can give the 5-HTP all at nighttime instead of giving it during the day. You can do, you can really do it either way. But if they have a major sleep problem, sometimes it's more effective to do the 5-HTP at night.

Okay, so now let's go back. Let me remind everybody what the heck we got going on here. We have our Business Essentials Bootcamp coming up, right? Right now. And then we have a Rupa discount that you can avail yourselves for or of. And then we have this complicated thing that I spent maybe, I don't know, three or four years working on. Three, let's not exaggerate, Dan. At least three years of my life working on this to develop all these other classes. So we've got protocol design bootcamps. There's four of them. We've got these workshop intensives. Intensives. There's four of them. We got Level 1 certification, Level 2 certification. It's a whole new panel, ple of courses that we've put together here. Okay. And if you guys are interested, you can scan these different things. I'm sure my team will send out emails tomorrow with more details on all this stuff. You can set up a call with us if you're curious to learn more. And let me grab the questions now. All right, let's see. And we're going to go overtime. So if you need to leave, we're right at the hour right now. Are we? Yeah, we are. Okay, so we're officially over. You go be with your families. If you want to hang around for a little extra question and answer time, we'll do some extra Q&A time. Uh, let's see. And I'm not going to have time for all of these.

"People should not gain weight with 5-HTP. If anything, they should lose weight. I've never seen someone gain weight from 5-HTP. That shouldn't be possible. It should curb their appetite. They should eat less and lose weight."

"Can you use you can use you can use these protocol? You can use. There are protocols. There are protocols for for getting people off of SSRIs. So if a patient comes in and they say, hey, I've been on Prozac for 12 years, I want to get off this drug. What should I do? There are specific protocols to help them do that. If the person comes in and says, hey, I was on Prozac for 12 years and I just stopped like six months ago. I've been off it for six months and I feel horrible. Is there something you can do? There are protocols for that. So there's protocols that you can use. If the person comes in says, hey, I've been on Prozac for 12 years, I don't want to stop my Prozac. Is there something that I can do so I can feel better while I'm on my Prozac? There's protocols for that."

"All that stuff I teach pretty much only in my super advanced classes because it's complicated. And if you screw it up, you're going to be in trouble and the patient will be in trouble. But there are ways to do all that. But I don't want to get into it now because it's something that's, you know, you need to sit down for a few hours and really study it, uh, in detail and and go through a bunch of cases. If you're asking those kind of questions, that's really kind of thing that we would go over either in our brain class, which we're going to offer later this year, or in the mentorship."

"Um, so for pediatric dosages of all these products related to the brain, if it's a child that's say, say over 100 pounds of body weight, but they're under the age of 18, you would use half the adult dose. Half the adult dose, exactly. If they're under 100 pounds of body weight, you'd probably use one-third of the adult dose for a younger child, a smaller child."

"Uh, see, and we have, let's see. Oh, yeah. So Annette was paying attention. She asked about the ammonia problem. I'll show you that in a second. Okay, let's see. Our alve. Yeah. So if you see like a high level of P-glutamic acid, it doesn't necessarily mean that there's toxins present. Many other things could cause that, you know. So somebody mentioned that, that's very true. And you can use NAC and glutathione can be used together if you want to give an extra boost. You could use glutathione by itself. You could use NAC by itself. Um, you could use glycine and NAC together also. So in terms of my practice, I use glycine and NAC together probably most of the time. Sometimes I use glutathione by itself. It depends on the labs because sometimes the labs indicate like the one we just saw, remember the cysteine was low? That person would probably be better served to give them an acetylcysteine to boost both their cysteine or cystine and their glutathione versus glutathione by itself, which wouldn't help with the amino acid deficiency. So if they're deficient in an amino acid like glycine or cysteine or cystine, then either acetylcysteine or glycine are better than glutathione in my mind because you're getting two things done. You're making up for the deficiency of the amino acid and you're boosting glutathione. If you have the luxury and the person is willing to take extra stuff, then you could do both. You could give the glycine or cysteine to replace the missing amino acid and you can give glutathione on top of that. So it depends on the labs, you know. So let's see. Becca is asking a question. Is our old mentorship student? Yeah. So for Becca's question, yes. Um, and good to see you again. It's been a little while. So for Becca, she's asking, the NAC and glycine together is like a core easy way to boost glutathione. If you're a little concerned and want it to go faster for the first three to six months, you could add glutathione to that. You're sort of doubling down. But remember that the NAC and glycine do convert to glutathione, but they do many other things in the body also, whereas a glutathione obviously is already glutathione. So using them in combination can work really well because you're covering the amino acid part of it and you're giving the straight up glutathione also."

"Uh, so B complex is either once a day or one twice a day. Twice a day is better if the person's quite sick, you know, and they have a lot going on."

"NAC can be given to people with leaky gut. I think everybody that we work with has leaky gut and we give NAC to a lot of people. So I don't think you're going to get into trouble on that."

"So if five hydroxyindoleacetate is high, it indicates a great a breakdown of serotonin at a rapid rate. That can be a stress indicator. It could be, I guess, a metabolic dysfunction. Um, but it doesn't necessarily mean they have too much serotonin necessarily."

"Let's see. So, oh, Christine. Christine's, I think one of our new mentorship students, aren't you, Christine? Yeah. If you're a mentorship student, you should be able to get into the Facebook or immediately. If you can't figure it out, just email the office. They'll let you know. Okay. All right. And let me, um, yeah, just email the office, Christine. They'll get you set up."

"So if and Sher's asking a question about bipolar disorder. I, I have a strong feeling about that. So for again, for 12 years, I worked at one of the neurotransmitter labs and I never saw in those 12 years, in the tens of thousands of patients, I never saw a successful bipolar case using amino acids. And never once in my practice, in any of the practices, every single bipolar patient that went through that program using amino acids needed other treatments in addition to what we're talking about tonight. So I do not feel like amino acids alone can help bipolar disorder because over the course of 12 years, I never saw it. Every once, and these are some pretty smart doctors that were trying to do that. So for bipolar disorder, I think you need to do different things."

"Um, and let's see here. There's one question that I just want to tie back to for one second because I skipped over it and somebody caught me on it. I was wondering if anybody would, I forget who it was, but why, how I, why did I say high ammonia? You see the orotic acid. So orotic acid, if that elevates, it shows it this ammonia toxicity in the brain. That's a really important marker. Super important marker. And let me just show you, um, one quick thing here. I just want to show you an image on that so you get a visual of it. Here it is. Download. Should pop up on your screen. There it goes. So here, so this one's blacked out. It's like a teaching example, but I'll draw in stuff for you so you can see. So ammonia building up in the brain leads to an elevation of orotic acid right here. Okay. And in order to correct that, you can use a variety of different amino acids. Usually people use arginine and citrulline and sometimes ornithine. That's a whole different toxin related problem is ammonia toxicity. We're going to be talking about that extensively in the boot camp at the end of the year. The detox boot camp, which is towards the end of this year. Okay. I'm going to wrap it up. I know I didn't cover all the questions. I'm sorry about that, but just too many to cover. Have a great rest of your evening, folks, and I'll talk to you again soon. Bye now."