Mentorship Miniseries - Supplement Protocol Design: How to Integrate Multiple Programs

Hi everyone, and welcome to our summer mentorship mini-series. I'm Dr. Dan Kalish, and we're talking about a brand new topic today that I've never done a talk on before, ever: supplement protocol design and how to integrate multiple programs.

Why are we doing this? Because this comes up with every single patient. I don't think you'll ever have a patient where you just do one program based on one lab, because that's really not how the human body works. So immediately, from the very beginning, you have to get really advanced, and you have to learn how to integrate multiple programs over time. And are they going to overlap? And are you getting overwhelmed? And what's going to happen with all this? So that's what today's talk is about.

So for those of you that are brand new, I will introduce myself, and then I will jump into the topic. We're going to look at a whole mess of labs today, just for fun, and then make programs based on those labs. And I want to show you a system as to how you can look at the biggest picture view of this. Okay, this is something that I found very confusing in my first 10 years of practice.

So for those of you that are brand new, I am Dan Kalish, and welcome to this class. I have trained thousands of practitioners in functional medicine techniques and practices. We do at the Kalish Institute. We're kind of focused on practice building, business building, a big emphasis on lab interpretation and understanding the biochemistry, but an even bigger background emphasis on how can you build a successful practice. And successful, to me, means that you're helping a lot of people, as many people as you possibly could, that you are having enough time for yourself so you can spend time with your family and loved ones, take care of your own personal health, be a good planetary citizen, recycle, I don't know, whatever it is that you want to do that makes you a better person. And then, um, that you're also actually making money. You know, because if you are not making money, then you really aren't going to have a retirement, you're going to be stressed out, and this whole thing kind of falls apart. So profitability is an important part of you being able to help a lot of people, surprisingly enough, just having a successful business so you don't close your doors.

Over the years, I've worked with the Mayo Clinic. I've worked with, for a long time, for a decade now, with Dr. Richard Lord. And, um, I actually am in practice. I saw patients for a couple hours today. I designed some pretty complex programs today. In fact, we could talk about those if you want. They'd be good examples, probably, for us to go over. I did a series of labs with a mom and her two kids, and that was pretty interesting. And then I did a second set of labs, uh, these are methylation tests, on a mom and her daughter. So it was actually family day today, and that was kind of fun to design. And, you know, how you're going to vary the programs based on age, gender, height, weight, sex, but their goals are all these different kinds of factors that that come into these programs.

And so, welcome to the Kalish Institute. I hope you guys stick around and enjoy other courses with us. This is the summer mini-series that we do every summer. We also have some bonuses for you if you are interested in the mentorship, which is my one-year class. It is starting in June, and you get a discount. And we will email you out that discount. You have to worry about finding a special code, anyways, but anywhere. But you will find a discount in your inbox. So if you're interested, set up a call with myself or my staff, and we can tell you about the mentorship.

So the mentorship is one year of what we're doing tonight, except for we're reviewing your cases, case after case, and designing programs for your patients, patient after patient, hundreds and hundreds of them coming in. We got like four or five hours of classes every week. There's doctors submitting labs to each one of them, and it is just pure educational chaos. I mean, I taught for two hours this morning. We covered, I don't know, probably a dozen or more cases, and so much learning comes out of the experience of seeing other practitioners' cases and learning as you're doing, basically. That's what this is all about. This is practical application training. Not a lot of sitting around. There's not a lot of pontificating. You know, um, if I'm chatty and not like on focus, it's because every 12 to 14 minutes, I try to give you guys a mental break so you can kind of catch up with your own thoughts.

There's another class that's starting in June, which is our Long-Haul Syndrome Boot Camp. It's a much shorter course, it's two months long. It could have intense look at how we're working with long-haul cases, which you're coming up every day in all of our practices, I'm sure yours as much as mine. So we have lab, it's all lab-based, right? So lab interpretation for long-haul syndrome and how we can help these folks. So that's coming up too. You get a discount also. You get something in your inbox on that.

And the last thought here is Rupa, one of our main partners. We've worked with for quite a while. I've used them in my practice for a long time now. You get a 100% discount off. Again, we'll send you an email link so you can take advantage of this. If you haven't used Rupa yet, you should go online, order a lab test for yourself using their system, get familiar with it. You'll see what I mean. It's the best in the industry. It's really the way to order labs now, basically, for all of us. They have every lab company, and you can get whatever you want there, and they take care of all the administrative hassles. It alone saved me ten, fifteen thousand dollars in expenses last year.

Okay, so that's enough of that stuff. Now let's look at what we're actually talking about here. So what do you do when you have multiple programs and you're not really sure which is the most important or which should be done first? Those are not necessarily the same thing. And then how are you going to figure out how to overlay one program or over another? Like, how many can you stack together? And how much is it better to just focus on one program?

And so I have a bunch of slides and notes here, but before before we get into that, I just want to give you like the biggest picture view possible, which is that I think of this in terms of body systems: neuroendocrine, GI, and detox. And in terms of tests: adrenal and hormone testing, GI testing, and organic acids. And in general, in treatment, treatment-wise, we're following that order: neuroendocrine treatments first, then working on the GI as much as it needs to be worked on, and then doing the organic acids-based work towards the end: amino acids, fatty acids, organic acids, nutrient replacement, and that kind of thing.

Do we always follow this order? No, because a lot of times you can't. But is it nice to have a model that you really consistently follow? Yeah, because then you don't have to wonder with every new patient what you're going to do. You have a model and you follow it unless you don't, unless you can't. And so if you don't have a model of some kind, and you don't have to use my model, but if you don't invent your own model or use my model or find a model, then on every new patient, you're constantly doing things completely differently, and you're never going to learn really that much because every patient is this unique butterfly or unique snowflake, and you can't get your skill set going if every single case you treat is done in a completely different order for completely different reasons. But if you have a sequence that you follow in general, you're going to know exactly when and why you should vary from that sequence, and what are the other things that you can do.

Okay, so when we say functional medicine is personalized, it's personalized, but you have a structure that you're putting that person into, and then you're personalizing it based on how they're reacting to the structure. In my mind, that's the only way to do this if you want to scale your practice. If you want to work with like one patient a day and spend seven hours with them, you don't need a model because you're only working with like a few people a week. But if you want to work with 10 new patients a week, year after year after year, you really have to have some kind of a system, or you're just going to implode. Your brain is just going to implode because you're going to be making too many decisions all the time, and you won't even probably make the best decisions possible.

So neuroendocrine first. That includes adrenals, thyroid, mitochondria, any kind of hormone, anything related to neurotransmitters. I would throw mitochondria in there just because, you know. And then GI second, in general. And sometimes these can go together. And then nutrient replacement, the heavy, you know, lifting with organic acids, fatty acids, amino acids, all that kind of stuff, in the third phase. Now, these phases could be one each month. So if you're going quickly, it could be six months for each phase. It just depends on the patient. I would say, on average, it takes me about a year to get through all the different programs that I want to lay out for a given patient when we're, you know, just starting from scratch.

Okay, so let me show you here. The, here we go. Here's the layout of it. So hormonal, then digestive. But hormonal is more neuroendocrine, okay? And then detoxification, slash organic acids, fatty acids, all that. If you follow this basic sequence, then let me show you here. Yeah, if you follow this basic sequence, and a couple things happen. When did you start to get really good at it? And you'll start to be able to spot people a mile away that you need to do something different with. And you'll, if you do the same things over and over again for a while, you're just going to get better at them, and then you're going to be able to vary this program, these kinds of programs, really easily. But if you're doing something completely different every time, it's just hard to learn, actually, what, you know, have any sense of progress.

So let me show you here. I have another slide here. I want to show you. This will kind of clarify it a little bit. All right, so neuroendocrine, GI, and detox. Detox, for most of our patients, may be the most important thing. But we generally run the higher risk of having side effects and causing problems if you start with detox. My two main teachers in the early 1990s, Dr. Bill Timmons and Dr. Michael Lebowitz, both had personal health crises. They had their own, you know, chronic fatigue phases of life. And both Lebowitz and Timmins were made deathly ill from detoxifying too early in the healing process. And so in the '70s and '80s, this happened a lot. All these detox centers are popping up. Sherry Rogers is writing her book, "Detox or Die." You know, doctors are trying to figure out, wow, our patients are toxic. That's part of the problem here. And so let's just fix that. And what they learned, in my personal experience, then what my two of my teachers learned personally on their own bodies, is if you aggressively detox someone in the very beginning of a program, you could send them to the hospital and really screw them up for a long time.

So I was trained intensively in the beginning: detox is the most important thing you do last, when the person is ready. You want their gut capable of binding up and removing toxins. So if they have a screwed-up gut, get that fixed. You want their brain and their hormonal system fully engaged. You want their mitochondria cranking away with energy so that they can detox. So we deal with the neuroendocrine, and then the GI, and then the detox. So that's like the biggest picture that you could have. And then within each one of these subheadings, you can break it down even more. So like, for example, within, well, let's say like what, uh, within the GI system itself, in general, are you going to fix a leaky gut first, the microbiome first, or go after the pathogens first? You know, what's your sequence of events there? I have a strong predilection to always do pathogens first, then deal with the GI organs, get them working, and then deal with the microbiome at the end. A lot of doctors would do it the opposite way. I think it's more effective and faster to deal with pathogens up front. So I do it that way. You can do it the other way, as long as you have a system. That's the thing. I don't care. Nobody cares what your system is, it's just that you have one. So you're like, oh, well, Dan's wrong. I want to do microbiome first on everybody because that's going to fix a lot of pathogens. Great. Just do microbiome first with every patient until you've done four or 500 of them, get some experience with it, and then see what you're going to do. Or copy me and do pathogens first for four or five hundred patients, and then learn what you're going to learn, and then, you know, change it as you need to.

So again, I see the GI system in three main areas: pathogens, GI organs, and then the microbiome itself. And there's arguments to be made about starting with any one of those, but just be consistent. When I worked with Diana Schwarzbein for a long time, she just did leaky gut programs with every new patient that walked in the door. She didn't even have to do a lab. She just walked in and said, "I want to be your patient," and she said, "Leaky gut," and she just put everybody on two monthly leaky gut programs. That was her system. Awesome. Good for you. You know, she had a clear system. Didn't it always work? No, but it was a really good idea to reduce the inflammation, get the gut healing, healing first. And as many of you know, Diana Schwarzbein is an endocrinologist by training. She wanted to get their leaky gut under control so she could correct her hormones. So she had a different sequence here. Key point is, she had a sequence. She did gut first for two months, as she tested and corrected their hormones.

Okay, so now there's also a question, which, and I'm kind of covering up on all these big picture items first, uh, just so you can think about this, and then we'll get into some specific program design. So what works really well? There's some pairings that work really well. Pairings. Um, you know, one of my favorite things to do, and I don't do this too often because I don't drink alcohol too much, but it's really nice when you're at a nice restaurant to get a wine pairing and to have this sommelier type person just pick the wines that go with the food. Certain foods go with certain wines, and it's just like, wow, that is just meant to be. It's the same with programs in functional medicine. There's pairings here that work well, and I'll tell you the ones that work really well for me and for all the students that we've trained at the Kalish Institute, which is like in the thousands now. So I'm pretty sure these will work well for you too.

Adrenals pair really well with GI pathogen programs. That's a natural pairing that I've seen work tens of thousands of times. You can run those programs together. Always start with the adrenals. But if you want to run two programs at the same time, an adrenal program, whatever that means to you, paired with a GI program is like one of the most classic and best pairings. All right, it's like a reasoning with clams or, I don't know, I made that up because I don't know anything about wine, but, you know, it's a just a intuitively battle-tested, well-thought-out pairing. Adrenal programs start after a month or two, get into the GI pathogens or other GI that work that you want to to do. And that's because the adrenals naturally impinge. When you improve the adrenals, you're reducing the inflammation in the gut, and you're improving the immune system in the gut, and you're reducing the leaky gut because the adrenals make the person catabolic, they have a leaky gut, the immune system falters, and they get inflamed. So the adrenal programs relieve a lot of the stress on the gut. And so that pairing of a GI system program and an adrenal system program is just beautiful. That's probably the number one pairing that we see work really well.

The next pairing is an odd one, but I'm going to show you it. It is neurotransmitters. And I could make you guys guess. Does anybody want to guess what pairs the best with neurotransmitters? And I know I just did a gut-brain class, but that's not it. You guys, what do you guys think? Somebody type in an answer. It's just the most beautiful fit. This work all the time. Nobody got it right. Detoxification. I know I said detox is supposed to be last, but there's a reason for this. There's a reason for this. Does anyone know what COMT is? Do you guys work with this whole like genetics thing and, you know, how rapidly people are breaking down neurotransmitters? Or do you work at all with hormones and you're concerned about methylation and COMT, the rate at which people break down hormones? So breaking down hormones, breaking down brain chemicals, that's the process of detoxification. So one of the main regulatory kind of control things that happens in a neurotransmitter balancing program or a female hormone or male hormone program is going to be the clearance of the hormone or the clearance of the neurotransmitter. And so this pairing of a neurotransmitter program with a detox program is just incredible. It works so well. It works so incredibly well. So you can stimulate the production of neurotransmitters and stimulate the clearance of neurotransmitters at the same time with the same exact products.

Okay, so I'll use COMT. People out there, detox people, methylation people, what's the stuff that runs the detox pathways for both hormones and for brain chemicals? Sulfur amino acids, B6, folate. There's a bunch of other things, but let's just stop there. Okay, these are the three of the biggest sulfur amino acids, like cysteine, methionine, B6, and folate. What are the three keys to making neurotransmitters? Sulfur amino acids, folate, and B6. It's the exact same stuff. That's why this is such a great pairing. It's not even different products, you guys. It's the same exact products you use to make neurotransmitters as you use to clear neurotransmitters. That's why this pairing is so beautiful, and you should pair these together every single time. I highly recommend that.

There's some other kind of like one-off pairings, like anytime you use NAC, N-acetylcysteine, you have to pair it with magnesium. You're just supposed to know that. It's called the Magnesium-Glutathione Dyad, and Richard Lord talks about it a lot in his book. If you want to buy his book. So anytime you use magnesium and you really want to be effective, use a little glutathione or N-acetylcysteine. Anytime you want to use N-acetylcysteine or glutathione, make sure there's some magnesium in the program. So there are these kind of individual pairings of products like that as well. But what we're trying to focus on more today is maybe the bigger picture ones. Okay?

So adrenals and GI pairing. Neurotransmitters and detox. Always pair those together. Those work just beautifully together. You kind of have to pair mitochondrial energy production and oxidative stress and methylation programs. Those kind of have to go together. They're kind of the same thing, aren't they? Okay, so those pair together.

So to answer the bigger picture, so you can figure some of this stuff out on your own, to answer the bigger picture question is, once you get multiple lab findings back and you've got like five or eight different things you need to do, think about this in terms of pairings. Think about it in terms of body systems with neuroendocrine first, then GI, and then detox. And then think, okay, there's an adrenal problem. I'm going to start there. In a month, I'm going to do the GI protocol. That's my pairing. Now, when you do a wine pairing at a nice restaurant, and you're in the middle of your clam dish with your Riesling, and again, I made that up, I don't know if that really works or not, but just pretend it's a Chardonnay, maybe that works, okay? It's a Chardonnay and your clam dish, and you know the duck is coming next. If they brought out a Cabernet in the middle of that course, would you be like, "Oh, that's great, I'll just take the Cabernet"? No, you wouldn't. You'd be like, "No, I'm paying all this money to get the Chardonnay with the clams and the Cabernet with the duck." So you're not mixing. Okay? You're doing adrenals and GI until the GI is done. Now we're on to the next course. Now we're on to like adrenals and whatever you want to do, adrenals and detox. But we're not doing the GI overlapping with the detox. You don't want to do two aggressive programs that push the body hard, like killing all these infections in the gut and detoxifying all these heavy metals. You don't want to pair two stressful programs.

Okay, so you see how this works. It's adrenals and GI. Adrenals supportive, GI killing of pathogens, challenging. Neurotransmitters supportive, detoxification stressful, right? So the pairings, others, I don't know what you want to call it, you know, like a positive negative ion kind of Yin Yang kind of thing. So adrenal supportive, strengthened immune response and inflammation, reduce inflammation in the gut, reduce leaky gut, kill the GI pathogens. That stresses the gut and the system. Neurotransmitters, obviously, regulate the brain. The person's feeling better, their brain is working better. Then you go after the toxins and remove them. So that's stressful and challenging. Okay, so you want to pair these things in ways that make sense. So those are the two pairings that we see the most often in terms of lab evidence, where you'll just see on the test that there's a big adrenal problem and a big GI problem. Knock those out. When the GI course is done, then you move on to detox. Or if you choose a different lane, and let's say you're doing a brain program, like, well, what goes really well with that? You could do gut. That's all right. I'm not against that. But always think about detox. So brain and detox together. When you feel like those programs are winding down, then you could come back and clean up something else in a different system if you want. Okay. And then also with energy, that's mitochondria. You're pretty much always having to think about oxidative stress, glutathione, and methylation. Okay, so mitochondria, methylation, M, M, those two together. Two. All right, so that's our big picture view for the moment. And then let's look at the list that I put together here. And then let's go find the list of real stuff. So adrenals, thyroid, neurotransmitters, mitochondria, female hormones, food, GI pathogens, leaky gut, detox, nutrient replacement. That's just the same exact thing as I just showed you with on the graphics side, okay? So let's go hunting now. Oh, now I'll come back. Let's do, let's do a program. Then I'll come back and show you some more details with the slides here. So let's find a good example. I pulled up 200 million labs here because I just couldn't really settle on one set. But I, let me find the right one here. Here we go.

All right, so this is a Genova, um, adrenal stress test. Relax. Oh my gosh, let's just see what's happening. Wow, what a mess. Okay, gotta get oriented here for a second. So we're just going to quickly do this because this, I'm not supposed to be interpreting that. I'm just supposed to be doing program design. But anyway, let's just say the DHEA is extremely low, like it's underneath the 10. That just makes me want to sit down and cry for a few minutes. That's extremely low. You don't see it that bad very often. The cortisols are low and high, which is the worst thing that could happen to the human brain. Half the day you're low in cortisol, which is just low lowness, and then your brain is getting fried with high cortisol. It's like putting your brain cells in a frying pan and just cranking it up to high. You know, it's just not a good situation for any human being. And then the cortisol awakening response, which should be around a 50 or 60, is at 193. This one should be this beautiful spike, can drop, is just so, this per, everything is potentially wrong with the adrenals here. So let's just say big adrenal problem, and we could call it a stage two if you want a name on it, but it's a major issue because the DHEA is so low. So we want to keep that in mind. There's a major adrenal problem. You probably can't ignore that and just kind of try to do something else.

Okay, here's a GI Map ordered by Rupa. Enterohemorrhagic E. coli. Just from the name, with the word "hemorrhagic" in it, you can kind of tell that's not a good thing, right? A little bit of H. pylori, but not a lot. Commensal bacteria kind of wonky, but doesn't look that bad. Oh, okay. And then we see a half a dozen dysbiosis markers. So now we've got an adrenal problem and dysbiosis. Okay. So, and let's just see if there's any other gut issues. Oh, and a yeast overgrowth also. So now we're getting into multiple complexity, right? Because we have two infections. I just picked these randomly. I really don't even know what I'm looking at here. Chilomastix. So there's a parasite, protozoa, says parasite. So that's three GI infections. Oh, this is a doozy, isn't it? And then elastase is low. So that's low pancreatic enzymes, and secretory IgA is low. So low immune response, that's just from the gut. So dysbiosis, Candida, and a parasite, low pancreatic enzymes, and low SIgA. That's one, two, three, four, five, plus we're not even counting the enterohemorrhagic thing, right? Which is. And then here's an organic acids test. This is from the Great Plains Lab, recently just changed their name. And just to keep it simple, let's try to not look at everything on here. Let's look at the mitochondrial part, maybe, and see what's happening there. All right. And the neurotransmitters. Oh, well, this is not too hard to see. So let me do a little line for you here. So these are difficult to interpret, but simply put, if you draw a line down the middle here, and you see the preponderance of these mitochondrial markers low, then that's what we call a hypometabolic state. So I'm going to write that down. That's a specific pattern of significant, one might say profound, mitochondrial depletion. When you look at the neurotransmitter markers, homovanillic and vanillylmandelic acids, they're both low, which is oftentimes the case with the hypometabolic state. So they're low in the catecholamines, and the mitochondria are poorly functioning. So I just write low dopamine and dopamine and adrenaline, if you want to call it that, or epinephrine.

So now let's go to a little program design moment and write all this down. And I'm just using this as an example so you can see more to do with the process really than with these individual, um, tests. So let's take a look here. Here is a health plan, and let's just write out the things that we're dealing with. So we'll talk a big time adrenal problem, remember, because it was low DHEA, cortisol rhythm was not good, and the CAR was off. That's all. That's as much as you could have wrong with your HPA axis. So you can't just leave that alone, right? You got to deal with that, and you have to deal with that first, probably. On the GI side, we have dysbiosis, we have a Candida overgrowth, and we had a parasite, the Chilomastix one, protozoa, if you like that term. Protozoa. Uh, uh, and that's not all. We had, uh, low enzymes, low pancreatic enzymes, and we had low SIgA, which is low. This is called low immune response in the gut. And then we had a big mitochondrial problem and a low dopamine and epinephrine. I suppose we should go back if we're going to be thorough here and just look at this test and see what the detox markers were like, just so we don't miss something. Okay, that's not good either. So pyroglutamic acid is low. So now we know. This is not probably a big surprise to any of you, but just to confirm, we also have low glutathione, which you could call a lot of different things. That's oxidative stress, whatever you want to call that. Okay. So now I don't even want to count how many things this is. It's a lot. It's like a dozen things that we have to deal with.

So now, if we go back, though, we have a model, so we're not like freaking out. We go, wait a minute. Okay, this is like a lot of stuff. So what do we get? How are we going to sequence? Well, there's a really big adrenal problem, so we should probably start there. Awesome. But there, there are transmitters were not very good, and the mitochondrial function was poor. I don't know, you could start with all three of those if you want. You could just do a straight-up neuroendocrine program for the first two or three months. Or you could pick one of those, one, two, or three of that neuroendocrine system, and then as soon as a person is starting to feel better and you're confident that they can handle the blow, then you go after the pathogens, which in this case is dysbiosis, Candida, and a parasite. You have to clear all that stuff out. And once that's in pretty good shape, not perfect, because it's going to take a while to get perfect, but once that's in good shape, once that course is finished, you're moving on to the detox part. Okay, so they can be a little bit of overlap, but you don't want to run a full-on GI clearing program with a full-on, you know, detoxification protocol. It's just too much for your liver to handle because it's all this debris coming from the gut, there's all this other stuff you're trying to process in terms of chemicals and heavy metals and ammonia you're trying to clear out. It's just, just too much for the human body to do. You can stack together multiple neuroendocrine system programs because that's just like, feel good with the adrenals, feel good with the brain, feel good with the mitochondria. That is not taxing. That just makes people feel good, good, good, good, good, better, better, better, excellent, excellent. But stacking together two aggressive GI clearing and detox programs is just too much for most people. In fact, you don't really want to try to kill multiple, multiple GI pathogens at the same time. So if we were going to get a microscope and kind of dive into that pathogen section there, this person has dysbiosis, Candida, and parasites. That's just too much. You can't kill all those at the same time without really making the patient extremely unhappy.

So how do you sequence that? Well, let's look. And by the way, this is a common example. I just picked up random labs. This, we did this 10 times this week in class already. Okay, if you guys are in the mentorship class, you would be like nodding your head, kind of dozing off right now. You're a little tired. We already saw that 10 times. Can you come up with something different? Uh, so we're going to, let me sequence it then here, because once you've done this like a couple hundred times, it's just going to be second nature. So we're going to do an adrenal program for six months. After about one or two months into the six-month program for adrenals, we're going to do the GI clearing. Yeah, they have dysbiosis, yeast, and a parasite. Dr. Timmons taught me in 1992, and I still do this because I think he was right, that if you have multiple infections like that, always do the parasite first. Always treat parasites first. That's based on me being taught that and then me watching that work for 30 years. You could do it in a different order, but this really seems to work. The reason being that oftentimes parasites are behind the dysbiosis, or parasites are behind the yeast overgrowth. So you may clear out the dysbiosis or yeast problem by getting rid of the parasites. It doesn't usually work the other way. Okay.

So now we've got an adrenal program. A month or two in, tip, we're going to go up to the parasites. Then we're just going to see what happens in terms of future GI programs. This, we're not sure. We're just going to put that on as a question mark. And then after GI has improved, we can go after the detoxification systems. Uh, we said there's low glutathione and all that. So there, that would be my basic framework there. Now, if you want to like fill things out and make the person feel better faster, you could do the adrenal program plus mitochondrial support, plus even neurotransmitter support. It's just a lot of supplements, and some people will be happy with that, and some people won't.

So let me show you what it would look like typically. And we already said this person's adrenals were in really bad shape, so we want the DHEA. Remember how low their DHEA was? I like the liquids. You can use pills if you prefer, but the liquid seem to work really well. Pregnenolone drops. They were like a stage two, so I'd probably use that. They had really low cortisol in the morning, so we used a special kind of licorice root. It's not DGL, it's the liquid, uh, like 10 or 15 of those in the morning. That brings up the cortisol, okay? And then some kind of a multi-pack. And then, uh, most of the time now, I'm using this, uh, either Metagenics, it's the, uh, Energize Pack from Pure Encapsulations. I like that one now. It's just all in one cap, one little thing. They just take it in the mornings. It's easier than the twice a day packs, but there's arguments, there's different kinds of packs you can use, there's arguments, you could go either way on that. And then some kind of an adrenal glandular support for someone that's that exhausted. Pure Encapsulations has this stuff called Adrenals. I like that one. I give her a little boost. And then, um, some kind of metabolic support. Can I use Metabolic Xtra from Pure? Something like that. Okay, so that would be like a basis of the adrenal program. This is six months long. Then after that's been going for a couple months, we'd come back and we'd want to do the parasite clearing. It depending on the patient and the circumstance, you may use a prescription drug for this. You may also use herbal formulas. I use Micro Defense from Pure, like two to three of those with each meal. There may be a lot of other things you do. I'd also use their Ultra Digest Plus because the person was low in pancreatic enzymes. So that would be something along the parasite clearing, and this would be about a two-month program. And then when that's coming to an end, so that's maybe four months into the program, you assess. You see if you need to do more GI killing. If you do, you have to do some more GI programs. If not, then you can move on to detox support, which would be, in this case, they had low glutathione. So you could use the NAC and Glycine powder. I use this every day with so many people. As one scoop is 1800 milligrams of each, and you can do that twice daily. So one scoop of the NAC and Glycine powder from Pure, and that nets you out 3600 NAC and 3600 NAC, I'm sorry, 3600 Glycine and 3600 NAC for the day, which is great. Just get their glutathione levels up like that, all with one product. The super simple. If you pair that with the packs and all this blood sugar support, this should work pretty well.

So here's like an example then of all three protocols: six months on the adrenals, two months on the parasites, but give it a month or two to start. When the parasite thing is winding down, then you could go and do some detox support. Now, if you want to get more aggressive and get the person feeling better in the beginning, you could do something like just L-tyrosine because they were low in the catecholamines, remember? You could do tyrosine in the very beginning if you wanted to do some neurotransmitter support. And if you wanted to do mitochondrial support, you could use something like Mitochondrial ATP. That's also from Pure. In the very beginning, it just ends up being a lot of products. A lot of people can't handle it. So you have to kind of assess that. It may be better to wait and do a more complete neurotransmitter and mitochondrial program a little bit later, or you can add in, sometimes I'll add in like one or two products just to get that system primed and starting to work well.

Okay, so now let me see where we're at time-wise. All right, let me see if there's any questions. Let me go through questions here. Um, okay, here's a great question from Jay. How do you follow up with patients on multiple programs? So no matter what, and no matter how long the program is or how many programs they're on, I want to talk to them either once a month, and that doesn't usually happen, or twice a, once every two months. So on the, I talk to them every two months. On the months that I don't talk to them, my health coach talks to them and checks in. So they're being monitored once a month. Every two months, I get to talk to them. Every six months, we have a big powwow and redo all the labs and that kind of stuff. But people need monitoring, or this, you know, is not going to go well. You know, you have to stay on top of people. Um, and a lot of the, honestly, a lot of the follow-up time is spent just saying, "Did you finish the, you know, GI program?" "No, I didn't, because, you know, I, I started throwing up when I took the mastic." I'm like, "Oh, why did you tell us?" "I forgot to tell you." Okay, then we have to re, you know, there's a lot of reconfiguring that happens. Consistently, these programs are rarely followed, you know, perfectly. Or they might start off on their adrenal program, and if they're in month two and they're like, "I don't feel any better." So I'm like, "Okay, well, that's not good. We're going to add in some, uh, DOPA-DOPA Plus. This will make anybody feel good." Okay. And, uh, if that's not enough, you just give them some extra tyrosine on top of that. So they're complaining about the adrenal program not working at month one. I'm like, "Okay, let's just get your catecholamines going because that's probably a bigger problem there than we thought. Add in some dopamine boosting products like these two." And whoosh, you kind of accelerate or speed up the effectiveness of the adrenal program by doing all the adrenaline or epinephrine support at the same time. Okay, so oftentimes I make the program stronger, or maybe even have to dilute them or cut out products or move products along, you know, around as we're going through that initial bunch of weeks. Once you're on a program for four to six months, they tend to settle down.

Oh, the name of the book is Richard Lord's book on labs. It's called Laboratory Guides. Let me show you guys this. You pretty much have to buy this book. It's expensive. If it's too expensive for you, then just wait because he's coming out with, uh, smaller versions of this book. I just talked to him a few days ago, maybe another six months or something like that. But eventually, Laboratory Guides to Health is the name of the book that has all the info. It's, it's the most thorough compendium on, um, functional medicine testing out there. It's kind of like, you have to have it. I have here, I have an original copy of it here. It used to be in a hardback book. Here's the original old one. Um, now it's, same author, Richard Lord, but it's, uh, it's an ebook. So I'll just show you here. It's easy to find in our community. This is our secret community that you get access to if you join the mentorship. You get to access to all this really good stuff. This is like an advertisement, but really, I just want to find the book here. Here it is. Here we go. There it is. Laboratory Guides to Health, Richard Lord. You can buy it from iTunes or iBooks, and you can buy it from Google Books. It's an online book. It's three, four hundred bucks, something like that. That's too expensive for you, wait six months. He's breaking it out into smaller books because the main book is like, I think it's 1200 pages. It's pretty hefty.

All right, let's see. Other questions. Oh, Lindsay, thank you for asking that question. Lindsay's asking, if magnesium shows up as sufficient on testing on the Nutri-Eval, do you need to add it if using NAC, EDTA? Okay, you guys want to vote on that one? You want to vote on that? She's bringing up a point which I wanted to make, so I'm very happy about that. So let me show you here. On a test, it's hard for me to think unless I have a lab in front of me. I don't know why my brain has just been conditioned in this way, you know? So let me just get, grab a test here. So the concept that we're about to go through is, oh, go over is one of the most important things if you want to be like next-level clinician, not like the average person who went to some conference or seminar, learned how to do something. But if you want to be like, whoa, like this person really knows what they're doing, you want to be like that. I'm not saying I'm like that, but I'm saying Richard Lord is like that because Richard Lord invented all these tests. And when Richard says stuff, I'm like, oh, why didn't I think of that? Like, well, maybe if I had 50 years of experience and developed every single one of these labs that we're looking at, I would know that too. So let me just find you a sample one here. All right, here we go. Ready for this? So this is a big picture theory. You can apply this to every case, okay? And you should apply this to every case that you have. You always want to think through this one concept here. And so Lindsay's asking the question, if you're going to give N-acetylcysteine, do you still need to give magnesium even if their magnesium tests normal?

Okay, let me tell you the big picture concept here. This is complicated, but let me try to talk through it. Is there's two completely unrelated things that are happening. One is that we are replacing nutrients that are missing. So let's just look at an easy example of that. In this case, I just, this is just a random lab. You can see in that, this is a Nutri-Eval from Genova. If glutathione levels are low, you give glutathione because it's missing. I don't know. That's like if you're baking a cake and it requires sugar, you put sugar in. It's an ingredient. It's missing. You're making the cake batter, you add the sugar. If you don't wonder, oh, am I going to put this ingredient in? No, it's just like part of what is necessary for this thing to be a cake. So glutathione is probably the most important nutrient in the human body, period. And if you're low in it, you just have to get the levels back to normal. That has to happen. That's a nutrient replacement. That's an absolute. What they call an absolute nutrient replacement versus relative. Relative, I'll tell you about in a second. So if vitamin D levels are low, you need vitamin D to survive. You just give the person vitamin D. That is not a difficult intellectual decision. Something's low, you give it. You are making cake, you need sugar, you add it. You're not discussing that with your partner. I wouldn't like ask my wife, like, honey, should I put, it's like sugar in the cake batter. She's looking at me like, well, I don't know, is that in the recipe? I'm like, yeah, I should be like, yeah, I don't think you might just don't. That's a no-brainer. But the next level that you guys want to be at is you want to be anticipating what you're going to cause to happen when you give that glutathione. What the heck do you think is going to happen when you give that glutathione? And if you, this is a relative nutritional deficiency, you're going to induce a relative nutritional deficiency by giving that glutathione. So you've got to think this through, or people are not going to get the full benefit from your programs. So one of the things that happens when you give somebody glutathione is, guess what? They start to make more ATP.

potentially because low glutathione sends a signal to your mitochondria to shut down energy production. You say that again. Low glutathione tells your mitochondria, "Stop it, guys. Stop it, for God's sake. Just stop making the ATP." Why? Because the main source of oxidative stress in the human body is the production of ATP. Every time you're making a little unit of ATP, you're generating all these free radicals. Like one or two percent of the free radicals just leak out and they screw your body up.

If you have glutathione, it's not a problem. If your glutathione levels are low, your body senses that, and your body shuts down ATP production because it would make you worse. If you made a lot of ATP and you had low glutathione, because then your oxidative stress would get even worse. So if we're going to be so arrogant as to come along and give somebody NAC and glutathione, we're going to then allow, in effect, their body to make more ATP than it's made for a long, long time. And what are the key nutrients that you need to make that ATP? Magnesium and B vitamins. That's a relative nutritional deficiency. If you're going to give NAC to boost glutathione, it's not going to work in someone who's had suppressed glutathione unless you pair it with what they're also going to need to make more ATP, which is magnesium and B vitamins.

So to answer Lindsay's question, if magnesium is low on a neutral valve, you have to give it. That's the no-brainer version. That's the sugar in the cake recipe. Something's low, it's required, you give it. But you also want to think one step ahead. If I'm going to give something to boost glutathione, are they going to need more magnesium? Absolutely yes, or they're not going to make more ATP. They won't even process the glutathione properly without the magnesium.

It works the other way too. If they're low in magnesium and you give magnesium, are they going to make more ATP? If their glutathione is low, no. Because there's a mechanism in your body that prevents that from happening. Your body will not make more ATP at large rates when glutathione is low because it's dangerous. It'll kill your cells, damage your cells. Your body won't do it. So when you give that magnesium and the magnesium deficient person, even if their glutathione looks okay, you want to crank up the glutathione a little bit to allow the magnesium to do its job. And so there's hundreds of examples of this where you're doing one thing and you want to make sure that you're addressing the other.

I'll give you one more obvious one so you can get the idea. And again, this is along the theme of pairings. I would say. So here's a neutral valve. You ready for this? So let's see if anybody gets this one right. Okay, so here we are. This is your challenge question. Do you put on your thinking cap? And I want people to type in answers. Whoever types in an answer first, uh, uh, gets like, I don't know, a gold star. I'll give you a virtual gold star. And Wendy just said, "I'd never see anyone who has enough magnesium on neutral valve." Yeah, the entire American population is deficient in magnesium. That kind of means that the entire American population needs glutathione support too, if you want to think about that way.

All right, so here's another example. This person is low in Omega-3s, and you're thinking, I want to replace their Omega-3s. What do you want to anticipate that you should give along with the Omega-3s so you don't make the person worse? Somebody want to type that in. Omega-6. That's that's accurate, but that's not what I was thinking. But that's a yes in this case, especially. So that's a yes, but that's not what I was going for. I'll give you a hint. I'll hover over it and we'll see if anyone gets it. There. I'll hover over it. I'll expand. I'll circle it. Well, think about it. Just think it through. Think through it. Yeah, yeah, yeah. You got it. Allison nailed it. Allison nailed it. And Joseph nailed it. You guys nailed it. Just think it through. If you're going to give Omega-3s, what's going to happen? Your goal is to build more cell membranes. You can have more lipids, more of these super important lipids in the system. You're going to be building mitochondrial membranes, membranes for neurons, membranes for all the cells in the heart. You're going to be building a bunch of membranes with those threes. You do not want lipids oxidized or damaged.

So if you have lipid peroxides high already and you give Omega-3s, those Omega-3s are going to get chewed up. Do you see that? It would be like if you have, I don't know, like, you know, those tree grinders. This happens a lot in my neighborhood. People cut down a tree and then they grind it up, you know, with these huge machines and they just throw in huge tree limbs. It's like that, right? So high lipid peroxides means that the lipids are being oxidized. They're being ripped and shredded apart like a tree shredder. You know, if you ever see that Cohen Brothers movie where they, they will tell you what happens, but they throw somebody into the, anyways, it's kind of a funny movie. You've ever saw that Cohen Brothers movie? You remember that scene with the tree shredder, right? But anyway, so you don't want your lipid, you don't want these fancy expensive Omega-3s to go into the tree shredder and have them oxidized and damaged. So you not only have to give vitamin E or CoQ10 to normalize the lipid peroxides, but you're going to be adding even more lipids on purpose. So you need to double up on whatever amount you thought you would give based on this marker here. You need to give at least double that because you want to protect the new Omega-3s that you're putting in. See that? That's a relative versus an absolute deficiency. So this person is already low in antioxidants that protect lipids, but you're going to make that situation worse.

Now, another way of saying it, I could say it backwards. Is if lipid peroxides was normal, let's say that this was normal, but you had low Omega-3s, would you give, would you give antioxidants? Yes, you would have to give it, right? Because lipid peroxide is being normal with low Omega-3s doesn't mean much. You see what I mean? If the Omega-3s just come up to normal, it's very possible the lipid peroxides are going to be too high. You see that all the time, all the time. You'll see normal lipid peroxides with really low Omega-3s. That's a problem just waiting to happen. If you just give the threes without protecting them, you run the risk of it being a problem. This was a little more obvious because this particular patient had the low lipoproxides already.

Okay, so we got a few more minutes. Let me go back to the program here and see if we can kind of wrap up a little bit here. So I think that this may be good. I hope you guys learned something because I think there's a couple of things going on here simultaneously which I wanted to talk about. One is just like, big, the biggest picture possible body systems and how you're going to orient yourself around treating them. And then there's the idea within the body system, like, are you going to treat pathogens first, the gut first, the gut lining first, or the microbiome first? But having a clear sequence that you always follow. Can you do multiple at the same time? Yeah, you could do multiple adrenal, neurotransmitter, and mitochondrial programs all together very successfully. But doing taxing, demanding programs side by side together, not so great. Killing them pathogens and aggressive detoxification of chemicals and heavy metals can make people sick frequently. And then they're the pairings. Adrenals and GI, beautiful. Neurotransmitters and detox. Now, that's an exception. Those two work so well together. In fact, I would you'd almost always want to do them together. Um, if there's a neurotransmitter problem, you almost always want to do some sulfur-containing amino acid support for the brain. You want to protect the brain as you're building up the neurotransmitters, just like you want to protect the gut as you're building up the adrenals, just like you want to protect the mitochondria as you're doing all the, you know, things for glutathione and methylation and all that. So, okay, those are the kind of the natural pairings.

All right, and let's go back here and we'll wrap up. There's a few questions and let me also tell you what's happening. Where am I? Bingo. Bingo. There you go. So now for those that joined us late, we have a couple of special things coming up. I just go through the classes that you guys could come into if you are so interested. Number one, we have our mentorship class starting in June. That's our one-year full-on lab interpretation training program. You want to be an expert at this stuff? You go these classes every week for a year. You just end up really, really good at this. It's like the black belt of functionalness and interpreting labs. People graduate. I should give out black belts. That's kind of a good idea. We have long haul syndrome. If you're not ready for a full year commitment yet, you know, I really want to do that. These are two-month classes just to learn a ton, and you'll be able to use this with every patient because everybody has long haul now. Super big problem. If you're not using Rupa, you should use them.

And then somebody asked specifically, is there a female hormone boot camp coming? There is a female hormone boot camp. It's not on our schedule yet, but it's going to be here in the summer, and it's a brand new one. And I'm integrating female hormone lab interpretation with the markers that are gut-related but have to do with hormones, like beta glucuronidase, and the markers that are detox-related but have to do with hormones, like methylation and COMT. So it's all about female hormones, but it also branches out into the gut factors that you need to address to correct female hormones and the detox clearance factors that you need to address. So I tried to make that one like a comprehensive female hormone class. It's a boot camp. It's going to be like a two-month thing, and we'll be promoting it probably in the next few weeks because it starts in the summer. I think it starts in August or something like that. Okay. And all the boot camps, well, the short, short boot camps are like one month long. The more robust ones or advanced ones are closer to the two-month mark. And then there's a few that I've built. I think really just one that's three months long. There's a crazy one. And those, you, they just are like crazy and obsessed with this stuff. There's one that we are coming out with. I don't know why it's going to be released, but maybe in like two or three months, it's going to be a three-month one on depression, chronic fatigue, hypo metabolic states. It's all the amino acid stuff. I think we turned that into a three-month class because it's like 16 years of information put into that one. I overbuild all these classes. Have you ever taken one of them? You kind of know what I mean. I would build them with tons of stuff because some of you guys get through it all. Most people don't, but that's okay. Um, I understand that some of you have time constraints, you can't listen to all the lectures, but we try to build them pretty robustly, right?

Okay, I think we're going to wrap it up for now. Thank you guys for participating and showing up, and I look forward to connecting with you the next one of these. Okay, all right. Bye for now. Thank you.