Advanced Liver Detoxification Lab Analytics

Good evening, afternoon, or morning, depending on where you are. If somebody could raise their hand so I am sure that my sound is working, that would be very helpful. Thank you, Grace, Gary, Michael. All right.

So guys, we're gonna have a kind of a hot topic here. This is sort of advanced liver detox lab analysis because, what the heck, the basic stuff is so basic. You guys should know. If you're not familiar with these advanced ideas, you should just jump into them and understand them. So I'm gonna do like a few PowerPoint slides and mostly focus on lab analytics and program design. And so, I don't know, I think it's just like we've all had enough PowerPoint lectures on me. And but, you know, just some slides so you kind of get some orientation and we have an understanding what we're talking about. But then I want to try to focus on program design and and the lab analytics as much as humanly possible. And this is basically how when you sign up for my one-year mentorship program, we look at things every day in this exact same light. In fact, I'm gonna use a whole bunch of case studies that were just submitted, you know, the last week or so to class so you guys can see what classes were like so you can sign up.

So if you're new to me, new to this stuff, this is me. I'm Dan Kalish. I've had a big year, you know, big couple years. So I'm now I've joined the IFM faculty as the head of their practice implementation program. I've been onstage at every IFM module, every week-long event for like last year and Chaos Institute in the house' booth at every IFM event as well. And we're just going full guns partnering with Institute for Functional Medicine, which is a dream for me. Right? This is like a local college professor getting a job at Harvard University. Never thought this would ever happen, but it's happening. And so we're also collaborating together, IFM and myself. I'm like the Chaos Institute on the my practice plan class, which is a wonderful thing. And we, as a matter of fact, started a new group yesterday. And I'll just show you guys that real quick. This is interesting stuff. You should know what's happening in the industry if you haven't run across these things yet.

So if you go to my website, you'll see there's a one-year mentorship, which is what we're talking about tonight. But then there's a my practice plan class and IFM collaboration. And it's about business and legal strategies in setting up, maintaining functional medicine practices. Somebody is really excited about the collaboration. IFM doctors that I work with are the most amazing human beings in the world. And I really mean that. It's absolute joy and a ton of fun. And you learn so much working with the people who are at the top of their profession. So that's a great thing.

For tonight, however, we're gonna focus on sort of the nitty-gritty of interpreting liver detox pathway markers. And I want to kind of focus on the things that are maybe a little subtle that you might have missed, you know, or never got explained to you properly. And certainly, I've been in that position myself where I was like, "Hey, why didn't I know that? Someone should have told me that like 25 years ago." So we're gonna look at the lab markers for liver detox on organic acids. We're gonna look at the detox systems and how the important marker sulfate can be interpreted and what that means with sulfate. And then we'll look at some program design related stuff, okay? So that's kind of the goals.

And so I'm going to start off by showing you a little bit about the labs themselves. Then we can do some slides. But there's two labs that you guys are probably familiar with and see every day in practice. And I just want to show you the similarities, right? So one is a Nutri-Eval by Genova. And this particular lab, we're gonna cut down to the parts that matter for today, just show you the markers that we're gonna focus on for the. Again, this is a Nutri-Eval from Genova. Nutri-Eval from Genova. And all the lab companies give you these, what do you call it, like scenarios or synopses or, you know, they give you like little hints about what's going on. But we really need to be able to read the lab itself. You don't want a computer telling you what to do with your patients, right? That's kind of. So it's a little confusing, but we're going to show go through this a couple times so you see here it says bacterial dysbiosis markers. Bacterial dysbiosis markers. And now you're thinking, "Well, I'm in the wrong class." All right, because we're talking about liver detox. Well, there's two of the more important liver detox markers are in this section, bacterial dysbiosis markers. Yeah, these are liver markers hiding. Benzoate and hippurate are, as they say on this lab form, this lab report, benzoic acid and hippuric acid. So just remember this, you should actually write this down somewhere. Probably get a pen out, write this down. Benzoic acid and hippuric acid are bacterial markers. Yes, but they're also reflective of liver detox capacity, okay? And we'll get into the detail on that. But you should remember that. So you can get a lot of information on someone's liver function based on benzoate and hippurate or benzoic acid and hippuric acid. Now, I'll explain why that's the case in a minute, but I just want to kind of throw that out there because this is like sometimes you will see labs where the liver markers in the liver marker section are all fine. And then these two will be your main clue that the problem is in the liver, okay? So this is super important. I'm gonna say it one more time. Benzoic acid or benzoate, hippuric acid or hippurate are markers for liver detox capacity, as well as being markers for bacterial overgrowth, okay? And we'll get into the details on that. And then I'll just want to throw that out there.

And then let's look at the other section that's more obviously named toxin and detoxification markers. So that one's a little more obvious, right? That there's four markers in that section that relate directly to detox capacity, okay? So that's important. And of course, the B vitamins are related. A lot of this stuff is related, but we're trying to kind of hone in on the super important parts. And then there are some amino acids we should just know these kind of off the top of our head that it directly relates to detox, right? Alanine comes to mind, maybe taurine as well, glycine, right? So those are ones that you know, you're going to think, "Huh, pretty strongly related to detoxification" in case you're doing some more advanced lab work with all the amino acids, okay? So let us do that. And then we'll get into detail. I'm just want to show this form so you guys can see what it looks like on your Nutri-Eval. And then I use this other lab from Genova for teaching the classes, but I want you to see that there's some overlap. So the one that I use is the organic acids profile from Genova. And they look like this. Again, it's Genova lab. It's the organics profile. It's a little different than the Nutri-Eval, but very, very similar, okay? And on this particular format of the same test results, what we're looking at again are, remember our hidden ones, the ones that are liver-related but they don't tell you that that's going to be here. Your benzoate and hippurate. Yes, these are bacterial markers, but they're also detox markers.

So let me explain a little more detail. So benzoate and hippurate are urinary byproducts of polyphenol consumption. What that means in regular English is that when you eat fruits and vegetables and you consume polyphenols, which are good for you, the bacteria in your gut feed on these polyphenols and they make benzoate, hippurate, they make all these here phenyl acetate, phenyl propionate, para-hydroxybenzoic, para-hydroxyphenyl. Has phenyl in the name there. Those are polyphenol derived. So if you eat fruits and vegetables, you will make more of all these here. This is a good thing, right? Because you're eating fruits and vegetables, you're having your polyphenols coming from your food. So these markers go up. What you want to see these markers is in the high end of the normal range. So the high end of the normal range, that doesn't mean that they're a problem. That's not a dysbiosis. The high end of the normal range is, "Congratulations, you're eating a lot of fruits and vegetables. Good job." You know, happy to see that happening, okay? Well, that's not what we're talking about tonight. We're talking about benzoate and hippurate. So the pattern with benzoate and hippurate is, if you ever see a benzoate level that's really high, if you see a high benzoate and the hippurate is normal or low, okay, benzoate is high, hippurate is normal or low, that's a major liver detox problem. Why is that? Because the body takes benzoate in the liver and breaks it down into hippurate. So if your, again, this is if the benzoate levels are very, very high, hippurate should be very, very high also. And if benzoate is high and hippurate is not high, it means that there is a problem with the liver, okay? So that's our hidden liver problem. In addition to that, the organic acids test from Genova has these detox indicators here. And there's six of them: methylhippurate, orotate, d-glucarate, alpha-hydroxybutyrate, pyroglutamate, and sulfate. That's kind of confusing that there's six, but this is break them down into sort of simple categories. So these three here are all doing the same thing. They're all telling you what is the status of this patient's glutathione. I'm going to say that like 16 times. This is the most important thing about this entire lab panel. Where's my book? Oh, I don't have my book with me. I get panicked. Keep it on my book. Anyways, I pretend that I'm holding up Richard Lord's book here. So I talk to Richard Lord every Monday for many, many hours. He is the scientist that developed these tests. This was his brainchild 35 years ago. He sat down at a bench in a lab in Atlanta and said, "Wow, would it be cool if we could test organic acids?" He made this happen. He's the original scientist that developed this. The Nutri-Eval is an outgrowth of his work. The ION panels are an outgrowth of his work. The GI FX is an outgrowth of his work. And now he and I work together really intensely. We're doing all kinds of projects. And one of them is just to get me up to speed on these markers so that I can teach. So this is directly from Richard Lord, who's the guy that wrote the book on this stuff, right? These three markers here are there because glutathione is super, super important. And Richard wanted to check glutathione levels three different ways. Any of these markers being off is a sign that there's a problem. To define the single worst thing that can happen on this test, according to Richard Lord, is that you can have low sulfate. Okay? Low sulfate means that your glutathione system is collapsed. That is like a car with an engine failure. That is like a rocket ship that blows up. That is not a good thing.

When my son turns 16, and I'm not saying this is a good thing that I did this, okay? I got him. Well, we went out and we bought together, pretty much. He had some money saved from his grandmother, but we basically, I paid for most of it. We bought a 1964 Thunderbird. This was totally his idea. You know, he was like, "Dad, I really want a T-bird." And I was like, "Oh, yeah," because he knows I'm a sucker for cars. So we went ahead and we bought him this 1964 Thunderbird. Here. And well, and and that's the story's a little more complicated than that because there was a momentary lapse of parenting on both his mother's part and my part. So usually I would say things like, "How up is a T-bird?" And his mom would go, "That's insane." No, but for some reason, we called his mom and she said, "Okay, get the car." So we bought this 1964 Thunderbird from a father and son who, you know, grabbed it out and they put like a racing motor in this car, okay? So and the, I guess, is it really? I know there's so many levels of bad to this, but anyways, this is what happens to choose story. So my son is driving this car for like maybe eight or ten months. And clearly, you know, who knows what's happening in his 16-year-old mind when he's driving this thing around. But, um, he finally did something which I don't think he ever fully will admit to. And the engine blew up, okay? And then the car just ceased to move forward and is, you know, been happily retired to a junkyard somewhere. So anyway, that was catastrophic failure, right? That was like this car is just not ever gonna work again. So, you know, it could have gotten a flat tire. I don't know. The windshield kind of broke. Stuff could have happened that we could have fixed. With the engine blowing up, Thunderbird gone forever, okay?

So if you're thinking about your liver, okay, the worst thing that can happen in a functional medicine situation for your liver is that sulfate can be low because glutathione is collapsing. That's like the engine blowing up in the car. This is not a good thing for your liver. And it's a single most important marker on this entire panel, okay? If it's low, if it's high, that's another story. High is not so great. Low is catastrophic failure of your glutathione system, okay? So right off the bat, we this patient has a problem with glutathione. Super, super important. And those are the two most important points, I think, for the whole class. One is that you can use benzoate and hippurate to find these hidden liver problems. And the second is that sulfate is the most important way to track how poorly the liver is functioning. And if your glutathione levels are really kind of scattered and failing, then you got a pretty serious problem on your hands for that patient, okay?

And then I'll mention one other thing and then we'll look at some other stuff, which is that as soon as you see that there's a problem with the liver detox markers, you want to immediately look at the brain markers and see, is there also a problem with neurotransmitters? Because obviously, if you can't clear toxins, many of these toxins are neurotoxins, and they're going to damage the brain. So immediately, you look at the brain. And then right after that, you should look at the mitochondrial markers because again, if you can't clear environmental toxins effectively, it's very likely you could have damage to the mitochondria, which is also a pretty serious problem, okay? So and if you want to kind of do a graphic image on that, let me show you here. Where is it? Here we go. Sorry, I got a bunch of windows open. This is the one I want, though. So another way of thinking about what I just said is, oh, wait a minute. I'm on the wrong side. Show it's right here. There we go. Yeah, another way of thinking about what I just said is that if you have a detox problem, the first thing you should think about is checking the neurotransmitters. Are there toxins that are impacting the brain? The next thing you should think about is, are there toxins that are impacting the mitochondrial systems or energy production? Either of which could cause depression, fatigue, all kinds of symptoms that we see every day in practice. So a toxic person could have neurotransmitter problems, could have energy problems, or mitochondrial energy problems, okay? It's that simple.

So when I get these tests back, which I do every day between the time that I teach and the time I work with patients, first thing that you want to do is look at that sulfate marker. Just get scanned right to that sulfate marker, kind of get yourself oriented. And if you see that this is low, you've got a system, detox system, a glutathione protection system that's faltering severely. Look at the brain markers, look at the mitochondrial markers. And so you start to see how that toxin buildup has impacted that particular person. And all right, so that is one idea. And then I'm going to mention one more time. Actually, let's just look at a different example. Let me pull up a better one or a different one. These are all from classes. This is how much fun you could be having if you're in the training program right now. You'll be going through your own patient cases over and over again. You should take the class. This is my subtle product placement. All right, let's see. Here's another class from this week. Here's another lab. And let's just look at this one real quick. So now, remember we talked about, okay, first thing you want to do, kind of stealthy, look at benzoate or benzoic acid, look at hippurate or hippuric acid. Now, this one, the benzoate is low and the hippurate is borderline high. That is not a liver problem. Remember we said the opposite pattern is when the liver is an issue. It's benzoate high and hippurate is either normal or low. That's a liver that's not clearing toxins effectively. And that's a glycine deficiency. It's a difference in efficiency of glycine specifically. So this is not the case in this patient. But if benzoate is high and hippurate is low, you got a major problem in the liver. And you're going to see those in some cases where you don't see the other liver markers. Then you can look at this person's sulfate. There, if sulfate level is fine, they don't have that total glutathione collapse. But this marker is not doing that great. So the liver is in a little bit of distress, but not as bad as the last person, okay? All right, so those are the two big points.

Let's look at some of the bigger picture slides here and then we'll keep going back to the labs. So, um, as we're going through the labs and we're trying to figure out patient programs, we're always thinking about, you know, where the, where's the patient coming from? Where are we coming from? We're coming from underlying cause detection, right? In this case, today, we're talking a lot about toxins, heavy metals, this kind of stuff. Patients are coming at this from a symptomatic standpoint. They're fatigued, tired, or depressed, and they want to figure out how to solve that. And so we want to sort of make sure that we're addressing both the underlying cause and that we're treating symptoms. To what I find works the best is that if you accommodate to the patient and please what their, you know, make their needs met, get their needs met, as well as meeting your needs. And so you don't have to just treat underlying causes. You can treat symptoms at the same time. In fact, when you get really good at functional medicine, you can switch back and forth and do them both. And then we always correct the body systems in the order in which they, the problems occurred. We're talking about detox now, so oftentimes that's saved for last. But in this case, we're just jumping in right away, okay? So what works the best in my experience is not if you start, you know, is to avoid starting someone on an aggressive detox that makes them feel really sick the first couple weeks that they're seeing you. What works the better, better usually is to work on the neuroendocrine system first, work on their adrenals, their mitochondria, or their neurotransmitters, or if it's a woman, their female hormones, and get a boost, get a, you know, a really major one or two month boost of energy and feeling good. And then go after the detox pathways. So even though the detox issues may be primary and more important, you want to get the person feeling better for a few months and then put them through the rigors of detox, okay? If you do it the opposite way, it doesn't work really as well. You won't get as good patient compliance. Once people are feeling better and they start to trust you and they trust functional medicine, they're much more likely to stay around.

And so we're going to talk about Phase 2 detox pathways and the oxidant protection and the methylation as well. Oh, that was fancy. Look at that. So there's a million different toxins out there. Actually, there's something like 80,000 different chemicals, I think, that they've been able to track that we've dumped into the environment. Pretty much every person that we work with has some level of body burden, whether it's lead or mercury or cadmium or xylene or toluene or DDT, you know, pretty much every human being on this planet now is saturated with 100, 200, 500 toxins that are in their system. It's just the way it is for all of us on the planet. And you can't really escape it. It doesn't matter where you live or what you're doing. It's in the air, in the water, the food. And even if you try to go to the mountains of Colorado and live a pristine life, you know, you're still going to get exposed. So that's this kind of the state of affairs for the current world. And we're the practitioners, I think, out of all the practitioners out there, they're saying, "Hey, this is a problem. You know, we should be able to effectively test and treat these issues." You can get toxins through your skin, through breathing, through your food, obviously. There's a lot of different ways. The ones that we're really worried about most, especially, are the ones that are fat-soluble, okay? Because they're made to be fat-soluble, right, for specific reasons, and the manufacturers are wanting that to happen. But from a physical standpoint, in a health standpoint, these lipophilic or fat-soluble toxins seek out fatty tissue. Unfortunately, our brain is surrounded by fatty tissue, right? So that's not such a great thing. And there's a big problem with toxins impacting the human brain. And when that starts to happen, you take the chemical or the heavy metal, it comes in and hits the neuron, it starts to impact the reuptake ports and how the neuron is actually functioning. And eventually, the brain ends up kind of snapping in a not great way. Who is, you know, kind of at risk for this? In the last couple months, I've had this one patient. He grew up in a mortuary. I mean, not like he was living in the mortuary, but his family ran a mortuary. And from the time he was like, I don't know, eight or nine years old, he worked in the family business, which was the mortuary. So he was around formaldehyde and all kinds of chemicals preserving bodies since he was a child. I've had patients who, or, you know, grew up in a family that owned a dry-cleaning business, copper mines. You know, sometimes it's extreme like that. And you're like, "Wow, that's some pretty intense exposure." In other cases, they grew up, you know, in the Midwest in an agricultural area where there's a lot of spraying, or in a city in the West or East Coast where there's a lot of, you know, toxin environment, toxin exposure from things like air pollution. It doesn't really matter. The fat-soluble toxins are going to get into the central nervous system, start to cause problems, right? So that is an issue.

All right, we're gonna take a short commercial break and I'm going to tell you how great the mentorship class is. So we're starting a mentorship. I don't know when. Let's see. There's a slide on that. Let me see. I think it's November. Oh, it's November 12th. November 13th. We're starting a mentorship November 13th. It's getting to be a better and better class, it really is. So I'm teaching all of Richard Lord's work now on the GI stuff, on organic acids, heavy metal toxicity. We've got just the best group of doctors in the class. The software program and the actual structure of the course is really good. I'm just kind of peaking right now after 15-20 years doing this in terms of training doctors. We've really got this down to a system. If you want to expand a functional medicine practice, start a functional medicine practice, get away from conventional medicine, get away from chiropractic, get away from acupuncture, whatever it is, wherever you are, if you're a nurse practitioner or medical doctor, chiropractor, acupuncturist, we have a wide mix of people coming in who want to start or expand a functional medicine practice. And we're really, I think, doing a great job at that. I mean, I know we are because every year they just get amazing feedback from the students. So if you sign up for the class, it's a year-long course. You get access to all these lectures right away to get that go throughout the year. Then we have a very active community that has resources that are quite remarkable, hundreds and hundreds of hours of special topic lectures, thousands of case studies in here that are directly relevant. And then it's all protocol driven. So we're really trying to teach people how to do these programs in real time. There's a live weekly call where we discuss labs like we are tonight. And it's just an awesome group of human beings. I learned so much from the other doctors in the call. And the calls like last night, say, Thursday. Now, it's two nights ago, Tuesday night. We have, I mean, the first of all, the class went to be an hour and a half, supposed to be an hour. There's so many good questions and so many good labs. I just couldn't stop. And nobody in the class got off the call. It was just like, it's riveting. It was really cool to see patients. I'm going to show one of those labs in a minute, just cool to see what's going on with people and how to fix them with these labs. So anyways, it's a really good class. If you're thinking about doing it, you get $1,000 if you sign up for this group. There's a promo code VIP November 18. If you're thinking about it, but you're not really sure and you're on the fence, you can schedule a call with Mark Herbert, who's been with me for a dozen years, and talk to you about the course. And if things are really curious and you really want to know, you can schedule a call with me as well. And again, we have a last start date for this year is November 13th. And super excited to be doing it. And it's a great class, right? So if you're on the fence, just do it. Everyone loves the class. Everyone loves the class. Think people get a lot out of it.

All right, so let me show you. I should. I want to show you the one from yesterday because this is from Tuesday, I think it was in this group. No, no, it was in the evening group, sorry. Did I get that one? Maybe I didn't. I forgot to pull that up. I did. Hang on a second. Let me grab that. So when we do classes, doctors submit their cases with labs. And the whole class, in terms of the live part of the call and the live part of the class, is, you know, reviewing what they sent in. And then there's also the lecture portion. And then there's the online. Here it is. Then there's the, the community feature, right? Those are the three different things. So let me just show you this. This is just just came in on Tuesday night, but it's a really good example of what we're talking about. Let's find a case. So, okay. And doctors submit stool testing. They submit, you know, salivary hormones. Like here's David, one of our new doctors in the class. He submitted all these adrenal panels. And we just went over adrenal panel. This is a cool one. After adrenal panel, David just kept going. Here is another one from Dr. Dr. David, another adrenal panel. You know, it's awesome. Here, yes, again, David submitted another adrenal panel. These are all his patients. He's getting so into this stuff. So, we did that for a while. And then let me just show you the one that's relevant for tonight, though. So this is again, we've obviously focusing on organic acids. But let me show you here. So this is from John Z and his group. He's an allergist on the East Coast. So this patient, 22-year-old student on Zoloft, gabapentin, Prevacid, Flonase. Another really great way to start life. Anxiety, OCD, GI symptoms, and allergies to foods, allergic rhinitis, lost 60 pounds in six months. That's not good, huh? Afraid to eat. Celiac disease, Crohn's disease. And the doctor is asking, "Hey, what's up? What do you recommend?" It we talked about this on Tuesday, the diet plan to reduce patient anxiety with food, with food choices. So let's look at his detox pathways. This is the organic acids again. And this again, it's a fresh case, just from Tuesday. And this is a young guy. He's a 22-year-old guy. So check this out. This is scary stuff. You know, this kid has got low sulfate. Remember we said low sulfate is the worst thing that can happen on this lab. Extremely low, 400. Okay? His pyroglutamate also low. Alpha-hydroxybutyrate underneath the detected limit. Remember what we said earlier? All three of these are markers for glutathione status. All three of these being low, it's just an absolute disaster for glutathione. It's as bad as things could get for your liver from a functional medicine standpoint, okay?

So now let's go up. Now, remember we say, "Okay, wait a minute. If sulfate is low, where are any of these glutathione markers are low, we're thinking brain, mitochondria, brain, mitochondria, brain, mitochondria." So we go up here and we look at the neurotransmitter markers. And oops, extremely low also with his epinephrine and norepinephrine, okay? So that's a brain-related issue, perhaps partially being triggered by the neurotoxins, remember the neurotoxins that are damaging the brain. And then we look at his mitochondrial markers. And it's a little bit beyond the scope of today's class, but let's just say that a lot of them are low. And it looks like his mitochondria are not doing very well either. So we go back to my little schematic thing here. And we've got a, not sorry, where'd that go? We've got a, now a real-life example of what we were just talking about, which is a collapse of the glutathione detox system impacting the neurotransmitters and impacting the energy levels of that person. So then how does that play out in human terms? Like, what do people experience when that's going on? Well, funny you should ask, because we have a young 22-year-old guy that's going through this right here. And how is his world affected? What is this like in human terms? Well, it sucks, man. Okay? You've got anxiety, OCD, you know, allergies. When the liver doesn't work, all these things are going to happen because the liver is shutting down, the brain's not working properly. And, you know, you get a 22-year-old who's just not doing very well, just not really in the world and the way that he should be. He should be having fun and drinking too much on the weekends in college and not, you know, freaking out because these other things are happening health-wise, okay?

So let's go on into a few more PowerPoints. Okay, don't forget about the class. That's my reminder there. So when we look at these labs, you want to always consider Phase 1 and Phase 2. We're going to talk tonight almost exclusively about Phase 2. That's the sulfur-containing amino acid system, right? That is, you know, supports glutathione. So we don't just want to mention Phase. Well, I don't forget about it. Phase 1 is important. I'm talking mostly about Phase 2. And that is the nutrients related to Phase 2: glycine, taurine, glutamine, and N-acetylcysteine, cysteine, or thiamine. These are other sulfur-containing amino acids that eventually lead to glutathione production, right? And so the reactions that are occurring, if you get into the sciency stuff, sulfation, glucuronidation, glutathione conjugation, all that kind of stuff, right? But what we're concerned about really is the treatment side of this, which is going to be the amino acids. And then of course, if you think about it, when you have a lot of these toxins, they can cause weight gain. Why? Well, if they damage the mitochondria, mitochondria, what are controlling our metabolism? Yeah. So let me say that again because that's not always intuitively obvious. If you have a problem with something, if you have a problem with something like this kid here, he's a bad example because he's skinny. Let's go to, let's go to someone else. If you have a problem with excessive toxins and those toxins are damaging the mitochondria, and you see that under the energy production portion of the lab, that means by definition that the metabolism is damaged. And that person is not going to be able to break down fat properly. They're going to get overweight. It's gonna be a, you know, some kind of weight-related problem, okay, as a result of an environmental toxin impacting your mitochondria. Similarly, we already said there could also be environmental toxins that damage the brain. And you're gonna see that on the neurotransmitter markers, okay? So toxins cause weight gain and fatigue. That's kind of a fancy way of explaining that toxins prevent fat burning and damage the mitochondria. And those are the ways that, you know, we can analyze this pretty sinister, pretty straightforward way. But these other detox markers, not going to talk about too much tonight. Got the issue with the mitochondria again being damaged by toxins or oxidative stress, if you want to call it that. And eventually, that's going to affect everything from liver cells to the carnitine shuttle. It's all this good stuff.

So let's look at another couple of lab examples here. And then we can start to design some programs. Also, I'll pop this one up real quick. Oh, wait a minute, wait a minute. Let's go back to the 22-year-old guy. Sorry, I'm over the map here, but here we go. There's one other point I, when I use based on this guy. So remember this, our 22-year-old with anxiety, OCD, but remember diagnosed with celiac disease and Crohn's. Celiac disease and Crohn's. So when you look at this poor guy, he's got all these low levels across the board here. So when you see a large number of low levels of the B vitamin markers combined with a lot of low levels of the mitochondrial markers, like energy production markers, you want to start to suspect damage to mitochondria and the lack of mitochondria. So we usually think about these markers as when they're high being a problem. But when there's six or more of these markers low, there's gonna be an even bigger problem with not enough mitochondria. And that has its origins in a lack of freeform amino acids to make the mitochondria, as well as a bunch of other stuff. So anyways, this guy needs freeform amino acids to rebuild his mitochondria. He needs amino acids to bring up his neurotransmitters, right? Because he's got a problem also with the brain, which is related to amino acids that help us make neurotransmitters. And he's got, remember these three levels here that are low that have to do with amino acids that regulate the liver detox pathways. So he's got a problem with freeform amino acids in the mitochondria, amino acids and the neurotransmitters, and amino acids and detox. Does that make sense for someone with Crohn's disease and a celiac diagnosis? Absolutely. That's, remember he's lost 60 pounds. That's malabsorption, okay? So gut malabsorption can trigger all of this. Can trigger the liver detox pathways failing, the neurotransmitter production failing, and the mitochondria failing. That is important. That's just another way of saying gut is important. And this poor guy, it makes sense that he's got these many problems, doesn't it? You know, you really start to think about, all right.

So let's find one more situation here. Here's a stool test, H. pylori, some bacterial markers, not so great. But that's here. Let's see. We can find a, look at one more example. And again, you can, this is from the Nutri-Eval. I just prefer the format of this test and they're much more familiar with it. But you can, you can make the correlations with the Nutri-Eval as well. And they have just slightly different names for everything, right? So like on this test, they call it benzoate. The other one is benzoic acid. On this test, it's separate. The other test, it's hippuric acid. Very, very similar. So this, so this is a nice one to look at. It's a little different than the others. So here's our sulfate marker, right in the middle, right where it should be. So that is not this glutathione collapse. There's a low pyroglutamate. So there's some problems with liver detox, but not as bad as the last person. This is borderline high methylhippurate. Some chemical toxicity potentially. Methylhippurate is a marker for chemical toxicity. So there's a liver problem here, but not nearly as bad as the last one that we saw. And it's going to show one more. Here's another stool test from a different patient. And let's get to the good stuff here. Here we go. Then this one's kind of in between. You can see the sulfate marker is heading low, but it's not quite low yet. Our glutamate is good. This one's on the low side. So, you know, not great, but not horrible. And also, remember, if these markers are high, it indicates liver, you know, stress on the liver as well. Not as severe as if they're low. They're low, it's a much bigger problem. And I see that's it for all those.

All right, so let's go back. Do a few more slides and then we can look at some more labs. We have time. Yeah, we got like another 10 or 15 minutes. So let's keep going. Hopefully, this is helpful. Kind of reviewing cases. Then I'll give you a little mental break here. Look at some slides. You can go get a snack if you want, relax a little bit. So methylation also involved in this. We want to make sure we have adequate B12, folate, and B6. Can't tell you how important those are for all this. Who do you want to test? Well, everyone, of course. And let's look at one more example here. They have, you know, that's not the one that I wanted. I'm gonna go back over here. So again, I want to just give you a quick little tour around the Nutri-Eval. So remember these markers are almost identical. They just have slightly different names. So likely cause, xanthic, xanthic, xanthomic acid, and the other one is xanthate. Methylmalonic acid, the other is methylmalonate. Glucaric acid, glutamic acid, the other is glucarate. You know, so they're basically orotic, orotic, orotic acid, the other one is orotate, okay? So they, you can, you can, if you're doing Nutri-Evals, you can kind of translate this over if you have to. Okay? But let me show you another example here. This is one I've been looking for. So there's a great one. Look how, look at this. This is phenomenal. So this, this, this dissect this real quick. So you have quintiles. You have the 95% reference range. So this number in the outer column here, 9.3, is the 95% reference range. So the way they do all these lab markers, like every other lab in the world, like a cholesterol test or any kind of test, is they do a, you know, they get a normal patient population and then they test them and see, as a thousand people, and they get 5% of them are considered low. And then 5% are considered high. And then I'm sorry, two and a half percent are considered low. And two and a half percent are considered high, right? So the 95% that people fall in the middle. And so it's no different with these kinds of tests. They do a normal population study. And then two and a half percent of them are above, two and a half percent are below. And that's, and they make this nice bell curve like this, right? So when you see this number here, 95% of the reference range, it means that 2.5% of people tested were above this number here, which is interesting. 2.5% going to be low at the lower end. This patient had a benzoate of 91. Remember the cutoff is a 9. So imagine, and this is the way I try to explain to patients, imagine that you're at a cocktail party for your, you know, your fifth grader's graduation from fifth grade or whatever. And you're talking to the other parents. And when a parent says, "Oh, you know, my daughter is in the 95th percentile for intelligence." And you're like, "Wow, whoopty-doo. So you got a really smart kid." And then another parent would come along and say, "Well, that's not much. My kid's ten times the 95th percentile for intelligence." And you would think that's statistically impossible. You're kind of stupid, right? So how can you have a number that's ten times the 95th percentile? Right? Only 2.5% of people squeezed over this number. How could ten? It's an impossible number, okay? So it's not something that's normal or typical. It shows that there's a genetic defect in play. So when you're interpreting these tests, and this is something you should write down, if the level of your patient is more than double the reference range here, this 9.3, then you're looking at a genetic condition because it's not possible statistically that that could be a number based on nutrient levels, foods that they're eating, etc. It's just too, it's insanely high. Again, it's like saying my child is 95, you know, is nine times the 95th percentile in intelligence. Lies, it's the number that's not possible. So this is a person who has a genetic issue or struggles with clearing benzoate. So the benzoate, it's building up. It's a ten times. It's 90. Why is it ten times that? In other words, if we were doing quintiles, we'd have to do like ten of them out here. You'd be going, you know, you'd be going like five feet over to the right to put this number on an actual chart or a graph that makes sense. So the numbers way the heck out there. So given that this is ten times the reference range to 95% of the reference range, the hippurate is that anywhere close to that level? No. It's at a 400 and the cutoff is a 1000. So this is an example of someone we can pick up a liver problem from benzoate and hippurate. So again, benzoate is in the liver metabolized or broken down to hippurate. If your liver's not working well, there's not enough glycine. Benzoate's gonna be high like this one, extremely. It's an extreme example. And hippurate will be either normal or low. So this is a person with a major liver problem related to glycine that may or may not show up on the other parts of the test. And so if you look at the detox markers themselves, you can see, oh, well, sulfate is up there. So you would have caught the liver problem anyways. But that benzoate and hippurate marker really gives you a higher level of concern. And remember, a high sulfate is bad, but a low sulfate is catastrophic. High sulfate is like a flat tire on the '64 Thunderbird. You know, low sulfate is like when my son was drag racing or whatever he did to that poor car and he blew up that beautiful engine. And it was the most beautiful engine to me. He lifts the hood up, it was all chromed and gorgeous with these huge carburetors. And it's gone now.

Let's see here. So let's do a little bit of program design now that we've had enough time to look at the labs. Hopefully, this is kind of sinking in a little bit. And let me just cut over to here. All I wanted to show you one more thing. Here's again, and what I was just talking about is in your liver, right? And your liver, your body takes benzoate and using glycine converts it to hippurate. Okay? So when you're looking at labs, sorry, it's kind of a mess here. Your lab, remember, your liver takes benzoate, converts it over to hippurate, and it uses glycine to do that. So if the benzoate is high or astronomically high like this one, and the hippurate is not coming along, then you know you've got a problem there. And let me just show that one more time. This is not written down anywhere, you know, the lab reporting never says this. Benzoate is high, hippurate is not. Glycine is what's converting benzoate into hippurate. So we know they have a glycine problem. Nicolle in the liver, which goes right back to Phase 2 or state, you know, Phase 2 liver detox.

So a little bit of program design. And we talked a lot about this already. We're worried about, that's like, let's do a quick program for our 22-year-old kid that's got the problem, right? So get a little program pro thing together for him here. And we want to do some liver support. So the easiest thing to use is NAC or and

Acetylcysteine, you may have other products that you prefer more, but that's a good solid one. 500 milligram capsules is sort of typical, and you want to give a pretty hefty dose, you know, probably a thousand milligrams three times a day.

And then you want to do some kind of herbal support for the liver. And, you know, those they have usually silymarin, UNAM, or turmeric curcumin type products, right? They may have a bunch of B vitamins, other herbs, so some general herbal support that's tonifying and strengthening for the liver. One of those products, a few of those, so the liver is supported in its effort to do all this work.

You need a little bit of antioxidants to run phase one, so some kind of combination formula for antioxidants. And most of all these companies we work with will have a detox antioxidant kind of thing, or, you know, broad-spectrum antioxidant formula. Those are usually pretty potent. I usually keep the dosages of those a little bit lower.

And then, um, C, depending. I mean, and I'm trying to do these in the order of importance, right? In case you can't do all of these things. So, anti-co 16, and that's going to raise up the glutathione. Oh, you could use glutathione itself if you're into it. I don't use two minutes go to the thigh because it tastes so bad, and the liquid forms and the pill forms don't work so well. So I just put a question mark by that. You could use that if you wanted.

And then we're going through our list of what the liver needs. And then you have to have a fair amount of B vitamins to make all this work. And that's going to include folate, B6, B12, and whatnot, right? Thought, thought, thought. And usually the way I handle that is with like a multi-pack type thing that'll have the bees and minerals and antioxidants in it. Okay.

And then if you're really going to push a person to detox heavily, then you need some kind of binding agent. And there's many of those. I just had a patient today, psyllium. She's loving her psyllium. She like, "Dr. K, every time I take that psyllium, I feel so much better." And I was like, "Wow, that's really nice. That was the simplest solution to ever come up with." Apple pectin fiber, some people like more. I went through a stage of diatomaceous earth. I was giving everybody the information. Sir, if that's kind of cool. So some kind of binding agent that's gonna, you know, grab that toxin and help the person pull it out.

And then the other thing that you can do, and I do this a lot, is a combination sulfur-containing phase two liver support product. Every company that we work with has these. And then some K, you can use the pure in acetylcysteine, you can use the combination product, you can use them both. I like the combination products. I usually, those people are really high on these because it covers a whole spectrum of the of the nutrients that we're talking about.

So let me just show you real quick. I mean, here, can I go back to the liver slide? There we go. So, you know, the one way to do it, I mean, and there's many ways to do this depending on what your personalities like. One way to do it is just with the n-acetylcysteine alone. That's great. I like to use combination products, and they will have typically some glycine, some tarring, cement acetylcysteine, so I'm assigning some cysteine. So those are the ones that I use almost exclusively. So I'm hitting all the different pathways, not just with the in the sealed cysteine, or you can use both and the co-cysteine and a combination product. And then, of course, you need the B vitamins mentioned over here, and then the antioxidants to get these other aspects of liver detox working. Okay.

Then what's not superimposed on all this is the fact that what makes phase one and phase two work? What's the fuel that drives them? ATP. How important is ATP? Well, if we have time for this. Yeah, we do. So everybody, you know, sit up straight, stand up, whatever. We're all sitting for an hour, and my back is stiff anyways. Take a deep breath in. It'll blow your breath all the way out. And then hold it out. Don't breathe in. Hold it out. See how long you can hold it out. Oh, it's hard. Is it? Okay. So holding your breath. Why do you think? A breath in and hold it. Breathe out and hold it. The reason why you can't do that for very long is because you need the oxygen to make ATP. And if you don't have oxygen, you don't make ATP. You really, really, really need oxygen. You really, really need ATP to function, right? And one of the major things that the ATP does is it runs your liver, as well as your heart and your brain, right? And you really need the ATP. So that's right back to mitochondria. Okay, you gotta have mitochondria.

So there's three nutrients on that in that regard. And you should just keep these in mind if you have a liver patient, the liver case, detox case, you look at the mitochondrial markers. And then there's three things to consider for the mitochondria that are of utmost importance. This is not a mitochondrial class. We're not going to talk about everything, but I just want to talk top three requirements for mitochondria to make mitochondria work. Okay, top three. Again, it's not a mitochondrial class, but you just should know these. Number one is magnesium. Number two is CoQ10. And number three is oxygen. So magnesium, you give them magnesium. CoQ10, you give them CoQ10. For oxygen, you give them breathing exercises. So if they're struggling and the liver is not seeming like it's doing well, or if you see evidence for this in the mitochondrial markers, then magnesium, CoQ10, and oxygen. Oxygen is done through breathing exercises. So you get some lifestyle changes me built-in there. Alright.

And then here's a go of the program again. And I see those 16 for that low sulfur resolves that problem. Some kind of herbal support just to make the liver a little happier. I mean, livers work hard. You should have some kind of silymarin or turmeric product or some combination liver product. And antioxidant formula, just so you keep phase one buzzing along there. Glutathione, maybe. I don't use it very often, but you can for sure if you want. Obviously, we're trying to correctly to fly on. We're using the an acetylcysteine, which is a precursor to glutathione, to get it back up. But you could use the glutathione itself. In fact, a lot of people do, and maybe it's a better idea. You can totally fine with that. B vitamins, especially folate, B6, and B12. I do that in a multipack sometimes with some extra B's. A binding agent to grab the product. And then I like the combination sulfur-containing products, sulfur amino acid products that again, what they have glycine, tari, methionine, and the sealed cysteine, cysteine, no combination. And those people really high on those to crank up phase two. Alright.

Let's see where we're at here. Just about time. If there's questions, you can raise your hand. I'm going to review the big concepts here. The labs are complex, but you start to get into this more, you'll get to understand them better and better. I want to start to get people to think about testing like organic acids in a systematic way so you don't get overwhelmed. Okay. And let me show you. I don't forget, we got a class starting. Let me show you a little bit more about that real quick. So if you're doing neutral valves, you just have to translate everything that I just said into this other language, but it's not as bad as it sounds. Like pyroglutamic acid, pyroglutamate, or I can, I can't say, or Rohtak acid, or rotate citric acid, citrate, right? It's usually pretty obvious. And then the ones that we talked about because these are sleepers, you know, they're kind of hiding in here. Remember these are liver detox markers. Benzoate or benzoic acid, hip rate or hip uric acid. Benzoate being high with hip rate normal or oh, and here's this is actually an example. Benzoate is high, hip rate or hip uric acid is normal or low. That's a liver problem right there that you're staring at. Yeah, I know it's under the bacterial markers, but it's a liver problem. And I'm going to end on one last little thing because I think this is historically important. Yeah, they don't have sulfate on there. I don't know why they don't meet. I don't know why. I don't know why. See here, if someone's on a low sulfur program, you just have to work around that and and and do this in different ways. There's plenty of other ways you can support the liver though without doing this.

So let me show you. Hang on. Let me go back to the other testing because I get so confused looking at these. Put up, but let me just show you one other thing and we'll wrap up on this final thought here. So we end down time. This will answer some of your questions too. So all right, here's where it gets a little bit interesting. And this is a historical fact, historical occurrence, I don't know. So benzoate, hipper eight, phenyl acetate, if you know propria Nate, para hydroxy phenyl benzoate, and para hydroxy phenyl acetate. These markers here. Okay, boom-boom-boom, one, two, three, four, five, six. These six markers are all telling you about polyphenol consumption. So I'm going to look at this really carefully for a minute and see what these guys said when they're sitting down to write this report. Compounds of bacterial origin. Let's forget about the yeast because when this is not the yeast section. So compounds of bacterial origin. And remember, this was the original test before the neutral vowel came out. So back a hundred years ago, when there was a lab called Metametrix and the lab called Genova. Metametrix came out with the organic acids test first, then Genova copied them with NutraVal. And you can see this historically in the evidence here. Compounds of bacterial origin. Does it say dysbiosis? No. Does it say bad compounds of bad bacteria origin? No. Does it say SIBO? No. Says literally compounds of bacterial origin. And that's what they are. These are compounds of bacterial origin. They're showing you what the bacteria are doing with polyphenols. Now, it's confusing because these markers are potentially good, and these down here are bad. Like dr. bennett all is a marker of yeast or candida. That's bad, bad, bad, bad, bad. D-lactate is a neurotoxin. If that's high, it's bad, bad, bad, bad, bad. But these markers up here, the first six, you want to see them in the high end of the normal range. That says that the person is eating a lot of vegetables and fruit. Is that bad? No, that is really, really good. So these markers got distorted over time, and people started to think that, you know, high end of normal is bad, but it's not. Now, if these markers are in the abnormally high range, it shows you something going on with the gut that's not okay. But, you know, there's gonna always be another reason. It's not like they're eating too many fruits and vegetables, obviously. So there's a, you know, a mild dysbiosis is going on, if something may be along those lines. And if these markers are low, it means that the person is not eating enough fruits and vegetables. Let's say that again. If these markers are low, it means the person is not eating enough fruits and vegetables. You want to see these markers in the high end of the normal range. If a ton of them that are high, it shows that there's something going on with the commensal or normal bacteria. Okay, I don't even know if I would call it a dysbiosis. I think that's a little misleading, maybe not. I don't know. But you don't know. It's not like, you know, that it's Klebsiella or Morganella or something really potentially inflammatory. You just know that there's a lot going on in the gut. And you, you can't really treat these markers yet. If they're high here, you got to figure out what else is going on. You have to do some stool testing and figure it out. Okay. So again, if these markers, these first six markers are low, it means more fruits and vegetables. If they're in the high normal range, it means that your patient is healthy in terms of their fruit and vegetable consumption. If they're high, you better just look at more with some stool testing and try to figure it out. Okay.

Alright. And then a couple last questions here. If you've already taken the one-year course, would like to get updated on the new info, just from Tammy. Yeah, Tammy, you can just join the community. It's like $199 bucks a month, and you get access to everything that's new. Everything that's new. Let me show you real quick. And I've been working on this a lot. I mean, I've been putting hundreds of hours into this stuff. So this would be like a little teaser for you that haven't taken the class. But some people on the call right now, I've already taken my class. So let's watch. Show Tammy what the answer to that is. So check this out, Tammy. This is how crazy I am. You know, and when I was in high school in 1982, I graduated. Thank you. From Berkeley High School. And I was named in 1982, the craziest guy at Berkeley High. And that is true. It's in the school yearbook. I can prove it. And let's see. Clinical topics. So this is the community now that you get when you get the one-year class. And for someone like Tammy, who already took the class, for $200 a month, you can get access to this. So you go right over here and you look at these are all hundreds and hundreds of hours of stuff. But if you look under where we're trying to find here, or get organic profile here, these are all the new lectures on the new materials. Okay, that you can. And that it's just again, it goes on hour after hour after hour after hour of stuff. And each one of these is transcribed and written up. You can also do like cases. So if you search in here for a case, liver detox, it'll pop up. Case balancing phase one and phase two, buh-buh-bah. Case number 800 and something. Looking at this, 1200. Looking at this, right? These are all cases. And each one of the cases is transcribed and on video as well. And then we don't have any official. For Karen's question, we don't have any official agreements on CEUs for any groups. But there, I've had some students take this class and they worked out like with their acupuncture board or with their school that they got school credit for what I'm doing here. But we don't have any official relationships like that. The only real official relationship I have with is with IFM, and that's on the business course. So there's no CEUs available for that one. Okay. I think I got all the questions answered pretty much. And Susan, I think it is a bit of a mystery that the sulfate is not on there. I guess if you're doing neutral vowels, let me answer Susan's question real quick and we'll wrap up. If you're doing neutral vowel, is the best that you could do for the sulfur? I would, since they don't have a sulfate marker here and I don't see it anyways, again, I don't order these unless it's hidden in here somewhere and we missed it. But you could go to the amino acid section. This is not a great solution, but it's a, you know, a decent solution. You could go to the amino acid section and look for the sulfur-containing amino acid levels, right? So remember there with finding taurine, cysteine, all those guys, and see what's happening with the sulfur amino acids and if they're low, then you know there's a problem. But I don't know that that's as accurate as a sulfate worker. I'm not sure on the sea. Okay.

Alright gang, and I wrap it up for tonight. Have a great rest of your evening. I hope to see some of you in the class in November. Be the final class for the year, and we're hoping to fill that up and have a bunch of new, really great practitioners join us. So take care. Have a good evening. We'll stop soon. Take care.