Anxiety, Depression, Weight Gain, Fatigue: Applying Organic Acids...
Transcript of Anxiety, Depression, Weight Gain, Fatigue: Applying Organic Acids...
Dr. Daniel Kalish
Anxiety, Depression, Weight Gain, Fatigue: Applying Organic Acids Testing
in Your Practice
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
INTRODUCTION
• 24 years of patient experience, with over thousands of patients world wide
• Trained over 1,000 practitioners in The Kalish Method of functional medicine
• Conducted a research study with Mayo Clinic researchers on The Kalish Method
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
LEARNING OBJECTIVES
• Learn when and how to effectively use organic acid testing in your practice
• Learn how to assess the origins of fatigue, weight gain and depression in your patients based on organic acids testing
• Be able to successfully communicate the value of organic acid testing to your patients so they can comprehend its contribution to their healing process
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
KALISH METHOD TREATMENT MODEL
UNDERLYING CAUSE
BODY SYSTEMS
PHYSIOLOGICAL DAMAGE
SYMPTOMS
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KALISH METHOD TREATMENT MODELUnderlying Cause Physiological Damage Body Systems Symptoms
Emotional/spiritual (trauma/abuse/chronic stress/addiction)
Dietary (blood sugar, poor diet, nutrient deficiencies, dairy, food allergies)
Gluten
GI infections
Toxins (heavy metals, chemicals)
Genetics/Epigenetics
Structural (physical trauma, chronic injury, pain, posture)
Sleep
Exercise
Medications/surgery
Dental
Lyme, mold, viral or bacterial (SIBO, environmental exposure)
Inflammation
Catabolic Physiology
Insulin Resistance
Oxidative Stress
Neuroendocrine
GI
Liver
Weight gain
Fatigue
Depression
Anxiety
GI problems (gas, bloating, constipation, diarrhea, heartburn)
Sex hormone imbalance (low sex drive, infertility, hot flashes, nightsweats, PMS, PCOS)
Pain
Allergies
ADHD
Insomnia
Brain fog
Sugar cravings
Skin problems
AutoimmuneKalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
DOCTOR-‐ PATIENT EQUILIBRIUM
UNDERLYING CAUSE
PHYSIOLOGICAL DAMAGE
BODY SYSTEMS SYMPTOMS
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GISYSTEM
THE TREATMENT MAP
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GI
DETOX
NEUROENDOCRINE
STANDARD TREATMENT SEQUENCE
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PROGRAM DESIGN
New pa*ent intake
• Pains • Gains • Life Goals
Lifestyle tasks
• Food • Exercise • Sleep • Medita*on/stress reduc*on
Supplement programs
• Therapeu*c programs • Long term maintenance
PROGRAM DESIGN
FACTORS
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WHAT IS ORGANIC ACIDS TESTING?
“Unlike amino acids and fatty acids, the category of compounds called organic acids contains no essential nutrients. Instead of directly measuring nutrient concentrations, abnormal concentrations of organic acids provide functional markers for the metabolic effects of micronutrient inadequacies, toxic exposure, neuroendocrine activity, and intestinal bacterial overgrowth. As such, organic acid testing can indicate the functional need for essential or conditionally essential nutrients, diet modification, antioxidant protection, detoxification, and other therapies” (Lord and Bralley).
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
ORGANIC ACIDS TEST
• Organic acid testing is a way to measure whether your body is getting and using nutrients to drive optimal health
• It is designed to assess metabolic dysfunction, not diseases• Like a car’s gauges warn of potential problems, your body has certain
chemical indicators, known as organic acids, that can alert you to potential problems
• In general, high organic acids is bad because that indicates there are too many acids
• Also measured are markers that assess intestinal health, neurotransmitter activity and detoxification demands. Early warnings can help you make diet and lifestyle changes that may both extend and enhance your quality of life
• Always start with macronutrients, micronutrient deficiencies are a second tier issue
• Making energy is anabolic, we want to make people more anabolic Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
WAYS THE OAT CAN BE INTERPRETED
Organic Acids Markers
The 4 Horsemen The 3 Body Systems
Common Patient PresentationsKalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
FOUR HORSEMEN OF PHYSIOLOGICAL DAMAGE
INFLAMMATION
INSULIN RESISTANCE
CATABOLIC PHYSIOLOGY
OXIDATIVE STRESS
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THE 3 BODY SYSTEMS
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GI SYSTEM
DETOX SYSTEM
NEUROENDOCRINE SYSTEM
SEVEN SECTIONS OF OAT BY BODY SYSTEM
(1) Carbohydrate Metabolism(2) Energy Production (3) Neurotransmitter Metabolism
(4) Bacterial, Clostridial, and Yeast
(5) Detoxification (6) Oxidation(7) Methylation
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ORGANIC ACIDS TESTING- NEUROENDOCRINE SYSTEM
(1) Carbohydrate metabolism • Lipoic acid• Chromium
(2) Energy Production• Fatty acid metabolism• Mitochondrial energy production• B-complex vitamins
(3) Neurotransmitters• Catecholamine and serotonin production• Inflammation triggered by NT depletion
NEUROENDOCRINE SYSTEM
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CARBOHYDRATE METABOLISM
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CARBOHYDRATE METABOLISM MARKERS
Provides insight into how well your body is able to metabolize glucose:
• Controls the regulation of glucose and anaerobic energy production• Carbohydrates are our body’s first choice for short-term energy production• Glucose will be stored as fat if it’s consumed in excess of your dietary needs
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GLYCOLYSIS VS. GLUCONEOGENESIS
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GLYCOLYSIS- PYRUVATE
• Pyruvate (3C)• End product of glycolysis• Actively transported into matrix for aerobic respiration• When mitochondrial metabolism is inhibited (anaerobic conditions)
it is converted into lactate, which regenerates NAD+• Lactate is a precursor for gluconeogenesis (more so than
amino acids)• When pyruvate and lactate are high = indicators of catabolic
physiology!
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ENERGY PRODUCTION
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OXIDATIVE STRESS
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ENERGY PRODUCTION AND THREE TYPES OF FATIGUE
• Most organic acids are intermediates or end stage metabolism of energy production
• High levels of intermediates is typically trouble – ACIDIC • Low levels mean there are not enough amino acids, which means there are
not enough components to convert into metabolites - CATABOLIC• Patients are tired because:
• They cant make energy efficiently in mitochondria • Have depletion of brain chemicals• Have depletion of hormone systemsALL THESE TRIGGERED BY STRESS, INFECTIONS AND TOXINS
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CORI CYCLE
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CORI CYCLE VS. KREBS CYCLE
• Cori cycle occurs during stress physiology, while the Krebs cycle occurs during normal physiology
• Lactate is resynthesized to glucose in the liver, so it can be used by tissues undergoing repair (at a cost of 4 ATP!)
• When all OAT markers are low, it usually means there are not enough amino acids, this is due to the Cori cycle
• Aerobic metabolism avoids build up of lactate• Anaerobic metabolism is costly:
• Utilizes the Cori cycle• Short-term: makes energy quickly• Long-term: lactate created as byproduct
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FAT METABOLISM- CARNITINE
• Carnitine is key in energy metabolism• Made from amino acids• Low carnitine= low energy• The less carnitine available the harder it is to burn fat for fuel
• Carnitine deficiency causes:• Increase production of free fatty acids to make more ATP• Excess intake of fructose• Chronic overuse of lipids by the mitochondria • Insulin resistance issues (Hyperinsulinemia)
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NEUROTRANSMITTERS
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NEUROTRANSMITTER MARKERS
• Stress related markers: production/lack of production (how much being broken down)• Vanilmandelate• Homovanillate• 5-Hydroxyindoleacetate
• Inflammation related markers: brain or body inflamed, INF (catecholamine)• Kynurenate• Quinolinate• Picolinate
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KYNURENIN PATHWAY
Tryptophan, in addition to making serotonin, is the parent compound in the Kynurenin Pathway (see figure below). This pathway is very active in the liver and is the way that our bodies make niacin, a B-vitamin.
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NEUROTRANSMITTER- HVA / VMA
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WHO DO WE USE ORGANIC ACIDS TESTING WITH?
EVERYONE…• Complex patients • Simple patients • Annual health assessment for long term maintenance • Prenatal nutritional programs• Chemotherapy and radiation recovery programs• Weight loss• Fatigue• Depression/anxiety• GI factors especially when stool testing normal
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COMMON PATIENT PRESENTATIONS
Overweight/ tired patient
Digestive issues patient
Brain issues patient
Catabolic patient
Toxic patient
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CHRONICALLY ILL PATIENTS
• The more complicated a patient is, the more the basics become essential
• Most chronically ill patients have major metabolic imbalances• May not be respond to treatment because the underlying
metabolic issues are still present, even though the proximate immediate issue has been resolved
• Can extrapolate from critical care literature to our patient base• Leaky gut is almost always present in chronically ill patients
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
My Organic Acids Test
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
SUMMARY
KEY CONCEPTS:• Complex but highly effective tool that allows a practitioner to
see a variety of patient’s body processes in depth• Organize programs by body system utilizing the 7 sections
of the Organic Acids Test to group markers together• View the results in several ways using the 4 Horsemen, 3
body systems, by individual organic acids markers, and patient archetype
• Invaluable tool in creating an individualized supplementation program
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.
KALISH METHOD 101 – Regular Price $397This 8 hour online lecture series:• Functional Medicine Philosophy• Stress Hormones• Leaky Gut and the Microbiome• Toxins and Detoxification• Brain Imbalances• The 5 Pillars of Building a Successful Practice• Live call with Dr. Kalish to answer your specific questions What else is included?• Downloadable Resources – powerpoints, audio files and
transcriptions of all lectures, Patient Program Guide and 2 eBooks
Special Price of $199 with Promo Code: FMTown50
Kalish Ins*tute © 2016 by Dr. Daniel Kalish. All rights reserved.