In this episode, I am speaking with Dan Kalish, DC – founder of the Kalish Institute. Dr. Kalish received his Bachelor of Arts in physiology and psychology from Antioch College and completed his chiropractic degree at Life West. We will talk about mitochondrial health and the best strategies to repair and optimize your mitochondria.
Table of Contents
In this podcast, Dr. Kalish and I discuss:
- The REAL reason your mitochondria are damaged
- Dr. Kalish’s top 3 supplements for repairing mitochondria
- How oxygen can radically transform your energy
- Awesome energy vs exhausted energy
- The best tests to assess mitochondrial function
- Practical strategies for improving mitochondrial function
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Ari: Hey there, this is Ari Whitten. And welcome back to the Energy Blueprint Podcast. I’m here with Dr. Dan Kalish, who is someone who I started following, as I was just talking to him about before we started recording here, I started following his work literally about 20 years ago.
I remember seeing his work on adrenal fatigue and when I was in my late teens and early twenties following mercola.com and Dr. Kalish was very big on there. He was kind of instrumental for me as someone to learn from, literally going back to the time where I was a teenager. So it’s a pleasure to actually connect with him for the first time right now.
So a little bit about him. He is the founder of the Kalish Institute, an online practice implementation training program, dedicated to building integrative and functional medicine practices through clinical and business courses. Since 2006, the Kalish Institute has helped develop practice models for over a thousand practitioners worldwide and graduates of the Kalish Institute include practitioners ranging from the Director of Integrative Medicine at the Mayo Clinic, to Cleveland Clinic Functional Medicine physicians. Then Dan received his Bachelor of Arts in physiology and psychology from Antioch College and completed his chiropractic degree at Life West.
He studied at the University of London and conducted research with biochemist Dr. Robin Monroe at Cambridge University, and his educational pursuits led him to mentoring with renowned psychiatrist, R.D. Lang, as well as John R. Lee, a pioneer in the use of progesterone and more recently, Dr. Kalish proudly served as an advisor to the Honorable Patrick Kennedy, and participated in the first One Mind For Research Conference hosted by Harvard University, where 200 of the nation’s top neuroscientists gathered to promote research on brain disorders. So, welcome to the show Dr. Kalish, such a pleasure to have you.
Dr. Kalish: Yeah, super glad to be here. Thank you.
Ari: So in this presentation, we’re going to be talking, you are going to be talking, about one of my favorite topics, which is optimizing mitochondrial health. So I will let you take it away from here.
The real cause of mitochondrial dysfunction
Dr. Kalish: Excellent. Well, thank you. So this is, it’s just been a personal obsession of mine for the last three years. What is the role of the mitochondria? How does that relate to fatigue? How does it relate to hormone producing glands like the adrenals and the thyroid and how does this all fit in?
And so one of the sort of big breakthroughs that has happened in the last several years, is through the lab testing that we do in functional medicine, looking at mitochondrial function through what are called organic acids, as well as other tests, but primarily through organic acids. We’ve discovered that there’s a new pattern that no one has really observed before. And this pattern is seeing very low levels of these metabolites on the labs and in the sort of classical version of functional medicine you’re looking for high markers that show nutrient deficits that indicate that the certain key nutrients, we’ll talk a lot about them today, that are required for the mitochondria to work right.
And so you can see if CoQ10 levels are wrong or off, or magnesium is not right. Or B vitamins are not working right or carnitine is not working right. That information has been around for 30 or 40 years for functional medicine docs based on organic acids testing. But the new information, which is even more exciting, is what does it mean when all of these markers are low? What does it mean when the output of the mitochondria to make these markers is low?
And this is what my teacher, Dr. Richard Lord calls a hypometabolic state, or mitochondrial retraction. It’s a lack of having sufficient mitochondria to even make energy or ATP. So we can have people in two different groupings, right? We can have people that have cellular energy problems because they’re nutrient deficits, of magnesium, CoQ10, carnitine, whatever it may be. But then we can have even more severe fatigue, depression, and those kinds of problems when the mitochondria aren’t even present in their proper numbers.
And we’re working a lot in the last few years with nutrient programs to stimulate the growth of mitochondria. And so that’s been really exciting.
Ari: Yeah. If I can interject one thing on that subject. The work of Dr. Robert Naviaux, I don’t know if you’re familiar with him, but the cell danger response, as well as one particular metabolomic study where they did on chronic fatigue syndrome where they found something like 80% of the overall markers, they measured over 600 markers, over 80% of them were depressed, were low.
And this has always kind of blew my mind because I’ve always felt like when we’re dealing with these functional medicine tests, in many cases, people are looking at, 10 or 15 different biomarkers and they find a few that are off and say, “Oh, we found the issue, it’s these three things that are off.” And I’m like, “Yeah, there’s probably like 400 other things that are off too, if you had the test to measure them.” Do you know what I mean?
Dr. Kalish: Absolutely. Absolutely. And in fact, to that point, when we run these ion panels, which include fatty acids, organic acids, amino acids, and every other thing you can imagine, we run those panels on people that are hypometabolic. Exactly what you just said happens. You see just this blood bath, all across the board, you see low neurotransmitter markers, you see low liver detox markers, you see really poor amino acid function, even see bad problems with fatty acids that are all part of it. Because it’s not like the mitochondria are targeted specifically. And that’s the only problem that you have anything that’s going to damage the mitochondria is going to oftentimes damage other systems in the body as well.
Ari: Absolutely. So what do you do in cases like this? I mean, I’m sure that’s the subject of this whole presentation, but kind of what does the path look like to help people who are, you know, when it’s not just, “Oh, your L-carnitine levels and CoQ10 levels are deficient, let’s put you on a supplement for those,” but you’re seeing this widespread dysfunction. What is the path to recovery look like?
Dr. Kalish: And so we go back to the original functional medicine playbook, which is, what’s causing this? What’s actually going on underneath the surface? What’s the root cause? And we’re thinking that there could be environmental toxicants that are stressing the system. It could be, I guess, emotional distress. So mitochondria don’t usually think of that as a number one thing. It could be a genetic disorder, right? There’s a lot of people that just are genetically predisposed to not have really great mitochondrial function.
But the main thing that we see is some kind of oxidative stress could be coming from the gut, it could be coming from environmental toxins, could be coming from the diet, some kind of overwhelming amount of oxidative stress that’s in turn damaging the mitochondria. And so you got to work on this on both sides, right? And for the short term energy boost, super energy, supercharge, make you feel like a million bucks, kind of stuff. You dump enough amino acids and CoQ10 and magnesium and B vitamins into the system, mitochondria will start to come back.
And then in parallel, you’re trying to find out, okay, where are these environmental toxins coming from? Is it a diet issue? Is it related to something that’s happening at work? Is it something from the past? Is it mercury in the person’s mouth from fillings? Or is it a gut problem that’s generating all this oxidative stress. And so you can run on both tracks trying to find the underlying cause of the oxidative stress, the damage to the mitochondria, while you’re repairing the mitochondria at the same time.
Ari: Absolutely. Excellent. So as far as your strategies for optimizing mitochondria, are we jumping ahead too much? Do you want to sort of go into some of the background around, deeper into mitochondrial health before we get into sort of the practical strategies?
Dr. Kalish: Let’s talk about a little bit of that. I think that’s a good idea, because it’s a fancy word, mitochondria. You can also think of it as cellular energy, but what you’re really talking about is your metabolism, how your body takes nutrients, proteins, fats, carbs, and then burns them up for fuel. You know, how is that all working? How’s the furnace of your body working and you can measure it with the labs. You know, most people can just tell based on how they’re feeling, whether their metabolism feels like it’s in good shape or not.
But the key point is that if you’re having a problem with it, with your energy levels, there’s some lifestyle things that we’re assuming people are doing. Like you’re exercising pretty well. You’re eating pretty well. You’re not exposing yourself to a lot of chemicals from your personal care products and from your cleaners you use in your home. You kind of figuring out that we live in a really toxic world in that we human beings are quite clever. We’ve developed tens of thousands of chemicals. And we’ve been extremely clever to just release those into the environment, without anyone really regulating or thinking about what the heck is going on.
And so when you test people now, every newborn baby in the United States has like 50 to 70 toxins the day they’re born. We used to think that somehow being in the womb protected you. Not true. So we’re all exposed to these compounds now. Everyone is, whether you’re in an industrialized country or not. And again, this could be also coming from the gut, it could be coming from poor digestion, infections, the wrong kind of foods, some kind of gut generated oxidative stress, is going to cause tissue damage. And mitochondria are quite sensitive and they’re very easily damaged by high levels of oxidative stress. And so when that starts to happen, we go into sort of emergency mode in a way, right. And the body’s trying to protect itself. And unfortunately, the way that we protect ourselves is by generating ATP so we can run body systems, but these environmental toxins or gut related compounds that are damaging the mitochondria, interfere with our energy production systems.
So it’s a very critical area of the body to be damaged because it’s part of how we protect ourselves, right? And so, if you’re actually damaging your sort of shield, then you’re going to be in pretty big trouble. And I think that for anyone who has fatigue, chronic depression, unexplained chronic pain, looking at the mitochondria, at least with some of the basic lab work that we do, make sense as a sort of getting started analysis.
And I do a lot of these labs. I teach a lot of classes in this and I work with a lot of patients on the phone and it’s not always a mitochondrial problem. In fact, we’ll be doing coursework with other doctors and then be like, “Oh, look at those mitochondria. This is great. They don’t have that problem.” I mean, it’s almost kind of a little surprising when we see normal mitochondria. But not everybody has this problem. I think that’s a good point to point out. But if you do have this problem, it can easily be missed because healthcare providers could just sort of misinterpret what’s happening.
My last really bad mitochondrial patient last week, it was sort of typical in that her doctor wanted to put her on antidepressants and she’s like, “I’m not depressed.” And she walked out of that office and came over to my office and did a phone consult and is trying to figure out, “Okay, I’m not really energetic here, but this is not an emotional problem. And I don’t want to do therapy and I don’t want to take antidepressants. I want to figure out why my energy isn’t so great.” So I think our culture is kind of on the wrong track in terms of figuring out mitochondrial problems, if you look at conventional medicine, which is obviously why we’re having these kinds of discussions, because a lot of these people that have a lot of fatigue end up drifting over to more of a functional medicine or integrative medicine approach.
Ari: To that point, I don’t know if you’re familiar with it, but there’s a paper that was published in 2015 called “Fatigue: an Overview”, which was published in the American Journal of Family Physician. And it was basically evidence based guidelines for physicians, for conventional medical doctors, of how to deal with their patients with fatigue, chronic fatigue. And they found a couple of really fascinating things.
One is that 95% of people with chronic fatigue will show up with no abnormalities whatsoever on their lab tests, on their conventional lab tests. That’s one interesting thing. And then the four treatments that they have as their standard recommendations for people with fatigue are: go for a walk for 30 minutes a day, walking and stretching, cognitive behavioral therapy, antidepressants, and stimulants as needed.
Dr. Kalish: Yeah.
Ari: So that’s pretty much the best of what they’ve got for people with fatigue.
Dr. Kalish: It’s kind of sad, right? It’s like, “Go take a walk. And if it doesn’t work, we’ve got either uppers or downers and we’ll just try to fix it.”
Ari: “Take a walk, get some psychotherapy. And if that doesn’t work, we have antidepressants and stimulants.”
Dr. Kalish: Hey, I live in Oakland. You could just go down to the corner in a bad neighborhood in Oakland and you could get that kind of advice pretty easily. It’s probably a lot cheaper. Yeah. I don’t know. We don’t have to go into that whole scenario, but you know, the thing that is important is that there’s a lot of things you can do, and that there’s a lot of science behind this, and it’s not like a bunch of health food store clerks running around and saying, “This is good for your energy.”
It’s just that the science is not widely disseminated. And so people just don’t know that these things are out there and that you can actually test and correct mitochondrial function. That’s kind of a newsflash, even a lot of people, even in the integrative medicine community, aren’t aware that you can actually do that.
We want to do a little better and we’re also not saying this is like a permanent situation for people, like you should just run out and take CoQ10 and magnesium for the rest of your life. We’re really trying to diagnose and treat a specific fatigue syndrome, fix things, and then let people move on with their lives. I think that’s an important thing to distinguish in that it’s not a forever kind of program for most people.
How to repair and optimize your mitochondria
Ari: So, what does this look like as far as repairing, optimizing, mitochondria? As far as practical strategies, how do you kind of approach that whole situation?
Dr. Kalish: So now in my practice, it’s very specifically, we do these labs and they tell you exactly what you need. However, there are some general categories of things that show up consistently with a lot of people. And if you’re not going to do the lab work, you can just sort of guess, I guess, and try these things and see how well they work. And there are four that we see really consistently.
One is that people have deficiencies of carnitine. There’s a lot of genetic reasons why some people need more carnitine than other people. There’s a lot of enzymes that are involved in the processing of carnitine. And it’s a very common place to have some kind of genetic thing going wrong, meaning that you may be getting enough carnitine. We typically get carnitine in adequate amounts if you’re eating meat. If you’re a vegan, there’s some people who are vegans that don’t have enough carnitine, some vegans do just fine with it.
So most people get enough carnitine in their diet. And what carnitine does is it shuttles fat. So it grabs fat molecules from storage sites and brings it over to the mitochondria, we can burn it up for energy. And so if you don’t have enough carnitine, it’s kind of crippling for your energy production. So that’s an obvious one. And most people notice a difference with carnitine in terms of making themselves feel better, you know, in the first month of taking it, if you need it.
The other that’s sort of the all-encompassing, it’s involved in every one of these steps of energy production, is magnesium. And I don’t want to say too much about magnesium because it’s, you know, people are really familiar with it, it’s not an unusual supplement, but it’s very important for energy production. And they have one that’s paired with magnesium is of course CoQ10.
And again, in isolation by themselves, sometimes the supplements don’t work at all, but if you have either lab work or some good sort of program design behind a supplement, and you get maybe a combination product from where the companies that sells combination products, and you have each one of these nutrients, you can get some pretty significant energy changes, carnitine, magnesium, and CoQ10.
And then the final one is the tricky one. And it’s the most important one and it’s oxygen. And I didn’t even really think about this until about two, three years ago, when, again, my current teacher, Dr. Richard Lord, who’s the main scientist that started these mitochondria labs, maybe 30 or 40 years ago. It was like, “Yeah, Dan, for your mitochondria, you need CoQ10, magnesium and oxygen.” And I thought, “Oxygen? Who buys oxygen?” He’s like, “You don’t buy it. This is called breathing.”
And so when your mitochondrial populations are not doing well, you tend to not be running around and being super active. You tend to slump instead of sitting up straight, you tend to not have enough oxygen. And that makes the whole problem worse. And as you know, the oxygen is essentially right for this whole electron transport chain energy production thing to happen.
So in terms of lifestyle change, because in functional medicine, we always want to encourage lifestyle change along with supplements. The lifestyle change is to do breathing exercises and to make sure that you’re heavily oxygenating yourself, not just through exercise, which obviously cause you to breathe a little harder, but also through breathing exercises. So you saturate your system with oxygen on a regular basis.
Ari: Now specifically, what kinds of breathing practices are you referring to? Because there’s everything from mindful breathing, of learning how to belly breathe in a calm way for the purposes of meditation and mindfulness practices to very intense breathing practices, holotropic breath work, breath holding practices, things like that. So what specifically are you referring to?
Dr. Kalish: Yeah, well, I have a personal bias on this one and I think there’s probably, there seems to be some science to back this up, but this goes back 5,000 years with Taoists too. And so I’ve been doing this Taoist meditation for 10 years now and it’s not like gentle easy breathing, I’m not against that. That’s a great thing. If you’re just not breathing deeply then just taking deep breaths is going to help.
If you really want to get into it, you can challenge your breathing. Kind of like with exercise, people do resistance training and then they do like intervals. It’s like intervals, but with breathing. So just give a couple of simple examples. First of all, the obvious one is you take a deep breath in and hold it. I’ve only been able to get to two minutes, but that’s an interesting experience right there.
And then the other is to take a breath in, breathe all the way out and hold it out. That is even more interesting if you want to try that. And then the other obvious ones are just your deep breathing, where you’re breathing in, holding for a few seconds, breathing out. The idea being that I think like with exercise, just taking a walk every day. Some days you run up a hill, some days you do weights, some days you’re mixing it up with your breathing and you’re stressing the system by withholding oxygen and triggering this whole because you want to make it so that you’re breathing deeply all the time, but you don’t have to think about it.
That’s what I’m trying to say. Right? So you’re breaking up these patterns that we have where we don’t breathe very deeply by making yourself aware of how important it is to have oxygen. Try holding your breath for two minutes, you will become very aware of how important oxygen is. So I do these exercises every day for a couple hours and lo and behold, the rest of the day I’m breathing pretty well because it’s on my mind.
Ari: Did you say a couple hours of breathing practices?
Dr. Kalish: Yeah. A couple of hours.
Ari: Are you just doing the breathing practices and nothing else or are you doing them while you’re working and doing other things?
Dr. Kalish: That’s while I’m doing the Taoist meditation, it’s a component of it. Like if you were in the gym working out, you would say, “Well, yeah, I’m breathing, but I’m doing my workout.” It’s kind of like that.
Ari: Got you. Now, is this something related to qigong or just for people who are interested in your Taoist meditation? Where might they learn about that?
Dr. Kalish: It’s very much along the lines of qigong. Absolutely.
Ari: Is that something you teach or would you refer some out to a book or some source for learning that?
Dr. Kalish: This year we’re launching a whole system on Taoist meditation teaching.
Ari: Your secret is safe with me and a hundred thousand or so people listening.
Dr. Kalish: Well. Yeah. And it’s the coolest stuff. And then, the thing about the Taoist that I really love is that they figured out how to take care of their mitochondria like 5,000 years ago, they’re not doing these things randomly. They were trying to extend a lifespan, that was one of their main goals. You lived to be a hundred, 200 years old. And one of the things they figured out is it’s really important that you figure out this breathing. And how can you stimulate and produce mitochondrial health through breathing? Just through trial and error, you know?
Ari: You may or may not know this, this is something that I kind of stumbled across well after I started looking into, many, many years after I learned about lots of breathing practices. Many, many years after I started learning about mitochondria because it’s all pretty much Russian research and most of it’s in Russian, but there’s a whole bunch of research on intermittent hypoxic training, which is various kinds of breath holding practices. And there’s even some research specifically talking about intermittent hypoxic training and how it relates to mitochondrial health.
Dr. Kalish: Yeah, exactly. And there’s actually this group that I connected with last year but they put you on a treadmill and they give you a mask and then they control the amount of oxygen that you’re getting. So they can mimic you being on the top of Mount Everest or you being saturated with oxygen. And one of the things they’re doing is getting people to work out and then restricting the amount of oxygen that they’re able to get to create this effect like you’re talking about with the Russian researchers, right?
Ari: Yeah. Yeah. That’s profound. So, okay, so you mentioned magnesium, carnitine, CoQ10, oxygen, breathing practices. Are there any other things you want to mention? I know that one of the things we talked about before we started recording was mTOR stimulation and you’ve mentioned some things along the lines of that and amino acids. I’m really curious to hear about what you’re doing there.
Dr. Kalish: Yeah. Now this, this is pretty deep. And you can take this the wrong way. So mTOR stands for mammalian targeted rapamycin. And basically in general, the most of the research community that’s looked at mTOR is concerned about mTOR and wants to slow mTOR down because mTOR stimulate cell growth, which could accelerate aging and put you at high risk for cancer.
So most of the research around mTOR is around slowing it down as a way to extend life. And what Dr. Lord determined in the last probably five, 10 years is looking at mitochondrial function. Sometimes we want to stimulate cellular repair, and we want to speed up the body’s ability to generate these organelles, like mitochondria. Now not doing it, if you had cancer, you wouldn’t want to do this, right, because this can make you worse, but we can actually stimulate mTOR by giving single large dosages of freeform amino acids. Seven to nine grams, usually about two teaspoons of a freeform amino acid powder. And you do that once a day, maybe twice a day, if you’re really gung ho on an empty stomach, and you’ll start to stimulate the repair of mitochondria by stimulating mTOR with these freeform aminos.
And this goes way back to like 40 years ago when Dr. Lord and Dr. Bralley first started a lab called Metametrix, which is gone now, but they sold their lab a little while ago. But in the early days of these amino acid testing programs, they were doing, I guess like in the eighties, they found that these amino acids, these freeform amino acids helped with so many different health conditions.
And now the scientific research is being sort of conducted in the last, maybe 10 years to show the mechanism of that is actually stimulating mTOR. Which is fascinating when you think about, and this is why so many people for so long have benefited from taking freeform amino acids. But the trick is you got to do it at seven to nine grams in a single dose in order to get this mTOR stimulating effect and works better on an empty stomach.
Ari: So a couple of questions. One, I definitely don’t take this the wrong way. I’m of the belief, which I think is, should be really non-controversial, that mTOR is neither good nor bad. It, like AMPK, like a lot of things in the body, like various hormones. It’s good when it’s in the appropriate amount and activated at the appropriate times. And to suppress mTOR all the time is a really horrible idea because mTOR, as you’re alluding to, mTOR serves many vital roles, as far as anabolic cell building tissue, building processes that are a necessary part of good health.
The same is true with like IGF 1. IGF 1 has been demonized heavily. It’s like if you have too high levels of IGF 1, then that’s linked with increased risk of cancer and death. But what a lot of people don’t talk about is too low IGF 1, too low of IGF 1 levels are similarly linked with increased risk of death. And there’s a whole middle ground of optimal range. I think the same principle is true of mTOR and pretty much everything else.
Dr. Kalish: Exactly.
Ari: So specifically on freeform amino acids, there’s a whole bunch of research around like branch chain amino acids in the context of bodybuilding and things of that nature. And there were many benefits that were sort of theorized about why you would want to use freeform branch chain amino acids, and almost all of the research that’s put it to the test has found that consuming whole protein with equivalent amounts of branch chain amino acids basically gives the same degree of benefits.
And there doesn’t seem to be really any significant additional benefits from consuming the freeform branch chain amino acids. We can stimulate mTOR through just consuming whole food, protein from consuming meat, or eggs, or fish, from consuming protein powders, whether whey protein, or plant food pea protein, and hemp protein and things like that. Why, specifically, do you feel freeform amino acids are uniquely beneficial?
Dr. Kalish: Yeah. So the research, and this is all in Dr. Lord’s lectures, I can send you a copy of it later on the hypometabolic state, but for specific stimulation of mTOR. And by the way, this is only done based on labs, right? So this is only done in people who have these patterns of extremely low mitochondrial markers. Maybe we don’t just wake up and decide to give people tons of amino acids only done in people where you can demonstrate that there’s a problem with a deficiency of these markers, right? These markers are all very low, but the freeform amino acids in the seven to nine gram range have a different effect in trying to do it with food. I can get you links to all the research on that you can read about it.
Ari: Yes, please. I would love to. Yeah, that’d be great. I’m curious, have you also heard of lipid replacement therapy, Garth Nicolson’s research?
Dr. Kalish: No, I don’t know about that.
Ari: Oh, okay. You’d definitely be fascinated by this. There’s some really great research around these specific phospholipid formulations that they’re using, that seemed to get transported, intact, to our cells and to our mitochondrial membranes, where they replaced damaged phospholipids in the mitochondrial membranes. And there’s some pretty darn remarkable and impressive research.
Again, mainly from this researcher, Garth Nicolson, I think it’s Garth Nicolson. Yeah. If you Google like lipid replacement therapy, there’s a literature review of this on its relationship to treating people with different kinds of chronic fatigue, showing really massive improvements in energy levels in a span of four weeks, eight weeks, 12 weeks of just taking this one phospholipid supplement.
Dr. Kalish: Oh, that’s interesting. So we do something similar in that with the organic, with the ION panels, is we’re measuring Omega 3, Omega 6, Omega 9, all those fatty acids and the curious thing is you would think that most people are low in threes, and the sixes are either high or normal, but there’s certain people who are low in Omega 6, or they may have odd fat like palmitic that’s really low, and sometimes will get very targeted.
It’s a little different than what you’re describing, but same vein of prescribing high dosages of Omega 6 or prescribing something to try to fix palmitic that’s out of balance or people that have arachidonic, like you’re saying, like high or low, and there’s a range for all these things and everything. Some people having super high arachidonic that you would think would be related to inflammation problems. Then some people having really low arachidonic, which can also cause problems. So I’m doing a lot of work with the cell membrane. So I’ll check that out. Because this is a lot of interest to me right now.
Awesome Energy versus Exhausted Energy
Ari: Yeah. For sure. Happy to send you the literature, but easy to find. You have in your slide presentation some interesting slides on what you called “Awesome Energy versus Exhausted Energy.” Can you talk a bit about that?
Dr. Kalish: So a little bit different topic here, right? So we’re thinking about when your energy production’s working right, and this is what we all learned in biochemistry or physiology class, is you get 38 units of ATP for each turn of this energy production wheel, right? So you imagine you’re pulling in protein, fat, and carbs and trying to make energy. And if that whole system is working beautifully, and on average, you should be generating 38 units of energy.
Now, if you’re in a catabolic state, if you’re in a breakdown state, if for some reason your blood sugar’s unstable, you don’t have the ability to burn fat and you have all these phospholipid problems and your fat burning is off, or your carnitine is off or something like that is happening. And you’re going to alternate energy pathways. Some of these energy pathways, you can only generate two ATP, right?
Some of them, you even get a net loss of energy to make energy, right. And these are the people that I talk to, they’re like, “I walk up the stairs and I’m just exhausted just by the time I get to the top of the stairs.” And so a lot of the fatigue that we see is because people are not able to get into what we call aerobic respiration. They’re not able to make the normal energy in the normal way. And they’re going into these all “the body is adaptable.”
When those systems break down and mitochondria can’t work, let’s say you don’t have enough CoQ10, right. Would be simple example, or you don’t have enough tryptophan or something like that is going on. Then all of a sudden you’re going to have a major problem and would have to shift to making energy from other sources. And it’s just not an efficient way to do things. So people get by, but they get by in a way that’s not exactly uplifting. They’re not exactly jumping out of bed and wanting to exercise. They’re going through this whole other way of producing energy and just letting out a very, very small amount of energy.
And it just shows that if we can fix those things, you can get that person back to just making normal. I mean, the normal production of energy is a huge amount of energy. It’s another way of saying it. You don’t have to, like jack someone up on steroids or something and give them an artificial boost. Just the normal functioning mitochondria is an abundant and endless source of energy for human beings.
Ari: Yeah, absolutely. I know we talked a bit about before we started recording, you mentioned that you could talk a bit in depth on tests and the sort of the most ideal test for assessing mitochondrial function. You’ve alluded to some tests thus far already, but can you kind or give a rundown on if somebody wants to know if they have damaged mitochondria or dysfunctional mitochondria or just, they’ve lost a lot of mitochondria over time through the course of aging, which happens to the vast majority of people. What are the best tests to assess mitochondrial function?
Dr. Kalish: Yeah, so I think the starting point, this is the central point, is organic acids. And there are several different lab companies that run these in slightly different ways. And through organic acids, you can measure the metabolic byproducts of all these different processes. And they’ll tell you very clearly if you need CoQ10, carnatine or various B vitamins and amino acids and how all those systems are working. So organic acids is usually like sort of the central point. And then if you want to dig a little deeper and figure out, “Okay, if I don’t have great mitochondrial function, well what’s going on with my oxidative stress?”
So many of these lab companies will have a combination profile like an ION profile, is the one I use, where you also look at oxidative stress, you also look at other factors that relate to energy production, liver detoxification capacity. You want to have a general sense of, “Is your liver able to clear things adequately?” Because if not, then that builds up in terms of oxidative stress. And then of course the microbiome is all we can talk about these days and in integrative and functional medicine.
So you want to make sure your microbiome is working well, that your gut is in good shape. So those are the kind of the bigger picture ones. Organic acids is a center point, probably the single most important. And then you want to figure out the toxic burden and the oxidative stress markers and that kind of stuff. And then separate, you want to make sure that the microbiome of the gut is working well. That’s a typical workup that I do in my practice.
Ari: Excellent. So this has been phenomenal. I’m wondering if you could wrap up with sort of the summary and the sort of list of practical strategies for people to implement to improve their mitochondrial health.
Dr. Kalish: Either you’re going to do a, I divide it into two categories, you’re going to do a lab based program or non-lab based. So if you’re going to do a non-lab based program and just guessing, then I think these things are safe to guess at, it won’t do any harm if you do this for a few months, carnitine, CoQ10, magnesium and oxygen, which is the breathing. And I’m making sure that you’re getting your life cleaned up in terms of not drinking alcohol, not doing caffeine, not being exposed to a lot of toxins and get a sauna, do some steam room stuff, sweat out the toxins, do a lot of exercise, that kind of thing.
So going on a health kick and seeing if you can sort of reset your mitochondrial function that way. If that’s not working and you’re three or four months into it, and you’re like, “Wow, how much more of this stuff can I take, nothing’s happening.” Then, get an organic acids lab and find a doc that knows how to interpret them well, and see if there’s an obvious issue there. As I said earlier, not everybody has mitochondrial problems, but it’s something you can figure out, spending maybe three or 400 bucks on lab work. Definitively figured out quite quickly.
Ari: Beautiful. And I know you’re accepting patients right now. And so where can people, if they want to get touch with you and work with you, what’s the best way to get in contact with you?
Dr. Kalish: Yeah, absolutely. So I have a phone consultation practice, work with patients all over the world. And that’s kalishwellness.com, K-A-L-I-S-H, kalishwellness.com. And yeah, if people are curious, they can come and talk. I have an intake coordinator that can speak with you for 15 minutes for free and kind of let you know what our practice is about. If you’re just curious, you want to check it out, you can schedule with her.
Ari: Beautiful and that it’s kalishwellness.com. We’ll probably have a link to it. It’s on one of the slides. So if you guys are watching the video while you’re listening to this, you’ll see it there. So, Dr. Kalish, thank you so much for coming on. It’s such a pleasure to have you. It’s also a great pleasure to connect with you after following your work for 20 years since I was a teenager.
Dr. Kalish: Yeah. I appreciate it very much and glad you’re doing this, getting the information out there is great.
Ari: Most definitely. Thank you so much.
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